Background: Resistance to extended-spectrum cephalosporins among Enterobacteriaceae has been reported yet
they serve as the last line treatment for severe infections in Uganda and other countries. This resistance often leads
to nosocomial infection outbreaks and therapeutic failures from multidrug resistant bacteria. The main objective of
this study was to determine the prevalence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae
in clinical samples of patients in various wards of Mulago Hospital; Uganda’s main national referral and teaching hospital.
Methods: This cross-sectional study was conducted between January-April, 2014. Purposive consecutive sampling was
used to collect pus swab, urine, blood and CSF samples from patients in the various wards. A total of 245 consecutive,
non-repetitive, clinical samples were obtained and tested for phenotypic ESBL production using the Double Disc
Synergy Test using cefotaxime, ceftazidime, cefotaxime-clavulanic acid and ceftazidime-clavulanic acid.
Results: Results show that 47 % of the 245 samples had Enterobacteriaceae isolates. Of these isolates 62 % were ESBL
producers while 38 % were of non-ESBL phenotype. E. coli was the most isolated organism (53.9 %), followed by K.
pneumoniae (28.7 %). Majority of Enterobacteriaceae organisms were isolated from urine samples, followed by pus
samples and of these 64.9 % and 47.4 % were ESBL-producers respectively. Klebsiella pneumoniae had the highest
percentage of ESBL producers (72.7 %). There was a higher percentage of isolates showing resistance to ceftazidime
(73 %) compared to cefotaxime (57.5 %). All Enterobacter cloacae isolates showed resistance to ceftazidime. There
were no statistically significant association between phenotype (ESBL/non-ESBL) and patients’ age or gender or
Conclusions: This study reveals a high prevalence of ESBL producing organisms in Mulago Hospital and high levels of
resistance to third generation cephalosporins. In addition to undertaking appropriate infection control measures, there
is urgent need for formulation of an antibiotic policy in Uganda to prevent spread of these organisms. This also calls for
continuous monitoring and reporting of the presence of such organisms in order to ensure rational and judicious use
of antibiotics by clinicians.
Keywords: ESBL, Enterobacteriaceae, Cefotaxime, Ceftazidime, Clavulanic acid
James, N (2019). ESBL-producing Enterobacteriaceae. Afribary.com: Retrieved February 25, 2021, from https://afribary.com/works/esbl-producing-enterobacteriaceae
Ndukui, James. "ESBL-producing Enterobacteriaceae" Afribary.com. Afribary.com, 24 Jun. 2019, https://afribary.com/works/esbl-producing-enterobacteriaceae . Accessed 25 Feb. 2021.
Ndukui, James. "ESBL-producing Enterobacteriaceae". Afribary.com, Afribary.com, 24 Jun. 2019. Web. 25 Feb. 2021. < https://afribary.com/works/esbl-producing-enterobacteriaceae >.
Ndukui, James. "ESBL-producing Enterobacteriaceae" Afribary.com (2019). Accessed February 25, 2021. https://afribary.com/works/esbl-producing-enterobacteriaceae