Molecular epidemiology of extended-spectrum beta-lactamase producing Gram-negative bacteria among surgical site infection patients in Ethiopia: a multicenter prospective study

Extended-spectrum beta-lactamases (ESBLs) producing Gram-negative bacteria are public health threats. This study aims to characterize ESBL-producing Gram-negative bacteria (GNB) isolated from surgical site infection patients. A multicenter cross-sectional study was conducted at four hospitals located in central (Addis Ababa), southern (Hawassa), northern (Debre Tabor), and Southwestern (Jimma) parts of Ethiopia. A wound culture was performed among 752 surgical site infection (SSI) patients where 286 GNB were confirmed using MALDI-TOF; of which 135 were subjected to whole genome sequencing using the Illumina (HiSeq 2500) system. The overall genotypic frequencies of ESBL-producing GNB were 57.8%. The detection of ESBL-producing GNB at Hawassa, Debre Tabor, Jimma, and Addis Ababa was 21.5%, 19.3%, 29.6%, and 29.6%, respectively. The detection frequency of bla_CTX-M, bla_TEM, and bla_SHV genes was 51.8%, 40%, and 8.1%, respectively. The most frequently detected ESBL gene was bla_CTX-M-15 (56.4%). Both bla_TEM-1B (41%) and bla_SHV-187 (5.1%) were the most frequently detected variants of bla_TEM and bla_SHV, respectively. The molecular epidemiology of ESBL-producing GNB among surgical site infection patients in Ethiopia showed many variants of ESBL genes. Good antimicrobial stewardship and standard bacteriological laboratory services are necessary for the effective treatment of ESBL-producing GNB.