Investigating the prevalence of multidrug-resistant enterobacterales at a quaternary hospital in KwaZulu-Natal, South Africa: A retrospective cross‑sectional study of ESBL-producing isolates.

Phumzile Sikosana; Nonkazimulo Precious  Mlangeni; Khethiwe Nomcebo  Bhengu

doi:10.51168/sjhrafrica.v7i2.2585

Authors

Phumzile Yvonne Sikosana Department of Biomedical Sciences, Faculty of Applied and Health Science, Mangosuthu University of Technology, Durban, South Africa.
Nonkazimulo Precious Mlangeni Department of Biomedical Sciences, Faculty of Applied and Health Science, Mangosuthu University of Technology, Durban, South Africa.
Khethiwe Nomcebo Bhengu Department of Biomedical Sciences, Faculty of Applied and Health Science, Mangosuthu University of Technology, Durban, South Africa.

DOI:

https://doi.org/10.51168/sjhrafrica.v7i2.2585

Keywords:

Multidrug resistant Enterobacterales, extended spectrum β lactamase producing Enterobacterales, antimicrobial resistance, Klebsiella pneumoniae, Escherichia coli, antimicrobial stewardship

Abstract

Background:

The emergence of multidrug‑resistant Enterobacterales (MDRE) presents a major challenge in healthcare settings due to limited therapeutic options and increased morbidity. Extended‑spectrum β‑lactamases (ESBLs) confer resistance to multiple β‑lactam antibiotics and are widely disseminated through plasmid‑mediated mechanisms, compromising the effectiveness of commonly used antimicrobial agents. This study aimed to evaluate the prevalence of ESBL‑producing Enterobacterales (ESBL‑PE) and describe associated antimicrobial susceptibility patterns at a quaternary hospital in KwaZulu-Natal, South Africa.

Methods:

A retrospective cross-sectional descriptive study was conducted using laboratory data from 2,421 Enterobacterales isolates recovered from clinical specimens of infected patients at a quaternary hospital in KwaZulu‑Natal, South Africa, between January 2023 and December 2023. Data were analysed to determine the prevalence of ESBL‑producing Enterobacterales, identify predominant ESBL‑producing species, and describe their antimicrobial susceptibility profiles.

Results:

ESBL‑producing Enterobacterales accounted for 27.8% (672/2 421) of all Enterobacterales isolates. Escherichia coli and Klebsiella pneumoniae species were the predominant ESBL producers. Antimicrobial susceptibility testing demonstrated high levels of resistance to β‑lactam antibiotics and fluoroquinolones among ESBL‑producing Enterobacterales. Carbapenems remained active against the majority of ESBL‑producing isolates; however, reduced susceptibility was identified among a subset of Klebsiella pneumoniae isolates.

Conclusion:

This study demonstrates a substantial burden of ESBL‑producing Enterobacterales in a quaternary hospital setting. The observed resistance patterns highlight the importance of strengthened antimicrobial stewardship, susceptibility‑guided therapy, and ongoing surveillance to limit the spread of multidrug‑resistant pathogens.

Recommendations:

Further studies are warranted to investigate molecular resistance mechanisms and potential sources of transmission.

Author Biographies

Phumzile Yvonne Sikosana, Department of Biomedical Sciences, Faculty of Applied and Health Science, Mangosuthu University of Technology, Durban, South Africa.

is a registered Medical Laboratory Scientist (Clinical Pathology Independent Practice) with the Health Professions Council of South Africa (HPCSA) and a Lecturer in the Department of Biomedical Sciences at Mangosuthu University of Technology. She brings extensive expertise across diagnostic, academic, and clinical trial laboratory settings. Her primary research focuses on communicable and non-communicable diseases and indigenous knowledge systems. Ms. Sikosana actively advocates for enhancing student medical laboratory scientist exposure to advanced diagnostic procedures, including the integration of artificial intelligence. Furthermore, she makes immense contributions to career guidance and recruitment in the STEM field, specifically targeting youth from disadvantaged and marginalized communities.

ORCID ID: https://orcid.org/0000-0002-4745-3491

Nonkazimulo Precious Mlangeni, Department of Biomedical Sciences, Faculty of Applied and Health Science, Mangosuthu University of Technology, Durban, South Africa.

Nonkazimulo Precious Mlangeni is a registered Medical Laboratory Scientist (Clinical Pathology Independent Practice) with the Health Professions Council of South Africa (HPCSA). She graduated with a degree in Medical Laboratory Sciences from Mangosuthu University of Technology, Department of Biomedical Sciences. As a dedicated young professional, she applies her expertise in clinical pathology to independent practice, contributing to enhanced diagnostic services and patient care in healthcare settings. Her research project supports the advancement of medical laboratory science by generating evidence that informs clinical practice, improves diagnostic accuracy, and guides therapeutic decision making, ultimately strengthening healthcare outcomes and laboratory service quality in South Africa. Furthermore, she is committed to fostering collaboration between laboratory professionals and clinicians to optimize patient management strategies and address public health challenges. Her work underscores the critical need for enhanced antimicrobial stewardship and susceptibility-guided therapy, informing clinical practice, public health policy, and future research directions to combat the growing threat of multidrug-resistant infections.

ORCID ID: https://orcid.org/0009-0007-0351-8496

Khethiwe Nomcebo Bhengu, Department of Biomedical Sciences, Faculty of Applied and Health Science, Mangosuthu University of Technology, Durban, South Africa.

is a Medical Laboratory Scientist and Lecturer in Clinical Pathology at Mangosuthu University of Technology, and a Scientist affiliated with the University of KwaZulu‑Natal. Before transitioning into academia, she served as the Laboratory Manager for the Biomedical Science Department’s training laboratory, which achieved accreditation from the Health Professions Council of South Africa (HPCSA) for its professional training programmes. Her research interests span infectious diseases, immunology, sexually transmitted infections, and non‑communicable diseases, with a strong focus on advancing diagnostic science and improving health outcomes in resource‑limited settings.

ORCID: https://orcid.org/0000-0003-2393-3519

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