Prevalence of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae and Their Carbapenem Susceptibility Patterns: A Cross-Sectional Study in Kandahar, Afghanistan
DOI:
https://doi.org/10.65486/bk8b8p63Keywords:
ESBL, Enterobacteriaceae, carbapenem resistance, imipenem; ertapenem, AfghanistanAbstract
Purpose:
This study aimed to determine the prevalence of Extended-Spectrum Beta-Lactamase (ESBL)-producing Enterobacteriaceae and to evaluate their resistance patterns against carbapenems among clinical isolates in Kandahar, Afghanistan.
Method:
A prospective cross-sectional laboratory-based study was conducted from October 2025 to January 2026 at Mirwais Regional Hospital in Kandahar, Afghanistan. Clinical isolates of Enterobacteriaceae obtained during the study period with complete ESBL testing data (n = 80) were included in the final analysis. ESBL production was detected using the disk diffusion method for phenotypic confirmation.
Antimicrobial susceptibility testing, including imipenem and ertapenem, was performed using the Kirby-Bauer disk diffusion method according to Clinical and Laboratory Standards Institute guidelines. A statistical analysis was conducted to assess associations between ESBL production, carbapenem resistance, and prior antibiotic exposure, with a p ≤ 0.05 considered significant.
Results:
Among the 80 Enterobacteriaceae isolates analysed, 21 (26.3%; 95% CI: 17.2–36.8%) were identified as ESBL producers. Among ESBL-producing isolates, susceptibility rates were 66.7% (14/21) for imipenem and 62.5% (10/16) for ertapenem. There was no statistically significant link between ESBL production and carbapenem resistance (p > 0.05). Prior antibiotic use was also not significantly associated with ESBL production or imipenem resistance. High resistance rates were observed for ampicillin, third-generation cephalosporins, tetracycline, and trimethoprim-sulfamethoxazole, indicating widespread multidrug resistance.
Practical Implications:
The findings emphasise the necessity of routine antimicrobial susceptibility testing for isolated enterobacteriaceae infections, rational antibiotic prescribing, and strengthened antimicrobial stewardship programs to preserve the effectiveness of carbapenems in this region.
Originality/Novelty:
This study provides baseline data on ESBL prevalence and carbapenem resistance patterns in Kandahar, Afghanistan, a region with limited published antimicrobial resistance data, thereby contributing valuable local evidence to guide clinical practice and policy decisions.
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References
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