Prevalence, Antimicrobial Resistance, and Distribution of blaCTX-M and blaTEM Genes Among ESBL-Producing Morganella morganii Isolated from Clinical Samples in Bangladesh
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Abstract
Background: Morganella morganii, previously considered harmless intestine inhabitants, is now causing various types of infection. Antimicrobial treatment options for Morganella morganii infection are limited due to the presence of chromosomal AmpC ß-lactamase. The emergence of multidrug-resistant (MDR) isolates has created the need to look for alternative treatment options. Objective: This study was carried out to determine the efficacy of antibiotic combination therapy against MDR Morganella morganii in vivo and in vitro. Methods: This observational and experimental study was conducted on 7 clinical strains of Morganella morganii from urine, wound swab/pus, blood and stool samples of patients attending Dhaka Medical College Hospital, Dhaka, Bangladesh, from November 2022 to June 2023. Isolation and identification of the organisms were done by culture, biochemical test, and PCR. Antimicrobial susceptibility was determined using disc diffusion method and Minimum Inhibitory Concentration (MIC) by agar dilution method. Clinical and Laboratory Standards Institute (CLSI, 2022) guideline was followed for all antibiotic discs. Result: Seven Morganella morganii strains were isolated in an overall prevalence rate of 1.72%. They were most commonly isolated from urine (42.85%) and wound swab (28.57%) samples in both sexes with significant predominance in the male (71.42%) population of the middle age group. They were mostly (85.71%) isolated from the patient department. Antibiotic susceptibility pattern showed cephalosporins as the least sensitive drug. About 28.57% of the total isolated Morganella morganii were detected as ESBL producers by DDS test. PCR revealed the presence of blaCTX-M gene (50%) and blaTEM gene (50%) among phenotypically confirmed ESBL producing Morganella morganii. About 50% and 25% of the total imipenem resistant Morganella morganii were detected as carbapenemase producers by CD assay and DDS test, respectively. About 57.14% of the total isolated Morganella morganii were multidrug resistant (MDR) and 14.28% were extremely drug resistant (XDR) isolates. Conclusion: This study showed that identification of Morganella morganii is of paramount importance to combat the dissemination of MDR strain in hospital. It may be concluded that ceftazidime plus amikacin and amikacin plus imipenem can be a good therapeutic option for the emerging MDR and XDR isolates.
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