Network of Interaction among Enterobacter Species and Klebsiella Pneumonia Clinical Isolates and the Antibiotic Resistance Pattern at Cape Coast

Introduction: Urgent surveillance is required to provide the needed information for the containment of multidrug-resistant (MDR) Enterobacteriaceae. The objective was to examine the antibiotic-resistant patterns among the clinically isolated Enterobacter species and Klebsiella pneumonia from the outpatient department of the University of Cape Coast from 2014 to 2020. Methodology: The cultured isolates were Gram-stained for morphological and biochemical tests. Antibiotic susceptibility tests for the K. pneumonia and Enterobacter spp were done using the modified Kirby-Bauer diffusion technique. A double-disk synergy antibiotic test using cefotaxime, amoxicillin/clavulanic acid and ceftazidime antibiotic test was used to identify extended-spectrum beta-lactase (ESBL) and MDR among the isolates. The network of interactions between bacteria isolates and resistant types and the pattern of interaction of K. pneumonia (in the resistant-10 group) and Enterobacter spp (resistant-12) and the various antibiotics tested was performed using Cytoscape version 3.8.2 software. The data are presented in percentage and statistical significance between MDR and extensively drug-resistant (XDR) compared with Chi-square test. Results: K. pneumonia formed a clustering network with other bacteria isolates around resistant type 10 (resistant-10) and Enterobacter spp around resistant type 12 (resistant-12). The interactions (edges) of bacteria isolates and resistant types (nodes) were unique for Staphylococcus saprophyticus with Proteus mirabilis which exhibited two patterns of interactions (resistant-10 and resistant-12), connecting the two resistant types among the bacteria isolates. The interactive network patterns of Enterobacter spp and the various antibiotics were different from the interaction patterns for K. pneumonia. The K. pneumonia isolates were highly resistant to cefuroxime 2/3 (66.67%) and ampicillin 2/3 (66.67%) in the year 2020. Enterobacter spp on the other hand were highly resistant to tetracycline 16/20 (80.00%) in 2014 and ceftriaxone 5/9 (55.56%), levofloxacin 5/9 (55.56%), ceftazidime 5/9 (55.56%) and gentamycin 5/9 (55.56%) in 2020. Chi-square analysis showed a highly significant difference of χ2 = 11.87, p=0.0006 and χ2 = 7.789, p=0.0053 between MDR and XDR Enterobacter spp isolates in 2014 and 2020, respectively. Conclusion: Early detection, constant monitoring and control practices and policies that prevent the misuse or overuse of these antibiotics are required to slow down the rapid development of resistance to Enterobacter spp and K. pneumonia in Cape Coast.