{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T10:35:24Z","timestamp":1788863724831,"version":"build-2803163510"},"reference-count":44,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T00:00:00Z","timestamp":1615420800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T00:00:00Z","timestamp":1615420800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Clin Microbiol Antimicrob"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Multidrug resistance (MDR), extended-spectrum beta-lactamase (ESBL) and carbapenemase-producing Gram-negative bacteria (GNB) has become a public health threat worldwide. This threat is worse in developing countries where there is high infectious disease burden and spread of antimicrobial resistance co-exist. The aim of the present study was, therefore, to assess MDR, ESBL and carbapenemase producing GNB from patients attending three selected referral hospitals in Amhara region.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A cross-sectional study was conducted from December 2017- April 2018 at the University of Gondar Comprehensive Specialized Hospital, Dessie Referral Hospital and Debre Markos Referral Hospital of Amhara national regional state. A total of 833 study subjects were recruited using a convenient sampling technique. Clinical samples such as blood, urine, stool, wound, abscess, ear discharge, nasal discharge, cervical discharge and body fluid specimens were aseptically collected. Culturing for identification of bacteria and determination of drug susceptibility testing were done following standard microbiological techniques. Selected MDR isolates were phenotypically assessed for ESBL and carbapenemase production.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of the 833 clinical samples cultured for bacterial growth, 141 (16.9%) were positive for GNB. The most common GNB identified were <jats:italic>E. coli<\/jats:italic> 46 (32.6%), <jats:italic>Klebsiella<\/jats:italic> spp. 38 (26.5%) and <jats:italic>Proteus<\/jats:italic> spp. 13 (9.2%). The overall MDR prevalence was 121 (85.8%). Among the total isolates, 137 (97.2%) were resistant to ampicillin followed by cotrimoxazole 115 (81.6%), amoxicillin-clavulanic acid 109 (77.3%), cefixime 99 (70.2%), cefepime 93 (66.0%) and tetracycline 91 (64.5%). The extended-spectrum beta-lactamase producing GNB were 69\/124 (55.6%). Of which <jats:italic>Klebsiella<\/jats:italic> spp. 19 (15.3%) and <jats:italic>E. coli<\/jats:italic> 17 (13.7%) were common ESBL producers. Carbapenemase-producing isolates were 8\/51(15.7%). Of which <jats:italic>Enterobacter<\/jats:italic>, <jats:italic>Klebsiella<\/jats:italic> and <jats:italic>E. coli<\/jats:italic> were common carbapenemase producers.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion and recommendation<\/jats:title>\n                <jats:p>Multi-drug resistance and ESBL producing isolates in the present study were high. <jats:italic>E. coli<\/jats:italic> and <jats:italic>Klebsiella<\/jats:italic> spp<jats:italic>.<\/jats:italic> were the most common ESBL producing GNB. <jats:italic>Klebsiella<\/jats:italic> spp<jats:italic>., Enterobacter<\/jats:italic> spp<jats:italic>., E. coli<\/jats:italic> and <jats:italic>Citrobacter<\/jats:italic> spp<jats:italic>.<\/jats:italic> were typical carbapenemase-producing isolates. Continuous monitoring, antibiotic stewardship and molecular detection of the gene responsible for drug resistance are important means to reduce the spread of drug-resistant pathogens.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12941-021-00422-1","type":"journal-article","created":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T15:06:05Z","timestamp":1615475165000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Multidrug resistance and extended-spectrum beta-lactamase producing Gram-negative bacteria from three Referral Hospitals of Amhara region, Ethiopia"],"prefix":"10.1186","volume":"20","author":[{"given":"Feleke","family":"Moges","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mucheye","family":"Gizachew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mulat","family":"Dagnew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azanaw","family":"Amare","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bekele","family":"Sharew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Setegn","family":"Eshetie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wondwossen","family":"Abebe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yihenew","family":"Million","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tigist","family":"Feleke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moges","family":"Tiruneh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,3,11]]},"reference":[{"issue":"1","key":"422_CR1","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.sjbs.2014.06.001","volume":"22","author":"S Shaikh","year":"2015","unstructured":"Shaikh S, Fatima J, Shakil S, Rizvi SMD, Kamal MA. Prevalence of multidrug resistant and extended spectrum beta-lactamase producing Pseudomonas aeruginosa in a tertiary care hospital. Saudi J Biol Sci. 2015;22(1):62\u20134.","journal-title":"Saudi J Biol Sci"},{"issue":"22","key":"422_CR2","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1016\/j.jgar.2020.02.030","volume":"9","author":"V Negvekar","year":"2020","unstructured":"Negvekar V, Sawant S, Amey S. Prevalence of multidrug-resistant Gram-negative bacteria cases at admission in multispecialty hospital. J Glob Antimicrob Resist. 2020;9(22):457\u201361.","journal-title":"J Glob Antimicrob Resist"},{"issue":"1","key":"422_CR3","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1186\/s13756-017-0208-x","volume":"6","author":"JA Ayukekbong","year":"2017","unstructured":"Ayukekbong JA, Ntemgwa M, Atabe AN. The threat of antimicrobial resistance in developing countries: causes and control strategies. Antimicrob Resist Infect Control. 2017;6(1):47.","journal-title":"Antimicrob Resist Infect Control"},{"issue":"7","key":"422_CR4","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1016\/S1473-3099(16)30127-X","volume":"16","author":"LJ Piddock","year":"2016","unstructured":"Piddock LJ. Reflecting on the final report of the O\u2019Neill Review on Antimicrobial Resistance. Lancet Infect Dis. 2016;16(7):767\u20138.","journal-title":"Lancet Infect Dis"},{"issue":"3","key":"422_CR5","doi-asserted-by":"publisher","first-page":"105","DOI":"10.4103\/2279-042X.162360","volume":"4","author":"M Izadpanah","year":"2015","unstructured":"Izadpanah M, Khalili H. Antibiotic regimens for treatment of infetions due to multidrug-resistant Gram-negative pathogens: An evidence-based literature review. J Res Pharm Pract. 2015;4(3):105\u201314.","journal-title":"J Res Pharm Pract"},{"issue":"4","key":"422_CR6","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1128\/CMR.14.4.933-951.2001","volume":"14","author":"PA Bradford","year":"2001","unstructured":"Bradford PA. Extended-spectrum \u03b2-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev. 2001;14(4):933\u201351.","journal-title":"Clin Microbiol Rev"},{"issue":"3","key":"422_CR7","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/S1473-3099(08)70041-0","volume":"8","author":"JD Pitout","year":"2008","unstructured":"Pitout JD, Laupland KB. Extended-spectrum \u03b2-lactamase producing enterobacteriaceae: an emerging public health concern. The Lan Infect Dis. 2008;8(3):159\u201366.","journal-title":"The Lan Infect Dis"},{"issue":"5","key":"422_CR8","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s13756-016-0117-4","volume":"14","author":"T Sonda","year":"2016","unstructured":"Sonda T, Kumburu H, van Zwetselaar M, Alifrangis M, Lund O, Kibiki G, Aarestrup FM. Meta-analysis of proportion estimates of extended-spectrum-beta-lactamase-producing Enterobacteriaceae in East Africa hospitals. Antimicrob Resist Infect Control. 2016;14(5):18.","journal-title":"Antimicrob Resist Infect Control"},{"key":"422_CR9","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/6167234","author":"A Bitew","year":"2020","unstructured":"Bitew A, Tsige E. High prevalence of multidrug resistant and extended spectrum of \u03b2-lactamase producing Enterobacteriaceae: a cross sectional study at arsho advanced medical laboratory, Addis Abeba. Ethiopia J Trop Medi. 2020. https:\/\/doi.org\/10.1155\/2020\/6167234.","journal-title":"Ethiopia J Trop Medi"},{"key":"422_CR10","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1371\/journal.pone.0215177","volume":"14","author":"F Moges","year":"2019","unstructured":"Moges F, Eshetie S, Abebe W, Mekonnen F, Dagnew M, Endale A, Amare A, Feleke T, Gizachew M, Tiruneh M. High prevalence of extended-spectrum beta-lactamase-producing Gram-negative pathogens from patients attending Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Amhara region. PLoS ONE. 2019;14:4.","journal-title":"PLoS ONE."},{"key":"422_CR11","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1016\/j.jhin.2009.10.024","volume":"74","author":"A Kohlenberg","year":"2010","unstructured":"Kohlenberg A, Weitzel-Kage D, Van der Linden P, Sohr D, V\u00f6geler S, Kola A, et al. Outbreak of carbapenem-resistant Pseudomonas aeruginosa infection in a surgical intensive care unit. J Hosp Infect. 2010;74:350\u20137.","journal-title":"J Hosp Infect"},{"key":"422_CR12","unstructured":"Centers for Disease Control and Prevention. Carbapenemase producing carbapenem-resistant Enterobacteriaceae (CP-CRE) 2018 case definition [Internet]. Atlanta, GA: Centers for Disease Control and Prevention. Available from: https:\/\/wwwn.cdc.gov\/nndss\/conditions\/carbapenemase-producing-carbapenem-resistantenterobacteriaceae\/case-definition\/2018\/."},{"issue":"Suppl 4","key":"422_CR13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/S0213-005X(14)70167-3","volume":"32","author":"\u00c1 Pascual","year":"2014","unstructured":"Pascual \u00c1, Pintado V, Rodr\u00edguez-Ba\u00f1o J, Mir\u00f3 JM. Carbapenemase-producing Enterobacteriaceae: the end of the antibiotic era? Enferm Infec Microbiol Clin. 2014;32(Suppl 4):1\u20133.","journal-title":"Enferm Infec Microbiol Clin"},{"key":"422_CR14","doi-asserted-by":"publisher","first-page":"27","DOI":"10.2147\/IDR.S127177.PMID:28182124;PMCID:PMC5279835","volume":"10","author":"MH Legese","year":"2017","unstructured":"Legese MH, Weldearegay GM, Asrat D. Extended-spectrum beta-lactamase- and carbapenemase-producing Enterobacteriaceae among Ethiopian children. Infect Drug Resist. 2017;10:27\u201334. https:\/\/doi.org\/10.2147\/IDR.S127177.PMID:28182124;PMCID:PMC5279835.","journal-title":"Infect Drug Resist"},{"key":"422_CR15","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511543470","volume-title":"District laboratory practice in tropical countries","author":"M Chesbrough","year":"2006","unstructured":"Chesbrough M. District laboratory practice in tropical countries. New York: Cambridge University Press; 2006."},{"key":"422_CR16","unstructured":"Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing; twenty-second informational supplement. 27th ed. CLSI Supplement M100 Wayne, PA: CLSI; 2017."},{"issue":"3","key":"422_CR17","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","volume":"18","author":"AP Magiorakos","year":"2012","unstructured":"Magiorakos AP, Srinivasan A, Carey R, Carmeli Y, Falagas M, Giske C, et al. Multidrug-resistant, extensively drug-resistant and pan drug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268\u201381.","journal-title":"Clin Microbiol Infect"},{"issue":"9","key":"422_CR18","doi-asserted-by":"publisher","first-page":"588","DOI":"10.3390\/medicina55090588","volume":"55","author":"AH Uc-Cach\u00f3n","year":"2019","unstructured":"Uc-Cach\u00f3n AH, Gracida-Osorno C, Luna-Chi IG, Jim\u00e9nez-Guillermo JG, Molina-Salinas GM. High prevalence of antimicrobial resistance among gram-negative isolated bacilli in intensive care units at a tertiary-care hospital in Yucat\u00e1n Mexico. Medicina (Kaunas). 2019;55(9):588.","journal-title":"Medicina (Kaunas)"},{"key":"422_CR19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3126\/tujm.v4i0.21667","volume":"4","author":"A Ghimire","year":"2018","unstructured":"Ghimire A, Acharya B, Tuladhar R. Extended Spectrum \u03b2-Lactamase (ESBL) producing multidrug resistant gram-negative bacteria from various clinical specimens of patients visiting a Tertiary Care Hospital. Tribhuvan Univ J Microbiol. 2018;4:1\u20138.","journal-title":"Tribhuvan Univ J Microbiol"},{"issue":"5","key":"422_CR20","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1016\/j.jiph.2020.01.004","volume":"13","author":"A Jaffar","year":"2020","unstructured":"Jaffar A, Rabaan A, Justin VS, Ali MB. Antimicrobial resistance of gram-negative bacteria: A six-year longitudinal study in a hospital in Saudi Arabia. J Infect Public Health. 2020;13(5):737\u201345.","journal-title":"J Infect Public Health"},{"issue":"3","key":"422_CR21","first-page":"404","volume":"52","author":"H Hadi","year":"2016","unstructured":"Hadi H, Pegah S, Ata M, SiminOzar M, Taher EM. Antimicrobial susceptibility patterns among bacteria isolated from intensive care units of the largest teaching hospital at the northwest of Iran. Braz J Pharm Sci. 2016;52(3):404\u201312.","journal-title":"Braz J Pharm Sci"},{"issue":"3","key":"422_CR22","first-page":"30","volume":"7","author":"B Lamichhane","year":"2014","unstructured":"Lamichhane B. Antibiotic resistance patterns of Gram-negative isolates in a tertiary care hospital of Nepal. Asian J Pharm Clin Res. 2014;7(3):30\u20133.","journal-title":"Asian J Pharm Clin Res"},{"issue":"5","key":"422_CR23","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1001\/archinte.1985.00360050078014","volume":"145","author":"JD McCue","year":"1985","unstructured":"McCue JD. Cefoxitin resistance in community acquired Gram negative bacillary bacteremia, associated clinical risk factors. Arch Intern Med. 1985;145(5):834\u20136.","journal-title":"Arch Intern Med"},{"issue":"4","key":"422_CR24","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1016\/j.ijantimicag.2011.01.009","volume":"37","author":"SS Jean","year":"2011","unstructured":"Jean SS, Hsueh PR. High burden of antimicrobial resistance in Asia. Int J Antimicrob Agents. 2011;37(4):291\u20135.","journal-title":"Int J Antimicrob Agents"},{"key":"422_CR25","doi-asserted-by":"publisher","first-page":"2337","DOI":"10.1093\/jac\/dku176","volume":"69","author":"SJ Leopold","year":"2014","unstructured":"Leopold SJ, van Leth F, Tarekegn H, et al. Antimicrobial drug resistance among clinically relevant bacterial isolates in sub-Saharan Africa: a systematic review. J Antimicrob Chemother. 2014;69:2337\u201353.","journal-title":"J Antimicrob Chemother"},{"key":"422_CR26","doi-asserted-by":"publisher","first-page":"e0166519","DOI":"10.1371\/journal.pone.0166519","volume":"11","author":"B Abera","year":"2016","unstructured":"Abera B, Kibret M, Mulu W. Extended-Spectrum beta (beta)-lactamases and Antibiogram in Enterobacteriaceae from clinical and drinking water Sources from Bahir Dar City Ethiopia. PLoS ONE. 2016;11:e0166519.","journal-title":"PLoS ONE."},{"key":"422_CR27","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1007\/s10096-012-1717-4","volume":"32","author":"CM Lonchel","year":"2013","unstructured":"Lonchel CM, Melin P, Gangou\u00e9-Pi\u00e9boji J, Assoumou MCO, Boreux R, De Mol P. Extended-spectrum \u03b2-lactamase-producing Enterobacteriaceae in Cameroonian hospitals. Eur J Clin Microbiol Infect Dis. 2013;32:79\u201387.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"422_CR28","first-page":"243","volume":"7","author":"R Vinodhini","year":"2014","unstructured":"Vinodhini R, Moorthy K, Palanivel P, Punitha T, Saranya S, Bhuvaneshwari M, Kanimozhi C. Detection and antimicrobial susceptibility pattern of ESBL producing Gram negative bacteria. Asian J Pharm Clin Res. 2014;7:243\u20137.","journal-title":"Asian J Pharm Clin Res"},{"key":"422_CR29","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1186\/s13756-018-0431-0","volume":"7","author":"M Gashaw","year":"2018","unstructured":"Gashaw M, Berhane M, Bekele S, Kibru G, Teshager L, Yilma Y, Ahmed Y, Fentahun N, Assefa H, Wieser A, Gudina EK, Ali S. Emergence of high drug resistant bacterial isolates from patients with health care associated infections at Jimma University medical centre: a cross sectional study. Antimicrob Resist Infect Control. 2018;7:138.","journal-title":"Antimicrob Resist Infect Control"},{"issue":"1","key":"422_CR30","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s12941-020-00365-z","volume":"19","author":"S Biset","year":"2020","unstructured":"Biset S, Moges F, Endalamaw D, Eshetie S. Multi-drug resistant and extended-spectrum \u03b2-lactamases producing bacterial uropathogens among pregnant women in Northwest Ethiopia. Ann Clin MicrobiolAntimicrob. 2020;19(1):25.","journal-title":"Ann Clin MicrobiolAntimicrob"},{"key":"422_CR31","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.ijantimicag.2010.08.019","volume":"37","author":"DO Ogbolu","year":"2011","unstructured":"Ogbolu DO, Daini OA, Ogunledun A, et al. High levels of multidrug resistance in clinical isolates of gram-negative pathogens from Nigeria. Int J Antimicrob Agents. 2011;37:62\u20136.","journal-title":"Int J Antimicrob Agents"},{"key":"422_CR32","first-page":"6068429","volume":"2016","author":"A Manzoor","year":"2016","unstructured":"Manzoor A, Mukhtiar H, Anwar K, Imran T, Muhammad H, Hassan BA, Abdul S, Qaisar M, Ghulam M. Prevalence of extended spectrum \u03b2-lactamase and antimicrobial susceptibility pattern of clinical isolates of pseudomonas from patients of Khyber Pakhtunkhwa, Pakistan. Pakistan Biomed Res Int. 2016;2016:6068429.","journal-title":"Pakistan. Biomed Res Int."},{"key":"422_CR33","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1186\/s12879-019-3838-1","volume":"19","author":"OM Oumar","year":"2019","unstructured":"Oumar OM, Manon L, Mallorie H, Yann D, Abelsalam T, Kadidja K, et al. High prevalence and characterization of extended-spectrum \u00df-lactamase producing Enterobacteriaceae in Chadian hospitals. BMC Infect Dis. 2019;19:205.","journal-title":"BMC Infect Dis"},{"key":"422_CR34","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1186\/s12879-018-3436-7","volume":"18","author":"A Zeynudin","year":"2018","unstructured":"Zeynudin A, Pritsch M, Schubert S, Messerer M, Liegl G, Hoelscher M, Belachew T, Wieser A. Prevalence and antibiotic susceptibility pattern of CTX-M type extended-spectrum beta-lactamases among clinical isolates of gram-negative bacilli in Jimma Ethiopia. BMC Infect Dis. 2018;18:524.","journal-title":"BMC Infect Dis"},{"key":"422_CR35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13756-016-0153-0","volume":"6","author":"NP Parajuli","year":"2017","unstructured":"Parajuli NP, Acharya SP, Mishra SK, Parajuli K, Rijal BP, Pokhrel BM. High burden of antimicrobial resistance among Gram negative bacteria causing healthcare associated infections in a critical care unit of Nepal. Antimicrob Resist Infect Control. 2017;6:1\u20139.","journal-title":"Antimicrob Resist Infect Control"},{"key":"422_CR36","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1186\/s12879-017-2529-z","volume":"17","author":"GM Tran","year":"2017","unstructured":"Tran GM, Ho-Le TP, Ha DT, Tran-Nguyen CH, Nguyen TSM, Pham TTN, Nguyen TA, Nguyen DA, Hoang HQ, Tran NV, et al. Patterns of antimicrobial resistance in intensive care unit patients: a study in Vietnam. BMC Infect Dis. 2017;17:429.","journal-title":"BMC Infect Dis"},{"key":"422_CR37","doi-asserted-by":"publisher","first-page":"1449","DOI":"10.1089\/mdr.2018.0278","volume":"25","author":"SC Francis","year":"2019","unstructured":"Francis SC, Eric SD, Thomas JS, Keith M. Phenotypic and genotypic characterization of carbapenem-resistant gram-negative bacilli pathogens from Hospitals in Ghana. Microbial Drug resistance. 2019;25:1449\u201357.","journal-title":"Microbial Drug resistance."},{"key":"422_CR38","doi-asserted-by":"publisher","first-page":"1972","DOI":"10.1017\/S0950268813002975","volume":"142","author":"L Hu","year":"2014","unstructured":"Hu L, Zhong Q, Shang Y, Wang H, Ning C, Li Y, et al. (2014) The prevalence of carbapenemase genes and plasmid-mediated quinolone resistance determinants in carbapenem-resistant Enterobacteriaceae from five teaching hospitals in central China. Epidemiol Infect. 2014;142:1972\u20137.","journal-title":"Epidemiol Infect"},{"issue":"4","key":"422_CR39","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1007\/s00103-013-1914-z","volume":"57","author":"I Ehrhard","year":"2014","unstructured":"Ehrhard I, Karaalp AK, Hackel T, H\u00f6ll G, Rodewald N, Reif U, et al. Prevalence of carbapenemase-producing bacteria in hospitals in Saxony, Germany. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2014;57(4):406\u201313.","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"422_CR40","first-page":"4","volume":"6","author":"RA Dahab","year":"2017","unstructured":"Dahab RA, Ibrahim AM, Mohamed MBB. Detection of carbapenem resistant gram-negative bacilli from infected wounds in Khartoum State-2014. Clin Microbiol. 2017;6:4.","journal-title":"Clin Microbiol"},{"key":"422_CR41","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1371\/journal.pone.0135745","volume":"10","author":"D Okoche","year":"2015","unstructured":"Okoche D, Asiimwe BB, Katabazi FA, Kato L. Najjuka CF (2015) prevalence and characterization of carbapenem-resistant enterobacteriaceae isolated from Mulago National Referral Hospital, Uganda. PLoS ONE. 2015;10:8. https:\/\/doi.org\/10.1371\/journal.pone.0135745.","journal-title":"PLoS ONE"},{"issue":"5","key":"422_CR42","first-page":"54","volume":"3","author":"A Alyahawi","year":"2018","unstructured":"Alyahawi A, Alkaf A, Alnamer R, Alnosary T. Study of resistance for recently marketed carbapenem drug among hospitalised patients in Sana\u2019a Yemen. Univers J Pharm Res. 2018;3(5):54\u20137.","journal-title":"Univers J Pharm Res"},{"key":"422_CR43","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1155\/2019\/2489063","volume":"15","author":"OA Muhie","year":"2019","unstructured":"Muhie OA. Antibiotic use and resistance pattern in Ethiopia: systematic review and meta-analysis. Int J Microbiol. 2019;15:20. https:\/\/doi.org\/10.1155\/2019\/2489063.","journal-title":"Int J Microbiol"},{"key":"422_CR44","first-page":"303","volume":"6","author":"JK Mukonzo","year":"2013","unstructured":"Mukonzo JK, Namuwenge PM, Okure G, Mwesige B, Namusisi OK, Mukanga D. Over-the-counter suboptimal dispensing of antibiotics in Uganda. J Multidiscip Healthc. 2013;6:303\u201310.","journal-title":"J Multidiscip Healthc"}],"container-title":["Annals of Clinical Microbiology and Antimicrobials"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12941-021-00422-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12941-021-00422-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12941-021-00422-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T15:10:55Z","timestamp":1615475455000},"score":1,"resource":{"primary":{"URL":"https:\/\/ann-clinmicrob.biomedcentral.com\/articles\/10.1186\/s12941-021-00422-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,11]]},"references-count":44,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["422"],"URL":"https:\/\/doi.org\/10.1186\/s12941-021-00422-1","relation":{},"ISSN":["1476-0711"],"issn-type":[{"value":"1476-0711","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,11]]},"assertion":[{"value":"15 October 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 March 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval was obtained from the institutional review board of the University of Gondar with reference number O\/VIP\/RCS\/05\/478\/2015. Informed written consent was obtained from each study participants. Children less than 18\u00a0years who are not able to give consent were also asked an assent and\/or written consent taken from their parents or guardians.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"16"}}