Abstract
BackgroundMulti-drug resistance pathogens such as Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae (ESBL-PE) are of great global health concern, since they are associated with increased morbidity and mortality. Even in the absence of infections caused by these pathogens, colonization is a great threat and can lead to cross transfer among hospitalized patients. To date data on carriage of these pathogens is still limited in Tanzania. Therefore, this study aimed to determine ESBL-PE fecal carriage rate and associated factors among hospitalized patients at Referral hospitals in Dar es Salaam.MethodsThis was a cross sectional study conducted from May to July 2017 among patients admitted in three referral hospitals in Dar es Salaam, Tanzania. Rectal swabs were collected and screened for ESBL production using MacConkey agar supplemented with Ceftazidime 2 μg/ml. Phenotypic confirmation of ESBL-PE was done by double disk diffusion method. Statistical analysis was performed using Statistical Package for Social Sciences (SPPS) software version 20.ResultsOf the 196 enrolled participants, 59.7% (117/196) were confirmed to carry ESBL-PE. Diarrheic patients (57/79) had statistically significant high prevalence of ESBL colonization compared to those without diarrhea (60/117) (p = 0.01). A total of 131 ESBL-PE were isolated from 117 patients, whereby, Escherichia coli accounted for 68.7%, Klebsiella pneumoniae 28.2% and Citrobacter species 0.8%. ESBL-PE carriage was significantly higher in patients with diarrhea compared to those without diarrhea (72% vs 53.1%, p = 0.01). Recent antibiotic use was independently associated with carriage of ESBL-PE (aOR 14.65, 95%CI 3.07–69.88, p = 0.01).ConclusionsHigh prevalence of fecal carriage of ESBL-PE was observed in patients admitted in tertiary hospitals in Dar es Salaam, Tanzania. The use of antibiotics was associated with carriage of ESBL producers among the study population.
Highlights
Multi-drug resistance pathogens such as Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae (ESBL-PE) are of great global health concern, since they are associated with increased morbidity and mortality
This study aimed to investigate Extended Spectrum Beta Lactamase producing Enterobacteriaceae (ESBL-PE) fecal carriage among hospitalized patients including those with diarrhea, and determine factors associated with their carriage in various referral hospitals in Dar es Salaam
Distribution of ESBL producing Enterobacteriaceae carriage Screening and phenotypic testing of isolates obtained from rectal swab specimen for ESBL-PE revealed that the overall fecal carriage of ESBL-PE was 59.7% (117/ 196)
Summary
Multi-drug resistance pathogens such as Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae (ESBL-PE) are of great global health concern, since they are associated with increased morbidity and mortality. Even in the absence of infections caused by these pathogens, colonization is a great threat and can lead to cross transfer among hospitalized patients. Extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-PE) infections poses a unique challenge to healthcare, as it is associated with mortality and morbidity [1]. These pathogens are increasingly implicated as causes of both community and hospital-acquired infections but even in the absence of infection, colonization with Extended-spectrum β-lactamase (ESBL) producing bacteria is a reason for concern [2, 3]. Several studies in East Africa have documented high rates of ESBL-PE from clinical settings [8, 9]
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