Abstract
BackgroundFaecal carriage of ESBL-producing bacteria is a potential risk for transmission and infection. Little is known about faecal carriage of antibiotic resistance in Tanzania. This study aimed to investigate the prevalence of faecal carriage of ESBL-producing Enterobacteriaceae and to identify risk factors for carriage among young children in Tanzania.Methodology/Principal FindingsFrom August 2010 to July 2011, children below 2 years of age were recruited in Dar es Salaam, including healthy community children (n = 250) and children hospitalized due to diarrhoea (n = 250) or other diseases (n = 103). ChromID ESBL agar and ChromID CARBA SMART agar were used for screening. Antimicrobial susceptibility testing was performed by the disk diffusion method. ESBL genotypes were identified by Real-Time PCR and sequencing.The overall prevalence of ESBL carriage was 34.3% (207/ 603). The prevalence of ESBL carriage was significantly higher among hospitalized children (50.4%), compared to community children (11.6%; P < 0.001; OR = 7.75; 95% CI: 4.99–12.03). We found high prevalence of Multidrug-resistance (94%) among Escherichia coli and Klebsiella pneumoniae isolates. No resistance to carbapenems was detected. For the majority of isolates (94.7%) we detected a blaCTX-M-15-like gene. In addition, the plasmid mediated AmpC beta-lactamase CMY-2 was detected for the first time in Tanzania. ESBL prevalence was significantly higher among HIV positive (89.7%) than HIV negative (16.9%) children (P = 0.001; OR = 9.99; 95% CI: 2.52–39.57). Use of antibiotics during the past 14 days and age below 1 year was also associated with ESBL carriage.Conclusions/SignificanceWe report a high rate of faecal carriage of ESBL-producing Enterobacteriaceae among children below 2 years of age in Tanzania, particularly those with HIV-infection. Resistance to a majority of the available antimicrobials commonly used for children in Tanzania leaves few treatment options for infections when caused by these bacteria.
Highlights
Antimicrobial resistance is a serious problem worldwide
This study aimed to investigate the prevalence of faecal carriage of Extended Spectrum Beta-Lactamases (ESBLs)-producing Enterobacteriaceae and to identify risk factors for carriage among young children in Tanzania
We report a high rate of faecal carriage of ESBL-producing Enterobacteriaceae among children below 2 years of age in Tanzania, those with HIV-infection
Summary
Antimicrobial resistance is a serious problem worldwide. Infections caused by resistant organisms pose an important challenge for treatment of both common and life-threatening infections. The World Health Organization (WHO) has declared infections caused by multidrug resistant bacteria as an emerging global health problem of major public health concern [1]. ESBL-producing bacteria are frequently associated with co-resistance to non-beta-lactam antimicrobial agents and resistance to several different antibiotics at the same time (Multidrug-resistance (MDR)), which may critically complicate the treatment of severe bacterial infections. While there are a number of publications on ESBL-producing bacteria causing clinical infections [4,5,6,7], relatively few studies from the African continent report on carriage of ESBL-producing organisms [8,9,10,11].
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