Prevalence and associated factors of Enterobacteriaceae producing extended spectrum beta-lactamase carriers in Thai rural area, 2018

Abstract

Background Enterobacteriaceae producing Extended Spectrum beta-lactamase, which resist to Penicillin and Cephalosporins was found to have 65.7% prevalence in rural community in Thailand 2012, higher than that of similar research in other countries. This resistance strain inhabited in lower intestinal tract, which can be found in feces. So, the study of associated factors for ESBL carrier is important for preventing spread and decreasing the prevalence. Methods The sample of this study including 414 volunteers from Phra Phloeng Community, Khao Chakarn District, Sa Kaeow Province samples presented at the time of questionnaire interviewing. This study use quantitative method. Cross-sectional study was designed to identify the prevalence and associated factors of being Enterobacteriaceae ESBL carriers. For specimen collection, volunteers were informed with the protocol of stool collection individually. Fresh stool will be transport to Cary-blair transport media in 2 hours. The transport media were refrigerated in foam box at 2–4 °C and were sent to Bangkok via public van in 12 hours. For laboratory process. We used selective agar as screening test and combination disk as confirmation test. MALDI-TOF was used to identify the species of ESBL colony. Online questionnaire to collect the data in the field. Questionnaire and lab results were matched by SPSS. Descriptive is used to show demographic data and prevalence, while analytic is used to find the relationship between each factor. Results The prevalence of Enterobacteriaceae producing ESBL carriers in Thai rural area, conducted in 455 healthy all ages volunteers is 73.8%. The predominated organism is Escherichia coli, which 337 colonies were isolated (72.6%). The second is Klebsiella pneumoniae (8.0%). We found that Married or living as spouse have more chance to be carriers 3.9 time when compare to those that single or widow or living separately from partner. Those who have education level at elementary school and above have more chance of being carriers 2.7 time when compare to people with education below elementary school. Having domestic mammal in the house have less chance of being ESBL carriers 0.4 time when compare to those that don’t have domestic mammal in their house. Discussion The prevalence of ESBL carriers in Thai rural area is higher than the similar study conducted in 2012, despite the government deliberately control of antibiotic use in both hospital and community started in 2015. Our study found that living in close contact like being spouse which is normally living in the same room, sleep on the same bed, and other intimacy contact is a risk support the idea. The cause of high prevalence could be that ESBL carriers in the area have poor hand and toilet hygiene causing the spread of ESBL from human-to-human- and to-environment rather than antibiotics misuse. Having some education level is a risk factor. We think that because they know if they are sick they should use medicine to cure their illness. However, they do not know how to use medicine properly. Anyway, in this study we did not ask about their behavior of using antibiotics. Further research using qualitative study might be useful in this area. Conclusion The public health protocol of controlling antibiotic use in human and livestock is theoretically response to reduce the new incidence, however is not enough to control the spreading of this germ due to its survival ability in harsh environment. To reduce the prevalence in community we should also focus on control the spreading on both human-to-human and human-to-environment especially farmers who have a chance to contact to community water source, soil and livestock. Intervention like using soap or alcohol gel after using toilet or after doing farm should be raised to the community awareness. Promotion of using toilet even working in the farm is also important issue that need to be put an effort for.