Prevalence and risk factors for CTX-M gram-negative bacteria in hospitalized patients at a tertiary care hospital in Kilimanjaro, Tanzania

Tolbert Sonda,Happiness Kumburu,Frank M Aarestrup,Gibson Kibiki,Ole Lund,Marco Van Zwetselaar,Michael Alifrangis,Blandina T Mmbaga

doi:10.1007/s10096-018-3196-8

Abstract

Emergence and spread of extended spectrum beta-lactamase (ESBL)-producing gram-negative bacteria, mainly due to CTX-M, is a major global public health problem. Patients infected with ESBL-producing gram-negative bacteria have an increased risk of treatment failure and death. We investigated the prevalence and risk factors for CTX-M gram-negative bacteria isolated from clinical specimens of patients hospitalized at a tertiary care hospital in Kilimanjaro, Tanzania. Isolated gram-negative bacteria from inpatients admitted at Kilimanjaro Christian Medical Centre (KCMC) between August 2013 and August 2015 were fully genome sequenced. The prevalence of ESBL-producing gram-negative bacteria was determined based on the presence of blaCTX-M. The odds ratio (OR) and risk factors for ESBL-producing gram-negative bacteria due to CTX-M were assessed using logistic regression models. The overall CTX-M prevalence (95% CI) was 13.6% (10.1–18.1). Adjusted for other factors, the OR of CTX-M gram-negative bacteria for patients previously hospitalized was 0.26 (0.08–0.88), p = 0.031; the OR for patients currently on antibiotics was 4.02 (1.29–12.58), p = 0.017; the OR for patients currently on ceftriaxone was 0.14 (0.04–0.46), p = 0.001; and the OR for patients with wound infections was 0.24 (0.09–0.61), p = 0.003. The prevalence of ESBL-producing gram-negative bacteria due to CTX-M in this setting is relatively low compared to other previous reports in similar settings. However, to properly stop further spread in the hospital, we recommend setting up a hospital surveillance system that takes full advantage of the available next-generation sequencing facility to routinely screen for all types of bacterial resistance genes.

Highlights

Existence of antibiotic resistance due to extended spectrum beta-lactamase (ESBL)-producing gram-negative bacteria is a major global public health problem [1] and has been reported in all regions of the world [2,3,4,5,6,7]
Compared to patients infected with beta-lactam susceptible bacteria, patients infected with ESBL-producing gram-negative bacteria put a greater burden on health-care resources and have an increased risk of treatment failure and poor outcomes including death [8, 9]
High-income countries (HICs) have surveillance systems in place to estimate the burden of bacterial infections due to ESBL-producing gram-negative bacteria, and to determine risk factors for acquisition of ESBL-producing gram-negative bacteria as well as the clinical outcomes associated with infection [1, 10,11,12]

Summary

Introduction

Existence of antibiotic resistance due to extended spectrum beta-lactamase (ESBL)-producing gram-negative bacteria is a major global public health problem [1] and has been reported in all regions of the world [2,3,4,5,6,7]. Compared to patients infected with beta-lactam susceptible bacteria, patients infected with ESBL-producing gram-negative bacteria put a greater burden on health-care resources and have an increased risk of treatment failure and poor outcomes including death [8, 9]. In Sub-Sahara Africa (SSA), data on ESBLproducing gram-negative bacteria epidemiology and risk factors associated with ESBL-producing gram-negative bacteria infection are scarce. Several risk factors have been documented to be associated with ESBL-producing gram-negative bacteria acquisition, including previous hospitalization, previous use of antibiotics such as third-generation cephalosporins, hospital overcrowding, bed sharing when hospitalized, and international travel [19,20,21,22,23,24,25]

Objectives

Methods

Results

Conclusion