Carriage Prevalence of Extended-Spectrum β-Lactamase Producing Enterobacterales in Outpatients Attending Community Health Centers in Blantyre, Malawi

Abstract

Antimicrobial resistance due to extended-spectrum β-lactamase (ESBL) production by Enterobacterales is a global health problem contributing to increased morbidity and mortality, particularly in resource-constrained countries. We aimed to determine the prevalence of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) in community patients in Blantyre, Malawi. Clinical samples were collected from 300 patients and screened for ESBL-E using a CHROMagarTM ESBL medium. Confirmation of ESBL production was done by a combination disk test (CDT). The prevalence of community-acquired ESBL-E was 16.67% (50/300, 95% CI = 12.43–20.91%). The most common ESBL-E species isolated was Escherichia coli (66%). All ESBL-E isolates were resistant to Trimethoprim-Sulfamethoxazole except for 2% of E. coli. Besides this, all ESBL-E were susceptible to Imipenem and only 4% were resistant to Meropenem. No patients with a positive ESBL-E phenotype had a history of hospital admission in the last three months, and the carriage of ESBL-E was neither associated with the demographic nor the clinical characteristics of participants. Our findings reveal a low presence of ESBL-E phenotypes in community patients. The low prevalence of ESBL-E in the community settings of Blantyre can be maintained if strong infection and antimicrobial use-control strategies are implemented.

The Molecular Characterization and Risk Factors of ST131 and Non-ST131 Escherichia coli in Healthy Fecal Carriers in Tehran, Iran

“…There is limited information on risk factors related to the fecal carriage of EPE (31). Different surveys have indicated adverse data on the association between sex and carriage of EPE; meanwhile, our results, in line with some studies, demonstrate an association between the males with EPE carriage (9,32,33). Therefore, these discrepancies may reflect the regional habit, social activity, and employment status related to gender.…”

“…For the isolation of ESBL-producing E. coli (EPE), we inoculated the stool samples on CHROMagar ESBL (CHRO-Magar, Paris, France) and identified red colonies by standard microbiologic techniques (9). Susceptibility to cefotaxime (CTX; 30 µg), ceftazidime (CAZ; 30 µg), nalidixic acid (NA; 30 µg), and ciprofloxacin (CIP; 5 µg; Mast Group Ltd, Merseyside, United Kingdom) was tested using the disc diffusion method (10).…”

Trends of antimicrobial resistance in patients with complicated urinary tract infection: Suggested empirical therapy and lessons learned from a retrospective observational study in Oman

“…Threefold increase in the prevalence of ESBL-producing Enterobacterales has been reported worldwide. [ 23 24 25 ] Identification of the underlying conditions and judicious use of appropriate antimicrobials is essential to prevent serious life-threatening conditions, such as urosepsis and renal failure. The increasing resistance to fluoroquinolones observed in E. coli (43%) and K. pneumoniae (30%) precludes their empirical use as IDSA guidelines discourage empirical use of fluoroquinolones if the local resistance is more than 10%.…”

Infection Prevention and Control: Practical and Educational Advances

“…Despite variations in study methodologies, a high rate of MRSA presence was reported, particularly in long-sleeved white coats and ties, as well as evidence of inappopriate laundering techniques. Onduru et al, found a rate of 16.7% of ESBL-producing Enterobacterales in community samples in Blantyre, Malawi, as well as a 4% resistance rate to meropenem [ 17 ]. Among 137 residents in 6 nursing homes in Crete, Greece, Moschou et al, reported rectal colonization by multidrug-resistant microorganisms in 18% of 255 isolates, primarily extended-spectrum-lactamase (ESBL)-producing organisms (26%) [ 18 ].…”