Colonization of patients hospitalized at orthopedic department of tertiary hospital in Uganda with extended-spectrum beta-lactamase-producing enterobacterales

Abstract

Background Beta-lactamase production remains the most contributing factor to beta-lactam resistance. Extended-Spectrum Beta-Lactamase-Producing Enterobacterales (ESBL-PE) are associated with risk factors both in hospital and community settings. Objectives To assess the incidence and risk factors for intestinal carriage of ESBL-PE among patients admitted to orthopedic ward of Mulago National Referral Hospital, and to analyze the acquisition of ESBL-PE during hospital stay and associated factors. Methods We screened 172 patients aged 18 years old and above who got admitted to the orthopedic ward of Mulago National Referral Hospital between May to July 2017. Stool samples or rectal swabs were collected at admission, every 3 days until fourteen days and screened for ESBL-PE. Data on demographic status, antibiotic use, admission and travel, length of hospital stay, hygiene practices and drinking boiled water were analyzed by logistic regression and cox regression model. Results At admission, 61% of patients showed intestinal ESBL-PE carriage. Co- resistance was common but no Carbapenem resistance was detected. Of the ESBL-PE negative, 49% were colonized during hospitalization. On admission, prior antibiotic use was significantly associated with carriage, but none was associated with acquisition during hospitalization at p-value < 0.05. Conclusion Carriage of ESBL-PE on admissions and acquisition at orthopedic ward of Mulago Hospital were high, and dissemination into the community are of substantial concern. We suggested refinement of empirical treatment based on risk stratification, and enhanced infection control measures that target health care workers, patients and attendants.

Role of CTX-M-15 gene in spread of extended-spectrum beta-lactamases among immunocompetent patients in Ghana

“…24 Feglo and Adu-Sarkodie in 2016 (57.8%, n = 234/405), 25 28 It is worth noting that variations in study populations can also influence ESBL carriage rates. For example, the proportion of ESBL faecal carriage reported in our work is lower than that cited for similar populations in comparative reviews 6,17,18 spanning several regions across Africa, including Uganda in 2023 (61%), 29 Ghana in 2022 (53.1%), 30 Kenya in 2022 (44%), 31 Niger in 2022 (92.4%), 32 Malawi in 2021 (47.2%), 33 Central African Republic in 2016 (59%), 10 Morocco in 2014 (42.9%), 14 and Cameroon in 2013 (55.3%). 11 In all these studies, the reports were silent on whether the study patients were immunocompetent or immunosuppressed.…”