High Fecal Carriage of Multidrug Resistant Bacteria in the Community among Children in Northwestern Tanzania

Abstract

Colonization of multidrug resistant (MDR) bacteria is associated with subsequent invasive infections in children with comorbidities. This study aimed to determine the resistance profile and factors associated with MDR pathogen colonization among HIV−and HIV+ children below five years of age in Mwanza, Tanzania. A total of 399 (HIV− 255 and HIV+ 144) children were enrolled and investigated for the presence of MDR bacteria. The median [IQR] age of children was 19 (10–36) months. Out of 27 Staphylococcus aureus colonizing the nasal cavity, 16 (59.5%) were methicillin resistant while 132/278 (47.2%) of Enterobacteriaceae from rectal swabs were resistant to third generation cephalosporins, with 69.7% (92/132) exhibiting extended spectrum beta lactamase (ESBL) phenotypes. The proportion of resistance to gentamicin, amoxicillin/clavulanic acid and meropenem were significantly higher among HIV+ than HIV− children. A history of antibiotic use in the last month OR 2.62 [1.1, 6.9] (p = 0.04) and history of a relative admitted from the same household in the past three months OR 3.73 [1.1, 13.2] (p = 0.03) independently predicted ESBL rectal colonization. HIV+ children had significantly more fecal carriage of isolates resistant to uncommonly used antibiotics. There is a need to strengthen antimicrobial stewardship and Infection Prevention and Control (IPC) programs to prevent the emergence and spread of MDR pathogens in children.

Extended Spectrum β-Lactamase Producing Lactose Fermenting Bacteria Colonizing Children with Human Immunodeficiency Virus, Sickle Cell Disease and Diabetes Mellitus in Mwanza City, Tanzania: A Cross-Sectional Study

“…Among the three groups, isolates from children with a HIV infection showed significantly high resistance to ampicillin, trimethoprim/sulfamethoxazole, and tetracycline. Similar findings in the same region reported that HIV-infected children had significantly higher multidrug resistance than non-HIV infected children [ 6 ]. The level of resistance reflects the high use of these antibiotics in the healthcare system and the community [ 37 ].…”

“…Rectal carriage of ESBL-producing bacteria is a potential endogenous source of infections and an independent risk of developing subsequent infections due to ESBL-producing bacteria [ 3 , 4 , 5 ]. Furthermore, the colonization of ESBL-producing bacteria was found to be high in individuals with comorbidities such as Human Immunodeficiency Virus (HIV) [ 6 ], diabetes mellitus (DM), organ transplant, and sickle cell disease (SCD) due to the fact that these patients are often in long-term antibiotic prophylaxis [ 7 , 8 ].…”

Allele distribution and phenotypic resistance to ciprofloxacin and gentamicin among extended-spectrum β-lactamase-producing Escherichia coli isolated from the urine, stool, animals, and environments of patients with presumptive urinary tract infection in Tanzania

“…Furthermore, the prevalence of ciprofloxacin and gentamicin resistance among ESBL E. coli is higher than the reported prevalence of ciprofloxacin and gentamicin reported in non-ESBL E. coli in our setting, which ranges from 48.6% to 62.7% and from 14.4% to 17% for ciprofloxacin and gentamicin, respectively (Msanga et al, 2022;Mtemisika et al, 2022). This relatively high resistance rate to fluroquinolones and aminoglycosides to ESBLproducing bacteria compared with non-ESBL-producing bacteria might be due to the co-existence of the ESBL genes with those conferring resistance to fluroquinolones and aminoglycosides in the same large plasmid (Lee et al, 2012).…”

Carriage of third-generation cephalosporin-resistant and carbapenem-resistant Enterobacterales among children in sub-Saharan Africa: a systematic review and meta-analysis

“…1 for reasons for exclusion). This left 40 studies, 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 involving a total of 9408 children, that reported on the carriage prevalence of Enterobacterales resistant to third-generation cephalosporins or carbapenems.

Fig.

…”

“…The risk of ESCR-E carriage also increased significantly among patients who had received antibiotics in the previous three months, with an OR of 3.20 (95% CI: 2.10–4.88) in the eight studies (2580 children) that examined this issue ( Table 3 , Appendix pp 13). 25 , 37 , 42 , 43 , 46 , 48 , 50 , 51 …”