High Prevalence of Fecal Carriage of Extended Spectrum β-Lactamase-Producing Enterobacteriaceae Among Newly HIV-Diagnosed Adults in a Community Setting in Tanzania

Abstract

Colonization in HIV-infected populations with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) is particularly worrisome in low-income settings. This study describes the prevalence of ESBL-PE carriage and associated risk factors among newly HIV-diagnosed adults in a community setting in Tanzania. A total of 595 newly diagnosed HIV adults with a median age of 35 years with interquartile range (IQR) 29–42 years and a median CD4 count of 492 cells/μL (IQR 390–666 cells/μL) were recruited. Among these, 194/595 (32.6%, 95% confidence interval [CI] 28.9–36.6) were ESBL-PE carriers. Participants with low CD4 count (<350 cells/μL) had significantly higher prevalence of ESBL-PE carriage compared with those with CD4 count ≥350 cells/μL (26/58, 44.8%, vs. 168/537, 31.3%, p = 0.04). Antibiotic use in last 4 weeks (odds ratio [OR] 1.55, 95% CI 1.08–2.22, p = 0.02) and CD4 count ≥350 cells/μL (OR 1.78, 95% CI 1.03–3.09, p = 0.04) were independent risk factors for fecal carriage of ESBL-PE. In total, 244 isolates of ESBL-PE were isolated from 194 participants. Of these, 238/244 (97.5%) harbored bla CTX-M genes, with bla CTX-M-15 being predominant (219/238 (92%), followed by bla CTX-M-27 (9/238 (3.8%), bla CTX-M-14 (8/238 (3.4%), bla CTX-M-55 (1/238), and bla CTX-M 211/3 (1/238). bla SHV-2a genes were detected in four isolates, whereas the bla SHV-12 gene was detected in one isolate. Phenotypic carbapenemase-producing Enterobacteriaceae was detected in one HIV-positive person with CD4 count 132 cells/μL. In conclusion prevalence of ESBL-PE carriage is high among newly diagnosed HIV adults in Dar es Salaam, and is significantly associated antibiotic use and low CD4 count.

Colonization of Extended-spectrum β-lactamase producing Enterobacterales and meticillin-resistant S. aureus in the intensive care unit at a tertiary hospital in Tanzania: Implications for Infection control and prevention

“…On the other hand, the high carriage we have observed in these patients at admission indicates a high risk of spreading ESBL-PE to other patients admitted to the ICU. Our findings align with those of our earlier investigations conducted in Dar es Salaam among inpatients (35–64%) and outpatients (32.6%) [ [18] , [19] , [20] , 32 ], which revealed a significant proportion of fecal carriage for ESBL-PE and previous use of antibiotic was found to be a reason for the high carriage. Previous use of antibiotics and hospitalization have all been associated with fecal carriage of ESBL-PE [ 13 , 19 , 20 ].…”

“…Our findings align with those of our earlier investigations conducted in Dar es Salaam among inpatients (35–64%) and outpatients (32.6%) [ [18] , [19] , [20] , 32 ], which revealed a significant proportion of fecal carriage for ESBL-PE and previous use of antibiotic was found to be a reason for the high carriage. Previous use of antibiotics and hospitalization have all been associated with fecal carriage of ESBL-PE [ 13 , 19 , 20 ]. Almost 66% of the patients in the present study had used antibiotics before admission, but only 31% had previously been hospitalization in the last six months.…”

“…Ceftriaxone and meropenem were commonly prescribed antibiotics: these antibiotics have high resistance potential [ 40 ]. The association between the irrational use of a WHO “watch” group antibiotics and antibiotic-resistant bacteria is well known [ 18 , 19 ]. The use of ceftriaxone could explain the high proportion of fecal carriage of ESBL-PE observed in this study.…”

“…Recent studies in Tanzania observed an increase in the prevalence of MDR bacteria causing infections and colonization of healthy populations [ [15] , [16] , [17] , [18] ]. The prevalence of fecal carriage of ESBL-PE in Tanzania ranges between 30% and 50% in hospitals and communities [ [17] , [18] , [19] , [20] , [21] ]. Studies have reported the isolation of MRSA and ESBL-PE in bloodstream infections [ 15 , 16 ], surgical site infections [ 22 , 23 ], and urinary tract infections [ 24 , 25 ].…”

Paediatric Enterobacteriaceae infections in hospitalised children in Durban, KwaZulu-Natal

“…Higher infection rates with Enteropathogenic E. coli (EPEC), Cryptosporidium and increased gut colonisation with ESBL Enterobacteriaceae have been found in HIV-infected children. 17,18,19,20 In our study, the incidence of Enterobacteriaceae infection was higher in children who were yet to be initiated on ART compared with those already on lifelong ART. Being ART naïve is probably associated with a compromised immune system.…”