Prevalence and patient related factors associated with Extended-Spectrum Beta-Lactamase producing Escherichia coli and Klebsiella pneumoniae carriage and infection among pediatric patients in Tanzania

Abstract

Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae (EPE) is increasing worldwide, though less documented in low-income settings. Here we determined the prevalence of EPE infection and carriage, and patient factors associated with EPE-carriage among pediatric patients in three health care levels in Tanzania. Between January and April 2016, 350 febrile children (median age 21 months) seeking care at a university or a regional referral hospital, or a health centre in Moshi municipality, Tanzania, were included. Socio-demographic characteristics were collected using a questionnaire. Rectal swabs and blood cultures were collected from all children (n = 350) and urinary samples from 259 children at admission. ESBL-phenotype and antimicrobial susceptibility were determined for Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli) isolates. Only one EPE case (E. coli) in blood and four in urine (one E. coli and three K. pneumoniae) were found, whereas (n = 90, 26%) of the children were colonized in feces (ESBL-E. coli; n = 76, ESBL-K. pneumoniae, n = 14). High resistance rates were seen in fecal ESBL-E. coli (n = 76) against trimethoprim-sulfamethoxazole (n = 69, 91%), gentamicin (n = 51, 67%), ciprofloxacin (n = 39, 51%) and chloramphenicol (n = 27, 35%) whereas most isolates were sensitive to amikacin (n = 71, 93%). Similar rates were seen for fecal ESBL-K. pneumoniae. Resistance to first line antibiotics were also very high in fecal E. coli not producing ESBL. No sociodemographic factor was associated with EPE-carriage. Children colonized with EPE were younger than 12 months (n = 43, 48%) and often treated with antibiotics (n = 40, 44%) in the previous two months. After adjustment for age children admitted to the intensive care unit had higher odds of EPE fecal carriage compared with those in the general wards (OR = 3.9, 95%CI = 1.4–10.4). Despite comparatively high rates of fecal EPE-carriage and previous antibiotic treatment, clinical EPE cases were rare in the febrile children. The very high resistant rates for the EPE and the non-ESBL producing E. coli to commonly used antibiotics are worrying and demand implementation of antibiotic stewardship programs in all levels of health care in Tanzania.

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

“…Furthermore, in a different part of the city, location 2 in Tehran with lower economic income and many immigrants had significantly high EPE carriers. Therefore, this area of the city has to be taken into account because the accommodation of high population density, a high proportion of immigrant residents, and the people of a lower socioeconomic class can affect the incidence of EPE carriage (35).…”

Faecal carriage of ESBL-producingEscherichia coliin a remote region of Niger

“…After finding an unexpectedly high prevalence of ESBL-E. coli faecal carriage in healthy subjects (>90%) in rural South Niger [14], we analysed the population structure, molecular support of resistance and mode of spread of these commensal strains in this community, using state-of-the-art sequencing techniques with both Ilumina WGS and an additional long-read sequencing by Nanopore (to specifically study strains with ESBL-encoded genes embedded in plasmids). Previous description of ESBL carriage in African settings has varied by the region, the community and the age of the subjects [2][3][4][5]12,13], ranging from 46 % in district hospital patients in South Africa in 2018 [3], 51% in hospitalized patients and 38% in healthy healthcare workers in Chad in 2019 [13], and 59% in healthy children in the community in the Central African Republic [12]. When resistance mechanisms and phylogenetic groups were described, bla CTX-M-15 was the most commonly encountered gene encoding for resistance to β-lactams (ranging from 75% to 90% of cases), and the clonal group ST131 was predominant among phylogroup B2 E. coli [12,13,15,25].…”

“…Prevalence of ESBL-E. coli faecal carriage in humans is a good indicator of the global burden of antibacterial resistance in a given community [11]. In Africa, the few available studies showed a prevalence of ESBL-E. coli community faecal carriage ranging from 15% to 92% depending on the country, the population studied and the year of stool collection, which is higher than in most high income countries [2][3][4][5][12][13][14]. However, little is known about the molecular epidemiology and evolution of resistance mechanisms in low-income countries [13,15].…”

“…Extended-Spectrum β-Lactamase-producing (ESBL) Enterobacterales, and particularly Escherichia coli (ESBL-E. coli) have spread worldwide and become endemic, especially in low-and middle-income countries [1][2][3][4][5]. The diffusion of ESBL-E. coli is mainly the result of the epidemiological success of bla CTX-M genes in the 2000s, which are ESBL-encoding genes often carried by mobile genetic elements such as plasmids.…”

Enterobacterias productoras de betalactamasas de espectro extendido, aisladas en hemocultivos de pacientes atendidos en diferentes áreas hospitalarias

“…Las enterobacterias productoras de BLEE predominan cada vez más a nivel mundial y varían en diferentes áreas geográficas (19). Se caracterizan por ser bacilos gramnegativos que pertenecen a la familia Enterobacteriaceae, tales como, Klebsiella pneumoniae, Escherichia coli, Proteus mirabilis, Serratia spp., Salmonella spp., etc.…”