Risk Factors for Colonization With Extended-Spectrum Cephalosporin-Resistant and Carbapenem-Resistant Enterobacterales Among Hospitalized Patients in Kenya: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study

Abstract

Background The spread of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) represents a significant global public health threat. We identified putative risk factors for ESCrE and CRE colonization among patients in 1 urban and 3 rural hospitals in Kenya. Methods During a January 2019 and March 2020 cross-sectional study, stool samples were collected from randomized inpatients and tested for ESCrE and CRE. The Vitek2 instrument was used for isolate confirmation and antibiotic susceptibility testing, and least absolute shrinkage and selection operator (LASSO) regression models were used to identify colonization risk factors while varying antibiotic use measures. Results Most (76%) of the 840 enrolled participants received ≥1 antibiotic in the 14 days preceding their enrollment, primarily ceftriaxone (46%), metronidazole (28%), or benzylpenicillin-gentamycin (23%). For LASSO models that included ceftriaxone administration, ESCrE colonization odds were higher among patients hospitalized for ≥3 days (odds ratio, 2.32 [95% confidence interval, 1.6–3.37]; P < .001), intubated patients (1.73 [1.03–2.91]; P = .009), and persons living with human immunodeficiency virus (1.70 [1.03–2.8]; P = .029). CRE colonization odds were higher among patients receiving ceftriaxone (odds ratio, 2.23 [95% confidence interval, 1.14–4.38]; P = .025) and for every additional day of antibiotic use (1.08 [1.03–1.13]; P = .002). Conclusions While CRE colonization was strongly associated with ceftriaxone use and duration of antibiotic use, the odds of ESCrE colonization increased with exposure to the hospital setting and invasive medical devices, which may reflect nosocomial transmission. These data suggest several areas where hospitals can intervene to prevent colonization among hospitalized patients, both through robust infection prevention and control practices and antibiotic stewardship programs.

Incidence of and Risk Factors for Third-Generation Cephalosporin-Resistant Escherichia coli Bloodstream Infections in Children

“… 21 The presence of drug-resistant bacteria may be attributed to the antibiotic-related sequelae, similar to the selection pressure for resistant organisms or changes in the microbiome leading to dysbiosis and increased susceptibility to colonization. 22 In our study, we also found that a history of carbapenem administration increased the risk of 3GC-R E. coli BSI 2.05-fold, and for patients who received antimicrobial agents before blood culture, the risk increased 1.86-fold. Although receiving extended-spectrum antimicrobial agents may increase the incidence of 3GC-R E. coli , 1-hour or 3-hour regimens are still recommended for patients with severe BSIs.…”

Carbapenem Resistance among HIV-Infected Patients: A Scoping Review

“…Within the scope of our review, a solitary study conducted by Omulo et al (16) offered insights into CRE colonization among individuals living with HIV. Notably, this investigation revealed that the HIV status of participants does not exert a discernible impact on the carriage of CRE (Table 1).…”

Long-term antibiotic exposure landscapes and resistant Escherichia coli colonization in a densely populated setting

“…With global use rates increasing [ 8 , 9 ], including among outpatients [ 10 ], monitoring of populations at risk of carrying AMR bacteria is important, and can help to inform AMR control interventions. However, studies that have examined antibiotics use-resistance colonization relationship have yielded mixed results; observing associations in data rich regional- and national-level ecological designed studies [ 11 – 13 ], and some intercommunity and household-level studies [ 14 , 15 ], but rarely in data-limited global-level studies [ 16 – 18 ] and intracommunity studies [ 19 ].…”