Carriage of antibiotic-resistant Enterobacteriaceae in hospitalised children in tertiary hospitals in Harare, Zimbabwe

Abstract

BackgroundExtended-spectrum β-lactamase-producing and gentamicin resistant Enterobacteriaceae are increasingly recognised as a major cause of infection in low-income countries. We assessed the prevalence of gastrointestinal carriage of these bacteria in hospitalised children in Harare, Zimbabwe.MethodsWe conducted a cohort study in paediatric inpatients at two tertiary-referral hospitals between May and July 2015. Rectal swabs and faecal samples were collected within 24 h of admission and further follow-up samples were collected on alternate days during hospitalization. Disc-based, selective and enrichment methods were used to detect carriage of these two forms of resistance. Standard methods were used to confirm resistance status and determine the susceptibility of resistant isolates to other commonly-used antibiotics.ResultsOne hundred and sixty four paediatric inpatient admissions (median age = 1.0 year, IQR = 0.2–2.2years) were enrolled, and an average of 1.9 faecal samples per patient were collected. On admission, 68/164 (41%) patients had both ESBL and gentamicin-resistant Enterobacteriaceae detected, 18 (11%) had ESBL only, 17 (10%) had gentamicin resistance only and 61 (37%) had negative screening for both forms of resistance. During hospitalisation, 32/164 (20%) patients were found to have a type of resistant organism which was not present in their admission sample. We found that faecal samples and use of a selective enrichment broth enhanced the detection of resistant organisms. Amongst resistant bacteria isolated, there were high levels of resistance to ciprofloxacin and chloramphenicol, but not ertapenem.ConclusionsMore than half of children had enteric carriage of a clinically-relevant form of antibiotic resistance on admission to public-sector hospitals in urban Zimbabwe. Additionally, a fifth of children acquired a further form of resistance during hospitalisation. Urgent action is needed to tackle the spread of antibiotic resistant enteric bacteria in African hospitals.

Trends in antimicrobial resistance of bacterial pathogens in Harare, Zimbabwe, 2012–2017: a secondary dataset analysis

“…From the study findings, carbapenem resistance by Enterobacteriaceae was very low (i.e., < 1%) throughout the 6 years in this study. The findings are consistent with Magwenzi et al 2017 who reported a low prevalence of carbapenem-resistant Enterobacteriaceae of 1% in Harare [17]. Carbapenems are therefore a treatment of choice for ESBL positive infections.…”

“…Our study reveals statistically significant increases in the prevalence of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae . Magwenzi et al 2017 reported ESBL carriage in 52% of patients before hospital admission, suggesting endemic ESBL carriage in Harare [17]. Other authors have explained the increasing prevalence of ESBL producing Enterobacteriaceae in multiple regions as representing the global expansion of ESBL-producing clones [18].…”

Understanding the Epidemiology of Multi-Drug Resistant Gram-Negative Bacilli in the Middle East Using a One Health Approach

“…The main concern of MDROs intestinal carriage is the acquisition of MDRO caused infections with limited therapeutic options (Magwenzi et al, 2017). In addition, as the carriage can last from months to years, the asymptomatic colonization of MDROs constitute a potent reservoir for transmission and dissemination (Decker et al, 2018).…”

Incidence, risk factors and microbiological aetiology of urinary tract infections in admitted stroke patients at a teaching hospital in Zimbabwe: A prospective cohort study

“…This is consistent with other studies which estimated the prevalence of ESBL producing Enterobacteriacae in Zimbabwe to be between 20 and 40 %. [ [33] , [34] , [35] ] Proteus species showed increased levels of resistance with half of the isolated Proteus species being ESBL positive and one [ 1 ] isolate being resistant to carbapenems (a CPE). A third of E. coli isolates and 18% of Klebsiella species isolates were ESBL producing organisms.…”