Colonisation with extended spectrum beta-lactamase-producing and carbapenem-resistant Enterobacterales in children admitted to a paediatric referral hospital in South Africa

Abstract

Introduction There are few studies describing colonisation with extended spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) and carbapenem-resistant Enterobacterales (CRE) among children in sub-Saharan Africa. Colonisation often precedes infection and multi-drug-resistant Enterobacterales are important causes of invasive infection. Methods In this prospective cross-sectional study, conducted between April and June 2017, 200 children in a tertiary academic hospital were screened by rectal swab for EBSL-PE and CRE. The resistance-conferring genes were identified using polymerase chain reaction technology. Risk factors for colonisation were also evaluated. Results Overall, 48% (96/200) of the children were colonised with at least one ESBL-PE, 8.3% (8/96) of these with 2 ESBL-PE, and one other child was colonised with a CRE (0.5% (1/200)). Common colonising ESBL-PE were Klebsiella pneumoniae (62.5%, 65/104) and Escherichia coli (34.6%, 36/104). The most frequent ESBL-conferring gene was blaCTX-M in 95% (76/80) of the isolates. No resistance- conferring gene was identified in the CRE isolate (Enterobacter cloacae). Most of the Klebsiella pneumoniae isolates were susceptible to piperacillin/tazobactam (86.2%) and amikacin (63.9%). Similarly, 94.4% and 97.2% of the Escherichia coli isolates were susceptible to piperacillin/tazobactam and amikacin, respectively. Hospitalisation for more than 7 days before study enrolment was associated with ESBL-PE colonisation. Conclusion Approximately half of the hospitalised children in this study were colonised with ESBL-PE. This highlights the need for improved infection prevention and control practices to limit the dissemination of these microorganisms.

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

“…In contrast to the low prevalence of MRSA colonization, the current study observed that almost two-thirds of children were colonized with potential ESBL-PE with a predominance of E. coli and K. pneumoniae complex. Similar findings regarding the colonization of ESBL producing E. coli and K. pneumoniae complex were reported in the same region among admitted neonates and street children [ 8 , 22 ], as well as other settings in LMIC [ 23 , 24 , 25 , 26 , 27 ] among non-HIV infected children. However, the prevalence was twice as high as that reported in HIC among non-HIV infected children [ 28 ], which could be attributed to poor hygiene, infrastructure and water sanitation, as documented previously in a meta-analysis [ 29 ].…”

“…A total of 399 children below five years of age were enrolled with a median [interquartile range [IQR] age of 19 [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ] months and 212 (53%) were males. The gender distribution was almost equal between two groups ( p = 0.463).…”

Molecular Epidemiology of Extended-Spectrum Beta-Lactamase and AmpC Producing Enterobacteriaceae among Sepsis Patients in Ethiopia: A Prospective Multicenter Study

“…In contrast, the detection of ESBL enzymes at DRH (55.8%), which is located in the northern part of Ethiopia, was comparatively low. However, the lower level of ESBL detection at DRH was still higher compared to studies conducted in South Africa [31], Mozambique [20] and South and South East Asia [32]. While it is known that the spread of ESBL genes varies geographically [33], the factors that contribute to its high occurrence in some hospitals and a lower detection rate in the other hospital within a single country requires investigation so that effective control mechanisms can be designed.…”

Genomic, Epigenomic, and Transcriptional Characterisation of Carbapenem and Colistin Resistance Mechanisms inKlebsiella pneumoniaeandEnterobacterspecies

“…The emergence of colistin- and carbapenem-resistant K. pneumoniae is a major concern owing to limited treatment options. Epidemiological data in South Africa shows an increased prevalence of carbapenemase-positive Gram-negative bacteria and a low prevalence of mcr genes within the public health sector 4,14,25,26 . However, there are carbapenem- and colistin-resistant isolates without any known resistance mechanism.…”