Extended Spectrum β-Lactamase Producing Lactose Fermenting Bacteria Colonizing Children with Human Immunodeficiency Virus, Sickle Cell Disease and Diabetes Mellitus in Mwanza City, Tanzania: A Cross-Sectional Study

Abstract

Rectal carriage of extended spectrum β-lactamase-lactose fermenters (ESBL-LF) is the major risk factor for the development of subsequent endogenous infections. This study determined the patterns and factors associated with the rectal carriage of ESBL-LF among children with Human Immunodeficiency Virus (HIV), Diabetes Mellitus (DM), and Sickle Cell Disease (SCD) attending clinics at different health care facilities in the city of Mwanza, Tanzania. A cross-sectional study was conducted among children living with HIV (n = 236), DM (n = 42) and SCD (n = 126) between July and September 2021. Socio-demographic and clinical data were collected using a structured questionnaire. Rectal swabs/stool samples were collected and processed to detect the rectal carriage of ESBL-LF following laboratory standard operating procedures (SOPs). Descriptive statistical analysis was conducted using STATA 13.0. The overall prevalence of ESBL-LF carriage was 94/404 (23.3%). Significantly higher resistance was observed to ampicillin, trimethoprim-sulfamethoxazole, and tetracycline among Enterobacteriaceae isolated from HIV infected children than in non-HIV infected children (p < 0.05). The commonest ESBL allele 45/62 (72.6%) detected was blaCTX-M. Generally, a parent’s low education level was found to be associated with ESBL-LF colonization among children living with HIV; (OR 4.60 [95%CI] [1.04–20], p = 0.044). A higher proportion of ESBL-LF from DM 10/10 (100%) carried ESBL genes than ESBL-LF from HIV 37/56 (66.1%) and SCD 15/28 (53.6%), p = 0.02. There is a need to collect more data regarding trimethoprim-sulfamethoxazole (SXT) prophylaxis and antibiotic resistance to guide the decision of providing SXT prophylaxis in HIV-infected children especially at this time, when testing and treatment is carried out.

Intestinal colonization with multidrug-resistant Enterobacterales: screening, epidemiology, clinical impact, and strategies to decolonize carriers

“…In the Swiss HIV cohort (2015-2016), the prevalence of 3GC-R-Ent carriers was found to be 6.7% [117], which is consistent with the rate found in healthy people (7.1%) during the same period [91]. In contrast, in low-income countries, subjects not receiving ART showed higher MDR-Ent colonization rates (e.g., 23-33% in Tanzania) than the general population [118,119]. Interestingly, in a recent analysis, carriage of ESBL-Ent was more frequent in men who have sex with men undergoing preexposure prophylaxis or living with HIV-positives and with high number of sexual partners [120].…”

Characterisation of genes encoding for extended spectrum β-lactamase in Gram-negative bacteria causing healthcare-associated infections in Mwanza, Tanzania

“… 16 Our findings are, however, higher than a study by Said et al, which was conducted in 2021 in Mwanza, Tanzania, which reported that about 65.9% of GNB colonising children, of whom the majority were not hospitalised, harboured ESBL genes at the same setting. 17 Therefore, the difference in study populations between the studies may explain the difference observed. Similar to previous studies published in 2020 and 2021 in Mwanza and in 2021 in Morogoro, Tanzania, 16 , 17 , 18 the majority of ceftriaxone-resistant GNB were harbouring the bla CTX-M gene.…”

“… 17 Therefore, the difference in study populations between the studies may explain the difference observed. Similar to previous studies published in 2020 and 2021 in Mwanza and in 2021 in Morogoro, Tanzania, 16 , 17 , 18 the majority of ceftriaxone-resistant GNB were harbouring the bla CTX-M gene. The predominance of bla CTX-M may be a result of successful dissemination by conjugative epidemic plasmids, which facilitates its horizontal and vertical transmission.…”

“…This observation is in line with previous studies conducted from the same setting, Mwanza, Tanzania, in 2020 and 2021. 16 , 17 The isolates may be harbouring other ESBL families which are non-cefotaximase-Munich beta-lactamase (non-CTX-M), non-temoniera beta-lactamase (non-TEM), and non-sulfhydryl reagent variable beta-lactamase (non-SHV), such as oxacillinase beta-lactamase, Pseudomonas extended resistant, Vietnam extended-spectrum β-lactamase, Tlahuica Indian- and Guiana-extended spectrum families. 22 …”