Gastrointestinal Tract Colonization Rate of Extended-Spectrum Beta-Lactamase-Producing Gram-Negative Bacteria and Associated Factors Among Orthopaedic Patients in a Tertiary Hospital in Tanzania: Implications for Infection Prevention

Abstract

Background:The dual burden of road traffic accidents and antimicrobial resistance in orthopaedic infections is challenging already strained health-care systems. Limited information exists in Tanzania on antimicrobial resistance surveillance to delineate the potential sources of multidrug-resistant bacteria for specific mitigation strategies among orthopaedic patients. Methods: A longitudinal study was conducted at Bugando Medical Centre in Mwanza city between January and May 2020. It involved the collection of rectal swabs/stools, hand swabs, and environmental sampling to identify extended-spectrum beta-lactamase (ESBL)-producing gramnegative bacteria. Participants' data were collected using a structured questionnaire and analysed to determine factors associated with ESBL colonization among index orthopaedic patients and correlates with other ESBL sources using OR (95% CI) and a cut-off p-value of ≤0.05. Results: We found that 47.2% (125/265) of index patients, 77.8% (14/18) of neighbouring patients, 8.3% (2/24) of health-care workers, 72.2% (13/18) of non-medical caregivers, and 31.4% (27/86) of samples taken from the hospital environment had ESBL producers. Escherichia coli and Klebsiella spp. predominated among participants and Acinetobacter spp. predominated in the environmental samples. Patients with open fractures had increased odds of being colonized with ESBL producers [OR (95% CI): 2.08 (1.16-3.75); p=0.015].The floor below patients' beds was commonly contaminated; however, the odds of environmental contamination decreased on the third round of sampling [OR (95% CI: 0.16 (0.04-0.67); p=0.012], apparently as a result of parallel infection prevention and control responsive measures against coronavirus disease 2019 (COVID-19). Conclusion:We found a high occurrence of ESBL colonization among participants and in the environmentat this tertiary hospital. The importance of routine ESBL surveillance among orthopaedic patients with open fractures on admission and strengthened decontamination of health-care premises is reiterated.

Unraveling virulence determinants in extended-spectrum beta-lactamase-producing Escherichia coli from East Africa using whole-genome sequencing

“…The study population constituted of whole-genome sequence data obtained from a total of 142 multi-drug resistant E. coli bacterial isolates provided by the mother study titled, “Understanding Transmission Dynamics and Acquisition of Antimicrobial Resistance at Referral Hospitals and Community Settings in East Africa using Conventional Microbiology and Whole-Genome Sequencing”. The multi-drug isolates were collected from both study sites in Uganda (n = 57) and Tanzania (n = 85) from patients, the immediate non-medical caretakers of these patients, the immediate health workers attending to these patients and the patients’ environment as previously discussed in detail by the recent publications from Uganda [ 1 ] and Tanzania [ 13 ].…”

Colonization with extended spectrum beta-lactamase and carbapenemases producing Enterobacteriaceae among hospitalized patients at the global level: A systematic review and meta-analysis

“…Secondly, during prolonged hospitalization, susceptible bacteria may acquire resistant gene through conjugation mechanism or through genetic mutation [7]. There are many factors that can facilitate the colonization rate of MDRB in hospitalized patients: such as low hygiene practice, improper antibiotic usage, prolonged hospitalization, implanted materials, sharing a single room with high carrier patients including door knobs, wheelchairs and sinks have been associated [8][9][10]. In addition, patients may remain colonized by MDRB after they leave the hospital and become a potential source of resistant gene transmission for the community [11].…”

Colonization of Extended-spectrum β-lactamase producing Enterobacterales and meticillin-resistant S. aureus in the intensive care unit at a tertiary hospital in Tanzania: Implications for Infection control and prevention

“…Recent studies in Tanzania observed an increase in the prevalence of MDR bacteria causing infections and colonization of healthy populations [ [15] , [16] , [17] , [18] ]. The prevalence of fecal carriage of ESBL-PE in Tanzania ranges between 30% and 50% in hospitals and communities [ [17] , [18] , [19] , [20] , [21] ]. Studies have reported the isolation of MRSA and ESBL-PE in bloodstream infections [ 15 , 16 ], surgical site infections [ 22 , 23 ], and urinary tract infections [ 24 , 25 ].…”