High Prevalence of Faecal Carriage of ESBL-Producing Enterobacteriaceae among Children in Dar es Salaam, Tanzania

Abstract

BackgroundFaecal carriage of ESBL-producing bacteria is a potential risk for transmission and infection. Little is known about faecal carriage of antibiotic resistance in Tanzania. This study aimed to investigate the prevalence of faecal carriage of ESBL-producing Enterobacteriaceae and to identify risk factors for carriage among young children in Tanzania.Methodology/Principal FindingsFrom August 2010 to July 2011, children below 2 years of age were recruited in Dar es Salaam, including healthy community children (n = 250) and children hospitalized due to diarrhoea (n = 250) or other diseases (n = 103). ChromID ESBL agar and ChromID CARBA SMART agar were used for screening. Antimicrobial susceptibility testing was performed by the disk diffusion method. ESBL genotypes were identified by Real-Time PCR and sequencing.The overall prevalence of ESBL carriage was 34.3% (207/ 603). The prevalence of ESBL carriage was significantly higher among hospitalized children (50.4%), compared to community children (11.6%; P < 0.001; OR = 7.75; 95% CI: 4.99–12.03). We found high prevalence of Multidrug-resistance (94%) among Escherichia coli and Klebsiella pneumoniae isolates. No resistance to carbapenems was detected. For the majority of isolates (94.7%) we detected a blaCTX-M-15-like gene. In addition, the plasmid mediated AmpC beta-lactamase CMY-2 was detected for the first time in Tanzania. ESBL prevalence was significantly higher among HIV positive (89.7%) than HIV negative (16.9%) children (P = 0.001; OR = 9.99; 95% CI: 2.52–39.57). Use of antibiotics during the past 14 days and age below 1 year was also associated with ESBL carriage.Conclusions/SignificanceWe report a high rate of faecal carriage of ESBL-producing Enterobacteriaceae among children below 2 years of age in Tanzania, particularly those with HIV-infection. Resistance to a majority of the available antimicrobials commonly used for children in Tanzania leaves few treatment options for infections when caused by these bacteria.

High fecal carriage of Extended Beta Lactamase producing Enterobacteriaceae among adult patients admitted in Referral Hospitals in Dar es salaam, Tanzania

“…Potential reasons for the observed difference include several factors such as; different ESBL detection techniques and specimen used, whereas in a study by Sabrina et al they used urine specimen and ESBL-E test strip for ESBL detection. Furthermore the carriage rate in our study is also higher compared to that reported among hospitalized children in Dar es Salaam, Tanzania (18). This difference may be accounted for by the difference in study population, whereby the study population in this study were children versus adults in our study.…”

“…However, in a study done among children by Tellevic and his colleagues, children hospitalized due to diarrhea had lower carriage rate compared to those hospitalized due to other diseases, probably because the latter group included children with many diverse conditions (18). The pattern observed in our study can be explained by the fact that diarrhea cause changes in the gut microbiota which provides conducive environment for exchange of resistance genes between inter and intra species including the indigenous organisms (23).…”

“…(IQR:[18][19][20][21][22][23][24][25][26][27][28][29][30] years. Half of the study participants were aged between 18 and 27 years, and those above 57 years were the least (0.5%).…”

Preliminary insights into the occurrence of similar clones of extended‐spectrum beta‐lactamase‐producing bacteria in humans, animals and the environment in Tanzania: A systematic review and meta‐analysis between 2005 and 2016

“…The overall prevalence of ESBL in the three interfaces was found to be 22.62% (95% CI: 21.08–24.16) (Blomberg et al., ; Moremi et al., ; Mshana, Imirzalioglu, et al., ; Mshana et al., , ; Ndugulile, Jureen, Harthug, Urassa, & Langeland, ; Onken, Said, Jorstad, Jenum, & Blomberg, ; Seni et al., ; Tellevik et al., ). The lowest and highest ESBL prevalence were 0.90% (95% CI: 0.46–1.34) and 53.40% (95% CI: 41.96–64.84), respectively (Blomberg et al., ; Moremi et al., ) (Figure ).…”

“…With regard to ESBL‐PE species, E. coli and Klebsiella species were the predominant bacterial species (93.2%) compared to other bacterial species, which accounted for only 6.8% (Blomberg et al., ; Moremi et al., ; Mshana et al., , ; Mshana, Imirzalioglu, et al., ; Ndugulile et al., ; Onken et al., ; Seni et al., ; Tellevik et al., ) (Figure ).…”