Prevalence and risk factors for CTX-M gram-negative bacteria in hospitalized patients at a tertiary care hospital in Kilimanjaro, Tanzania

Abstract

Emergence and spread of extended spectrum beta-lactamase (ESBL)-producing gram-negative bacteria, mainly due to CTX-M, is a major global public health problem. Patients infected with ESBL-producing gram-negative bacteria have an increased risk of treatment failure and death. We investigated the prevalence and risk factors for CTX-M gram-negative bacteria isolated from clinical specimens of patients hospitalized at a tertiary care hospital in Kilimanjaro, Tanzania. Isolated gram-negative bacteria from inpatients admitted at Kilimanjaro Christian Medical Centre (KCMC) between August 2013 and August 2015 were fully genome sequenced. The prevalence of ESBL-producing gram-negative bacteria was determined based on the presence of blaCTX-M. The odds ratio (OR) and risk factors for ESBL-producing gram-negative bacteria due to CTX-M were assessed using logistic regression models. The overall CTX-M prevalence (95% CI) was 13.6% (10.1–18.1). Adjusted for other factors, the OR of CTX-M gram-negative bacteria for patients previously hospitalized was 0.26 (0.08–0.88), p = 0.031; the OR for patients currently on antibiotics was 4.02 (1.29–12.58), p = 0.017; the OR for patients currently on ceftriaxone was 0.14 (0.04–0.46), p = 0.001; and the OR for patients with wound infections was 0.24 (0.09–0.61), p = 0.003. The prevalence of ESBL-producing gram-negative bacteria due to CTX-M in this setting is relatively low compared to other previous reports in similar settings. However, to properly stop further spread in the hospital, we recommend setting up a hospital surveillance system that takes full advantage of the available next-generation sequencing facility to routinely screen for all types of bacterial resistance genes.

Carbapenem-Resistant Enterobacteriaceae Posing a Dilemma in Effective Healthcare Delivery

“…While our study showed that of the factors investigated, only literacy levels (p value = 0.0058) and hospitalization (p value < 0.0001) actually affected the rate of CRE infections; the infection rates of enterobacteriaceae generally were found to be affected by factors such as age, marital status, level of education and hospital setting. Other studies proved that younger age group and hospitalization are common risk factors for Gram-negative enterobacteriaceae (GNE) infections [18,19] while hospitalization remains the leading cause of CRE infections [20][21][22]. Since hospitalization is a strong risk factor in CRE colonization; clinicians, other health workers and in fact, everyone should join hands to reduce patients' length of stay in hospitals as this will reduce the risk of spread of CRE as well as control them.…”

Point Prevalence survey of antimicrobial use in three hospitals in North-eastern Tanzania

“…Injudicious use of ceftriaxone may contribute to the high burden of AMR, including nosocomial infections with extended spectrum beta lactamase (ESBL)-producing Enterobacteriaceae, and complicate empirical treatment of severe bacterial infections. In view of the high prevalence of colonization and infections with ESBL positive Enterobacteriaceae in Tanzanian hospitals [15][16] [17] [18], increasing use of carbapenems in the future can be anticipated. In an attempt to limit empiric carbapenem use, the Tanzanian National Health Insurance Fund (NHIF) implemented a policy in July 2016 that limits carbapenem coverage to infections with a positive bacterial culture and sensitivity [19].…”

Point Prevalence Survey of antimicrobial use in three hospitals in North-eastern Tanzania

“…Injudicious use of ceftriaxone may contribute to the high burden of AMR, including nosocomial infections with extended spectrum beta lactamase (ESBL)-producing Enterobacteriaceae, and complicate empirical treatment of severe bacterial infections. In view of the high prevalence of colonization and infections with ESBL positive Enterobacteriaceae in Tanzanian hospitals [21][22][23][24], increasing use of carbapenems in the future can be anticipated. In an attempt to limit empiric carbapenem use, the Tanzanian National Health Insurance Fund (NHIF) implemented a policy in July 2016 that limits carbapenem coverage to infections with a positive bacterial culture and sensitivity [25].…”