Department of Epidemiology, University of Washington, Seattle, Washington, United States of America.
Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
PLoS Negl Trop Dis. 2022 Mar 31;16(3):e0010283. doi: 10.1371/journal.pntd.0010283. eCollection 2022 Mar.
Children who have been discharged from hospital in sub-Saharan Africa remain at substantial risk of mortality in the post-discharge period. Antimicrobial resistance (AMR) may be an important factor. We sought to determine the prevalence and risk factors associated with AMR in commensal Escherichia coli (E. coli) from Kenyan children at the time of discharge.
METHODOLOGY/PRINCIPLE FINDINGS: Fecal samples were collected from 406 children aged 1-59 months in western Kenya at the time of discharge from hospital and cultured for E. coli. Susceptibility to ampicillin, ceftriaxone, cefotaxime, ceftazidime, cefoxitin, imipenem, ciprofloxacin, gentamicin, combined amoxicillin/clavulanic acid, trimethoprim-sulfamethoxazole, azithromycin, and chloramphenicol was determined by disc diffusion according to guidelines from the Clinical and Laboratory Standards Institute (CLSI). Poisson regression was used to determine associations between participant characteristics and the presence of extended-spectrum beta-lactamases (ESBL) producing E. coli. Non-susceptibility to ampicillin (95%), gentamicin (44%), ceftriaxone (46%), and the presence of ESBL (44%) was high. Receipt of antibiotics during the hospitalization was associated with the presence of ESBL (aPR = 2.23; 95% CI: 1.29-3.83) as was being hospitalized within the prior year (aPR = 1.32 [1.07-1.69]). Open defecation (aPR = 2.02; 95% CI: 1.39-2.94), having a toilet shared with other households (aPR = 1.49; 95% CI: 1.17-1.89), and being female (aPR = 1.42; 95% CI: 1.15-1.76) were associated with carriage of ESBL E. coli.
CONCLUSIONS/SIGNIFICANCE: AMR is common among isolates of E. coli from children at hospital discharge in Kenya, including nearly half having detectable ESBL.
在撒哈拉以南非洲，从医院出院的儿童在出院后仍面临很大的死亡风险。抗生素耐药性（AMR）可能是一个重要因素。我们试图确定肯尼亚儿童在出院时肠道共生大肠杆菌（E. coli）中 AMR 的流行情况及其相关的危险因素。
方法/原理发现：在肯尼亚西部，从 406 名 1-59 个月大的住院儿童出院时收集粪便样本并进行大肠杆菌培养。根据临床和实验室标准协会（CLSI）的指南，通过纸片扩散法测定氨苄西林、头孢曲松、头孢噻肟、头孢他啶、头孢西丁、亚胺培南、环丙沙星、庆大霉素、阿莫西林/克拉维酸合剂、复方磺胺甲噁唑、阿奇霉素和氯霉素的敏感性。采用泊松回归分析确定参与者特征与产超广谱β-内酰胺酶（ESBL）大肠杆菌之间的关系。对氨苄西林（95%）、庆大霉素（44%）、头孢曲松（46%）和 ESBL 的非敏感性率较高。住院期间使用抗生素与 ESBL 的存在相关（aPR = 2.23；95%CI：1.29-3.83），去年住院的情况也相关（aPR = 1.32 [1.07-1.69]）。露天排便（aPR = 2.02；95%CI：1.39-2.94）、与其他家庭共用厕所（aPR = 1.49；95%CI：1.17-1.89）以及女性（aPR = 1.42；95%CI：1.15-1.76）与 ESBL 大肠杆菌的携带相关。
结论/意义：在肯尼亚，从儿童出院时分离的大肠杆菌中，AMR 很常见，包括近一半的大肠杆菌可检测到 ESBL。
