Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Department of Clinical Science, University of Bergen, Bergen, Norway.
J Glob Antimicrob Resist. 2022 Sep;30:107-114. doi: 10.1016/j.jgar.2022.05.023. Epub 2022 Jun 3.
Gastrointestinal colonization of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) is of concern because prior colonization increases risk for subsequent infections. To date, the link between ESBL-PE faecal carriage and the risk of subsequent ESBL-PE infection has not been well established, and information on carriage of such pathogens among children with invasive infections such as bloodstream infections (BSI) remains to be explored worldwide.
This cross-sectional study was conducted among children under the age of 5 years admitted for febrile illness in Dar es Salaam, Tanzania, between March 2017 and July 2018. We used rectal swabs to screen for ESBL-PE using selective media, ChromID ESBL. Bacterial isolates were identified by MALDI-TOF. Blood cultures were drawn from all children. Antimicrobial susceptibility testing was done using a disk diffusion method. ESBL alleles were identified by real-time PCR and sequencing.
The overall prevalence of ESBL-PE carriage was 56% (112/200) and was highest among children 4 to 6 months old (17/21, 81%) (P = 0.05). Children with BSI had high ESBL-PE carriage (78.4%) compared to those without BSI (53.1%) (P = 0.02; aOR 3.4, 95% confidence interval 1.20-9.58). The most common isolate was E. coli (64/112, 45%). Sixteen pairs of ESBL-PE isolates (from the gut and from blood) had a similar antimicrobial susceptibility profile. We detected bla gene in 97% of all phenotypically detected ESBL-PE; among those, bla was dominant (99%).
We report a high prevalence of ESBL-PE faecal carriage among children with BSI in Tanzania. Colonization of ESBL-PE was a risk factor for ESBL-BSI.
产超广谱β-内酰胺酶肠杆菌科（ESBL-PE）的胃肠道定植令人担忧，因为定植会增加随后感染的风险。迄今为止，ESBL-PE 粪便携带与随后发生 ESBL-PE 感染的风险之间的联系尚未得到很好的证实，关于此类病原体在血流感染（BSI）等侵袭性感染患儿中的携带情况，全球范围内的信息仍有待探索。
本横断面研究于 2017 年 3 月至 2018 年 7 月期间在坦桑尼亚达累斯萨拉姆，对因发热性疾病住院的 5 岁以下儿童进行。我们使用选择性培养基 ChromID ESBL 对直肠拭子进行 ESBL-PE 筛查。采用基质辅助激光解吸电离飞行时间质谱（MALDI-TOF）对细菌分离株进行鉴定。所有儿童均抽取血培养。采用纸片扩散法进行药敏试验。通过实时 PCR 和测序鉴定 ESBL 等位基因。
ESBL-PE 携带率总体为 56%（112/200），4-6 月龄儿童携带率最高（17/21，81%）（P=0.05）。BSI 患儿的 ESBL-PE 携带率（78.4%）明显高于无 BSI 患儿（53.1%）（P=0.02；优势比 3.4，95%置信区间 1.20-9.58）。最常见的分离株为大肠埃希菌（64/112，45%）。16 对（肠道和血液）ESBL-PE 分离株的抗菌谱相似。我们在所有表型检测到的 ESBL-PE 中检测到 bla 基因的比例为 97%；其中 bla 占主导地位（99%）。
我们报告了坦桑尼亚 BSI 患儿中 ESBL-PE 粪便携带率较高。ESBL-PE 定植是 ESBL-BSI 的危险因素。
