Said Maria M, Msanga Delfina R, Mtemisika Conjester I, Silago Vitus, Mirambo Mariam M, Mshana Stephen E
Department of Clinical Laboratory, Kondoa Town Hospital, Kondoa P.O. Box 40, Tanzania.
Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Bugando, Mwanza P.O. Box 1464, Tanzania.
Trop Med Infect Dis. 2022 Jul 22;7(8):144. doi: 10.3390/tropicalmed7080144.
Rectal carriage of extended spectrum β-lactamase-lactose fermenters (ESBL-LF) is the major risk factor for the development of subsequent endogenous infections. This study determined the patterns and factors associated with the rectal carriage of ESBL-LF among children with Human Immunodeficiency Virus (HIV), Diabetes Mellitus (DM), and Sickle Cell Disease (SCD) attending clinics at different health care facilities in the city of Mwanza, Tanzania. A cross-sectional study was conducted among children living with HIV (n = 236), DM (n = 42) and SCD (n = 126) between July and September 2021. Socio-demographic and clinical data were collected using a structured questionnaire. Rectal swabs/stool samples were collected and processed to detect the rectal carriage of ESBL-LF following laboratory standard operating procedures (SOPs). Descriptive statistical analysis was conducted using STATA 13.0. The overall prevalence of ESBL-LF carriage was 94/404 (23.3%). Significantly higher resistance was observed to ampicillin, trimethoprim-sulfamethoxazole, and tetracycline among Enterobacteriaceae isolated from HIV infected children than in non-HIV infected children (p < 0.05). The commonest ESBL allele 45/62 (72.6%) detected was blaCTX-M. Generally, a parent’s low education level was found to be associated with ESBL-LF colonization among children living with HIV; (OR 4.60 [95%CI] [1.04−20], p = 0.044). A higher proportion of ESBL-LF from DM 10/10 (100%) carried ESBL genes than ESBL-LF from HIV 37/56 (66.1%) and SCD 15/28 (53.6%), p = 0.02. There is a need to collect more data regarding trimethoprim-sulfamethoxazole (SXT) prophylaxis and antibiotic resistance to guide the decision of providing SXT prophylaxis in HIV-infected children especially at this time, when testing and treatment is carried out.
产超广谱β-内酰胺酶乳糖发酵菌（ESBL-LF）的直肠携带是随后发生内源性感染的主要危险因素。本研究确定了坦桑尼亚姆万扎市不同医疗机构门诊就诊的感染人类免疫缺陷病毒（HIV）、糖尿病（DM）和镰状细胞病（SCD）儿童中ESBL-LF直肠携带的模式及相关因素。2021年7月至9月期间，对236例HIV感染儿童、42例DM儿童和126例SCD儿童进行了一项横断面研究。使用结构化问卷收集社会人口统计学和临床数据。按照实验室标准操作程序（SOPs）收集直肠拭子/粪便样本并进行处理，以检测ESBL-LF的直肠携带情况。使用STATA 13.0进行描述性统计分析。ESBL-LF携带的总体患病率为94/404（23.3%）。从HIV感染儿童分离出的肠杆菌科细菌对氨苄西林、甲氧苄啶-磺胺甲恶唑和四环素的耐药性显著高于未感染HIV的儿童（p<0.05）。检测到的最常见ESBL等位基因是blaCTX-M，占45/62（72.6%）。总体而言，发现父母教育水平低与HIV感染儿童的ESBL-LF定植有关；（比值比4.60[95%置信区间][1.04−20]，p = 0.044）。DM患者的ESBL-LF中携带ESBL基因的比例（10/10，100%）高于HIV患者（37/56，66.1%）和SCD患者（15/28，53.6%），p = 0.02。有必要收集更多关于甲氧苄啶-磺胺甲恶唑（SXT）预防和抗生素耐药性的数据，以指导在HIV感染儿童中提供SXT预防的决策，尤其是在目前进行检测和治疗的这个时候。
