Carriage Prevalence of Extended-Spectrum β-Lactamase Producing Enterobacterales in Outpatients Attending Community Health Centers in Blantyre, Malawi
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Duration and Location
2.2. Study Population, Sample Size and Sampling
2.3. Specimen Collection
2.4. Screening for ESBL-E
2.5. Identification of Enterobacterales Species
2.6. Phenotypic Confirmation of ESBL Production by Enterobacterales
2.7. Antimicrobial Susceptibility Testing (AST)
2.8. Quality Control
2.9. Statistical Analysis
3. Results
3.1. Social Demographic and Clinical Characteristics of the Study Population
3.2. Prevalence of ESBL-E in Community Patients in Blantyre
3.3. Antimicrobial Resistance Profiles of Commonly Isolated ESBL-E
3.4. Univariate Analysis
4. Discussion
5. Limitations of the Study
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Frequency (%) | ESBL Phenotype | p-Value | |
---|---|---|---|---|
Positive, n (%) | Negative, n (%) | |||
Age, years | 0.63 | |||
18–27 | 125 (41.67) | 20 (6.67) | 105 (35.00) | |
28–37 | 95 (31.67) | 13 (4.34) | 82 (27.33) | |
38–47 | 43 (14.33) | 10 (3.33) | 33 (11.00) | |
48–57 | 20 (6.67) | 3 (1.00) | 17 (5.67) | |
≥58 | 17 (5.67) | 4 (1.33) | 13 (4.34) | |
Sex | 0.11 | |||
Male | 137 (45.67) | 28 (9.33) | 109 (36.33) | |
Female | 163 (54.33) | 22 (7.34) | 141 (47.00) | |
Marital status | 0.05 | |||
Separated, divorced or widowed | 23 (7.67) | 8 (2.67) | 15 (5.00) | |
Single (never married) | 93 (31.00) | 14 (4.67) | 79 (26.33) | |
Married or cohabiting | 184 (61.33) | 28 (9.33) | 156 (52.00) | |
Education | 0.54 | |||
Primary | 133 (44.33) | 23 (7.67) | 110 (36.67) | |
Secondary | 115 (38.33) | 16 (5.33) | 99 (33.00) | |
College/University | 6 (2.00) | 2 (0.67) | 4 (1.33) | |
Did not attend any school | 46 (15.33) | 9 (3.00) | 37 (12.33) | |
Occupation | 0.29 | |||
Unemployed | 138 (46.00) | 24 (8.00) | 114 (38.01) | |
Self-employed or business | 57 (19.00) | 12 (4.00) | 45 (15.00) | |
Employed | 78 (26.00) | 8 (2.67) | 70 (23.33) | |
Student | 27 (9.00) | 6 (2.00) | 21 (7.00) | |
History of prior antibiotic use in the previous three months | 0.71 | |||
Yes | 66 (22.00) | 10 (3.33) | 56 (18.67) | |
No | 234 (78.00) | 40 (13.33) | 194 (64.67) | |
History of surgery in the previous three months | 0.54 | |||
Yes | 29 (9.67) | 6 (2.00) | 23 (7.67) | |
No | 271 (90.33) | 44 (14.67) | 227 (75.66) | |
History of hospital admission in the previous three months | 0.23 | |||
Yes | 7 (2.33) | 0 (0) | 7 (2.33) | |
No | 293 (97.67) | 50 (16.67) | 243 (81.00) | |
Outpatient health center | 0.20 | |||
Limbe | 99 (33.00) | 13 (4.33) | 86 (28.67) | |
Ndirande | 100 (33.33) | 22 (7.33) | 78 (26.00) | |
Zingwangwa | 101 (33.67) | 15 (5.00) | 86 (28.67) |
ESBL Enterobacterales | Rectal Swab | Urine | Total n (%) |
---|---|---|---|
Acinetobacter baumannii | 1 | 0 | 1 (2) |
Acinetobacter lwoffii | 2 | 0 | 2 (4) |
Enterobacter aerogens | 1 | 0 | 1 (2) |
Enterobacter agglomerans | 1 | 1 | 2 (4) |
Escherichia coli | 29 | 4 | 33 (66) |
Klebsiella oxytoca | 2 | 0 | 2 (4) |
Klebsiella pneumoniae | 2 | 0 | 2 (4) |
Providencia rettgeri | 0 | 1 | 1 (2) |
Serratia liquefaciens | 0 | 1 | 1 (2) |
Serratia rubidaea | 0 | 1 | 1 (2) |
Shigella sonnei | 1 | 0 | 1 (2) |
Yersinia enterocolitica | 3 | 0 | 3 (6) |
Total, n (%) | 42 (84) | 8 (16) | 50 (100) |
Antimicrobial Agents | ESBL-Enterobacterales (% Resistant) | |||||
---|---|---|---|---|---|---|
Acinetobacter spp. | Enterobacter spp. | E.coli | Klebsiella spp. | Serratia spp. | Yersinia spp. | |
Amikacin | 0 | 0 | 15 | 25 | 0 | 0 |
Amoxicillin | 67 | 67 | 79 | 75 | 50 | 33 |
Cefepime | 33 | 67 | 21 | 50 | 0 | 33 |
Ceftriaxone | 100 | 67 | 87 | 75 | 50 | 100 |
Ciprofloxacin | 67 | 33 | 70 | 75 | 50 | 67 |
Doxycycline | 67 | 67 | 82 | 75 | 50 | 67 |
Gentamicin | 67 | 67 | 85 | 50 | 100 | 67 |
Imipenem | 0 | 0 | 0 | 0 | 0 | 0 |
Meropenem | 33 | 0 | 0 | 0 | 0 | 33 |
Nitrofurantoin | 67 | 0 | 27 | 75 | 0 | 100 |
Trimethoprim-Sulfamethoxazole | 100 | 100 | 91 | 100 | 100 | 100 |
Associated Factor | Odds Ratio (95% CI) | p-Value |
---|---|---|
Age, years | ||
18–27 | 0.62 (0.18–2.09) | 0.44 |
28–37 | 0.52 (0.15–1.82) | 0.30 |
38–47 | 0.98 (0.26–3.71) | 0.98 |
48–57 | 0.57 (0.12–3.02) | 0.51 |
Sex | ||
Male | 1.65 (0.89–3.04) | 0.11 |
Marital status | ||
Married or cohabiting | 0.77 (0.41–1.42) | 0.34 |
Education | ||
Primary | 0.86 (0.36–2.02) | 0.71 |
Secondary | 0.66 (0.27–1.63) | 0.37 |
College/University | 2.06 (0.32–13.03) | 0.45 |
Occupation | ||
Unemployed | 0.72 (0.12–1.28) | 0.12 |
Self-employed or business | 0.93 (0.31–2.83) | 0.90 |
Employed | 0.4 (0.12–1.28) | 0.12 |
History of surgery in the previous three months (Yes) | 1.35 (0.52–3.49) | 0.54 |
History of antibiotic use in the last three months (Yes) | 0.87 (0.41–1.84) | 0.71 |
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Onduru, O.G.; Mkakosya, R.S.; Rumisha, S.F.; Aboud, S. Carriage Prevalence of Extended-Spectrum β-Lactamase Producing Enterobacterales in Outpatients Attending Community Health Centers in Blantyre, Malawi. Trop. Med. Infect. Dis. 2021, 6, 179. https://doi.org/10.3390/tropicalmed6040179
Onduru OG, Mkakosya RS, Rumisha SF, Aboud S. Carriage Prevalence of Extended-Spectrum β-Lactamase Producing Enterobacterales in Outpatients Attending Community Health Centers in Blantyre, Malawi. Tropical Medicine and Infectious Disease. 2021; 6(4):179. https://doi.org/10.3390/tropicalmed6040179
Chicago/Turabian StyleOnduru, Onduru Gervas, Rajhab Sawasawa Mkakosya, Susan Fred Rumisha, and Said Aboud. 2021. "Carriage Prevalence of Extended-Spectrum β-Lactamase Producing Enterobacterales in Outpatients Attending Community Health Centers in Blantyre, Malawi" Tropical Medicine and Infectious Disease 6, no. 4: 179. https://doi.org/10.3390/tropicalmed6040179