Extended Spectrum β-Lactamase Producing Lactose Fermenting Bacteria Colonizing Children with Human Immunodeficiency Virus, Sickle Cell Disease and Diabetes Mellitus in Mwanza City, Tanzania: A Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Duration, Population and Setting
2.2. Data and Sample Collections
2.3. Microbiological Procedure
2.4. Molecular Confirmation of ESBL Enzymes Production
2.5. Multiplex PCR Amplifications
2.6. Quality Control
2.7. Data Management and Data Analysis
3. Results
3.1. Social-Demographic and Clinical Characteristic of Enrolled Children
3.2. Bacteria Culture Results
3.3. Antibiotics Susceptibility Patterns
3.4. Molecular Characterization of Phenotypically Confirmed ESBL (N = 93)
3.5. Factors Associated with ESBL Carriage
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Ghafourian, S.; Sadeghifard, N.; Soheili, S.; Sekawi, Z. Extended spectrum beta-lactamases: Definition, classification and epidemiology. Curr. Issues Mol. Biol. 2015, 17, 11–22. [Google Scholar] [PubMed]
- McGowan, J.E., Jr. Economic impact of antimicrobial resistance. Emerg. Infect. Dis. 2001, 7, 286. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tamma, P.D.; Savard, P.; Pál, T.; Sonnevend, A.; Perl, T.M.; Milstone, A.M. An outbreak of extended-spectrum β-lactamase–producing Klebsiella pneumoniae in a neonatal intensive care unit. Infect. Control. Hosp. Epidemiol. 2012, 33, 631–634. [Google Scholar] [CrossRef] [PubMed]
- Marando, R.; Seni, J.; Mirambo, M.M.; Falgenhauer, L.; Moremi, N.; Mushi, M.F.; Kayange, N.; Manyama, F.; Imirzalioglu, C.; Chakraborty, T. Predictors of the extended-spectrum-beta lactamases producing Enterobacteriaceae neonatal sepsis at a tertiary hospital, Tanzania. Int. J. Med. Microbiol. 2018, 308, 803–811. [Google Scholar] [CrossRef]
- Martin, R. Identification of Clinical and Bacterial Genetic Risk Factors Associated with Klebsiella pneumoniae Infection. Ph.D. Thesis, University of Michigan, Ann Arbor, MI, USA, 2017. [Google Scholar]
- Msanga, D.R.; Silago, V.; Massoza, T.; Kidenya, B.R.; Balandya, E.; Mirambo, M.M.; Sunguya, B.; Mmbaga, B.T.; Lyamuya, E.; Bartlet, J.; et al. High Fecal Carriage of Multidrug Resistant Bacteria in the Community among Children in Northwestern Tanzania. Pathogens 2022, 11, 379. [Google Scholar] [CrossRef]
- Alves, M.; Lemire, A.; Decré, D.; Margetis, D.; Bigé, N.; Pichereau, C.; Ait-Oufella, H.; Baudel, J.-L.; Offenstadt, G.; Guidet, B. Extended-spectrum beta-lactamase- producing enterobacteriaceae in the intensive care unit: Acquisition does not mean cross-transmission. BMC Infect. Dis. 2016, 16, 147. [Google Scholar] [CrossRef] [Green Version]
- Tanwar, J.; Das, S.; Fatima, Z.; Hameed, S. Multidrug resistance: An emerging crisis. Interdiscip. Perspect. Infect. Dis. 2014, 2014, 541340. [Google Scholar] [CrossRef] [Green Version]
- Vink, J.; Edgeworth, J.; Bailey, S.L. Acquisition of MDR-GNB in hospital settings: A systematic review and meta-analysis focussing on ESBL-E. J. Hosp. Infect. 2020, 106, 419–428. [Google Scholar] [CrossRef]
- Birgy, A.; Levy, C.; Bidet, P.; Thollot, F.; Derkx, V.; Béchet, S.; Mariani-Kurkdjian, P.; Cohen, R.; Bonacorsi, S. ESBL-producing Escherichia coli ST131 versus non-ST131: Evolution and risk factors of carriage among French children in the community between 2010 and 2015. J. Antimicrob. Chemother. 2016, 71, 2949–2956. [Google Scholar] [CrossRef] [Green Version]
- Nicolas-Chanoine, M.-H.; Gruson, C.; Bialek-Davenet, S.; Bertrand, X.; Thomas-Jean, F.; Bert, F.; Moyat, M.; Meiller, E.; Marcon, E.; Danchin, N. 10-Fold increase (2006–11) in the rate of healthy subjects with extended-spectrum β-lactamase-producing Escherichia coli faecal carriage in a Parisian check-up centre. J. Antimicrob. Chemother. 2013, 68, 562–568. [Google Scholar] [CrossRef]
- Pan, F.; Tian, D.; Wang, B.; Zhao, W.; Qin, H.; Zhang, T.; Zhang, H. Fecal carriage and molecular epidemiology of carbapenem-resistant Enterobacteriaceae from outpatient children in Shanghai. BMC Infect. Dis. 2019, 19, 678. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Islam, S.; Selvarangan, R.; Kanwar, N.; McHenry, R.; Chappell, J.D.; Halasa, N.; Wikswo, M.E.; Payne, D.C.; Azimi, P.H.; McDonald, L.C.; et al. Intestinal Carriage of Third-Generation Cephalosporin-Resistant and Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Healthy US Children. J. Pediatric Infect. Dis. Soc. 2017, 7, 234–240. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Fernández-Reyes, M.; Vicente, D.; Gomariz, M.; Esnal, O.; Landa, J.; Oñate, E.; Pérez-Trallero, E. High rate of fecal carriage of extended-spectrum-β-lactamase-producing Escherichia coli in healthy children in Gipuzkoa, northern Spain. Antimicrob. Agents Chemother. 2014, 58, 1822–1824. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tellevik, M.G.; Blomberg, B.; Kommedal, Ø.; Maselle, S.Y.; Langeland, N.; Moyo, S.J. High prevalence of faecal carriage of ESBL-producing Enterobacteriaceae among children in Dar es Salaam, Tanzania. PLoS ONE 2016, 11, e0168024. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wilmore, S.M.S.; Kranzer, K.; Williams, A.; Makamure, B.; Nhidza, A.F.; Mayini, J.; Bandason, T.; Metcalfe, J.; Nicol, M.P.; Balakrishnan, I.; et al. Carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae in HIV-infected children in Zimbabwe. J. Med. Microbiol. 2017, 66, 609–615. [Google Scholar] [CrossRef] [Green Version]
- Ouédraogo, A.-S.; Sanou, S.; Kissou, A.; Poda, A.; Aberkane, S.; Bouzinbi, N.; Nacro, B.; Ouédraogo, R.; Van De Perre, P.; Carriere, C. Fecal carriage of Enterobacteriaceae producing extended-spectrum beta-lactamases in hospitalized patients and healthy community volunteers in Burkina Faso. Microb. Drug Resist. 2017, 23, 63–70. [Google Scholar] [CrossRef]
- Nelson, E.; Kayega, J.; Seni, J.; Mushi, M.F.; Kidenya, B.R.; Hokororo, A.; Zuechner, A.; Kihunrwa, A.; Mshana, S.E. Evaluation of existence and transmission of extended spectrum beta lactamase producing bacteria from post-delivery women to neonates at Bugando Medical Center, Mwanza-Tanzania. BMC Res. Notes 2014, 7, 279. [Google Scholar] [CrossRef] [Green Version]
- Moremi, N.; Claus, H.; Vogel, U.; Mshana, S.E. Faecal carriage of CTX-M extended-spectrum beta-lactamase-producing Enterobacteriaceae among street children dwelling in Mwanza city, Tanzania. PLoS ONE 2017, 12, e0184592. [Google Scholar] [CrossRef] [Green Version]
- Moremi, N.; Claus, H.; Rutta, L.; Frosch, M.; Vogel, U.; Mshana, S. High carriage rate of extended-spectrum beta-lactamase-producing Enterobacteriaceae among patients admitted for surgery in Tanzanian hospitals with low rate of endogenous surgical site infections. J. Hosp. Infect. 2018, 100, 47–53. [Google Scholar] [CrossRef]
- Manyahi, J.; Moyo, S.J.; Tellevik, M.G.; Langeland, N.; Blomberg, B. High Prevalence of Fecal Carriage of Extended Spectrum β-Lactamase-Producing Enterobacteriaceae Among Newly HIV-Diagnosed Adults in a Community Setting in Tanzania. Microb. Drug Resist. 2020, 26, 1540–1545. [Google Scholar] [CrossRef]
- Mshana, S.E.; Falgenhauer, L.; Mirambo, M.M.; Mushi, M.F.; Moremi, N.; Julius, R.; Seni, J.; Imirzalioglu, C.; Matee, M.; Chakraborty, T. Predictors of blaCTX-M-15 in varieties of Escherichia coli genotypes from humans in community settings in Mwanza, Tanzania. BMC Infect. Dis. 2016, 16, 187. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Silago, V.; Kovacs, D.; Samson, H.; Seni, J.; Matthews, L.; Oravcová, K.; Lupindu, A.M.; Hoza, A.S.; Mshana, S.E. Existence of multiple ESBL genes among phenotypically confirmed ESBL producing Klebsiella pneumoniae and Escherichia coli concurrently isolated from clinical, colonization and contamination samples from neonatal units at Bugando Medical Center, Mwanza, Tanzania. Antibiotics 2021, 10, 476. [Google Scholar] [PubMed]
- Harris, A.D.; McGregor, J.C.; Johnson, J.A.; Strauss, S.M.; Moore, A.C.; Standiford, H.C.; Hebden, J.N.; Morris, J.G., Jr. Risk factors for colonization with extended-spectrum beta-lactamase-producing bacteria and intensive care unit admission. Emerg. Infect. Dis. 2007, 13, 1144–1149. [Google Scholar] [CrossRef]
- Koneman, E.W.; Allen, S. Koneman. Diagnostico Microbiologico/Microbiological diagnosis: Texto y Atlas en Color/Text and Color Atlas; Editorial Médica Panamericana: Madrid, Spain, 2008. [Google Scholar]
- Hudzicki, J. Kirby-Bauer disk diffusion susceptibility test protocol. Am. Soc. Microbiol. 2009, 15, 55–63. [Google Scholar]
- In, C. Performance Standards for Antimicrobial Susceptibility Testing; Clinical and Laboratory Standards Institute: Wayne, PA, USA, 2018. [Google Scholar]
- CLSI. Performance Standards for Antimicrobial Susceptibility Testing, 31st ed.; CLSI supplement M100; Clinical and Laboratory Standards Institute: Malvern, PA, USA, 2021. [Google Scholar]
- Silago, V.; Mukama, Y.; Haule, A.L.; Chacha, F.; Igenge, J.; Mushi, M.F.; Mshana, S.E. Bacteriospermia, extended spectrum beta lactamase producing Gram-negative bacteria and other factors associated with male infertility in Mwanza, Tanzania: A need of diagnostic bacteriology for management of male infertility. Afr. Health Sci. 2020, 20, 4–13. [Google Scholar] [CrossRef] [PubMed]
- Monstein, H.J.; Östholm-Balkhed, Å.; Nilsson, M.; Nilsson, M.; Dornbusch, K.; Nilsson, L. Multiplex PCR amplification assay for the detection of blaSHV, blaTEM and blaCTX-M genes in Enterobacteriaceae. Apmis 2007, 115, 1400–1408. [Google Scholar] [CrossRef]
- Otter, J.; Natale, A.; Batra, R.; Auguet, O.T.; Dyakova, E.; Goldenberg, S.; Edgeworth, J. Individual-and community-level risk factors for ESBL Enterobacteriaceae colonization identified by universal admission screening in London. Clin. Microbiol. Infect. 2019, 25, 1259–1265. [Google Scholar] [CrossRef]
- Dib, A.L.; Agabou, A.; Chahed, A.; Kurekci, C.; Moreno, E.; Espigares, M.; Espigares, E. Isolation, molecular characterization and antimicrobial resistance of enterobacteriaceae isolated from fish and seafood. Food Control 2018, 88, 54–60. [Google Scholar] [CrossRef]
- Karanika, S.; Karantanos, T.; Arvanitis, M.; Grigoras, C.; Mylonakis, E. Fecal colonization with extended-spectrum beta-lactamase–producing Enterobacteriaceae and risk factors among healthy individuals: A systematic review and metaanalysis. Rev. Infect. Dis. 2016, 63, 310–318. [Google Scholar] [CrossRef] [Green Version]
- Rossolini, G.; D’andrea, M.; Mugnaioli, C. The spread of CTX-M-type extended-spectrum β-lactamases. Clin. Microbiol. Infect. 2008, 14, 33–41. [Google Scholar] [CrossRef] [Green Version]
- Minja, C.A.; Shirima, G.; Mshana, S.E. Conjugative Plasmids Disseminating CTX-M-15 among Human, Animals and the Environment in Mwanza Tanzania: A Need to Intensify One Health Approach. Antibiotics 2021, 10, 836. [Google Scholar] [CrossRef] [PubMed]
- Mshana, S.E.; Kamugisha, E.; Mirambo, M.; Chakraborty, T.; Lyamuya, E.F. Prevalence of multiresistant gram-negative organisms in a tertiary hospital in Mwanza, Tanzania. BMC Res. Notes 2009, 2, 49. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ndaki, P.M.; Mushi, M.F.; Mwanga, J.R.; Konje, E.T.; Ntinginya, N.E.; Mmbaga, B.T.; Keenan, K.; Sabiiti, W.; Kesby, M.; Benitez-Paez, F. Dispensing Antibiotics without Prescription at Community Pharmacies and Accredited Drug Dispensing Outlets in Tanzania: A Cross-Sectional Study. Antibiotics 2021, 10, 1025. [Google Scholar] [CrossRef]
- World Health Organization. Guidelines on Co-Trimoxazole Prophylaxis for HIV-Related Infections among Children, Adolescents and Adults in Resource-Limited Settings: Recommendations for a Public Health Approach; World Health Organization: Geneva, Switzerland, 2006. [Google Scholar]
- Silago, V.; Kovacs, D.; Msanga, D.R.; Seni, J.; Matthews, L.; Oravcová, K.; Zadoks, R.N.; Lupindu, A.M.; Hoza, A.S.; Mshana, S.E. Bacteremia in critical care units at Bugando Medical Centre, Mwanza, Tanzania: The role of colonization and contaminated cots and mothers’ hands in cross-transmission of multidrug resistant Gram-negative bacteria. Antimicrob. Resist. Infect. Control. 2020, 9, 1–14. [Google Scholar] [CrossRef]
- Bulabula, A.N.; Dramowski, A.; Mehtar, S. Maternal colonization or infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in Africa: A systematic review and meta-analysis. Int. J. Infect. Dis. 2017, 64, 58–66. [Google Scholar] [CrossRef] [Green Version]
- Isendahl, J.; Turlej-Rogacka, A.; Manjuba, C.; Rodrigues, A.; Giske, C.G.; Naucler, P. Fecal carriage of ESBL-producing E. coli and K. pneumoniae in children in Guinea-Bissau: A hospital-based cross-sectional study. PLoS ONE 2012, 7, e51981. [Google Scholar] [CrossRef] [PubMed]
Gene | Sequence | Amplicon Size | Reference |
---|---|---|---|
bla SHV f bla SHV r | 5′-ATGCGTATATTCGCCTGTG-3′ 5′-TGCTTTGTTATTCGGGCCAA-3′ | 747 | [30] |
bla TEM f bla TEM r | 5′-TCGCCGATACACTATTCTCAGAATGA-3′ 5′-ACGCTCACCGGCTCCAGATTAT-3′ | 445 | |
bla CTX-M f blaCTX-M r | 5′-ATGTGCAGYACCAGTAARGTKATGGC- 3′ 5′-TGGGTRAARTAGTSACCAGAAYCAGCGG- 3′ | 593 |
Variables | HIV (N = 236) | DM (N = 42) | SCD (N = 126) | Overall (N = 404) | p-Value * | |
---|---|---|---|---|---|---|
Median [IQR] age in years (N = 404) | 4 (2–8) | 10 (8–13) | 7 (4–10) | 6 (3–9) | ||
Sex (N = 404) | Male | 122 (51.7%) | 18 (42.9%) | 77 (61.1%) | 217 (53.7%) | 0.076 |
Female | 114 (48.3%) | 24 (57.1%) | 49 (38.9%) | 187 (46.3%) | ||
Location (N = 404) | Urban | 209 (88.6%) | 28 (66.7%) | 115 (91.3%) | 352 (87.1%) | 0.000 |
Rural | 27 (11.4%) | 14 (33.3%) | 11 (8.7%) | 52 (12.9%) | ||
Parent education (N = 404) | Primary | 175 (74.2%) | 26 (61.9%) | 60 (64.6%) | 261 (64.6) | <0.001 |
Secondary | 61 (25.8%) | 16 (38.1%) | 66 (52.4%) | 143 (35.4%) | ||
Parent occupation (N = 404) | Employed | 35 (14.8%) | 26 (61.9%) | 54 (42.9%) | 115 (28.5%) | |
Unemployed | 201 (85.2%) | 16 (38.1%) | 72 (57.1%) | 289 (71.5%) | <0.001 | |
History of fever (N = 257) | Yes | 32 (27.8%) | 6 (37.5%) | 53 (42.1%) | 91 (35.4%) | 0.069 |
No | 83 (72.2%) | 10 (62.5%) | 73 (57.9%) | 166 (64.6%) | ||
History of admission past 3-month (N = 289) | Yes | 3 (2.5%) | 7 (16.7%) | 30 (23.8%) | 40 (13.84%) | <0.001 |
No | 118 (97.5%) | 35 (83.3%) | 96 (76.2%) | 249 (86.0%) | ||
Relative history of admission (N = 377) | Yes | 30 (12.7%) | 4 (25.0%) | 20 (16.0%) | 54 (14.3%) | |
No | 206 (87.3%) | 12 (75.0%) | 105 (84.0%) | 323 (85.7%) | 0.321 | |
** Current antibiotic (N = 404) | Yes | 25 (10.5%) | 8 (19.1%) | 52 (41.3%) | 85 (21.1%) | <0.001 |
No | 211 (89.5%) | 34 (80.9%) | 74 (58.7%) | 319 (78.9%) | ||
History of antibiotic Past 3-month (N = 404) | Yes | 44 (18.6%) | 9 (21.4%) | 56 (44.4%) | 109 (27.0%) | <0.001 |
No | 192 (81.4%) | 33 (78.6%) | 70 (55.6%) | 295 (73.0%) | ||
Median [IQR] members in household | 5 (5–7) | 6 (5–7) | 5 (4–7) | 5 (4–7) | 0.001 | |
Type of toilet (N = 378) | Modern | 199 (84.3%) | 14 (87.5%) | 119 (94.4%) | 332 (87.8) | |
Pit | 37 (15.7%) | 2 (12.5%) | 7 (5.6%) | 46 (12.2%) | 0.0019 | |
Is the child on Pen V prophylaxis, SCD (N = 126) | Yes | NA | NA | 43 (34.1%) | ||
No | NA | NA | 83 (65.9%) | |||
Is the child on SXT prophylaxis, HIV (N = 236) | Yes | 57 (24.2%) | NA | NA | ||
No | 179 (75.8%) | NA | NA |
DRUG | HIV (N = 175) n (%) | DM (N = 15) n (%) | SCD (N = 109) n (%) | Overall n (%) | p-Value |
---|---|---|---|---|---|
SXT | 149 (85.1) | 10 (66.7) | 82 (75.2) | 241 (80) | 0.045 |
AMP | 158 (90.3) | 9 (60.0) | 95 (87.2) | 262 (87.6) | 0.003 |
TET | 128 (73.1) | 5 (33.3) | 72 (66.1) | 205 (68.5) | 0.005 |
CN | 40 (22.9) | 0 (0.00) | 27 (24.8) | 67 (22.4) | 0.095 |
AK | 21 (12.0) | 0 (0.00) | 12 (11.0) | 33 (11.0) | 0.363 |
CIP | 88 (50.3) | 5 (33.3) | 53 (48.6) | 146 (48.8) | 0.451 |
MEM | 18 (10.3) | 3 (20.0) | 8 (7.3) | 39 (9.7) | 0.240 |
CAZ | 41 (23.4) | 4 (26.7) | 27 (24.7) | 72 (24.0) | 0.946 |
CRO | 50 (28.6) | 5 (33.3) | 32 (29.4) | 87 (29.1) | 0.924 |
ESBL Gene | DM (10), n (%) | HIV(56), n (%) | SCD(28), n (%) | Total(94), n (%) |
---|---|---|---|---|
blaCTX-M | 7 (70) | 27 (48.2.) | 11 (39.3) | 45 (47.9) |
blaSHV | 0 (0) | 1 (1.8) | 0 (0) | 1 (1.1) |
blaTEM | 2 (20) | 4 (7.1) | 1 (3.6) | 7 (7.4) |
blaCTX-M/SHV | 0 (0) | 4 (7.1) | 2 (7.2) | 6 (6.4 |
blaTEM/SHV | 1 (10) | 1 (1.8) | 1 (3.2) | 3 (3.2) |
None | 0 (0.0) | 19(33.9) | 13 (46.4) | 32(34.0) |
Total positive | 10 (100) | 37 (66.1) | 15 (53.6) | 62 (65.9) |
Variables | ESBL Colonization | Univariate Logistic Analysis | Multivariate Logistic Analysis | |||
---|---|---|---|---|---|---|
Positive n (%) | OR [95%CI] | p-Value | OR [95%CI] | p-Value | ||
ESBL colonization among HIV children | ||||||
Age | 5 [4–6] | 1.6 [0.9–1.113] | 0.9160 | |||
Sex | Female (114) | 22 (19.39) | ||||
Male (122) | 34 (27.87) | 1.6 [0.87–2.97) | 0.122 | 1.4 [0.78–2.76] | 0.253 | |
Residence | Urban (209) | 52 (24.88) | 1.9 [0.62–5.7] | 0.247 | ||
Rural (27) | 4 (14.81) | 1 | ||||
Parent/Guardian Education level | Primary (175) | 47 (26.86) | 2.1 [0.9–4.6] | 0.056 | 4.60 [1.04–20] | 0.004 |
Secondary (61) | 9 (14.75) | 1 | ||||
Child on SXT | Yes (179) | 49 (27.37) | 2.6 [1.14–6.30] | 0.020 | 1.7 [0.6–4.67] | 0.253 |
No (57) | 7 (12.28) | 1 | ||||
ESBL colonization among SCD children | ||||||
Age | 6.5 [10.5–3.5] | 0.97 [0.87–1.09] | 0.678 | |||
Parent education level | Secondary (60) | 6 (10) | 1 | |||
Primary (66) | 22 (33.33) | 4.5 [1.69–12.2] | 0.002 | 5 [1.54–11.3] | 0.006 | |
Relative history of admission | Yes (20) | 8 (40.00) | 2.86 [1.0–7.9] | 0.037 | 2.43 [0.8–7.3] | 0.116 |
No (106) | 20 (18.87) | 1 | ||||
Source of antibiotic | Hospital (21) | 2 (9.52) | 0.17 [0.33–0.88] | 0.024 | 1.1 [0.45–2.8] | 0.768 |
Pharmacy (29) | 11 (37.93) | 1 |
VARIABLES | ESBL-PE CARRIAGE | p-Value * | ||
---|---|---|---|---|
POS | NEG | |||
Age | 10 [7–12] | 11 [8–13] | 0.254 | |
SEX | Female | 3 (12.50) | 21 (87.50) | |
Male | 7 (38.89) | 11 (61.11) | 0.047 | |
Residence | Urban | 1 (28.57) | 20 (71.43) | |
Rural | 2 (14.29) | 12 (85.71) | 0.306 | |
Parent education | Primary | 2 (12.50) | 14 (87.50) | |
Sec | 8 (30.77) | 18 (69.23) | 0.177 | |
Parent occupation | Employed | 2 (7.69) | 24 (92.31) | |
Unemployed | 8 (50.00) | 8 (50.00) | 0.002 | |
History fever | Yes | 3 (50.00) | 3 (50.00) | 0.424 |
No | 3 (30.00) | 7 (70.00) | ||
History of Antibiotic | Yes | 3 (50.00) | 3 (50.50) | |
No | 29 (80.56) | 7 (19.44) | 0.104 | |
Current antibiotic use | Yes | 3 (37.50) | 5 (62.50) | 0.31 |
No | 7 (20.59) | 27 (79.41) | ||
Past history of admission | Yes | 5 (71.43) | 2 (28.57) | 0.001 |
No | 5 (14.25) | 20 (85.71) | ||
Relative history of Admission | Yes | 2 (50.00) | 2 (50.00) | 0.551 |
No | 4 (33.33) | 8 (66.67) | ||
Insulin | Yes | 32 (76.19) | 10 (23.81) | |
Source | Hospital | 3 (50.00) | 3 (50.00) | |
Pharmacy | 0 (0.00) | 4 (100.00) |
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Said, M.M.; Msanga, D.R.; Mtemisika, C.I.; Silago, V.; Mirambo, M.M.; Mshana, S.E. Extended Spectrum β-Lactamase Producing Lactose Fermenting Bacteria Colonizing Children with Human Immunodeficiency Virus, Sickle Cell Disease and Diabetes Mellitus in Mwanza City, Tanzania: A Cross-Sectional Study. Trop. Med. Infect. Dis. 2022, 7, 144. https://doi.org/10.3390/tropicalmed7080144
Said MM, Msanga DR, Mtemisika CI, Silago V, Mirambo MM, Mshana SE. Extended Spectrum β-Lactamase Producing Lactose Fermenting Bacteria Colonizing Children with Human Immunodeficiency Virus, Sickle Cell Disease and Diabetes Mellitus in Mwanza City, Tanzania: A Cross-Sectional Study. Tropical Medicine and Infectious Disease. 2022; 7(8):144. https://doi.org/10.3390/tropicalmed7080144
Chicago/Turabian StyleSaid, Maria M., Delfina R. Msanga, Conjester I. Mtemisika, Vitus Silago, Mariam M. Mirambo, and Stephen E. Mshana. 2022. "Extended Spectrum β-Lactamase Producing Lactose Fermenting Bacteria Colonizing Children with Human Immunodeficiency Virus, Sickle Cell Disease and Diabetes Mellitus in Mwanza City, Tanzania: A Cross-Sectional Study" Tropical Medicine and Infectious Disease 7, no. 8: 144. https://doi.org/10.3390/tropicalmed7080144
APA StyleSaid, M. M., Msanga, D. R., Mtemisika, C. I., Silago, V., Mirambo, M. M., & Mshana, S. E. (2022). Extended Spectrum β-Lactamase Producing Lactose Fermenting Bacteria Colonizing Children with Human Immunodeficiency Virus, Sickle Cell Disease and Diabetes Mellitus in Mwanza City, Tanzania: A Cross-Sectional Study. Tropical Medicine and Infectious Disease, 7(8), 144. https://doi.org/10.3390/tropicalmed7080144