Abstract:
Background: The intestinal tract serves as a reservoir for ESBL–producing Enterobacteriaceae and colonized patients act as a source of dissemination and infections. What is not clear in literature is whether the immune status of patients influences ESBL intestinal colonization patterns. Available studies on ESBL faecal colonization have not clearly distinguished between immunocompetent and suppressed patients.
Aim: The aim of the study was to examine immunocompetent patients for faecal carriage with extended-spectrum beta-lactamase-producing enterobacteria at a district care hospital setting in Ghana.
Method: Between March and May 2017, a cross-sectional sampling was performed to enrol patients and conduct questionnaire-structured interviews for factors that predispose patients to ESBL faecal carriage. Faecal samples from study patients were quantified to determine the predominant ESBL-producing enterobacteria. PCR and sequencing were used to characterize ESBL genes.
Results: The overall faecal carriage prevalence of ESBL was 35.5% (n = 38/107). The blaCTX-M-gene, mostly CTX-M-15, was detected in 79% (n = 30/38) of the ESBL-producing isolates. Other ESBL types detected include blaSHV(n=3) and blaOXA(n=1). The CTX-M-15-positive isolates, when present in a faecal sample, constituted the predominant faecal enterobacteria-with significantly higher colony counts than all other enterobacteria in a faecal sample. In multivariate regression, the following were identified as independent risk factors for faecal carriage with ESBL-producing enterobacteria: hospitalization in the past 1 year, infections since admission, use of antibiotics in past 6 weeks, and admission from another hospital.
Conclusion: Nearly one in every 3 patients included in the study was colonized by ESBL-producing enterobacteria. The high colonization level is worrying, therefore prudent antimicrobial use should be adopted in the hospital.
