Carriage Of Multi-Drug Resistant Enterobacterales And Acinetobacter Baumannii Among Hospitalised Paediatric Patients At The Child Health Department, Korle-Bu Teaching Hospital

Abstract

BACKGROUND: Infection and carriage of multidrug resistant (MDR) Enterobacterales and Acinetobacter baumannii are increasing globally and complicate the management of infections in children. Outbreaks of infections due to these MDR pathogens, particularly carbapenem-resistant Enterobacterales (CRE) and A. baumannii in hospitals are widespread and are a growing problem. Carriage of MDR pathogens is a precursor for invasive infections which are associated with high morbidity and mortality. This study determined the prevalence and epidemiology of MDR pathogens, with a focus on carbapenem-resistant Enterobacterales and A. baumannii among paediatric inpatients of the Korle-Bu Teaching Hospital. AIM: This study aimed at identifying the risk factors for carriage of carbapenem-resistant Enterobacterales and A. baumannii, and the molecular genotypes of carbapenemase-producing isolates, among paediatric inpatients at the Korle-Bu Teaching Hospital. METHOD: A cross-sectional study was conducted over 8 months period, from March to October 2021 at the Child Health Department, Korle-Bu Teaching Hospital. A systematic sampling method was used to recruit the participants. Relevant clinical data was extracted from participants’ medical records per a structured data collection instrument. Rectal swabs were collected from participants and inoculated onto MacConkey agar and incubated at 35-37°C for 18-24hrs. Different colonial morphotypes were identified by standard bacteriological techniques and confirmed with MALDI-TOF spectometry. Antimicrobial susceptibility testing was performed on all isolates. Carbapenem resistant isolates were screened for carbapenemase production using modified Hodge test. Multiplex polymerase chain reaction (PCR) and gel imaging techniques were used to evaluate the presence, and to characterise carbapenemase genes present. Frequency tables were used to University of Ghana http://ugspace.ug.edu.gh v

summarize the prevalence and distribution of MDR organisms. Associations between risk factors and carriage of carbapenem resistant organisms were analysed using multinomial logistic regression. RESULTS: A total of 344 bacteria isolates; 331 Enterobacterales and 13 A. baumannii were isolated from rectal swabs of 299 paediatric inpatients ≤ 13years. The most common isolates were E. coli (60.5%, n = 208), K. pneumoniae (29.9%, n = 103) and A. baumannii (3.8%, n = 13). Prevalence of MDR among the isolated organisms were 75.6% (n = 260); E. coli (74.0%, n = 154), K. pneumoniae (76.7%, n = 79), and A. baumannii (100%, n = 13). Carriage of ESBL producing Enterobacterales was 72.6% (n = 217); with E. coli (46.8%, n = 140) and K. pneumoniae (25.1%, n = 75) being the most predominant ESBL phenotypes. Faecal carriage of carbapenem resistant bacteria was 23.1% (n = 69). E. coli (11%, n = 33), K. pneumoniae (7.4%, n = 22), A. baumannii (3.3%, n = 10) were the most common carbapenem resistant isolates. 52.2% (n = 36) of these carbapenem resistant isolates expressed phenotypic carbapenemase activity by the modified Hodge test (MHT). Thirty two (46.4%) were found to harbour at least one carbapenemase gene; blaOxa-48 (20.3%, n = 14), blaVIM (15.9%, n = 11), blaNDM (4.4%, n = 3), and blaIMP (5.8%, n = 4). Five (15.6%) harboured 2 carbapenemase genes, but none harboured 3 or more genes. Prior exposure to carbapenems and fluoroquinolones increased the odds of carriage of carbapenem-resistant Enterobacterales and A. baumannii by approximately two folds. CONCLUSION: This study reports high faecal carriage of MDR bacteria among paediatric inpatients of the Korle-Bu Teaching Hospital. This includes carbapenem-resistant Enterobacterales and A. baumannii with blaOxa-48 and blaVIM carbapenemase genes being the commonest. Prior antibiotic exposure to carbapenems and fluoroquinolones within the past year were significant risk factors for carriage of carbapenem-resistant isolates.