Intense pre-admission carriage and further acquisition of ESBL-producing Enterobacteriaceae among patients and their caregivers in a tertiary hospital in Rwanda
| Autor: | Mathis S. E. Kurz, Jules Ndoli, Anita Durst, Augustin Sendegeya, Claude Bayingana, Frank P. Mockenhaupt, Jean Bosco Gahutu, Roland Pfüller |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male 0301 basic medicine medicine.medical_specialty Pediatrics Adolescent Klebsiella pneumoniae medicine.drug_class 030106 microbiology Antibiotics Esbl production Microbial Sensitivity Tests beta-Lactamases Young Adult 03 medical and health sciences Patient Admission Enterobacteriaceae Risk Factors Internal medicine Humans Medicine Young adult Child Aged Aged 80 and over biology business.industry Transmission (medicine) Enterobacteriaceae Infections Infant Newborn Rwanda Public Health Environmental and Occupational Health Infant Middle Aged biology.organism_classification Anti-Bacterial Agents Infectious Diseases Carriage Caregivers Child Preschool Female Parasitology business Enterobacter cloacae |
| Zdroj: | Tropical Medicine & International Health. 22:210-220 |
| ISSN: | 1360-2276 |
| DOI: | 10.1111/tmi.12824 |
| Popis: | Objectives To assess the presence and risk factors of intestinal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) among patients admitted to the University Teaching Hospital of Butare and among their attending caregivers, and to analyse the acquisition of ESBL-PE carriage during hospital stay and associated factors. Methods We screened 392 patients and their attending caregivers at admission and discharge for ESBL-PE carriage. Bacterial species were determined using the API-20E system, and antimicrobial susceptibility testing was performed by agar disc diffusion. Data on socio-economic status, diet, behaviour, household assets, livestock and hospital procedures were collected. Results At admission, 50% of the patients showed intestinal ESBL-PE carriage (Escherichia coli, 51%; Klebsiella pneumoniae, 39%; Enterobacter cloacae, 19%) as did 37% of their caregivers. Co-resistance was common but no carbapenem resistance was detected. At discharge, the proportion of ESBL-PE-colonised patients increased to 65% (caregivers, 47%) with almost complete carriage in paediatric patients (93%). The acquisition rate among initially non-colonised patients was 55% (or, 71/1000 patient days). Independent predictors of admission carriage included a colonised caregiver, prior antibiotic intake, egg consumption and neglecting to boil drinking water, whereas being a paediatric patient, undergoing surgery and male gender predicted acquisition during hospitalisation. Conclusions Abundant admission carriage of ESBL-PE and a high acquisition rate in a Rwandan university hospital point to potential intrahospital transmission and community dissemination. Caregivers are an additional source of possible spread. Risk factors of colonisation such as diet and water source need to be tackled to prevent the further emergence and spread of ESBL-PE. |
| Databáze: | OpenAIRE |
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