ArticlePloS one2025
Fecal carriage and associated factors of extended-spectrum beta-lactamase-producing Enterobacteriaceae in children under five years old with diarrhea at a tertiary hospital in Tanzania.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe prevalence of extended-spectrum beta-lactamase-producing Enterobacteriales (ESBL-PE) is high in resource-limited settings. Carriage in young children has been linked to increased morbidity and mortality. However, there is limited information on the prevalence of ESBL-PE among children under five in our settings. This study aimed to determine the fecal carriage of ESBL-PE in children under five years old suffering from diarrhea at a tertiary hospital in Tanzania. METHODOLOGY: This cross-sectional study was conducted over a three-month period at Muhimbili National Hospital in Dar es Salaam, Tanzania. Participants' socio-demographic and clinical information were collected using a structured questionnaire and the child's clinic card. Stool samples were collected and screened for the presence of ESBL-PE using MacConkey agar supplemented with ceftazidime. Confirmation of ESBL-PE was achieved through a double disk synergy test. Logistic regression analysis was employed to identify factors independently associated with ESBL-PE carriage. A p-value of less than 0.05 was considered statistically significant.
resultsWe enrolled 181 children with a median age of 29 months (interquartile range: 20-37). The female-to-male ratio was 1:1. Among all participants, 54.1% (98/181) were malnourished, and the parents of 54.1% (98/181) had low levels of education. The overall fecal carriage rate of ESBL-PE was 65.7% (119/181). A total of 120 ESBL-PE isolates were confirmed. E. coli was the predominant ESBL-PE, contributing to (74.2%, 89/120), followed by K. pneumoniae (21/120, 17.5%), K. oxytoca (8/120, 6.7%), and Citrobacter spp. (2/120, 1.7%). Malnourished children had a higher carriage rate of ESBL-PE (77.6%) compared to non-malnourished children (51.8%) (p = 0.0003). Prolonged hospital stay (aOR=1.12, 95% CI = 1.05-1.19, p = 0.001), malnourishment (aOR=3.15, 95% CI = 1.61-6.19, p = 0.001), and a history of antibiotic use (aOR=2.28, 95% CI = 1.15-4.54, p = 0.018) were independently associated with the carriage of ESBL-PE. Furthermore, we observed that ESBL-producing E. coli isolated from malnourished children had high resistance rates of 75% and 65% against aztreonam and sulfamethoxazole/trimethoprim, respectively, while ESBL-producing K. pneumoniae isolated from the same group exhibited high resistance rates of 84.6% and 69.2%.
conclusionThe present study revealed that children under five years old with diarrhea have a higher rate of ESBL-PE fecal carriage. Furthermore, prolonged hospital stays, malnutrition, and a history of antibiotic use are independently associated with ESBL-PE carriage. We also report high resistance rates of ESBL-PE isolated from malnourished children. These findings emphasize the importance of enhancing infection prevention and control measures to mitigate the spread of multidrug-resistant pathogens in both hospital and community settings.
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