Purpose: Increasing prevalence of healthcare-associated infections due to Extended Spectrum Beta Lactamase (ESBL)-producing strains in a tertiary hospital in Mwanza necessitated the investigation of the surrounding community to assess the clonal spread of genotypes and the prevalence.

Methods & Materials: Between April and July 2015, 108 street children were enrolled in a study. Demographic and other relevant data were collected. ESBL screening and confirmation were done using MacConkey Agar supplemented with 2 μg/ml of cefotaxime and VITEK® 2 system respectively. Molecular characterization of the isolates was done by multilocus sequence typing. Data were analyzed using STATA-13 software.

Results: The mean age of the enrolled children was 14.2 ± 3.7 years. Among 108 children, 34 (31.5%, 95% CI; 22.7-40.3) carried ESBL-producing E. coli and K. pneumoniae. Two children were colonized by both species resulting in a total number of isolates of 36. Of 36 ESBL isolates 30 (83.3%) were E. coli and 6 were K. pneumoniae, p˂0.001. Out of 36 isolates 16 (44%), 25 (69%) and 35 (97%) were found to be non-susceptible to gentamicin, ciprofloxacin and trimethoprim-sulfamethoxazole, respectively. Notably, 4 of the 6 K. pneumoniae isolated were resistant to tigecycline. Eighteen different E. coli sequence types were observed of which ST131 (5/30), ST10 (3/30), ST448 (3/30) and ST617 (3/30) were the most prevalent. ESBL isolation rate was significantly high in children reported to use local herbs (48.9% vs. 21.5%, p=0.003).

Conclusion: A high carriage rate of ESBL-producing Enterobacteriaceae was observed in street children which warrants close monitoring and surveillance. Detection of STs 131, 10, 38 and 648 which were previously detected in E. coli isolates from patients, companion and domestic farm animals in the same region calls for “One Health” approach to combat Antimicrobial resistance burden.