Abstract:

Background: The rate of infections caused by Extended Spectrum Beta-Lactamases (ESBL) producing gram negative bacterial in particular Escherichia coli has increased and been declared as a threat to public health worldwide. Despite the established evidence describing the possible development of infections caused by multidrug resistant bacteria colonizing the respective patient, data from developing countries are limited. This study was conducted to investigate the magnitude of ESBL-producing E. coli colonization among patients undergoing surgery at Bugando medical centre (BMC) in Mwanza, Tanzania.

Material and Methods: A cross-sectional hospital study conducted between November, 2014 and August, 2015 enrolled 604 patients. Their demographic characteristics and relevant medical information related to the study were recorded. ESBL screening and conformation were done using MacConkey Agar supplemented with 2µg/ml of cefotaxime and VITEK 2 system respectively. Data were analyzed using STATA version 13 software.

Results: Among 604 patients who underwent surgery at BMC, 104 (17.2%) were found to harbor ESBL-producing E. coli strains upon admission. Of 215 patients re-screened upon their discharge from the hospital, 71 (33%) were positive ESBL producing E. coli ESBL carriage rate was found to increase significantly upon discharge (17.2% vs. 33%, p<0.001). Of 179 patients who tested negative upon admission to the hospital, 50 (27.9%) were positive upon discharge. Patients who stayed in the hospital longer than 6 days were found to have 4% increased risk of acquiring ESBL-producing E. coli isolates although the difference was not significant (OR: 1.04, 96% CI: 0.984 – 1.102, p=0.154). There was no significant difference of elevated cefotaxime MICs among admission and discharge ESBL positive isolates (99.04% vs. 100%, p=0.381).

Conclusion: Not only the carriage rate of ESBL-producing E. coli doubled significantly but also a significantly number of naïve ESBL-producing E. coli carries were detected upon discharge. The findings call or inevitable improvement in infection prevention and control measures at BMC hospital to reduce hospital-related carriage of resistance strains.