Infection and Drug Resistance (May 2021)

Gastrointestinal Tract Colonization Rate of Extended-Spectrum Beta-Lactamase-Producing Gram-Negative Bacteria and Associated Factors Among Orthopaedic Patients in a Tertiary Hospital in Tanzania: Implications for Infection Prevention

  • Seni J,
  • Akaro IL,
  • Mkinze B,
  • Kashinje Z,
  • Benard M,
  • Mboowa G,
  • Aruhomukama D,
  • Sserwadda I,
  • Joloba ML,
  • Mshana SE,
  • Kidenya BR

Journal volume & issue
Vol. Volume 14
pp. 1733 – 1745

Abstract

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Jeremiah Seni,1 Inyasi Lawrence Akaro,2,3 Baraka Mkinze,2,3 Zengo Kashinje,1 Modest Benard,1 Gerald Mboowa,4 Dickson Aruhomukama,4 Ivan Sserwadda,4 Moses L Joloba,4 Stephen E Mshana,1 Benson R Kidenya5 1Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 2Department of Surgery, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 3Department of Orthopaedic Surgery, Bugando Medical Centre, Mwanza, Tanzania; 4Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda; 5Department of Biochemistry and Molecular Biology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, TanzaniaCorrespondence: Jeremiah SeniDepartment of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Bugando, Mwanza, TanzaniaTel: +255 784 593000Email [email protected]: The dual burden of road traffic accidents and antimicrobial resistance in orthopaedic infections is challenging already strained health-care systems. Limited information exists in Tanzania on antimicrobial resistance surveillance to delineate the potential sources of multi-drug-resistant bacteria for specific mitigation strategies among orthopaedic patients.Methods: A longitudinal study was conducted at Bugando Medical Centre in Mwanza city between January and May 2020. It involved the collection of rectal swabs/stools, hand swabs, and environmental sampling to identify extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacteria. Participants’ data were collected using a structured questionnaire and analysed to determine factors associated with ESBL colonization among index orthopaedic patients and correlates with other ESBL sources using OR (95% CI) and a cut-off p-value of ≤ 0.05.Results: We found that 47.2% (125/265) of index patients, 77.8% (14/18) of neighbouring patients, 8.3% (2/24) of health-care workers, 72.2% (13/18) of non-medical caregivers, and 31.4% (27/86) of samples taken from the hospital environment had ESBL producers. Escherichia coli and Klebsiella spp. predominated among participants and Acinetobacter spp. predominated in the environmental samples. Patients with open fractures had increased odds of being colonized with ESBL producers [OR (95% CI): 2.08 (1.16– 3.75); p=0.015]. The floor below patients’ beds was commonly contaminated; however, the odds of environmental contamination decreased on the third round of sampling [OR (95% CI: 0.16 (0.04– 0.67); p=0.012], apparently as a result of parallel infection prevention and control responsive measures against coronavirus disease 2019 (COVID-19).Conclusion: We found a high occurrence of ESBL colonization among participants and in the environmentat this tertiary hospital. The importance of routine ESBL surveillance among orthopaedic patients with open fractures on admission and strengthened decontamination of health-care premises is reiterated.Keywords: ESBL colonization, orthopaedic patients, Mwanza, Tanzania

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