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ORIGINAL RESEARCH article

Front. Microbiol.
Sec. Antimicrobials, Resistance and Chemotherapy
Volume 15 - 2024 | doi: 10.3389/fmicb.2024.1517182

High Prevalence of Fecal Carriage of Extended-Spectrum Beta-Lactamase Producing Enterobacterales Among Patients with Urinary Tract Infections in Rural Tanzania

Provisionally accepted
Magreth E. Macha Magreth E. Macha 1,2,3*Weihong Qi Weihong Qi 4Salome N. Seiffert Salome N. Seiffert 5Anja Bösch Anja Bösch 2Philipp Kohler Philipp Kohler 2Honorathy Msami Urassa Honorathy Msami Urassa 6Sabine Haller Sabine Haller 2Erin West Erin West 2Maja Weisser Rohacek Maja Weisser Rohacek 7,8,9Baharak Babouee Flury Baharak Babouee Flury 2*
  • 1 University of Bern, Bern, Switzerland
  • 2 Kantonsspital St. Gallen, St.Gallen, Switzerland
  • 3 St. Francis University College of Health and Allied Sciences, Ifakara, Tanzania
  • 4 Functional Genomics Center Zurich, ETH Zurich, Zurich, Zürich, Switzerland
  • 5 Zentrum für Labormedizin (ZLM), St.Gallen, St Gallen, Switzerland
  • 6 St. Francis Regional Referral Hospital, Ifakara, Tanzania
  • 7 University Hospital of Basel, Basel, Basel-Stadt, Switzerland
  • 8 Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Basel-Landschaft, Switzerland
  • 9 Ifakara Health Institute, Ifakara, Tanzania

The final, formatted version of the article will be published soon.

    Introduction The global rise of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) challenges resource-limited countries with insufficient laboratory infrastructure. This study investigates fecal carriage and risk factors for ESBL-PE and carbapenemase-producing organisms among patients with urinary tract infection (UTI) in rural Tanzania. Methods This cross-sectional study was conducted at St. Francis Regional Referral Hospital, Ifakara, Tanzania, from October 2021 to August 2023, involving 326 UTI patients. Demographic data and resistance risk factors were collected via structured questionnaires. Stool samples collected pre-antibiotic treatment were screened for ESBL-PE and carbapenemase locally. Positive samples underwent further analysis in Switzerland using MALDI-ToF, Vitek MS, and whole-genome sequencing. Multivariable analysis assessed predictors associated with ESBL-PE carriage for risk factors with p < 0.05. Results We enrolled 326 UTI patients (median age: 35.5 years, range: 25-52) and 189 (58.0%) were females. Fecal ESBL-PE colonization was detected in 70.9% of patients, predominantly E. coli (62.8%) and K. pneumoniae (33.0%). Whole-genome sequencing identified diverse phylogroups and sequence types, with CTX-M-15 being the most common ESBL gene. IncF plasmids were the primary carriers. Younger age (aOR: 0.98, 95% CI: 0.97 - 0.99; p = 0.0239) and inpatient status (aOR: 1.77, 95% CI: 1.08 - 2.91; p = 0.0036) were significant risk factors for ESBL-PE carriage. Conclusion The high prevalence of ESBL-PE fecal carriage in rural Tanzania highlights the need for improved infection control and further research into community transmission dynamics. Keywords: Fecal carriage, Extended-spectrum beta-lactamase, Enterobacterales, Urinary tract infections, rural Tanzania

    Keywords: fecal carriage, extended-spectrum beta-lactamase, Enterobacterales , Urinary Tract Infections, Rural tanzania

    Received: 25 Oct 2024; Accepted: 11 Dec 2024.

    Copyright: © 2024 E. Macha, Qi, Seiffert, Bösch, Kohler, Urassa, Haller, West, Rohacek and Babouee Flury. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Magreth E. Macha, University of Bern, Bern, Switzerland
    Baharak Babouee Flury, Kantonsspital St. Gallen, St.Gallen, Switzerland

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.