Faecal carriage of extended spectrum β-lactamase producing Enterobacterales (ESBL-PE) in children under five years of age at a tertiary hospital in southwest Nigeria

[1]Abayomi, S. A., 2Oladibu, O. T., 3Lawani, O. A., 4Owolabi, K. I., 2Alabi, A. O.,        and *2Onigbinde, M. O.

1Cancer Research UK, Swansea, Wales, United Kingdom

2Department of Paediatrics and Child Health, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria

3Department of Medical Microbiology and Parasitology, University of Ilorin Teaching Hospital, Ilorin, Nigeria

42102 Cole Street, Dudley, West Midlands, United Kingdom                                         

*Correspondence to: moonigbinde@lautech.edu.ng


Background:  The main reservoir of Enterobacterales is the human gut, which has been reported as a source of hospital acquired infection. Enterobacterales carrying the extended spectrum β-lactamase (ESBL) genes have emerged over the years as significant multidrug resistant (MDR) pathogens, that have hindered effective therapy of infections caused by them, and limited treatment to a small number of drugs such as carbapenems, leading to selection pressure and emergent resistance to carbapenems. The objective of this study was to determine the faecal carriage of ESBL-producing Enterobacterales (ESPL-PE) among children under 5 years of age at the Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Nigeria.   

Methodology: A total of 144 children under 5 years of age were consecutively recruited over a period of 5 months from the paediatrics outpatient clinic, children emergency, paediatrics ward, and neonatal unit of the hospital. Rectal swabs were collected from selected children and transported to the medical microbiology laboratory of the hospital for inoculation on MacConkey agar plates and aerobic incubation at 37oC for 24 hours. All positive growth on the culture plates were identified by colony morphology, Gram stain reaction and conventional biochemical tests scheme. Antimicrobial susceptibility test was performed by the disc diffusion method against selected antibiotics, and ESBL production was confirmed by the double disc synergy test (DDST). Association of risk factors with ESBL-PE faecal carriage was determined using Chi‑square or Fisher Exact test, with statistical significance set at p< 0.05.

Results: The prevalence of ESBL-PE faecal carriage was 37.5% (54/144), with 34.7% (50/144) for Escherichia coli and 2.1% (3/144) for Klebsiella pneumoniae. The overall resistance rate of both ESBL and non-ESBL producing isolates were to ampicillin (100.0%), amoxicillin-clavulanic acid (96.2%), ceftazidime (94.3%) and ciprofloxacin (90.6%), while resistance to carbapenems was low at 22.2%. Significant risk factors associated with ESBL-PE faecal carriage were age group 24-59 months (p=0.0187), prior intake of antibiotics (p=0.014), and intake of antibiotics without prescription (p=0.0159), while gender (p=0.8877), mother’s education level (p=0.3831) and previous hospital visit (p=0.8669) were not significantly associated with faecal ESBL carriage.

Conclusion: The relatively high faecal carriage rate of ESBL-PE in children <5 years of age in our study highlights the risk for antimicrobial resistance transmission within the hospital and community.

Keywords: Antimicrobial resistance, Faecal carriage, ESBL, Enterobacterales, Children

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Faecal carriage of extended spectrum β-lactamase producing Enterobacterales (ESBL-PE) in children under five years of age at a tertiary hospital in southwest Nigeria