Antimicrobial Resistance Patterns and Risk Factors Associated with ESBL-Producing and MDR Escherichia coli in Hospital and Environmental Settings in Lusaka, Zambia: Implications for One Health, Antimicrobial Stewardship and Surveillance Systems

Maisa Kasanga; Geoffrey Kwenda; Jian Wu; Maika Kasanga; Mark J Mwikisa; Raphael Chanda; Zachariah Mupila; Baron Yankonde; Mutemwa Sikazwe; Enock Mwila; Doreen M Shempela; Benjamin B Solochi; Christabel Phiri; Steward Mudenda; Duncan Chanda

doi:10.3390/microorganisms11081951

Antimicrobial Resistance Patterns and Risk Factors Associated with ESBL-Producing and MDR Escherichia coli in Hospital and Environmental Settings in Lusaka, Zambia: Implications for One Health, Antimicrobial Stewardship and Surveillance Systems

Microorganisms. 2023 Jul 31;11(8):1951. doi: 10.3390/microorganisms11081951.

Authors

Maisa Kasanga¹, Geoffrey Kwenda², Jian Wu¹, Maika Kasanga³, Mark J Mwikisa⁴, Raphael Chanda⁵, Zachariah Mupila⁴, Baron Yankonde⁴, Mutemwa Sikazwe⁶, Enock Mwila⁶, Doreen M Shempela^{7

8}, Benjamin B Solochi⁴, Christabel Phiri⁹, Steward Mudenda^{10

11}, Duncan Chanda⁵

Affiliations

¹ Department of Epidemiology and Biostatistics, School of Public Health, Zhengzhou University, Zhengzhou 450001, China.
² Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka 10101, Zambia.
³ Department of Pharmacy, University Teaching Hospital, Lusaka 50110, Zambia.
⁴ Department of Pathology and Microbiology, University Teaching Hospital, Lusaka 50110, Zambia.
⁵ Adult Centre of Excellence, University Teaching Hospital, Lusaka 50110, Zambia.
⁶ Department of Pathology, Lusaka Trust Hospital, Lusaka 35852, Zambia.
⁷ Churches Health Association of Zambia, Lusaka 34511, Zambia.
⁸ Department of Laboratory and Research, Central University of Nicaragua, Managua 12104, Nicaragua.
⁹ Department of Microbiology, School of Public Health, University of Zambia, Lusaka 10101, Zambia.
¹⁰ Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka 10101, Zambia.
¹¹ Research and Surveillance Technical Working Group, Zambia National Public Health Institute, Lusaka 10101, Zambia.

Abstract

Antimicrobial resistance (AMR) is a public health problem threatening human, animal, and environmental safety. This study assessed the AMR profiles and risk factors associated with Escherichia coli in hospital and environmental settings in Lusaka, Zambia. This cross-sectional study was conducted from April 2022 to August 2022 using 980 samples collected from clinical and environmental settings. Antimicrobial susceptibility testing was conducted using BD Phoenix^TM 100. The data were analysed using SPSS version 26.0. Of the 980 samples, 51% were from environmental sources. Overall, 64.5% of the samples tested positive for E. coli, of which 52.5% were from clinical sources. Additionally, 31.8% were ESBL, of which 70.1% were clinical isolates. Of the 632 isolates, 48.3% were MDR. Most clinical isolates were resistant to ampicillin (83.4%), sulfamethoxazole/trimethoprim (73.8%), and ciprofloxacin (65.7%) while all environmental isolates were resistant to sulfamethoxazole/trimethoprim (100%) and some were resistant to levofloxacin (30.6%). The drivers of MDR in the tested isolates included pus (AOR = 4.6, CI: 1.9-11.3), male sex (AOR = 2.1, CI: 1.2-3.9), and water (AOR = 2.6, CI: 1.2-5.8). This study found that E. coli isolates were resistant to common antibiotics used in humans. The presence of MDR isolates is a public health concern and calls for vigorous infection prevention measures and surveillance to reduce AMR and its burdens.

Keywords: ESBL; Escherichia coli; One Health; Zambia; antibiotics; antimicrobial stewardship; multidrug resistance.

Grants and funding

This research was funded by the European Union Horizon 2020 research and innovation programme/Trials of Excellence in Southern Africa (EDCTP2/TESA III), Key Project of TESA III (CSA2020NOE3104).