Fecal carriage and factors associated with extended-spectrum β-lactamase-producing Enterobacteriaceae among pregnant women at the tertiary referral hospital, Tanzania

Ambele M Mwandigha; Doreen Kamori; Upendo O Kibwana; Salim Masoud; Joel Manyahi; Mtebe Majigo

doi:10.1186/s41182-020-00271-2

Fecal carriage and factors associated with extended-spectrum β-lactamase-producing Enterobacteriaceae among pregnant women at the tertiary referral hospital, Tanzania

Trop Med Health. 2020 Oct 8:48:84. doi: 10.1186/s41182-020-00271-2. eCollection 2020.

Authors

Ambele M Mwandigha¹, Doreen Kamori¹, Upendo O Kibwana¹, Salim Masoud¹, Joel Manyahi¹, Mtebe Majigo¹

Affiliation

¹ Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.

Abstract

Background: Infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are increasing worldwide. Evidence indicates that fecal carriage of ESBL-E in pregnancy predisposes women to potential life-threatening urinary tract infections and subsequently increasing the risk of neonatal infections. There is limited data regarding fecal carriage of ESBL-E and associated factors among pregnant women in Tanzania. We aimed to address the gap by determining the proportion of pregnant women with ESBL-E fecal carriage and identify the related factors.

Methodology: A hospital-based cross-sectional study was conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. A total of 182 pregnant women at the gestational age of 37 weeks and above were enrolled. Participants' socio-demographic, clinical, and hygienic information were collected by using a well-structured questionnaire. Rectal swabs were collected and processed for isolation of ESBL-E. The extended-spectrum β-lactamase production and antibiotic susceptibility test (AST) were performed using a double-disc synergy test and Kirby-Bauer disc diffusion method, respectively.

Results: A total of 117 (64.3%) pregnant women were found to carry ESBL-E. Factors such as self-prescription of antibiotic medication during pregnancy, low education level, and toilet sharing were independently associated with ESBL-E fecal carriage. Five ESBL-E species that were isolated include Escherichia coli (84.6%), Klebsiella pneumoniae (8.9%), Klebsiella oxytoca (3.3%), Citrobacter spp. (1.6%), and Enterobacter spp. (1.6%). ESBL-E isolates demonstrated high resistance to aztreonam and sulphamethoxazole-trimethoprim.

Conclusion: This study has revealed a relatively high fecal carriage of ESBL-E among pregnant women, suggesting that there is a need for routine screening among that population. We recommend further studies to explore comprehensively the factors associated with high fecal carriage of ESBL-E in pregnancy and the potential transmission kinetics to their newborn babies.

Keywords: Antimicrobial resistance; Enterobacteriaceae; Extended-spectrum beta-lactamase; Fecal carriage; Pregnancy.