Open AccessHigh Prevalence of Fecal Carriage of Extended Spectrum β-Lactamase-Producing Enterobacteriaceae Among Newly HIV-Diagnosed Adults in a Community Setting in Tanzania
Author(s) -
Joel Manyahi,
Sabrina John Moyo,
Marit Gjerde Tellevik,
Nina Langeland,
Bjørn Blomberg
Publication year - 2020
Publication title -
microbial drug resistance
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.889
H-Index - 70
eISSN - 1931-8448
pISSN - 1076-6294
DOI - 10.1089/mdr.2020.0066
Subject(s) - carriage , interquartile range , medicine , odds ratio , confidence interval , feces , gastroenterology , microbiology and biotechnology , biology , pathology
Colonization in HIV-infected populations with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) is particularly worrisome in low-income settings. This study describes the prevalence of ESBL-PE carriage and associated risk factors among newly HIV-diagnosed adults in a community setting in Tanzania. A total of 595 newly diagnosed HIV adults with a median age of 35 years with interquartile range (IQR) 29-42 years and a median CD4 count of 492 cells/μL (IQR 390-666 cells/μL) were recruited. Among these, 194/595 (32.6%, 95% confidence interval [CI] 28.9-36.6) were ESBL-PE carriers. Participants with low CD4 count (<350 cells/μL) had significantly higher prevalence of ESBL-PE carriage compared with those with CD4 count ≥350 cells/μL (26/58, 44.8%, vs. 168/537, 31.3%, p = 0.04). Antibiotic use in last 4 weeks (odds ratio [OR] 1.55, 95% CI 1.08-2.22, p = 0.02) and CD4 count ≥350 cells/μL (OR 1.78, 95% CI 1.03-3.09, p = 0.04) were independent risk factors for fecal carriage of ESBL-PE. In total, 244 isolates of ESBL-PE were isolated from 194 participants. Of these, 238/244 (97.5%) harbored bla CTX-M genes, with bla CTX-M-15 being predominant (219/238 (92%), followed by bla CTX-M-27 (9/238 (3.8%), bla CTX-M-14 (8/238 (3.4%), bla CTX-M-55 (1/238), and bla CTX-M 211/3 (1/238). bla SHV-2a genes were detected in four isolates, whereas the bla SHV-12 gene was detected in one isolate. Phenotypic carbapenemase-producing Enterobacteriaceae was detected in one HIV-positive person with CD4 count 132 cells/μL. In conclusion prevalence of ESBL-PE carriage is high among newly diagnosed HIV adults in Dar es Salaam, and is significantly associated antibiotic use and low CD4 count.