Carbapenem-Resistant Enterobacterales (CRE) Colonization Prevalence in Botswana: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study
Open Forum Infectious Diseases
; 8(SUPPL 1):S464-S465, 2021.
Article
in English
| EMBASE | ID: covidwho-1746388
ABSTRACT
Background. Although CRE are a global threat, data in low- and middle-income countries are scarce. Colonization data are vital for informing antibiotic resistance strategies. We characterized the colonization prevalence of CRE in various settings in Botswana. Methods. This study was conducted in 3 districts in Botswana (1 hospital and 2 clinics per district). Adult inpatients and clinic patients were randomly selected for enrollment. Community subjects were enrolled by inviting each enrolled clinic subject to refer up to 3 adults. Each adult clinic or community subject was also asked to refer their children. All subjects had rectal swabs obtained and inoculated on selective chromogenic media for preliminary identification of CRE. Final identification and susceptibility testing were performed using MALDI-TOF MS and VITEK-2, respectively. CRE underwent genotyping for carbapenemase genes. Results. Subjects were enrolled from 1/15/20-9/4/20 with a pause from 4/2/20-5/21/20 due to a countrywide COVID lockdown. Of 5,088 subjects approached, 2,469 (49%) participated. Enrollment by subject type was hospital - 469 (19%);clinic - 959 (39%);community adult - 477 (19%);and community child - 564 (23%). Of 2,469 subjects, the median (interquartile range) age was 32 years (19-44) and 1,783 (72%) were female. 42 (1.7%) subjects were colonized with at least one CRE;10 subjects were colonized with multiple strains. E. coli (n=17), K. pneumoniae (n=20), and E. cloacae complex (n=11) were most common. CRE colonization prevalence was 6.8% for hospital subjects, 0.7% for clinic subjects, 0.2% for adult community subjects, and 0.5% for child community subjects (p< 0.001)). CRE prevalence varied across regions (Figure 1) and was significantly higher pre- vs post-lockdown (Figure 2). VIM and NDM were the most common carbapenemase genes (Figure 3). Conclusion. CRE colonization was significantly higher in hospital vs community settings in Botswana. CRE prevalence varied by region and decreased significantly following a countrywide lockdown. With CRE prevalence still modest, elucidating risk factors for CRE colonization holds promise in developing strategies to curb further emergence of CRE. Additional investigation of the CRE isolates without identified resistance genes is warranted.
carbapenem; carbapenemase; endogenous compound; adult; antibiotic resistance; antibiotic sensitivity; bacterial colonization; bacterial strain; bacterium isolate; Botswana; child; conference abstract; controlled study; coronavirus disease 2019; Enterobacterales; Escherichia coli; female; genotyping; hospital patient; human; Klebsiella pneumoniae; lockdown; major clinical study; male; matrix assisted laser desorption ionization time of flight mass spectrometry; microbial identification system; multicenter study; national lockdown; nonhuman; pediatric hospital; prevalence; randomized controlled trial; rectal swab; risk factor
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Observational study
Language:
English
Journal:
Open Forum Infectious Diseases
Year:
2021
Document Type:
Article
Similar
MEDLINE
...
LILACS
LIS