High Magnitude of Fecal Carriage of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae at Debre Berhan Comprehensive Specialized Hospital, Ethiopia

Figures & data

Table 1 Sociodemographic Characteristics of Study Participants at Debre Berhan Comprehensive Specialized Hospital from November 2020 to March 2021

Variables	Categories	Number (n=383)	Percent (%)
Sex	Male	190	49.6
	Female	193	50.4
Age group	Neonate	39	10.2
	Children	65	17.0
	Adults	279	72.8
Residence	Rural	237	61.9
	Urban	146	38.1
Adults Marital status	Married	245	64.0
	Single	31	8.1
	Divorced	3	0.8
Educational status	Illiterate	245	64.0
	Primary	69	18.0
	Secondary	36	9.4
	Higher and above	33	8.6
Adults occupational status	Unemployed	7	28.7
	Government employed	33	8.6
	Daily labour	3	0.8
	Farmer	65	17.0
	Housewife	82	21.4
	Others	90	23.5

Table 2 Clinical Profile of the Study Participants at Debre Berhan Comprehensive Specialized Hospital from November 2020 to March 2021

Variables	Categories	Frequency	Percent (%)
History of antibiotic use in the past 3 months	Yes	107	27.9
	No	276	72.1
History of hospitalization in the past 12 months	Yes	91	23.8
	No	292	76.2
Previous history of hospital stays	3–7 days	22	5.7
	8–14 days	48	12.5
	>14 days	21	5.5
Previous ICU stay	Yes	1	0.3
	No	382	99.7
Number of bed/rooms	2–4	48	12.5
	5–8	335	87.5
Number of patient/rooms	2–4	140	36.6
	5–8	243	63.4
Reason for admission	Sepsis	34	8.9
	UTI	13	3.4
	Pneumonia	22	5.7
	Meningitis	10	2.6
	Malnutrition	21	5.5
	Heart failure	28	7.3
	Peptic ulcer disease	16	4.2
	Others	239	62.4
History of invasive procedure in the past 3 months	Yes	46	12.0
	No	337	88.0
Types of invasive procedure	Catherization	32	8.4
	Surgery	14	3.6
Admission ward	Neonatal ICU	39	10.2
	Paediatric	63	16.4
	Medical	104	27.2
	Surgery	92	24.0
	Adult ICU	7	1.8
	Gynaecology and obstetrics	53	13.8
	Ophthalmology	25	6.5
Ward stays	3–7 days	326	85.1
	8–14 days	44	11.5
	>15 days	13	3.4
Chronic disease	Yes	85	22.2
	No	298	77.8
Types of chronic disease	Diabetes	23	6.0
	HIV	20	5.2
	Hypertension	31	8.1
	Haematological malignancy	1	0.3
	Tuberculosis	6	1.5
	Kidney disease	1	0.3
	Heart disease	3	0.8

Figure 1 Enterobacteriaceae isolated from the fecal specimen of Debre Berhan Comprehensive Specialized Hospital from November 2020 to March 2021.

Table 3 Antimicrobial Resistance Pattern of Enterobacteriaceae Isolated at Debre Berhan Comprehensive Specialized from November 2020 to March 2021

Isolates	Antimicrobial resistance level in n (%)
	AMP	FOX	GM	CIP	STX	IPM	MEP	AMC	CTX	CAZ	CRO	TE	FEP	C
E. coli (n=221)	215(97.3)	42(19.0)	162(73.3)	66(29.9)	121(54.8)	6(2.7)	6(2.7)	103(46.6)	94(42.5	66(29.9)	93(42.)	150(67.9)	35(15.8)	19(8.6)
Citrobacter spp (n=4)	4(100.0)	2(50.0)	4(100.0)	1(25.0)	3(75.0)	0(0.0)	0 (0.0)	2(50.0)	3(75.0)	2(50.0)	3(75.0)	4(100.0)	0(0.0)	0(0.0)
K. pneumoniae (n=92)	92(100.0)	3(38.0)	88(95.7)	54(58.7)	78(84.8)	12(13.0)	14 (15.2)	68(73.9)	63(68.5)	50(54.3)	65(70.7)	74(80.4)	34(37.0)	25(27.2)
E. cloacae (n=12)	12(100.0)	6(50.0)	10(83.3)	5(41.7)	11(91.7)	0(0.0)	0(0.0)	8(66.8)	8(66.7)	7(58.3)	8(66.7)	12(100.0)	4(33.3)	7(58.3
K. oxytoca (n=9)	9(100.0)	4(44.4)	8(88.9)	6(66.7)	7(77.8)	4(44.4)	4(44.4)	7(77.8)	9(100.0)	9(100.0)	9(100)	7(77.8)	5(55.6)	2(22.2)
C. diversus (n=5)	5(100.0)	1(20.0)	5(100.0)	0(0.0)	3(60.0)	0(0.0)	0(0.0)	5(100.0)	4(100.0)	3(60.0)	2(40.0)	5(100.0)	0(0.0)	0(0.0)
M. morganii (n=2	2(100.0)	2(100.0)	2(100.0)	0(0.0)	1(50.0)	0(0.0)	0(0.0)	2(100.0)	2(100.0)	2(100.0)	0(0.0)	2(100.0)	0(0.0)	2(100).0)
P. stuartii (n=1)	1(100.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	1(100.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)
K. ozaenae (n=1)	1(100.0)	0(0.0)	1(100.0)	1(100.0)	1(100.0)	0(0.0)	0(0.0)	1(100.0)	1(100.0	1(100.0)	1(100.0)	1(100.0)	0(0.0)	0(0.0)
Total resistance (n=347)	341(98.3)	92(26.5)	280(80.7)	133(38.3)	225(64.8)	22(6.3)	24(6.9)	196(56.5)	184(53.0)	140(40.3)	181(52.2)	255(73.3)	78(22.5)	55(15.9)

Abbreviations: AMP, ampicillin; FOX, cefoxitin; GM, gentamicin; CIP, ciprofloxacin; STX, trimethoprim-sulfamethoxazole; IPM, imipenem; MEP, meropenem; AMC, amoxicillin-clavulanic acid; CTX, cefotaxime; CAZ, ceftazidime; CRO, ceftriaxone; TE, tetracycline; FEP, cefepime; C, chloramphenicol.

Table 4 Multi-Drug Resistance Patterns of Enterobacteriaceae Isolates at Debre Berhan Comprehensive Specialized Hospital from November 2020 to March 2021

Isolates (Number)	Number of Antimicrobials Resisted (n (%)
	R0	R1	R2	R3	R4	R5	R6	≥R7	Total MDR Isolates (R≥3)
E. coli (n=221)	1(0.5)	12(5.4)	27(12.2)	30(13.6)	32(14.4)	27(12.2)	21(9.5)	71(32.2)	181(81.9)
Citrobacter spp (n=4)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	1(25.0)	1(25.0)	2(50.0)	4(100.0)
K. pneumoniae (n=92)	0(0.0)	0(0.0)	1(2.2)	7(7.6)	1(1.0)	10(9.7)	9(9.7)	64(69.5)	91(98.9)
E. cloacae (n=12)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	2(16.6)	2(16.6)	8(66.6)	12(100.0)
K oxytoca (n=9)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	1(11.1)	8(88.9)	9(100.0)
C. diversus (n=5)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	1((20.0)	2(40.0)	2(40.0)	5(100.0)
M. morganii (n=2)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	2(100.0)	2(100.0)
P. stuartii (n=1)	0(0.0)	1(100.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)
K. ozaenae (n=1)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)	1(100.0)	1(100.0)
Total (n=347)	1(0.3)	13(3.7)	28(8.1)	37(10.6	33(9.5)	41(11.8)	36(10.3)	158(45.5)	305(87.8)

Note: R0: resistance to no antibiotics, R1-7: resistance to 1, 2, 3, 4, 5, 6, and 7 antibiotics; ≥R3: resistance to 3 or more antibiotics from different classes.

Figure 2 The magnitude of ESBL-PE and non-E ESBL-PE at Debre Berhan Comprehensive Specialized Hospital from November 2020 to March 2021.

Figure 3 Antibiotics susceptibility pattern of ESBL producing and non-ESBL-producing Enterobacteriaceae at Debre Berhan Comprehensive Specialized Hospital from November 2020 to March 2021.

Abbreviations: AMP, ampicillin; FOX, cefoxitin; GM, gentamicin; CIP, ciprofloxacin; STX, trimethoprim-sulfamethoxazole; IPM, imipenem; MEP, meropenem; AMC, amoxicillin-clavulanic acid; CTX, cefotaxime; CAZ, ceftazidime; CRO, ceftriaxone; TE, tetracycline; FEP, cefepime; C, chloramphenicol.

Table 5 Distribution of ESBL-PE and MDR Isolates at Debre Berhan Comprehensive Specialized Hospital from November 2020 to March 2021

Isolates (Number)	ESBL Positive n (%)	Total MDR n%)
E. coli (n=221)	89 (49.2)	181(59.3)
K. pneumoniae (n=92)	55 (61.1)	91(29.8)
E. cloacae (n=12)	6(50.0)	12(3.9)
K. oxytoca (n=9)	8 (88.9)	9(2.9)
C. diversus (n=5)	2(40.0)	5(1.63)
Citrobacter spp (n=4)	2(50.0)	4(1.3)
M. morganii (n=2)	0(0.0)	2(0.6)
P. stuartii (n=1)	0(0.0)	0(0.0)
K. ozaenae (n=1)	1(100.0)	1(0.0)
Total (n=347)	163(53.4)	305(87.8)

Table 6 Factors Associated with Fecal Carriage of ESBL-PE at Debre Berhan Comprehensive Specialized Hospital from November 2020 to March 2021

Variables	Categories	ESBL Carriage n (%)	COR (95% CI)	P-value	AOR (95% CI)	P-value
Age group	Neonates	23 (6.6)	3.92 (1.69–9.09)	0.001	1.65 (0.9–4.79)	0.67
	Children	31 (8.9)	1.69 (0.945–3.02)	0.077	1.50 (0.28–8.09)	0.63
	Adults	110 (31.7)	1
History of antibiotic use in the past 3 months	Yes	80 (23.1)	7.35 (4.25–12.71)	0.000	4.68 (2.28–9.58)	≤0.001
	No	84 (24.2)	1
History of hospitalization in the past 12 months	Yes	62 (17.9)	4.03 (2.36–6.86)	0.000	1.02 (0.48–2.14)	0.960
	No	102 (24.4)	1
History of invasive procedure in the past 3 months	Yes	37 (10.7)	5.63 (2.63–12.09)	0.000	2.28 (0.91–5.74)	0.078
	No	127 (36.6)	1
Admission ward	NICU	23 (6.6)	6.11 (1.91–19.55)	0.02	4.86 (1.24–18.96)	0.023
	Pediatric	31 (8.9)	2.84 (1.01–7.77)	0.039	1.15 (0.38–3.52)	0.81
	Medical	39 (11.2)	1.45 (0.57–3.69)	0.432
	Surgery	39 (11.2)	1.69 (0.66–34.32)	0.273
	Gynecology and obstetrics	17 (4.9)	1.24 (0.44–3.49)	0.676
	Ophthalmology	8 (2.3)	1
Chronic disease	Yes	60 (17.3)	4.45 (2.55–7.75)	0.000	3.65 (1.87–7.13)	≤0.001
	No	104 (30.0)	1

Note: 1 =reference.

Abbreviations: CI, confidence interval; COR, crude odd ratio; AOR, adjusted odd ratio; NICU, neonatal intensive care unit.