Prevalence and patient related factors associated with Extended-Spectrum Beta-Lactamase producing Escherichia coli and Klebsiella pneumoniae carriage and infection among pediatric patients in Tanzania

Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae (EPE) is increasing worldwide, though less documented in low-income settings. Here we determined the prevalence of EPE infection and carriage, and patient factors associated with EPE-carriage among pediatric patients in three health care levels in Tanzania. Between January and April 2016, 350 febrile children (median age 21 months) seeking care at a university or a regional referral hospital, or a health centre in Moshi municipality, Tanzania, were included. Socio-demographic characteristics were collected using a questionnaire. Rectal swabs and blood cultures were collected from all children ( n = 350) and urinary samples from 259 children at admission. ESBL-phenotype and antimicrobial susceptibility were determined for Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli ) isolates. Only one EPE case ( E. coli ) in blood and four in urine (one E. coli and three K. pneumoniae ) were found, whereas ( n = 90, 26%) of the children were colonized in feces (ESBL- E. coli ; n = 76, ESBL- K. pneumoniae, n = 14). High resistance rates were seen in fecal ESBL- E. coli ( n = 76) against trimethoprim-sulfamethoxazole ( n = 69, 91%), gentamicin ( n = 51, 67%), ciprofloxacin ( n = 39, 51%) and chloramphenicol ( n = 27, 35%) whereas most isolates were sensitive to amikacin ( n = 71, 93%). Similar rates were seen for fecal ESBL- K. pneumoniae . Resistance to first line antibiotics were also very high in fecal E. coli not producing ESBL. No sociodemographic factor was associated with EPE-carriage. Children colonized with EPE were younger than 12 months ( n = 43, 48%) and often treated with antibiotics ( n = 40, 44%) in the previous two months. After adjustment for age children admitted to the intensive care unit had higher odds of EPE fecal carriage compared with those in the general wards (OR = 3.9, 95%CI = 1.4–10.4). Despite comparatively high rates of fecal EPE-carriage and previous antibiotic treatment, clinical EPE cases were rare in the febrile children. The very high resistant rates for the EPE and the non-ESBL producing E. coli to commonly used antibiotics are worrying and demand implementation of antibiotic stewardship programs in all levels of health care in Tanzania.