Carriage of ESBL-producing Klebsiella pneumoniae and Escherichia coli among children in rural Ghana: a cross-sectional study

Abstract

Background: Extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae (ESBL-KP) and Escherichia coli (ESBL-EC) present a high burden in both communities and healthcare sectors, leading to difficult-to-treat infections. Data on intestinal carriage of ESBL-KP and ESBL-EC in children is scarce, especially in sub-Saharan African countries. We provide data on faecal carriage, phenotypic resistance patterns, and gene variation of ESBL-EC and ESBL-KP among children in the Agogo region of Ghana.

Methods: From July to December 2019, fresh stool samples were collected within 24 h from children < 5 years with and without diarrhoea attending the study hospital. The samples were screened for ESBL-EC and ESBL-KP on ESBL agar and confirmed using double-disk synergy testing. Bacterial identification and an antibiotic susceptibility profile were performed using the Vitek 2 compact system (bioMérieux, Inc.). ESBL genes, blaSHV, blaCTX-M, and blaTEM were identified by PCR and further sequencing.

Results: Of the 435 children recruited, stool carriage of ESBL-EC and ESBL-KP was 40.9% (n/N = 178/435) with no significant difference in prevalence between children with diarrhoea and non-diarrhoea. No association between ESBL carriage and the age of the children was found. All isolates were resistant to ampicillin and susceptible to meropenem and imipenem. Both ESBL-EC and ESBL-KP isolates showed over 70% resistance to tetracycline and sulfamethoxazole-trimethoprim. Multidrug resistance was observed in over 70% in both ESBL-EC and ESBL-KP isolates. The blaCTX-M-15 was the most prevalent ESBL gene detected. blaCTX-M-27, blaCTX-M-14, and blaCTX-M-14b were found in non-diarrhoea stools of children, whereas blaCTX-M-28 was found in both the diarrhoea and non-diarrhoea patient groups.

Conclusions: The carriage of ESBL-EC and ESBL-KP among children with and without diarrhoea in the Agogo community with a high prevalence of blaCTX-M-15 is noteworthy, highlighting the importance of both the population as a possible reservoir. This study reports for the first time the ESBL gene blaCTX-M-28 among the studied populations in Ghana.

Keywords: Carriage; Children; Diarrhoea; Escherichia coli; Extended-spectrum beta-lactamase; Ghana; Klebsiella pneumoniae; Non-diarrhoea.

Fig. 1

Distribution and frequency of different β-lactamase genes among the ESBL isolates

Fig. 2

Antimicrobial resistance among ESBL-EC and ESBL-KP isolates from diarrhoea and non-diarrhoea stool samples of children. Abbreviations: Ampicillin (AMP), Ciprofloxacin (CIP), Ertapenem (ETP), Gentamicin (GM), Imipenem (IPM), Meropenem (MEM), Sulfamethoxazole-Trimethoprim (SXT), Tetracycline (TE), Piperacillin-Tazobactam (TZP), Ampicillin-Sulbactam (SAM). ^aMultidrug resistance I defined as resistance to three antibiotics. ^bMultidrug resistance II defined as resistance to four antibiotics. ^cMultidrug resistance III defined as resistance to five antibiotics