Prevalence of Extended-Spectrum β-Lactamase Producing Enterobacteriaceae in Community Patients in Blantyre, Malawi

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Abstract Background Antimicrobial resistance due to production of extended-spectrum β-lactamase (ESBL) by Enterobacteriaceae is a global health problem contributing to increased morbidity and mortality particularly in resource-constrained countries. We examined in the current study the prevalence of extended spectrum β-lactamase producing Enterobacteriaceae (ESBL-E) in community patients in Blantyre, Malawi. Methods This was a cross sectional study conducted between March and September 2020 at selected outpatient health facilities in Blantyre, Malawi. Clinical samples were first screened for ESBL-E using CHROMagar™ ESBL medium and later confirmed by a combination disk test method (CDT). The isolates were identified to species level using a commercially acquired biochemical substrate strips (Microbact™ GNB, Oxoid). Descriptive summary statistics were generated as frequencies and proportions. Chi square or Fishers Exact tests and student’s t-test were used where appropriate. Association between variables was determined by logistic regression analysis. Results were presented as odds ratio and 95% confidence interval. A p-value ≤ 0.05 was regarded as statistically significant. Results A total of 199 rectal swabs and 101 urine samples from 300 outpatient adults were screened for ESBL-E. Of these, seventy three (24.33%; 95%, CI = 19.45–29.22%) gave positive culture. Prevalence of community acquired ESBL-E was 16.67% (50/300, 95% CI = 12.43–20.91%). The most common ESBL-E species isolated were Escherichia coli (66%). Community prevalence of ESBL-E was higher in male 56% (28/50) compared to female 44% (22/50) patients. Prevalence of ESBL-E was higher in community patients who lacked history of surgery 88% (44/50) and prior history of antibiotic use in the last three months 80% (40/50) compared to those with same characteristics. All community patients with isolated ESBL-E had no history of admission in the last three months and neither demographic characteristics nor clinical characteristics of participants showed any degree of association with the carriage of ESBL-E. Conclusion Our findings revealed moderate presence of ESBL-E phenotypes in a community patients who lacked history of hospital admissions in the past three months an indication of community acquisition of ESBL-E in Blantyre, Malawi. Low prevalence of ESBL-E in the community settings in Blantyre can be maintained if strong infection and antimicrobial use control strategies are to be implemented.

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