Risk factors associated with rectal carriage of extended spectrum beta-lactamases producing Enterobacterales among inpatients at a tertiary hospital in Northern Nigeria: A cross-sectional study

Abstract

Antimicrobial resistance (AMR) is a major cause of morbidity and mortality. AMR is a global problem that disproportionately affects the low and middle-income countries (LMIC), and Extended Spectrum Beta-lactamases producing Enterobacterales (ESBL-PE) are an important contributor. This study was aimed at understanding what risk factors were associated with the rectal carriage of ESBL-PE before the recent COVID-19 epidemic. This was a cross-sectional study conducted in 2017 at a tertiary health facility in northern Nigeria. Risk factors of interest were investigated using an interviewer-administered questionnaire, and a rectal swab sample was collected for analysis. Multiple logistic regression analyses were done to appreciate what risk factors were associated with rectal ESBL-PE carriage. This study found a rectal ESBL-PE carriage of 87.5% (N = 168). Significant risk factors included length of hospital stay in the past year outside Nigeria (X2 = 14.3, p = 0.003), any form of antibiotic use outside Nigeria (X2 = 8.2, p = 0.004), and beta-lactam antibiotic use outside Nigeria (X2 = 8.2, p = 0.004). Previous hospital admission outside Nigeria was found to be a protective independent risk factor against rectal ESBL-PE carriage (OR = 0.065, CI 0.005-0.806, p = 0.004). Rectal ESBL-PE carriage was high during the pre-COVID era in the LMIC context. As the COVID pandemic era ensures, it will be necessary to appreciate what risk factors for the rectal carriage of CRE look like. This would enable LMIC policymakers to contextualize countermeasures to be effective in mitigating the problem of AMR.