Extended Spectrum Beta-Lactamase Carriage in acute care surgery patients at a tertiary referral hospital in Rwanda

Author(s):
Christophe Mpirimbanyi; Miguel Gasakure; Barbra Mutamba; Nathalie Umugwaneza; Jean Paul Rugambwa; Jennifer Rickard

Background:

Gram negative bacteria are commonly isolated from surgical infections with high rates of extended-spectrum-beta-lactamase (ESBL), in these isolates. Some individuals have been shown to be colonized (but not infected) with bacteria. The aim of this study was to determine the prevalence of ESBL carriage on hospital admission in acute care surgery patients at a tertiary referral hospital in Rwanda.

Hypothesis:

We hypothesize that ESBL-PE carriage is a risk factor for ESBL SSI and interventions targeted toward ESBL carriers can reduce the risk of SSI.

Methods:

We performed a cross-sectional study of acute care surgery patients presenting to a tertiary referral hospital in Rwanda. We collected nasal and rectal samples, testing for ESBL using culture and sensitivity testing to determine the frequency of ESBL carriage on hospital admission. We use Chi square and Fischer’s exact test to determine factors associated with ESBL carriage.

Results:

Over a one-year period, we collected samples from 106 acute care surgery patients. Most (n=83, 78%) were male and 84 (86%) had been transferred from another facility. The most common diagnoses were peritonitis (n=17, 16%), peptic ulcer disease perforation (n=17, 16%), and intestinal obstruction (n=14, 13%) with most (n=76, 71%) patients undergoing exploratory laparotomy. Overall, 29 (27%) patients were carriers of ESBL on hospital admission with rectal carriage more common than nasal carriage (26 vs 5 patients). Diagnosis of trauma was associated with lower ESBL carriage on hospital admission (p=0.034).

Conclusions:

ESBL carriage is relatively high in acute care surgery patients presenting to a tertiary referral hospital in Rwanda. This should be taken into consideration when developing antibiotic prophylaxis and treatment regimens