# Faecal Carriage of Multidrug Resistant Enterobacterales and Associated Factors among Neonates Admitted at Tertiary Hospital in Dar es Salaam, Tanzania

## TL;DR

This study found that nearly 40% of hospitalized neonates in Tanzania carried drug-resistant bacteria, with factors like antibiotic use and hospital stay length increasing the risk.

## Contribution

The study identifies key risk factors for multidrug-resistant Enterobacterales carriage in neonates in a low-resource setting.

## Key findings

- 39.4% of neonates carried ESBL-producing Enterobacterales, with Klebsiella pneumoniae being the most common.
- Antibiotic use, age increase, and prolonged hospitalization were independently associated with ESBL carriage.
- Only 1.8% of neonates carried carbapenemase-producing Enterobacterales, but this was linked to longer hospital stays.

## Abstract

Hospitalised neonates are at increased risk of carrying extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) and carbapenemase-producing Enterobacterales (CPE), possibly leading to invasive infections. This study determined the faecal carriage of ESBL-PE, CPE, and associated factors among neonates at Muhimbili National Hospital (MNH).

A hospital-based cross-sectional study was conducted among neonates aged ≤ 28 days admitted at MNH. The participants’ data and rectal swab samples were collected. Samples were processed to detect ESBL-PE and CPE. Results were confirmed using the double-disc diffusion synergy test and modified carbapenem inactivation method, respectively. An antimicrobial susceptibility test was performed using the Kirby Bauer disk diffusion method.

Three hundred forty neonates with a median age of 3 days (IQR: 2–9) were enrolled. The carriage rate of ESBL-E and CPE was 39.4%(134/340) and 1.8%(6/340), respectively. Klebsiella pneumoniae (66.9%) and Escherichia coli (66.7%) were the common isolates for ESBL-PE and CPE, respectively. The factors independently associated with ESBL-PE carriage were antibiotic use (aOR 2.73, 95% CI: 1.38–5.39, p=.04), age increase (aOR 1.09, 95% CI: 1.02–1.15, p=.006), prolonged hospitalisation (aOR 2.92, 95% CI: 1.17–7.29, p=.02), and neonate-sucking their fingers (aOR 2.98, 95% CI: 1.04–8.58, p=.04). The study observed a trend of CPE carriage toward neonates with prolonged hospitalisation (p=.05). ESBL-PE low resistance was observed to meropenem (0.9%), amikacin (2.7%-6.7%), and gentamicin (19.4% to 100 %).

The study revealed a relatively high carriage rate of multidrug resistant Enterobacterales among neonates admitted to a tertiary hospital. These findings underscore the importance of continuous surveillance of ESBL-PE and CPE to prevent infections and limit their potential transmission within hospital settings and the community.