Impact of antibiotic intake on incidence of extended spectrum beta-lactamase producing Enterobacterales in sub-Saharan Africa – results from a community-based longitudinal study

Abstract

Objectives

The global prevalence of intestinal extended spectrum beta-lactamases producing Enterobacterales (ESBL-PE) is about 17% in communities, with significant variations between regions. This longitudinal study aimed to assess the impact of antibiotic intake on incidence of intestinal ESBL-PE in Ghanaian pharmacy costumers outside of hospitals.

Methods

Screening for ESBL-PE was performed in four independent pharmacies in Kumasi, Ghana, by using rectal swabs and ESBL-PE-selective medium. Pharmacy customers purchasing antibiotics were recruited, those buying non-antibiotic drugs served as controls. Participants who were negative for ESBL-PE provided follow-up swabs for up to 28 days.

Results

At baseline, 302 of 404 participants (75%) were colonized with ESBL-PE. Sixty-three participants negative for ESBL-PE at baseline received per-protocol follow-up, including 28 individuals who took antibiotics and 35 controls. The cumulative proportion of ESBL-PE in the antibiotics and control group was 71% (20/28) vs. 54% (19/35) at the first follow-up (p=0.258), 86% (24/28) vs. 80% (28/35) at the second follow-up (p=0.741) and 86% (24/28) vs. 94% (33/35) at the third follow-up (p=0.393), respectively.

Conclusions

The rate of intestinal ESBL-PE carriage among pharmacy costumers outside of hospitals was higher than expected at baseline and further increased during the 28 days of follow-up - irrespective of antibiotic intake. This alarming finding needs to be considered in antibiotic treatment of outpatients and emphasizes the urgent need of improved prevention strategies,development of new antibiotic drugs and potential future elimination strategies. Further longitudinal studies on ESBL-PE in African communities, also outside of pharmacy settings, are required.