Impact of Empirical Antibiotic Therapy on the Carriage and Acquisition of Multidrug-Resistant Enterobacteriaceae in Paeditric Department of Sylvanus Olympio Teaching Hospital, Lomé, Togo

Abstract

Background: Antibiotic resistance in Enterobacteriaceae is a major global threat, particularly in hospitalized children, where it leads to difficult-to-treat infections and prolonged hospital stays. The gastrointestinal tract serves as a key reservoir for transmission, and limited pediatric data, including in Togo, highlights the need for further research. Aims: To estimate the prevalence of digestive carriage of multidrug-resistant Enterobacteriaceae (MDR-E) upon admission and after antibiotic treatment among children hospitalized in the paediatric department of the Sylvanus Olympio Teaching Hospital, Lomé, Togo, in 2023. Study Design: This was a cross-sectional before-and-after study involving children who received empirical antibiotic therapy. Place and Duration of Study: Intensive care units of the paediatric department, and microbiology laboratory of the of the Sylvanus Olympio Teaching Hospital in Lomé (Togo). The study took place from June 6 to September 11, 2023. Methodology: 203 rectal swabs were collected at admission, and 132 rectal swabs after empirical antibiotic therapy at discharge in hospitalized children. Screening for resistance was performed using media made selective through the addition of antibiotics. MacConkey medium (Oxoid) was made selective by the addition of cefotaxime (CTX) at a ratio of 20 ml of MacConkey medium+ 20 µl/ml of CTX for ESBL screening, and by adding ertapenem (ERT) at a ratio of 20 ml of MacConkey medium +0.5 µl/ml of ERT to screen for carbapenem-resistant strains. Results: Rectal swab at admission revealed a carriage rate of 52.7% for Extended-Spectrum Beta-Lactamase-producing Enterobacteriaceae (ESBL-E) and 15.3% for Carbapenem-Resistant Enterobacteriaceae (CRE). The most frequently isolated strain was Escherichia coli in 61.2% of cases. Rectal swab at discharge isolated 84.1% of ESBL strains and 48.5% of carbapenem-resistant strains. The overall carriage rate of MDR-E (multidrug-resistant Enterobacteriaceae) was 53.2% at admission and 84.8% at discharge. An MDR-E acquisition rate of 74.2% was observed. The acquisition of MDR-E strains was significantly associated with the length of hospital stay (p=0.003) and age (p=0.0001). Conclusion: The faecal carriage rate of multidrug-resistant Enterobacteriaceae strains in hospitalized children in this study is very high. It is therefore urgent to take measures to raise awareness about the spread of multidrug-resistant strains among children in Togo.