title: Intense pre-admission carriage and further acquisition of ESBL-producing Enterobacteriaceae among patients and their caregivers in a tertiary hospital in Rwanda.
abstract: To assess the presence and risk factors of intestinal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) among patients admitted to the University Teaching Hospital of Butare and among their attending caregivers, and to analyse the acquisition of ESBL-PE carriage during hospital stay and associated factors.
  
  
  
  We screened 392 patients and their attending caregivers at admission and discharge for ESBL-PE carriage. Bacterial species were determined using the API-20E system, and antimicrobial susceptibility testing was performed by agar disc diffusion. Data on socio-economic status, diet, behaviour, household assets, livestock and hospital procedures were collected.
  
  
  
  At admission, 50% of the patients showed intestinal ESBL-PE carriage (Escherichia coli, 51%; Klebsiella pneumoniae, 39%; Enterobacter cloacae, 19%) as did 37% of their caregivers. Co-resistance was common but no carbapenem resistance was detected. At discharge, the proportion of ESBL-PE-colonised patients increased to 65% (caregivers, 47%) with almost complete carriage in paediatric patients (93%). The acquisition rate among initially non-colonised patients was 55% (or, 71/1000 patient days). Independent predictors of admission carriage included a colonised caregiver, prior antibiotic intake, egg consumption and neglecting to boil drinking water, whereas being a paediatric patient, undergoing surgery and male gender predicted acquisition during hospitalisation.
  
  
  
  Abundant admission carriage of ESBL-PE and a high acquisition rate in a Rwandan university hospital point to potential intrahospital transmission and community dissemination. Caregivers are an additional source of possible spread. Risk factors of colonisation such as diet and water source need to be tackled to prevent the further emergence and spread of ESBL-PE.
authors.affiliation: Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Mathis S E
authors.initials: MS
authors.lastname: Kurz
authors.affiliation: University Teaching Hospital of Butare and School of Medicine and Pharmacy, University of Rwanda, Butare, Rwanda.
authors.forename: Claude
authors.initials: C
authors.lastname: Bayingana
authors.affiliation: University Teaching Hospital of Butare and School of Medicine and Pharmacy, University of Rwanda, Butare, Rwanda.
authors.forename: Jules M
authors.initials: JM
authors.lastname: Ndoli
authors.affiliation: University Teaching Hospital of Butare and School of Medicine and Pharmacy, University of Rwanda, Butare, Rwanda.
authors.forename: Augustin
authors.initials: A
authors.lastname: Sendegeya
authors.affiliation: Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Anita
authors.initials: A
authors.lastname: Durst
authors.affiliation: Medizinisch-Diagnostische Institute, Berlin, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Pfüller
authors.affiliation: University Teaching Hospital of Butare and School of Medicine and Pharmacy, University of Rwanda, Butare, Rwanda.
authors.forename: Jean Bosco
authors.initials: JB
authors.lastname: Gahutu
authors.affiliation: Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Mockenhaupt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification* / Q000378:metabolism; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010343:Patient Admission; D012307:Risk Factors; D012432:Rwanda / Q000453:epidemiology; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases
keywords: ESBL; Rwanda; acquisition; carriage; hospital