Table 4_High prevalence of fecal carriage of extended-spectrum beta-lactamase producing Enterobacterales among patients with urinary tract infections in rural Tanzania.docx

IntroductionThe global rise of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) challenges resource-limited countries with insufficient laboratory infrastructure. This study investigates fecal carriage and risk factors for ESBL-PE and carbapenemase-producing organisms among patients with urinary tract infection (UTI) in rural Tanzania.
MethodsThis cross-sectional study was conducted at St. Francis Regional Referral Hospital, Ifakara, Tanzania, from October 2021 to August 2023, involving 326 UTI patients. Demographic data and resistance risk factors were collected via structured questionnaires. Stool samples collected pre-antibiotic treatment were screened for ESBL-PE and carbapenemase locally. Positive samples underwent further analysis in Switzerland using MALDI-ToF, Vitek MS, and whole-genome sequencing. Multivariable analysis assessed predictors associated with ESBL-PE carriage for risk factors with p < 0.05.
ResultsWe enrolled 326 UTI patients (median age: 35.5 years, range: 25–52) and 189 (58.0%) were females. Fecal ESBL-PE colonization was detected in 70.9% of patients, predominantly E. coli (62.8%) and K. pneumoniae (33.0%). Whole-genome sequencing identified diverse phylogroups and sequence types, with CTX-M-15 being the most common ESBL gene. IncF plasmids were the primary carriers. Younger age (aOR: 0.98, 95% CI: 0.97–0.99; p = 0.0239) and inpatient status (aOR: 1.77, 95% CI: 1.08–2.91; p = 0.0036) were significant risk factors for ESBL-PE carriage.
ConclusionThe high prevalence of ESBL-PE fecal carriage in rural Tanzania highlights the need for improved infection control and further research into community transmission dynamics.

引言
产超广谱β-内酰胺酶肠杆菌目细菌（extended-spectrum beta-lactamase-producing Enterobacterales, ESBL-PE）在全球范围内的流行态势，给实验室基础设施匮乏的资源受限国家带来了严峻挑战。本研究旨在调查坦桑尼亚农村地区尿路感染（urinary tract infection, UTI）患者中产ESBL-PE与碳青霉烯酶微生物的粪便携带情况及其相关危险因素。

方法
本研究为横断面研究，于2021年10月至2023年8月在坦桑尼亚伊法卡拉市圣弗朗西斯区域转诊医院开展，共纳入326名UTI患者。研究人员通过结构化问卷收集受试者的人口统计学资料与耐药相关危险因素。在抗生素治疗前采集的粪便样本将在本地完成ESBL-PE与碳青霉烯酶的初步筛查，阳性样本随后被送往瑞士，采用基质辅助激光解吸电离飞行时间质谱（matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, MALDI-ToF）、维特克质谱系统（Vitek MS）及全基因组测序进行深入分析。针对p值<0.05的危险因素，采用多变量分析评估与ESBL-PE携带相关的预测因子。

结果
本研究共纳入326名UTI患者，年龄中位数为35.5岁（范围25~52岁），其中女性189例，占比58.0%。70.9%的患者检测出粪便ESBL-PE定植，主要致病菌为大肠埃希菌（62.8%）与肺炎克雷伯菌（33.0%）。全基因组测序结果显示存在多种系统发育群与序列型，其中CTX-M-15是最常见的ESBL基因型，IncF型质粒为耐药基因的主要载体。分析显示，年龄更小（调整优势比（adjusted odds ratio, aOR）=0.98，95%置信区间（confidence interval, CI）：0.97~0.99；p=0.0239）与住院状态（aOR=1.77，95%CI：1.08~2.91；p=0.0036）是ESBL-PE携带的显著独立危险因素。

结论
坦桑尼亚农村地区ESBL-PE粪便携带率居高不下，这一现状凸显了加强感染防控工作、开展更多社区传播动态相关研究的必要性。