Prevalence and Determinants of Carbapenem Resistance Among ESBL-Producing Enterobacteriaceae in Biological Specimens at Kilimanjaro Christian Medical Centre, Moshi, Tanzania

Abstract

Background: Carbapenem resistance represents a critical global health threat, as it undermines the efficacy of last resort antibiotics used to manage infections caused by multidrug-resistant, extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. The burden is disproportionately higher in low- and middle-income countries, particularly in Africa, due to economic constraints and limited healthcare infrastructure. In sub-Saharan Africa, data on the prevalence and distribution of carbapenem resistance remain limited; however, existing studies highlight its growing emergence among the ESBL-producing Enterobacteriaceae in the region.
Objectives: The aim of this study was to determine the prevalence and determinants of carbapenem resistance among ESBL-producing Enterobacteriaceae isolated from biological specimens at Kilimanjaro Christian Medical Centre.
Methodology: A cross-sectional laboratory-based study was conducted from April to June 2023 at KCMC University, analysing 166 Enterobacteriaceae isolates from urine, pus, and blood. The production of ESBL was confirmed by phenotypic carbapenemase screening via the modified carbapenem inactivation method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Socio-demographic and clinical data were retrieved using data extraction sheets. Statistical analysis was performed using SPSS version 27, and a P value of <.05 was considered statistically significant.
Results: A total of 166 ESBL-producing Enterobacteriaceae were tested for carbapenemase production, 36 (21.7%) revealed to be resistant to carbapenem. The distribution of carbapenemase production E. coli were most prevalent at 23 (13.8%) followed by Citrobacter freundii at 7 (4.2%). Multivariable analysis revealed history of hospital admission within the past three months (AOR 6.28, 95% confidence interval [CI], 1.79 to 22.04; P=.004), the use of indwelling devices during the study period (P=.038), and the presence of comorbid conditions (P=.014) as independent predictors of carbapenem resistance.
Conclusion: The substantial prevalence observed underscores the urgent need to strengthen antimicrobial stewardship, enhance infection prevention strategies, and improve routine surveillance systems in resource-limited healthcare settings.