High prevalence of antimicrobial resistance mechanisms in a rural hospital in Ethiopia

INTRODUCTION: To determine the prevalence of fecal carriage of antimicrobial resistance (AMR) genes in 40 pediatric inpatients managed in a rural hospital in Ethiopia (May-June 2024). PATIENTS AND METHODS: We conducted a prospective study in 40 pediatric inpatients managed at Gambo Rural General Hospital, Oromia, Ethiopia (May-June 2024). Stool samples were collected to assess for intestinal carriage and screened using the Allplex™ Entero-DR multiplex PCR assay for genes associated with carbapenemase-producing Enterobacterales (CPE), extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales, and vancomycin-resistant Enterococcus (VRE). We collected data on demographic and clinical characteristics and antibiotic exposure. The statistical analysis included the Mann-Whitney U and Fisher's exact tests. RESULTS: Fecal carriage of AMR genes was detected in 82.5% of patients. The most prevalent resistance mechanism was CTX-M (80.0%), followed by NDM (37.5%), vanA (32.5%), and VIM (10.0%). Testing did not detect KPC, OXA-48, IMP, or vanB genes. Malnutrition was present in 65% of the patients. There were no statistically significant differences in clinical outcomes (length of stay, severity) between patients with and without AMR genes (P > .05 in all comparisons; limited by the sample size of n = 40). Severe chronic malnutrition was less frequent among carbapenemase carriers (12.5% vs 62.5%; P = .033). This exploratory finding should be interpreted with extreme caution due to multiple testing, low statistical power (n = 40), and potential sources of bias including altered gut microbiota, reduced health care exposure among severely malnourished children, or chance. These observations only describe colonization patterns and cannot be used to infer causality. CONCLUSIONS: We found a high prevalence of fecal carriage of AMR genes in stool samples from pediatric inpatients in this hospital in rural Ethiopia, underscoring the need for enhanced surveillance, stewardship, and infection control measures in resource-limited settings.