Risk factors associated with rectal carriage of carbapenem resistant Enterobacterales in northern Nigeria: a hospital surveillance

BACKGROUND: Carbapenem resistant Enterobacterales (CRE) are important cause of antimicrobial resistance (AMR). AMR is a global problem that disproportionately affects the low and middle income countries (LMIC) more. Appreciating what these risk factors were before the recent COVID-19 epidemic would help us appreciate what changes have happened in the post COVID-19 era. METHODS: This was a hospital-based cross-sectional study conducted in 2017 in the largest tertiary health facility in northern Nigeria. Epidemiologic risk factors of interest were investigated using an interviewer administered questionnaire, followed by collection of a rectal swab sample. Regression analyses were conducted to appreciate what were the strengths of association between the outcome of interest as rectal carriage of CRE and the investigated risk factors. RESULTS: Rectal carriage of CRE was 4.2% (N = 168) in this study. Increasing age was independent risk factor (adjusted OR = 0.2, CI:0.04-0.98, p = 0.047) that increased the risk of rectal carriage of CRE. Education appeared to decrease the risk (unadjusted OR = 0.21, CI:0.06-0.76, p = 0.018) while length of admission stay in Nigeria increased the risk of rectal carriage of CRE (adjusted OR = 3.9, CI: 1.12-13.49, p = 0.030) against rectal carriage of CRE. Also the ward a patient was admitted into was an important risk factor that increased the risk (adjusted OR = 3.1, CI:1.14-8.20, p = 0.030) for rectal carriage of CRE. CONCLUSIONS: Length of hospital stay and the ward a patient was admitted into were associated with increasing risk for rectal carriage of CRE. Epidemiologic risk factors for rectal carriage of CRE are quite similar within the LMIC context. It will be important to appreciate how these risk factors have changed since the COVID-19 pandemic. This would help make policies that focus on the most efficient counter measures to reduce the burden antimicrobial resistance in the LMIC. CLINICAL TRIAL NUMBER: Not applicable.