Kofi Kobina Amandzé Adams^{1, 2,}, Koffi Kouadio Stéphane^{2, 3}, Yapi Ivane Alexia³, Dine Mourtada^{3, 4}, Obouayeba Nguessan Djaman Carole¹, Guessend Nathalie⁵, Kra Adou Koffi Mathieu¹, Kacou-N’douba Adèle³

Background: The growing threat of antibiotic resistance poses a major challenge to global public health as it could lead to up to 10 million deaths annually by 2050, particularly in low-income countries. The COVID-19 pandemic has further worsened the issue of multidrug-resistant bacteria, particularly extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE). In Africa, data on intestinal carriage on ESBL-PE are scarce. This study aimed to assess the prevalence and risk factors associated with ESBL-PE intestinal carriage among outpatients at Treichville University Hospital. Method: This study was conducted from July to December 2023 at Treichville University Hospital. Rectal swabs were collected from patients attending the general medical consultation ward selected by systematic random sampling. Enterobacteriaceae strains were identified by conventional methods and antibiotic susceptibility testing was carried out in accordance with the CA-SFM EUCAST 2022 guidelines. Data were analysed using R studio software version 4.0.3. Results: Rate of intestinal carriage with resistance Enterobacteriaceae was 54.55%. Prevalence of ESBL-PE in intestinal carriage was 30.90%. Among ESBL-PE carriers, the predominant age group was between 40 years and older; with a sex ratio of 1.26 (55.88% male). Escherichia coli and Klebsiella pneumoniae were the common ESBL producer species at 43.33% and 11.67% respectively. According to observed resistance patterns and predefined multidrug resistance categories, 94.60% of Escherichia coli strains and 100.00% of Klebsiella pneumoniae strains were identified as Multidrug-resistant. Only 5.40% of Escherichia coli strains were identified as Extensively drug-resistant. No isolates were classified as Pandrug- resistant. Risk factors like size of household living in a single room, presence of children under 15 years old, previous hospitalization (less than 6 months), antibiotic use (less than 3 months) and chronic medical diseases were significantly associated with ESBL-PE intestinal carriage (p<0.05). Conclusion: High rate of ESBL-PE in intestinal carriage was observed. The knowledge of factors associated with Multi-resistant Enterobacteriaceae carriage helps to identify patients at risk to combat the spread of resistant bacteria within the healthcare system.

intestinal carriage, antibiotic resistance, enterobacteriaceae, ESBL, Low-income contry, Côte d’Ivoire