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Here we determined the prevalence of EPE infection and carriage, and patient factors associated with EPE-carriage among pediatric patients in three health care levels in Tanzania. Between January and April 2016, 350 febrile children (median age 21\u00a0months) seeking care at a university or a regional referral hospital, or a health centre in Moshi municipality, Tanzania, were included. Socio-demographic characteristics were collected using a questionnaire. Rectal swabs and blood cultures were collected from all children (<jats:italic>n<\/jats:italic>\u2009=\u2009350) and urinary samples from 259 children at admission. ESBL-phenotype and antimicrobial susceptibility were determined for <jats:italic>Klebsiella pneumoniae (K. pneumoniae)<\/jats:italic> and <jats:italic>Escherichia coli (E. coli<\/jats:italic>) isolates. Only one EPE case (<jats:italic>E. coli<\/jats:italic>) in blood and four in urine (one <jats:italic>E. coli<\/jats:italic> and three <jats:italic>K. pneumoniae<\/jats:italic>) were found, whereas (<jats:italic>n<\/jats:italic>\u2009=\u200990, 26%) of the children were colonized in feces (ESBL-<jats:italic>E. coli<\/jats:italic>; <jats:italic>n<\/jats:italic>\u2009=\u200976, ESBL-<jats:italic>K. pneumoniae, n<\/jats:italic>\u2009=\u200914). High resistance rates were seen in fecal ESBL-<jats:italic>E. coli<\/jats:italic> (<jats:italic>n<\/jats:italic>\u2009=\u200976) against trimethoprim-sulfamethoxazole (<jats:italic>n<\/jats:italic>\u2009=\u200969, 91%), gentamicin (<jats:italic>n<\/jats:italic>\u2009=\u200951, 67%), ciprofloxacin (<jats:italic>n<\/jats:italic>\u2009=\u200939, 51%) and chloramphenicol (<jats:italic>n<\/jats:italic>\u2009=\u200927, 35%) whereas most isolates were sensitive to amikacin (<jats:italic>n<\/jats:italic>\u2009=\u200971, 93%). Similar rates were seen for fecal ESBL-<jats:italic>K. pneumoniae<\/jats:italic>. Resistance to first line antibiotics were also very high in fecal <jats:italic>E. coli<\/jats:italic> not producing ESBL. No sociodemographic factor was associated with EPE-carriage. Children colonized with EPE were younger than 12\u00a0months (<jats:italic>n<\/jats:italic>\u2009=\u200943, 48%) and often treated with antibiotics (<jats:italic>n<\/jats:italic>\u2009=\u200940, 44%) in the previous two months. After adjustment for age children admitted to the intensive care unit had higher odds of EPE fecal carriage compared with those in the general wards (OR\u2009=\u20093.9, 95%CI\u2009=\u20091.4\u201310.4). Despite comparatively high rates of fecal EPE-carriage and previous antibiotic treatment, clinical EPE cases were rare in the febrile children. The very high resistant rates for the EPE and the non-ESBL producing <jats:italic>E. coli<\/jats:italic> to commonly used antibiotics are worrying and demand implementation of antibiotic stewardship programs in all levels of health care in Tanzania.<\/jats:p>","DOI":"10.1038\/s41598-021-02186-2","type":"journal-article","created":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T11:02:20Z","timestamp":1637665340000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Prevalence and patient related factors associated with Extended-Spectrum Beta-Lactamase producing Escherichia coli and Klebsiella pneumoniae carriage and infection among pediatric patients in Tanzania"],"prefix":"10.1038","volume":"11","author":[{"given":"Nuru","family":"Letara","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James Samwel","family":"Ngocho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nahid","family":"Karami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sia E.","family":"Msuya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balthazar","family":"Nyombi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy A.","family":"Kassam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susann","family":"Skovbjerg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"\u00c5hren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rune","family":"Philemon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blandina T.","family":"Mmbaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,11,23]]},"reference":[{"issue":"1","key":"2186_CR1","first-page":"20342","volume":"4","author":"V Storberg","year":"2014","unstructured":"Storberg, V. 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