Prevalence, Antimicrobial Susceptibility Profile of Citrobacter and Risk Factors Associated with Diarrheal Diseases in Water Wells in Urban West Region, Zanzibar

Citrobacter are Gram-negative bacteria that give public health challenges due to their zoonotic infections. Diarrheal diseases and antimicrobial resistance are global concerns that increase the burden of implementing infectious disease monitoring, especially in poor economic countries. This study was conducted to determine the prevalence and antimicrobial susceptibility and assess the risk factors of diarrheal diseases caused by bacteria from drinking water wells in the Urban West Region of Zanzibar. A cross-sectional study design was conducted where samples and data were collected from different locations in the Urban West Region of Zanzibar. A total of 250 water samples and respondents were randomly selected. Citrobacter spp. was identified by culture media, gram staining, biochemical tests, MALDI-TOF, PCR and sequencing. Antimicrobial susceptibility test to common antimicrobials was done using disc diffusion methods on Mueller Hinton agar. Antimicrobial resistance genes were detected by using PCR. Descriptive statistics were used for data analysis and evolutionary analysis was conducted in MEGA XI whereby a phylogenetic tree was constructed. A total of 13 (5.2%) Citrobacter spp were isolated from wells water samples, namely, C. amalonaticus, C. freundii, C. braakii, C. werkmanii and C. farmeri. Antimicrobial susceptibility tests revealed the potential of isolates to resist antimicrobials. Whereas genomic detection of resistance genes revealed the existence of tetA, blaSHV, bla-CTXM and sul1 and sul2. 87.6% of respondents were knowledgeable about diarrheal diseases. 54.8% of respondents expressed a positive attitude and 50.4% demonstrated effective practice for preventing diarrheal diseases. This study recommends that the best public health measures be taken in order to reduce the contamination of enteric pathogens that are potentially resistant to antimicrobials in well water. Water authorities and health officials should minimize the risk of diarrheal diseases, by providing knowledge, positive attitude and monitoring preventive practices to drinking water consumers.