Abstract
BackgroundIn recent years, the world has seen a surge in extended-spectrum β-lactamase (ESBL)-producing bacteria. However, data on the dissemination of ESBL-producing Enterobacteriaceae in the community from systematically enrolled study subjects in Africa remains limited. To determine the prevalence, phenotypic resistance patterns and genetic characteristics of ESBL-producing E. coli and K. pneumoniae in fecal carriage and to analyze associated risk factors in children attending a pediatric emergency department in Guinea-Bissau.Methodology/Principal FindingsFrom June to September 2010, children <5 years of age with fever or tachycardia attending a pediatric emergency ward during the day was screened for ESBL carriage in feces. Socio-demographic and health seeking behavior data was collected. Antibiotic susceptibility was tested with VITEK2 and EUCAST disk diffusion method, molecular characterization of ESBL-encoding genes was performed with multiplex PCR and clonal relatedness was established by automated rep-PCR. Of 408 enrolled children 133 (32.6%) were ESBL carriers. In total, 83 E. coli and 91 K. pneumoniae ESBL-producing isolates were obtained. Nearly all isolates were multidrug-resistant. Co-resistance to ciprofloxacin, trimethoprim-sulfamethoxazole and aminoglycosides was common. Of the isolates, 38.5% were co-resistant to these classes plus extended-spectrum cephalosporins, which infers resistance to all easily available antibiotic agents for treatment of gram-negative sepsis in Guinea-Bissau. The predominant resistance-encoding gene subgroup was bla CTX-M-1 and epidemiologic typing showed that the bacterial ESBL population was highly diverse both for E. coli and K. pneumoniae. Bed sharing with another child <5 years of age was a risk factor for ESBL carriage, indicating crowding as a potential risk factor for transmission of ESBL-producing bacteria.Conclusions/SignificancePrevalence of ESBL-producing bacteria in this population was high and clonally diverse. This is alarming considering the limited diagnostic and treatment possibilities in Guinea-Bissau and other resource-poor countries.
Highlights
During the past few decades, ever-increasing use of antibiotic agents has led to selective pressure in favor of bacteria that have acquired resistance enzymes [1]
The blaCTX-M genes are located on such plasmids and the presence of the blaCTX-M-15 gene has been linked to the ongoing spread of extended-spectrum b-lactamase (ESBL) globally [5]
408 patients were included in the analyses of which 133 (32.6%) were carriers of at least one ESBL-producing E. coli or K. pneumoniae strain
Summary
During the past few decades, ever-increasing use of antibiotic agents has led to selective pressure in favor of bacteria that have acquired resistance enzymes [1]. ESBLs are currently spreading rapidly amongst Enterobacteriaceae, largely due to genes located on plasmids that can disseminate across species barriers [3,4]. The blaCTX-M genes are located on such plasmids and the presence of the blaCTX-M-15 gene has been linked to the ongoing spread of ESBLs globally [5]. Such dissemination of CTX-Mproducing Enterobacteriaceae strains is an emerging public health concern [6].
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