Abstract
BackgroundFecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) remains poorly documented in Africa. The objective of this study was to determine the prevalence of ESBL-PE fecal carriage in Chad.MethodsIn total, 200 fresh stool samples were collected from 100 healthy community volunteers and 100 hospitalized patients from January to March 2017. After screening using ESBL-selective agar plates and species identification by MALDI-TOF mass spectrometry, antibiotic susceptibility was tested using the disk diffusion method, and ESBL production confirmed with the double-disc synergy test. The different ESBL genes in potential ESBL-producing isolates were detected by PCR and double stranded DNA sequencing. Escherichia coli phylogenetic groups were determined using a PCR-based method.ResultsESBL-PE fecal carriage prevalence was 44.5% (51% among hospitalized patients vs 38% among healthy volunteers; p < 0.05). ESBL-producing isolates were mostly Escherichia coli (64/89) and Klebsiella pneumoniae (16/89). PCR and sequencing showed that 98.8% (87/89) of ESBL-PE harbored blaCTX-M genes: blaCTX-M-15 in 94.25% (82/87) and blaCTX-M-14 in 5.75% (5/87). Phylogroup determination by quadruplex PCR indicated that ESBL-producing E. coli isolates belonged to group A (n = 17; 27%), C (n = 17; 27%), B2 (n = 9; 14%), B1 (n = 8; 13%), D (n = 8; 13%), E (n = 1; 1.6%), and F (n = 1; 1.6%). The ST131 clone was identified in 100% (9/9) of E. coli B2 strains.ConclusionsThe high fecal carriage rate of ESBL-PE associated with CTX-M-15 in hospital and community settings of Chad highlights the risk for resistance transmission between non-pathogenic and pathogenic bacteria.
Highlights
Extended-Spectrum β-Lactamase-Producing Enterobacterial (ESBL-PE) have spread worldwide, and have become endemic in several countries since their first description in 1983 [1, 2]
We recently reported a high prevalence of ESBL-PE containing the CTX-M-15 enzyme in clinical isolates from three major Chadian hospital [15] (48%)
ESBL-PE rate was significantly higher among hospitalized patients (51%) than healthy volunteers (51% vs 38%; p < 0.05, Chisquare test)
Summary
Extended-Spectrum β-Lactamase-Producing Enterobacterial (ESBL-PE) have spread worldwide, and have become endemic in several countries since their first description in 1983 [1, 2]. Data on ESBL-PE fecal carriage in Sub-Saharan Africa are limited, and a few available studies reported a prevalence ranging from 6 (in Mauritania) to 66% (in Cameroon) in healthy volunteers and hospitalized patients [13, 14]. This small number of studies does not facilitate the identification of factors associated with this carriage in order to prevent and reduce the spread of ARB. The objective of this study was to determine the prevalence of ESBL-PE fecal carriage in Chad
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