Abstract
BackgroundExtended-spectrum ß-lactamase-producing Enterobacteria (ESBL-PE) emerged at the end of the 1980s, causing nosocomial outbreaks and/or hyperendemic situations in hospitals and long-term care facilities. In recent years, community-acquired infections due to ESBL-PE have spread worldwide, especially across developing countries including Madagascar.ObjectivesThis study aimed to determine the prevalence and risk factors of intestinal carriage of ESBL-PE in the community of Antananarivo.MethodsNon-hospitalized patients were recruited in three health centers in different socio economic settings. Fresh stool collected were immediately plated on Drigalski agar containing 3 mg/liter of ceftriaxone. Gram-negative bacilli species were identified and ESBL production was tested by a double disk diffusion (cefotaxime and ceftazidime +/− clavulanate) assay. Characterization of ESBLs were perfomed by PCR and direct sequencing . Molecular epidemiology was analysed by Rep-PCR and ERIC-PCR.Results484 patients were screened (sex ratio = 1.03, median age 28 years). 53 ESBL-PE were isolated from 49 patients (carrier rate 10.1%). The isolates included Escherichia coli (31), Klebsiella pneumoniae (14), Enterobacter cloacae (3), Citrobacter freundii (3), Kluyvera spp. (1) and Pantoae sp.(1). In multivariate analysis, only the socioeconomic status of the head of household was independently associated with ESBL-PE carriage, poverty being the predominant risk factor.ConclusionsThe prevalence of carriage of ESBL in the community of Antananarivo is one of the highest reported worldwide. This alarming spread of resistance genes should be stopped urgently by improving hygiene and streamlining the distribution and consumption of antibiotics.
Highlights
53 extended spectrum b-lactamases (ESBLs)-PE were isolated from 49 patients
Only the socioeconomic status of the head of household was independently associated with ESBL-producing enterobacteria (ESBL-PE) carriage, poverty being the predominant risk factor
New classes of enzymes conferring resistance to b-lactam antibiotics have emerged over the last few decades, due to antibiotic selection pressure; most alarming are the extended spectrum b-lactamases (ESBLs) produced by enteric pathogens that have spread worldwide since their first description in 1983 [1]
Summary
New classes of enzymes conferring resistance to b-lactam antibiotics have emerged over the last few decades, due to antibiotic selection pressure; most alarming are the extended spectrum b-lactamases (ESBLs) produced by enteric pathogens that have spread worldwide since their first description in 1983 [1]. TEM- and SHV-type b- lactamases, mainly produced by Klebsiella pneumoniae, have spread throughout hospital settings, and CTX-M enzymes, mainly produced by Escherichia coli, have become predominant in the community [3,4]. Extended-spectrum ß-lactamase-producing Enterobacteria (ESBL-PE) emerged at the end of the 1980s, causing nosocomial outbreaks and/or hyperendemic situations in hospitals and long-term care facilities. Community-acquired infections due to ESBL-PE have spread worldwide, especially across developing countries including Madagascar
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