Abstract
The worldwide dissemination of extended-spectrum beta-lactamase producing Enterobacteriaceae, (ESBL-E) and their subset producing carbapenemases (CPE), is alarming. Limited data on the prevalence of such strains in infections from patients from Sub-Saharan Africa are currently available. We determined, here, the prevalence of ESBL-E/CPE in bacteriemic patients in two teaching hospitals from Bamako (Mali), which are at the top of the health care pyramid in the country. During one year, all Enterobacteriaceae isolated from bloodstream infections (E-BSI), were collected from patients hospitalized at the Point G University Teaching Hospital and the pediatric units of Gabriel Touré University Teaching Hospital. Antibiotic susceptibility testing, enzyme characterization and strain relatedness were determined. A total of 77 patients had an E-BSI and as many as 48 (62.3%) were infected with an ESBL-E. ESBL-E BSI were associated with a previous hospitalization (OR 3.97 95% IC [1.32; 13.21]) and were more frequent in hospital-acquired episodes (OR 3.66 95% IC [1.07; 13.38]). Among the 82 isolated Enterobacteriaceae, 58.5% were ESBL-E (20/31 Escherichia coli, 20/26 Klebsiella pneumoniae and 8/15 Enterobacter cloacae). The remaining (5 Salmonella Enteritidis, 3 Morganella morganii 1 Proteus mirabilis and 1 Leclercia adecarboxylata) were ESBL negative. CTX-M-1 group enzymes were highly prevalent (89.6%) among ESBLs; the remaining ones being SHV. One E. coli produced an OXA-181 carbapenemase, which is the first CPE described in Mali. The analysis of ESBL-E relatedness suggested a high rate of cross transmission between patients. In conclusion, even if CPE are still rare for the moment, the high rate of ESBL-BSI and frequent cross transmission probably impose a high medical and economic burden to Malian hospitals.
Highlights
Bacterial resistance to antibiotics is increasing worldwide in healthcare settings and in the community
There, during one year, we prospectively investigated and characterized the prevalence of extended spectrum beta-lactamase (ESBL-E) and carbapenemase producing Enterobacteriaceae (CPE) in bacteremic patients hospitalized at the University Teaching Hospitals of Bamako, which are at the top of the health care pyramid in the country
Materials and methods Study design and definitions. This prospective study has been conducted from January 1 to December 31 2014, at the Point G University Teaching Hospital (PGUH) (550 adult beds) and in the pediatric department of Gabriel Toure University Teaching Hospital (GTUH) (110 beds), both located in Bamako, Mali
Summary
Bacterial resistance to antibiotics is increasing worldwide in healthcare settings and in the community. The dissemination of multi-drug resistant Enterobacteriaceae, i.e. extended spectrum beta-lactamase (ESBL-E) and carbapenemase producing Enterobacteriaceae (CPE), is alarming [1]. The use of carbapenems, which are the first choice drug to treat ESBL-E severe infections, has increased. Carbapenem resistant bacteria, i.e. CPE, have emerged and disseminated all over the world, leaving few therapeutic options [3]. In addition infections are most often under-documented microbiologically and most antibiotic regimens are chosen empirically. This is for instance the case in Mali, belonging to the 30 poorest countries in the world (http:// data.worldbank.org/). There, during one year, we prospectively investigated and characterized the prevalence of ESBL-E and CPE in bacteremic patients hospitalized at the University Teaching Hospitals of Bamako, which are at the top of the health care pyramid in the country. The results show that the prevalence of resistance is very high and cross transmission of resistant strains is rather frequent
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