1887

Abstract

A previous study conducted in Gabon, Central Africa, in 2010/11 found a high colonization rate with extended-spectrum β-lactamase-producing enterobacterales (ESBL-E) among children of ~34 %. Eight years later, we aimed to reassess the ESBL-E rate and previously identified risk factors for colonization in children from Gabon. We conducted a cross-sectional cohort study in 2018 on 92 outpatients under 5 years of age with diarrhoea in Lambaréné, Gabon, in whom a rectal swab was obtained at the initial medical encounter (baseline). Fifty-eight of these provided a further rectal swab 1 week afterwards. ESBL-E colonization was assessed [following the European Committee on Antimicrobial Susceptibility Testing (EUCAST)], and in confirmed ESBL-E isolates the susceptibility to meropenem and the prevalence of the most abundant ESBL genes, , , and , were investigated. At baseline, the ESBL-E colonization rate was 57 % (52/92; 95 % CI: 46–67). Hospitalization during the previous year, chicken consumption in the past week and young age were identified as independent risk factors for ESBL-E colonization at baseline. On day 7, the ESBL-E carriage rate was 72 % (42/58; 95 % CI: 59–83). All ESBL-E isolates (=293) were susceptible to meropenem and was the most frequently detected β-lactamase gene. The ESBL-E colonization rate among children from Gabon is alarmingly high, with indications of further increase over recent years. While all ESBL-E strains remain currently susceptible to meropenem, in practice no adequate treatment is available locally for severe infections with such isolates. It is thus of the utmost importance to invest in improved hospital infection prevention and control measures to combat ESBL-E effectively.

Funding
This study was supported by the:
  • Deutsche Forschungsgemeinschaft (Award GZ EI 1044/1-1)
    • Principle Award Recipient: NotApplicable
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2021-08-17
2022-09-30
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References

  1. Review on Antimicrobial Resistance Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations 2014
    [Google Scholar]
  2. Tacconelli E, Carrara E, Savoldi A et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis 2018; 18:318–327 [View Article] [PubMed]
    [Google Scholar]
  3. Rottier WC, Ammerlaan HS, Bonten MJ. Effects of confounders and intermediates on the association of bacteraemia caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae and patient outcome: a meta-analysis. J Antimicrob Chemother 2012; 67:1311–1320 [View Article] [PubMed]
    [Google Scholar]
  4. Lautenbach E, Patel JB, Bilker WB, Edelstein PH, Fishman NO. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin Infect Dis 2001; 32:1162–1171 [View Article] [PubMed]
    [Google Scholar]
  5. Karanika S, Karantanos T, Arvanitis M, Grigoras C, Mylonakis E. Fecal colonization with extended-spectrum beta-lactamase-producing enterobacteriaceae and risk factors among healthy individuals: A systematic review and metaanalysis. Clin Infect Dis 2016; 63:310–318 [View Article] [PubMed]
    [Google Scholar]
  6. Emmanuel Martinez A, Widmer A, Frei R et al. ESBL-colonization at ICU admission: impact on subsequent infection, carbapenem-consumption, and outcome. Infect Control Hosp Epidemiol 2019; 40:408–413 [View Article] [PubMed]
    [Google Scholar]
  7. Schaumburg F, Alabi A, Kokou C et al. High burden of extended-spectrum β-lactamase-producing Enterobacteriaceae in Gabon. J Antimicrob Chemother 2013; 68:2140–2143 [View Article] [PubMed]
    [Google Scholar]
  8. Ouchar Mahamat O, Tidjani A, Lounnas M et al. Fecal carriage of extended-spectrum β-lactamase-producing. Antimicrob Resist Infect Control 2019; 8:169 [View Article]
    [Google Scholar]
  9. Magoué CL, Melin P, Gangoué-Piéboji J. Prevalence and spread of extended-spectrum β-lactamase-producing Enterobacteriaceae in Ngaoundere, Cameroon. Clin Microbiol Infect 2013; 19:E416 [View Article]
    [Google Scholar]
  10. Djuikoue IC, Woerther PL, Toukam M et al. Intestinal carriage of extended spectrum beta-lactamase producing E. coli in women with urinary tract infections, Cameroon. J Infect Dev Ctries 2016; 10:1135–1139 [View Article] [PubMed]
    [Google Scholar]
  11. Farra A, Frank T, Tondeur L et al. High rate of faecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae in healthy children in Bangui, Central African Republic. Clin Microbiol Infect 2016; 22:891 [View Article]
    [Google Scholar]
  12. Lonchel CM, Melin P, Gangoué-Piéboji J et al. Extended-spectrum β-lactamase-producing Enterobacteriaceae in Cameroonian hospitals. Eur J Clin Microbiol Infect Dis 2013; 32:79–87 [View Article] [PubMed]
    [Google Scholar]
  13. Lonchel CM, Meex C, Gangoué-Piéboji J et al. Proportion of extended-spectrum ß-lactamase-producing Enterobacteriaceae in community setting in Ngaoundere, Cameroon. BMC Infect Dis 2012; 12:53 [View Article] [PubMed]
    [Google Scholar]
  14. The Center for Disease Dynamics, Economics & Policy ResistanceMap: Antibiotic use in French West Africa; 2019 https://resistancemap.cddep.org/CountryPage.php?countryId=75&country=French+West+Africa
  15. Gudiol C, Cuervo G, Carratala J. Optimizing therapy of bloodstream infection due to extended-spectrum beta-lactamase-producing Enterobacteriaceae. Curr Opin Crit Care 2019; 25:438–448 [View Article] [PubMed]
    [Google Scholar]
  16. Hijazi SM, Fawzi MA, Ali FM, Abd El Galil KH. Prevalence and characterization of extended-spectrum beta-lactamases producing Enterobacteriaceae in healthy children and associated risk factors. Ann Clin Microbiol Antimicrob 2016; 15:3 [View Article] [PubMed]
    [Google Scholar]
  17. European Committee on Antimicrobial Susceptibility Testing Guidelines for detection of resistance mechanisms and specific resistances of clinical and/or epidemiological importance (version 2.0). EUCAST; 2017 http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Resistance_mechanisms/EUCAST_detection_of_resistance_mechanisms_170711.pdf
  18. Naiemi NA, Murk JL, Savelkoul PH, Vandenbroucke-Grauls CMJ, Debets-Ossenkopp YJ. Extended-spectrum beta-lactamases screening agar with AmpC inhibition. Eur J Clin Microbiol Infect Dis 2009; 28:989–990 [View Article] [PubMed]
    [Google Scholar]
  19. Monstein HJ, Ostholm-Balkhed A, Nilsson MV et al. Multiplex PCR amplification assay for the detection of blaSHV, blaTEM and blaCTX-M genes in Enterobacteriaceae. APMIS 2007; 115:1400–1408 [View Article] [PubMed]
    [Google Scholar]
  20. Villegas MV, Kattan JN, Quinteros MG, Casellas JM. Prevalence of extended-spectrum beta-lactamases in South America. Clin Microbiol Infect 2008; 14:154–158 [View Article] [PubMed]
    [Google Scholar]
  21. Schaumburg F, Alabi AS, Frielinghaus L et al. The risk to import ESBL-producing Enterobacteriaceae and Staphylococcus aureus through chicken meat trade in Gabon. BMC Microbiol 2014; 14:286 [View Article] [PubMed]
    [Google Scholar]
  22. Ewers C, Bethe A, Semmler T, Guenther S, Wieler LH. Extended-spectrum β-lactamase-producing and AmpC-producing Escherichia coli from livestock and companion animals, and their putative impact on public health: a global perspective. Clin Microbiol Infect 2012; 18:646–655 [View Article] [PubMed]
    [Google Scholar]
  23. World Health Organization The Treatment of Diarrhoea: a Manual for Physicians and Other Senior Health Workers – Fourth Revision of WHO/CDD/SER/80.2WHO Genf, Switzerland: WHO; 2005
    [Google Scholar]
  24. Armon K, Stephenson T, MacFaul R, Eccleston P, Werneke U. An evidence and consensus based guideline for acute diarrhoea management. Arch Dis Child 2001; 85:132–142 [View Article] [PubMed]
    [Google Scholar]
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