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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Fecal Carriage of ESBL-Producing E. coli and K. pneumoniae in Children in Guinea-Bissau: A Hospital-Based Cross-Sectional Study
PLoS ONE, Volume 7, No. 12, Article e51981, Year 2012
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Description
Background: In 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 Findings: From 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 blaCTX-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/Significance: Prevalence 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. © 2012 Isendahl et al.
Authors & Co-Authors
Isendahl, Joakim
Sweden, Stockholm
Karolinska Institutet
Turlej-Rogacka, Agata
Sweden, Stockholm
Karolinska Institutet
Manjuba, Cristóvão
Guinea-bissau
Hospital Nacional Simão Mendes
Rodrigues, Amabélia
Guinea-bissau
Instituto Nacional da Saúde Pública
Giske, Christian Georg
Sweden, Stockholm
Karolinska Institutet
Nauclér, Pontus
Sweden, Stockholm
Karolinska Institutet
Sweden, Stockholm
Karolinska Universitetssjukhuset
Statistics
Citations: 93
Authors: 6
Affiliations: 4
Identifiers
Doi:
10.1371/journal.pone.0051981
e-ISSN:
19326203
Research Areas
Genetics And Genomics
Health System And Policy
Maternal And Child Health
Study Design
Cross Sectional Study
Study Approach
Quantitative
Study Locations
Guinea
Guinea-Bissau