Fecal Colonization With Extended-spectrum Beta-lactamase–Producing<i>Enterobacteriaceae</i>and Risk Factors Among Healthy Individuals: A Systematic Review and Metaanalysis

Karanika, Styliani; Karantanos, Theodoros; Arvanitis, Marios; Grigoras, Christos; Mylonakis, Eleftherios

doi:10.1093/cid/ciw283

Cited by 368 publications

(352 citation statements)

References 38 publications

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“…Faecal carriage of ESBL producing Enterobacteriaceae has been documented in both children and in adults [8, 10, 15, 22–24]. A global prevalence of 14% ESBL carriage among healthy individuals has been reported [23]. …”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Faecal Carriage of ESBL-Producing Enterobacteriaceae among Children in Dar es Salaam, Tanzania

et al. 2016

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BackgroundFaecal carriage of ESBL-producing bacteria is a potential risk for transmission and infection. Little is known about faecal carriage of antibiotic resistance in Tanzania. This study aimed to investigate the prevalence of faecal carriage of ESBL-producing Enterobacteriaceae and to identify risk factors for carriage among young children in Tanzania.Methodology/Principal FindingsFrom August 2010 to July 2011, children below 2 years of age were recruited in Dar es Salaam, including healthy community children (n = 250) and children hospitalized due to diarrhoea (n = 250) or other diseases (n = 103). ChromID ESBL agar and ChromID CARBA SMART agar were used for screening. Antimicrobial susceptibility testing was performed by the disk diffusion method. ESBL genotypes were identified by Real-Time PCR and sequencing.The overall prevalence of ESBL carriage was 34.3% (207/ 603). The prevalence of ESBL carriage was significantly higher among hospitalized children (50.4%), compared to community children (11.6%; P < 0.001; OR = 7.75; 95% CI: 4.99–12.03). We found high prevalence of Multidrug-resistance (94%) among Escherichia coli and Klebsiella pneumoniae isolates. No resistance to carbapenems was detected. For the majority of isolates (94.7%) we detected a blaCTX-M-15-like gene. In addition, the plasmid mediated AmpC beta-lactamase CMY-2 was detected for the first time in Tanzania. ESBL prevalence was significantly higher among HIV positive (89.7%) than HIV negative (16.9%) children (P = 0.001; OR = 9.99; 95% CI: 2.52–39.57). Use of antibiotics during the past 14 days and age below 1 year was also associated with ESBL carriage.Conclusions/SignificanceWe report a high rate of faecal carriage of ESBL-producing Enterobacteriaceae among children below 2 years of age in Tanzania, particularly those with HIV-infection. Resistance to a majority of the available antimicrobials commonly used for children in Tanzania leaves few treatment options for infections when caused by these bacteria.

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Section: Discussionmentioning

confidence: 99%

High Prevalence of Faecal Carriage of ESBL-Producing Enterobacteriaceae among Children in Dar es Salaam, Tanzania

et al. 2016

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“…1). However, data concerning exposure to nonantibiotic treatments, such as protein pump inhibitors or, more importantly, concerning recent travel abroad, both of which have been found to be associated with ESBL carriage, were not collected (13).…”

mentioning

confidence: 99%

Prospective Cohort Study of the Relative Abundance of Extended-Spectrum-Beta-Lactamase-Producing Escherichia coli in the Gut of Patients Admitted to Hospitals

Lastours

Jacquier

d’Humières

et al. 2016

Antimicrob Agents Chemother

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A total of 458 patients were prospectively included at hospital admission and screened for extended-spectrum-beta-lactamaseproducing (ESBL) Escherichia coli carriage in 2007 and in 2010 to 2012. A 4-fold increase in ESBL carriage (3% to 12%), a 5-fold increase in numbers of community patients among ESBL carriers, and a higher number of multiple ESBL strains was found in the 2010 to 2012 period. ESBL E. coli represented the dominant E. coli strain (relative abundance, >50%) in 10/32 (31%) of ESBL carriers. This represents a major threat in terms of infectious risk and dissemination.T he epidemiology of Escherichia coli infections has recently been profoundly modified with the global emergence of strains resistant to third-generation cephalosporins (3GC), specifically, strains producing extended-spectrum ␤-lactamases (ESBL), in both hospitals and the community (1). CTX-M-type ESBLs, which have spread in a polyclonal manner on all continents, constitute a major public health concern worldwide (1).Gut colonization is the first step toward infections by E. coli (2). Recently, it has been shown that a high relative abundance (RA) of ESBL E. coli in the feces increases the risk of urinary tract infection (UTI) by ESBL E. coli (3). Additionally, a high ESBL E. coli RA has been associated with longer fecal carriage time, increasing the numbers of excreted E. coli in the environment and the potential risk of dissemination of these resistant strains (4). However, most studies focusing on ESBL fecal carriage have described the presence or absence of ESBL E. coli in the gut but have lacked quantitative data. Moreover, whether the ESBL populations are dominant was not specified. Here, we characterized and determined the prevalence, bacterial load, and diversity of ESBL E. coli in the gut of patients at hospital admission at two different time periods and determined factors associated with high relative abundance of ESBL carriage.We used samples collected in two previous prospective clinical trials (5, 6) (https://clinicaltrials.gov/ct2/show/NCT00520715 and https://clinicaltrials.gov/ct2/show/NCT01209247). In both works, clinical data (age, sex, Charlson comorbidity index, hospitalization ward, history of immunosuppression, previous hospitalization in the last 12 months, previous antibiotic exposure in the last 3 months, and antibiotic class) as well as a rectal swab had been collected from patients at admission in the same two tertiarycare hospitals from the Paris region in France (5, 6). The first collection period (P1) was between May and November 2007, and the second period (P2) was between October 2010 and July 2012. Both studies were approved by the local institutional review board (IRB 00008522), and patients gave informed consent (5, 6). Rectal swabs were discharged in 1 ml of brain heart infusion (BHI) broth with glycerol and stored at Ϫ80°C in duplicates (5, 6). After thawing, 50 l was plated on Drigalski agar plates (Pasteur Diagnostics, Paris, France), one containing no antibiotics and one containing 1 g/ml cefotax...

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“…ESBL-PE acquisition after travel is able to diffuse to other family members in 12% of the cases [5]. ESBL-PE carriage in healthy people is 14% worldwide on average and increases by more than 5% per year [6]. Even in the Netherlands ESBL-PE carriage is 8.6% in healthy people, favored by recent antimicrobial use [7].…”

Section: Emergence Of Resistant Bacteria Worldwide: a Need For Antibimentioning

confidence: 99%

Antipathy against SDD is justified: Yes

Timsit

Bassetti

2018

Intensive Care Med

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Fecal Colonization With Extended-spectrum Beta-lactamase–ProducingEnterobacteriaceaeand Risk Factors Among Healthy Individuals: A Systematic Review and Metaanalysis

Cited by 368 publications

References 38 publications

High Prevalence of Faecal Carriage of ESBL-Producing Enterobacteriaceae among Children in Dar es Salaam, Tanzania

High Prevalence of Faecal Carriage of ESBL-Producing Enterobacteriaceae among Children in Dar es Salaam, Tanzania

Prospective Cohort Study of the Relative Abundance of Extended-Spectrum-Beta-Lactamase-Producing Escherichia coli in the Gut of Patients Admitted to Hospitals

Antipathy against SDD is justified: Yes

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