High rate of faecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae in healthy children in Bangui, Central African Republic

Abstract

The aim of this study was to estimate the prevalence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) in faeces of healthy children aged 0-59 months in Bangui (Central African Republic). Stool samples of 134 children, recruited for a matched case-control study, were cultured on a commercial ESBL-selective chromogenic medium (CHROMagar ESBL, France). The phenotypic resistance patterns of isolated strains were investigated, as well as the genetic basis for antibiotic resistance. The factors associated with increased risk for ESBL-E carriage were also studied. The prevalence of ESBL-E carriage was 59% (79/134), one of the highest reported worldwide. The only factor found to be associated with carriage was living in a highest-income family (p=0.03). In all, 83 ESBL-E were recovered as simultaneous carriage of two strains was detected in four children. bla was found in all strains except two, frequently associated with qnr (54/81, 66%) and aac(6')-Ib-cr (35/81, 43%) genes. Escherichia coli, the most commonly recovered species (51/83, 61%), was assigned mainly to the pandemic B2-O25b-ST131 group (39/51, 76%). Resistance transfer, which was studied in 20 randomly selected ESBL-E strains, was successful in 13 (13/20, 65%) isolates. In eight of these isolates (8/13, 62%), bla genes were found in incompatibility group FIb conjugative plasmids. We found one of the highest prevalence rates of faecal carriage of ESBL-E reported worldwide, highlighting the need to improve control of the distribution of antibiotics in limited-resource countries.

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

“…Carriage rate among healthy community children in our study is comparable to the prevalence of 16.5% found in community settings in Mwanza in northern Tanzania, including both children and adults [15]. However, it is twice the prevalence found among healthy children in France [27], but still half the prevalence found among children in Laos and Lebanon [22, 28] and much lower than the prevalence of 59% found among children in Bangui [11]. We observed a very high carriage rate among hospitalized children.…”

“…Data on ESBL carriage among community children on the sub-Saharan continent are limited [9, 11, 15, 25], and numbers of children included in previous studies are low. There is only one publication on ESBL carriage in the community in Tanzania [15].…”

“…High prevalence of ESBL-producing bacteria has been reported worldwide [1–3]. While there are a number of publications on ESBL-producing bacteria causing clinical infections [4–7], relatively few studies from the African continent report on carriage of ESBL-producing organisms [8–11]. …”

High Gastrointestinal Colonization Rate with Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients: Emergence of Carbapenemase-Producing K. pneumoniae in Ethiopia

“…However the colonization rates of ESBL-producing Enterobacteriaceae among hospitalized neonates (74%) and children (59%) in this study is much higher than reports from other paediatric or neonatal clinics from elsewhere, including other African countries [7] such as Gabon (45% in children) [26], Ghana (65.1% in neonates) [25], Guinea-Bissau (32.6% in children)[27] and Ecuador (56% in neonates) [28]. Recently a high rate of fecal carriage of ESBL-E (59%) in healthy children from Bangui, Central African Republic is reported [10]. Previously based on a systematic review of old data, Tansarli et.al, reported that proportion of ESBL-producing Enterobacteriaceae may not be high in Africa [7].…”

Prevalence and resistance profile of extended-spectrum -lactamases-producing Enterobacteriaceae in Ouagadougou, Burkina Faso

“…and Escherichia coli taking a lead. To further substantiate this, Farra et al (2016) identified the high rate of faecal carriage of ESBL-E in healthy children in Bangui Central African Republic which portend a high risk of continuous dissemination of multi-drug resistant pathogen with grave consequences to the general health of the public. However there is paucity of information and extended study of ESBL producing Enterobacteriaceae (ESBL-E) in Ouagadougou of which study conducted has been restricted to single health centers (Zeba et al, 2007;Métuor-Dabiré et al, 2014;Ouedraogo et al, 2016).…”