Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.
J Antimicrob Chemother. 2013 Sep;68(9):2140-3. doi: 10.1093/jac/dkt164. Epub 2013 May 3.
Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are sporadically reported from infections in sub-Saharan Africa. Travellers returning from the tropics have a high risk of ESBL-E colonization, which suggests a high prevalence of ESBL-E in Africa. Our objective was to assess the burden of rectal ESBL-E colonization and associated risk factors in Gabon, Central Africa
We performed a cross-sectional study on 200 hospitalized children in Gabon, Central Africa, on rectal ESBL-E colonization and applied a standardized questionnaire to assess risk factors. The antimicrobial resistance and the type of β-lactamase (SHV, TEM and CTX-M) were analysed for each isolate. Isolates associated with nosocomial spread were further genotyped.
The overall colonization rate of ESBL-E was 45% (n = 90) and increased from 33.6% (n = 37) at admission to 94.1% (n = 16) during hospitalization. Risk factors for ESBL-E carriage were age <5 years, hospitalization for ≥5 days and a hospital stay during the past year. All isolates were susceptible to meropenem, but non-susceptible to ciprofloxacin in 52.8% (n = 57). CTX-M-15 was the predominant β-lactamase. Genotyping revealed a polyclonal structure of nosocomial isolates.
ESBL colonization in hospitalized children in Gabon is high. The risk of nosocomial transmission of ESBL-E is a challenge in rural Africa and underlines the need for sentinel surveillance in the absence of a broad decentralized microbiology laboratory.
产超广谱β-内酰胺酶肠杆菌科（ESBL-E）在撒哈拉以南非洲的感染中偶有报道。从热带地区返回的旅行者有很高的 ESBL-E 定植风险，这表明非洲的 ESBL-E 流行率很高。我们的目的是评估中非加蓬住院儿童直肠 ESBL-E 定植的负担及其相关危险因素。
我们对中非加蓬的 200 名住院儿童进行了横断面研究，评估直肠 ESBL-E 定植情况，并应用标准化问卷评估危险因素。对每个分离株进行了抗生素耐药性和β-内酰胺酶类型（SHV、TEM 和 CTX-M）分析。与医院传播相关的分离株进一步进行基因分型。
ESBL-E 的总体定植率为 45%（n=90），从入院时的 33.6%（n=37）增加到住院期间的 94.1%（n=16）。ESBL-E 定植的危险因素为年龄<5 岁、住院时间≥5 天和过去一年的住院时间。所有分离株对美罗培南均敏感，但 52.8%（n=57）对环丙沙星耐药。CTX-M-15 是主要的β-内酰胺酶。基因分型显示医院分离株呈多克隆结构。
加蓬住院儿童中 ESBL 定植率很高。ESBL-E 医院传播的风险是非洲农村地区的一个挑战，这凸显了在缺乏广泛的分散式微生物实验室的情况下，进行哨点监测的必要性。
