Tellevik Marit G, Blomberg Bjørn, Kommedal Øyvind, Maselle Samuel Y, Langeland Nina, Moyo Sabrina J
National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Science, University of Bergen, Bergen, Norway.
PLoS One. 2016 Dec 9;11(12):e0168024. doi: 10.1371/journal.pone.0168024. eCollection 2016.
Faecal 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 FINDINGS: From 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/SIGNIFICANCE: We 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.
产超广谱β-内酰胺酶(ESBL)细菌的粪便携带是传播和感染的潜在风险。在坦桑尼亚,关于抗生素耐药性的粪便携带情况知之甚少。本研究旨在调查坦桑尼亚幼儿中产ESBL肠杆菌科细菌的粪便携带率,并确定携带的风险因素。
方法/主要发现:2010年8月至2011年7月,在达累斯萨拉姆招募了2岁以下儿童,包括健康社区儿童(n = 250)、因腹泻住院的儿童(n = 250)或其他疾病住院的儿童(n = 103)。使用ChromID ESBL琼脂和ChromID CARBA SMART琼脂进行筛查。采用纸片扩散法进行药敏试验。通过实时聚合酶链反应(PCR)和测序鉴定ESBL基因型。ESBL携带的总体患病率为34.3%(207/603)。与社区儿童(11.6%)相比,住院儿童中ESBL携带率显著更高(50.4%;P < 0.001;比值比(OR)= 7.75;95%置信区间(CI):4.99 - 12.03)。我们发现大肠杆菌和肺炎克雷伯菌分离株中多重耐药率很高(94%)。未检测到对碳青霉烯类的耐药性。对于大多数分离株(94.7%),我们检测到blaCTX-M-15样基因。此外,在坦桑尼亚首次检测到质粒介导的AmpCβ-内酰胺酶CMY-2。HIV阳性儿童(89.7%)的ESBL患病率显著高于HIV阴性儿童(16.9%)(P = 0.001;OR = 9.99;95% CI:2.52 - 39.57)。过去14天内使用抗生素以及年龄低于1岁也与ESBL携带有关。
结论/意义:我们报告了坦桑尼亚2岁以下儿童中产ESBL肠杆菌科细菌的粪便携带率很高,尤其是那些感染HIV的儿童。坦桑尼亚儿童常用的大多数现有抗菌药物耐药,这些细菌引起感染时几乎没有治疗选择。