Fecal carriage of ESBL-producing E. coli and K. pneumoniae in children in Guinea-Bissau: a hospital-based cross-sectional study.
Fecal carriage of ESBL-producing E. coli and K. pneumoniae in children in Guinea-Bissau: a hospital-based cross-sectional study.
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DOI：
10.1371/journal.pone.0051981
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Nauclér P
中科院分区：
文献类型：
--
作者：
Isendahl J;Turlej-Rogacka A;Manjuba C;Rodrigues A;Giske CG;Nauclér P
近年来，世界上出现了广谱β-内酰胺酶（ESBL）产生细菌的激增。然而，从非洲系统登记的研究对象中获得的关于产esbl肠杆菌科在社区传播的数据仍然有限。确定在几内亚比绍儿科急诊科就诊的儿童粪便中产生esbls的大肠杆菌和肺炎克雷伯菌的患病率、表型耐药模式和遗传特征，并分析相关危险因素。2010年6月至9月，在儿科急诊病房白天就诊的5岁以下发热或心动过速儿童进行粪便携带ESBL筛查。收集社会人口统计学和健康寻求行为数据。采用VITEK2和EUCAST纸片扩散法检测抗生素敏感性，多重PCR检测esbl编码基因的分子特征，全自动rep-PCR检测克隆相关性。在408名入组儿童中，133名（32.6%）为ESBL携带者。共分离得到83株大肠杆菌和91株产esbl的肺炎克雷伯菌。几乎所有分离株都具有多重耐药。对环丙沙星、甲氧苄啶-磺胺甲恶唑和氨基糖苷类共耐药较为常见。在分离株中，38.5%对这些类别和广谱头孢菌素共同耐药，这推断对几内亚比绍治疗革兰氏阴性败血症的所有容易获得的抗生素药物具有耐药性。主要的耐药编码基因亚群为bla CTX-M-1，流行病学分型显示大肠杆菌和肺炎克雷伯菌的ESBL细菌种群高度多样化。与另一名小于5岁的儿童同床是携带ESBL的危险因素，表明拥挤是传播产ESBL细菌的潜在危险因素。产esbl细菌在该人群中流行率高，且克隆多样性强。考虑到几内亚比绍和其他资源贫乏国家有限的诊断和治疗机会，这是令人震惊的。
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. 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 bla CTX-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. 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.
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DOI：
10.3904/kjim.2012.27.2.128
发表时间：
2012-06
期刊：
The Korean journal of internal medicine
影响因子：
--
作者：
Livermore DM
通讯作者：
Livermore DM
影响因子：
14.2
作者：
Magiorakos, A. -P.;Srinivasan, A.;Monnet, D. L.
通讯作者：
Monnet, D. L.
影响因子：
2.2
作者：
Brolund, Alma;Haeggman, Sara;Giske, Christian G.
通讯作者：
Giske, Christian G.
影响因子：
3.7
作者：
Andriatahina, Todisoa;Randrianirina, Frederique;Richard, Vincent
通讯作者：
Richard, Vincent
影响因子：
4.2
作者：
Namboodiri, Sreela S.;Opintan, Japheth A.;Okeke, Iruka N.
通讯作者：
Okeke, Iruka N.