High prevalence of fecal carriage of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a pediatric unit in Madagascar
High prevalence of fecal carriage of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a pediatric unit in Madagascar
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DOI：
10.1186/1471-2334-10-204
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发表时间：
2010-07-12
影响因子：
3.7
通讯作者：
Richard, Vincent
中科院分区：
文献类型：
--
作者：
Andriatahina, Todisoa;Randrianirina, Frederique;Richard, Vincent
背景：产超广谱β-内酰胺酶(ESBL)的肠杆菌科细菌已在世界范围内传播，但在低收入国家医院携带的报道很少。产超广谱β-内酰胺酶肠杆菌科细菌(ESBL-PE)在马达加斯加塔那那利佛的医院感染中越来越多地被分离。方法：我们于2008年3月至4月在某儿科病房进行了患病率调查。还对医务人员和环境进行了抽样。结果：入院时粪便携带率为21.2%，出院后粪便携带率为57.1%(P<；0.001)。入院时最常见的是大肠埃希菌和肺炎克雷伯菌(36.9%)，而出院时最常见的是肺炎克雷伯菌(52.7%)。产超广谱β-内酰胺酶相关耐药与甲氧西林-磺胺甲恶唑(91.3%)、庆大霉素(76.1%)、环丙沙星(50.0%)有关，与阿米卡星、亚胺培南无关。住院期间携带者的增加与标准的抗菌治疗有关。结论：马达加斯加医院出现严重的多重耐药肠道病原菌，对健康构成严重威胁，需要实施医院感染的监测和控制措施。
Background: Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae have spread worldwide but there are few reports on carriage in hospitals in low-income countries. ESBL-producing Enterobacteriaceae (ESBL-PE) have been increasingly isolated from nosocomial infections in Antananarivo, Madagascar.Methods: we conducted a prevalence survey in a pediatric unit from March to April 2008 Patient rectal swabs were sampled on the first and the last day of hospitalization. Medical staff and environment were also sampled. Rectal and environmental swabs were immediately plated onto Drigalski agar supplemented with 3 mg/liter of ceftriaxon.Results: Fecal carriage was detected in 21.2% of 244 infants on admission and 57.1% of 154 on discharge, after more than 48 hours of hospitalization (p < 0.001). The species most frequently detected on admission were Escherichia coli and Klebsiella pneumoniae (36.9%), whereas, on discharge, K. pneumoniae was the species most frequently detected (52.7%). ESBL-associated resistances were related to trimethoprim-sulfamethoxazole (91.3%), gentamicin (76.1%), ciprofloxacin (50.0%), but not to amikacin and imipenem. The increased prevalence of carriage during hospitalization was related to standard antimicrobial therapy.Conclusion: The significant emergence of multidrug-resistant enteric pathogens in Malagasy hospitals poses a serious health threat requiring the implementation of surveillance and control measures for nosocomial infections.