[Evolution of Enterobacteriaceae resistance to antibiotics in Reunion Island: emergence of extended-spectrum beta-lactamases]

Abstract

Aim of the study: The antibiotic resistance of enterobacteriacae knows a worldwide worrying evolution with an increase of the extended spectrum betalactamases (ESBL) that spread into the community. Few publications describe this problem in the Indian Ocean area. The aim of this study is first to identify in Félix Guyon Hospital (Reunion Island) the emergent antibiotics resistance for enterobacteriaceae between 1997/1998 and 2006/2007 periods, at second, to update the prophylactic and therapeutic measures for handling the risk linked to multiresistant enterobacteriaceae in our hospital and third, to assess the risk in Reunion Island and especially at the community level.

Methods: The antibiotic susceptibility of 7814 enterobacteriaceae strains collected among patients, during 1997/1998 and 2006/2007 periods, were analysed as well as the consumption of the third generation cephalosporins, imipenem and fluoroquinolones.

Results: Within a span of time of 10 years, an important increase (+57 %) of the resistance prevalence of enterobacteriaceae is observed. The resistance by the ESBL production mechanism is predominant especially for Enterobacter cloacae and Escherichia coli. An important use of broad spectrum antibiotics is correlated with this resistance evolution.

Conclusion: The emergence of ESBL-producing enterobacteriaceae in our hospital is impairing both therapeutic and health care. It requires a much better control of antibiotics prescriptions and therefore, an important multidisciplinary implication. A proof molecular analysis would allow to evaluate the risk more precisely, especially at the community level.