High burden of extended-spectrum β-lactamase-producing Enterobacteriaceae in Gabon

Abstract

Objectives: 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

Patients and methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Africa; ESBLs; colonization; risk factors.