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Open Access Highly Accessed Research article

High prevalence of fecal carriage of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a pediatric unit in Madagascar

Todisoa Andriatahina1, Frédérique Randrianirina2, Eliosa Ratsima Hariniana2, Antoine Talarmin2, Honoré Raobijaona1, Yves Buisson3 and Vincent Richard2*

Author Affiliations

1 Hôpital Joseph Raseta Befelatanana, Antananarivo, Madagascar

2 Institut Pasteur, Antananarivo, Madagascar

3 Institut de la Francophonie pour la Médecine Tropicale, Ventiane, Laos

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BMC Infectious Diseases 2010, 10:204  doi:10.1186/1471-2334-10-204

Published: 12 July 2010

Abstract

Background

Extended-spectrum β-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.