title: Emergence and dissemination of extended-spectrum beta-lactamase-producing Escherichia coli in the community: lessons from the study of a remote and controlled population.
abstract: BACKGROUND
  Intestinal carriage is a key factor in extended-spectrum beta-lactamase (ESBL) infection epidemiology but is difficult to study in open communities. To overcome this problem, we studied a highly stable group of Amerindians for whom we reported an ESBL carriage prevalence of 3.2% in 2001.
  
  
  METHODS
  In 2006, ESBL carriage was assessed among 163 healthy volunteer adults. ESBL isolates were identified, and their molecular resistance mechanisms were characterized. Antibiotic use in the year before sampling and the epidemiological characteristics of the population were analyzed. Results were compared to those obtained in 2001.
  
  
  RESULTS
  In 2006, the ESBL carriage prevalence, exclusively comprising Escherichia coli, was 8.0%. It mainly consisted of CTX-M-type ESBL. The strains and plasmids carrying ESBL were heterogeneous, but 1 CTX-M-2-producing strain was found in 4.3% of the subjects analyzed. No individual risk factor was identified. However, overall antibiotic use had almost doubled since 2001. A 3-fold increase was noted for beta-lactams.
  
  
  CONCLUSIONS
  In this population, the frequency of ESBL increased with time because of the appearance of CTX-M ESBL, mimicking what occurs in the developed world. This resulted from the probable repeated introduction of new strains and plasmids and from interindividual dissemination. During the same period, antibiotic use substantially increased.
authors.affiliation: Equipe d'Accueil (EA) 3964 Université Paris-Diderot and Centre National de Référence, Résistance bactérienne dans les flores commensales, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. paul-louis.woerther@bch.aphp.fr
authors.forename: Paul-Louis
authors.initials: PL
authors.lastname: Woerther
authors.forename: Cécile
authors.initials: C
authors.lastname: Angebault
authors.forename: Mathilde
authors.initials: M
authors.lastname: Lescat
authors.forename: Etienne
authors.initials: E
authors.lastname: Ruppé
authors.forename: David
authors.initials: D
authors.lastname: Skurnik
authors.forename: Assiya El
authors.initials: AE
authors.lastname: Mniai
authors.forename: Olivier
authors.initials: O
authors.lastname: Clermont
authors.forename: Hervé
authors.initials: H
authors.lastname: Jacquier
authors.forename: Anaelle Da
authors.initials: AD
authors.lastname: Costa
authors.forename: Magaly
authors.initials: M
authors.lastname: Renard
authors.forename: Régis Marc
authors.initials: RM
authors.lastname: Bettinger
authors.forename: Loïc
authors.initials: L
authors.lastname: Epelboin
authors.forename: Claire
authors.initials: C
authors.lastname: Dupont
authors.forename: Didier
authors.initials: D
authors.lastname: Guillemot
authors.forename: François
authors.initials: F
authors.lastname: Rousset
authors.forename: Guillaume
authors.initials: G
authors.lastname: Arlet
authors.forename: Erick
authors.initials: E
authors.lastname: Denamur
authors.forename: Félix
authors.initials: F
authors.lastname: Djossou
authors.forename: Antoine
authors.initials: A
authors.lastname: Andremont
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002353:Carrier State / Q000382:microbiology* / Q000635:transmission; D017714:Community-Acquired Infections / Q000382:microbiology* / Q000635:transmission; D004363:Drug Utilization / Q000706:statistics & numerical data; D004926:Escherichia coli / Q000201:enzymology* / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000382:microbiology* / Q000635:transmission; D005260:Female; D005616:French Guiana; D005798:Genes, Bacterial; D006801:Humans; D007199:Indians, South American; D008297:Male; D010957:Plasmids; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases