Emergence and dissemination of extended-spectrum beta-lactamase-producing Escherichia coli in the community: lessons from the study of a remote and controlled population.
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.
Woerther
Paul-Louis
PL
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
Angebault
Cécile
C
Lescat
Mathilde
M
Ruppé
Etienne
E
Skurnik
David
D
Mniai
Assiya El
AE
Clermont
Olivier
O
Jacquier
Hervé
H
Costa
Anaelle Da
AD
Renard
Magaly
M
Bettinger
Régis Marc
RM
Epelboin
Loïc
L
Dupont
Claire
C
Guillemot
Didier
D
Rousset
François
F
Arlet
Guillaume
G
Denamur
Erick
E
Djossou
Félix
F
Andremont
Antoine
A
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
D000900:Anti-Bacterial Agents; D001618:beta-Lactamases