title: Rectal carriage of extended-spectrum beta-lactamase-producing gram-negative bacilli in community settings in Madagascar.
abstract: BACKGROUND
  Extended-spectrum ß-lactamase-producing Enterobacteria (ESBL-PE) emerged at the end of the 1980s, causing nosocomial outbreaks and/or hyperendemic situations in hospitals and long-term care facilities. In recent years, community-acquired infections due to ESBL-PE have spread worldwide, especially across developing countries including Madagascar.
  
  
  OBJECTIVE
  This study aimed to determine the prevalence and risk factors of intestinal carriage of ESBL-PE in the community of Antananarivo.
  
  
  METHODS
  Non-hospitalized patients were recruited in three health centers in different socio economic settings. Fresh stool collected were immediately plated on Drigalski agar containing 3 mg/liter of ceftriaxone. Gram-negative bacilli species were identified and ESBL production was tested by a double disk diffusion (cefotaxime and ceftazidime +/- clavulanate) assay. Characterization of ESBLs were perfomed by PCR and direct sequencing. Molecular epidemiology was analysed by Rep-PCR and ERIC-PCR.
  
  
  RESULTS
  484 patients were screened (sex ratio  =  1.03, median age 28 years). 53 ESBL-PE were isolated from 49 patients (carrier rate 10.1%). The isolates included Escherichia coli (31), Klebsiella pneumoniae (14), Enterobacter cloacae (3), Citrobacter freundii (3), Kluyvera spp. (1) and Pantoae sp. (1). In multivariate analysis, only the socioeconomic status of the head of household was independently associated with ESBL-PE carriage, poverty being the predominant risk factor.
  
  
  CONCLUSIONS
  The prevalence of carriage of ESBL in the community of Antananarivo is one of the highest reported worldwide. This alarming spread of resistance genes should be stopped urgently by improving hygiene and streamlining the distribution and consumption of antibiotics.
authors.affiliation: Institut de la Francophonie pour la Médecine Tropicale, Ventiane, Laos.
authors.forename: Perlinot
authors.initials: P
authors.lastname: Herindrainy
authors.forename: Frédérique
authors.initials: F
authors.lastname: Randrianirina
authors.forename: Rila
authors.initials: R
authors.lastname: Ratovoson
authors.forename: Elisoa
authors.initials: E
authors.lastname: Ratsima Hariniana
authors.forename: Yves
authors.initials: Y
authors.lastname: Buisson
authors.forename: Nathalie
authors.initials: N
authors.lastname: Genel
authors.forename: Dominique
authors.initials: D
authors.lastname: Decré
authors.forename: Guillaume
authors.initials: G
authors.lastname: Arlet
authors.forename: Antoine
authors.initials: A
authors.lastname: Talarmin
authors.forename: Vincent
authors.initials: V
authors.lastname: Richard
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002353:Carrier State; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification / Q000472:pathogenicity; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008134:Long-Term Care; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012007:Rectum / Q000382:microbiology*; D012307:Risk Factors; D055815:Young Adult; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases