title: High burden of extended-spectrum β-lactamase-producing Enterobacteriaceae in Gabon.
abstract: OBJECTIVE
  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
  
  
  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.
authors: Institute of Medical Microbiology, University Hospital Münster, Münster, Germany. frieder.schaumburg@ukmuenster.de
authors: Frieder
authors: F
authors: Schaumburg
authors: Abraham
authors: A
authors: Alabi
authors: Cosme
authors: C
authors: Kokou
authors: Martin P
authors: MP
authors: Grobusch
authors: Robin
authors: R
authors: Köck
authors: Harry
authors: H
authors: Kaba
authors: Karsten
authors: K
authors: Becker
authors: Akim A
authors: AA
authors: Adegnika
authors: Peter G
authors: PG
authors: Kremsner
authors: Georg
authors: G
authors: Peters
authors: Alexander
authors: A
authors: Mellmann
mesh_terms: D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D003430:Cross-Sectional Studies; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D005681:Gabon / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D015995:Prevalence; D012007:Rectum / Q000382:microbiology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases
keywords: Africa; ESBLs; colonization; risk factors