title: Antimicrobial resistance of bacterial enteropathogens isolated from stools in Madagascar.
abstract: BACKGROUND
  Diarrheal diseases are a major public health problem in developing countries, and are one of the main causes of hospital admissions in Madagascar. The Pasteur Institute of Madagascar undertook a study to determine the prevalence and the pathogenicity of bacterial, viral and protozoal enteropathogens in diarrheal and non-diarrheal stools of children aged less than 5 years in Madagascar. We present here the results of the analysis of antimicrobial susceptibility of the bacteria isolated during this study.
  
  
  METHODS
  The study was conducted in the community setting in 14 districts of Madagascar from October 2008 to May 2009. Conventional methods and PCR were used to identify the bacteria; antimicrobial susceptibility was determined using an agar diffusion method for enterobacteriaceae and MICs were measured by an agar dilution method for Campylobacter sp. In addition to the strains isolated during this study, Salmonella sp and Shigella sp isolated at the Pasteur Institute of Madagascar from 2005 to 2009 were included in the analysis to increase the power of the study.
  
  
  RESULTS
  Twenty-nine strains of Salmonella sp, 35 strains of Shigella sp, 195 strains of diarrheagenic E. coli, 203 strains of C. jejuni and 71 strains of C. coli isolated in the community setting were tested for antibiotic resistance. Fifty-five strains of Salmonella sp and 129 strains of Shigella sp isolated from patients referred to the Pasteur Institute of Madagascar were also included in the study. Many E. coli and Shigella isolates (around 80%) but fewer Salmonella isolates were resistant to ampicillin and trimethoprim/sulfamethoxazole. A small proportion of strains of each species were resistant to ciprofloxacin and only 3% of E. coli strains presented a resistance to third generation cephalosporins due to the production of extended-spectrum beta-lactamases. The resistance of Campylobacter sp to ampicillin was the most prevalent, whereas less than 5% of isolates were resistant to each of the other antibiotics.
  
  
  CONCLUSIONS
  The highest prevalence of antimicrobial resistance was to ampicillin and trimethoprim/sulfamethoxazole. Antibiotic treatment is not recommended for children with diarrhea in Madagascar and the emphasis should be placed on oral rehydration.
authors.forename: Frederique
authors.initials: F
authors.lastname: Randrianirina
authors.forename: Elisoa Hariniana
authors.initials: EH
authors.lastname: Ratsima
authors.forename: Lova
authors.initials: L
authors.lastname: Ramparany
authors.forename: Rindra
authors.initials: R
authors.lastname: Randremanana
authors.forename: Hanitra Clara
authors.initials: HC
authors.lastname: Rakotonirina
authors.forename: Tahiry
authors.initials: T
authors.lastname: Andriamanantena
authors.forename: Fanjasoa
authors.initials: F
authors.lastname: Rakotomanana
authors.forename: Soatiana
authors.initials: S
authors.lastname: Rajatonirina
authors.forename: Vincent
authors.initials: V
authors.lastname: Richard
authors.affiliation: Institut Pasteur de Madagascar, Antananarivo, Madagascar. atalarmin@pasteur-guadeloupe.fr.
authors.forename: Antoine
authors.initials: A
authors.lastname: Talarmin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000667:Ampicillin / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D000890:Anti-Infective Agents / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D003967:Diarrhea / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects; D004926:Escherichia coli / Q000187:drug effects; D005243:Feces / Q000382:microbiology; D005260:Female; D005843:Geography; D006801:Humans; D007223:Infant; D008270:Madagascar / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015995:Prevalence; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000667:Ampicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination