title: Identification of nasal colonization with β-lactamase-producing Enterobacteriaceae in patients, health care workers and students in Madagascar.
abstract: This study assesses the nasal occurrence of β-lactamase-producing Enterobacteriaceae both in patients in a hospital department of infectious diseases at admission and in healthy Madagascan students and health care workers. Nasal swabs from 681 students, 824 health care workers, and 169 patients were obtained in Antananarivo, Madagascar, and transferred to Germany. Screening for β-lactamase (ESBL, ampC) producing Enterobacteriaceae was performed by cultural and molecular approaches, comprising Brilliance ESBL agar, E-testing, ABCD-testing, and commercial hyplex ESBL and SuperBug ID PCR. Regarding ESBL-positive strains and strains with resistance against at least three out of the four tested bactericidal antibiotic drugs, 0.3% (five out of 1541) of the students and health care workers group showed nasal colonization, whereas colonization was observed in 7.1% (12 out of 169) of the hospitalized patients at admission. No appreciably reduced detection rates after sample storage and intercontinental transport were observed. A considerable proportion of nasal colonization with cephalosporin-resistant Enterobacteriaceae was demonstrated in Madagascan hospital patients at admission, posing a risk of developing future endogenous infections. The nasal colonization of healthy individuals was negligible. Good storage and transport stability of Enterobacteriaceae will allow for future studies even in areas difficult to access.
authors.forename: Volker
authors.initials: V
authors.lastname: Micheel
authors.forename: Benedikt
authors.initials: B
authors.lastname: Hogan
authors.forename: Rivo Andry
authors.initials: RA
authors.lastname: Rakotoarivelo
authors.forename: Raphael
authors.initials: R
authors.lastname: Rakotozandrindrainy
authors.forename: Fetra
authors.initials: F
authors.lastname: Razafimanatsoa
authors.forename: Tsiriniaina
authors.initials: T
authors.lastname: Razafindrabe
authors.forename: Jean Philibert
authors.initials: JP
authors.lastname: Rakotondrainiarivelo
authors.forename: Sabine
authors.initials: S
authors.lastname: Crusius
authors.forename: Sven
authors.initials: S
authors.lastname: Poppert
authors.forename: Norbert Georg
authors.initials: NG
authors.lastname: Schwarz
authors.forename: Jürgen
authors.initials: J
authors.lastname: May
authors.forename: Hagen
authors.initials: H
authors.lastname: Frickmann
authors.forename: Ralf Matthias
authors.initials: RM
authors.lastname: Hagen
keywords: Enterobacteriaceae; Madagascar; colonization; extended-spectrum β-lactamase; resistance