Multidrug-resistant ESBL-producing Enterobacteriaceae and associated risk factors in community infants in Lebanon.
BACKGROUND
Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) infections are a growing threat to children, and the treatment of these infections becomes more and more challenging. A huge reservoir for ESBLs in the community is the fecal flora of children. This study investigates the rectal colonization, associated risk factors, antimicrobial susceptibility, and molecular characterization of ESBL-PE in Lebanese community infants.


METHODS
A total of 117 rectal swabs were taken from healthy infants between 1 and 12 months of age. Detection of ESBLs was carried out using the double-disk synergy test, combination-disk method, and multiplex polymerase chain reaction (PCR). A questionnaire about the infant's history and risk factors for carrying ESBL-PE was administered.


RESULTS
In total, 58 (49.6%) of 117 participants were ESBL-PE carriers. Some significant important risk factors for colonization in this study were male gender, hospital birth, caesarean delivery, and being formula-fed. Observed decrease in colonization rate was associated with intimate hygiene habits. Carriers of multiple bla genes were the most common. CTX-M type was the major harbored, gene and CTX-M-9 was the most predominant, followed by CTX-M-15 type.


CONCLUSIONS
To the best of our knowledge, this is the first available data about the carriage rate of ESBL-PE in community infants in Lebanon and the Middle East, the first study showing that birth in hospital, caesarean delivery, and being formula-fed are all significantly associated risk factors for the high colonization rates in community - not hospitalized - infants, and showing the dominance of multiple resistance gene carriage and wide dissemination of CTX-M-9 ESBL.
Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon. somayahijazi@yahoo.com.
Soumaya Moustafa
SM
Hijazi
Mohamad Anwar
MA
Fawzi
Faten Moustafa
FM
Ali
Khaled Hussein
KH
Abd El Galil
D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D052978:Disk Diffusion Antimicrobial Tests; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D007223:Infant; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D060885:Multiplex Polymerase Chain Reaction; D012307:Risk Factors; D011795:Surveys and Questionnaires; D001618:beta-Lactamases / Q000378:metabolism*
D001618:beta-Lactamases