title: High third-generation cephalosporin resistant Enterobacteriaceae prevalence rate among neonatal infections in Dakar, Senegal.
abstract: BACKGROUND
  Neonatal infection constitutes one of Senegal's most important public health problems, with a mortality rate of 41 deaths per 1,000 live births.
  
  
  METHODS
  Between January 2007 and March 2008, 242 neonates with suspected infection were recruited at three neonatal intensive care units in three major tertiary care centers in Dakar, the capital of Senegal. Neonatal infections were confirmed by positive bacterial blood or cerebrospinal fluid culture. The microbiological pattern of neonatal infections and the antibiotic susceptibility of the isolates were characterized. In addition, the genetic basis for antibiotic resistance and the genetic background of third-generation cephalosporin-resistant (3GC-R) Enterobacteriaceae were studied.
  
  
  RESULTS
  A bacteriological infection was confirmed in 36.4 % (88/242) of neonates: 22.7 % (30/132) during the early-onset and 52.7 % (58/110) during the late-onset periods (p > 0.20). Group B streptococci accounted for 6.8 % of the 88 collected bacterial isolates, while most of them were Enterobacteriaceae (n = 69, 78.4 %). Of these, 55/69 (79.7 %) were 3GC-R. The blaCTX-M-15allele, the blaSHVand the blaTEMwere highly prevalent (63.5, 65.4 and 53.8 %, respectively), usually associated with qnr genes (65.4 %). Clonally related strains of 3GC-R Klebsiella pneumoniae and 3GC-R Enterobacter cloacae, the two most commonly recovered 3GC-R Enterobacteriaceae (48/55), were detected at the three hospitals, underlining the role of cross-transmission in their spread. The overall case fatality rate was 18.6 %.
  
  
  CONCLUSIONS
  Measures should be taken to prevent nosocomial infections and the selection of resistant bacteria.
authors.affiliation: Institut Pasteur, Laboratoire de Bactériologie, 36 Avenue Pasteur, BP220, Dakar, Senegal. sbreurec@gmail.com.|Centre Hospitalier Universitaire de Pointe-à-Pitre/les Abymes, Laboratoire de Microbiologie clinique et environnementale, BP465, 97159, Pointe-à-Pitre, Guadeloupe, France. sbreurec@gmail.com.|Faculté de Médecine, Université des Antilles, Campus de Fouillole, BP 145, 97154, Pointe-à-Pitre, Guadeloupe, France. sbreurec@gmail.com.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Breurec
authors.affiliation: Institut Pasteur, Laboratoire de Bactériologie, 36 Avenue Pasteur, BP220, Dakar, Senegal.
authors.forename: Coralie
authors.initials: C
authors.lastname: Bouchiat
authors.affiliation: Institut Pasteur, Laboratoire de Bactériologie, 36 Avenue Pasteur, BP220, Dakar, Senegal.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Sire
authors.affiliation: Institut Pasteur, Laboratoire de Bactériologie, 36 Avenue Pasteur, BP220, Dakar, Senegal.
authors.forename: Olivier
authors.initials: O
authors.lastname: Moquet
authors.affiliation: Institut Pasteur, Laboratoire de Bactériologie, 36 Avenue Pasteur, BP220, Dakar, Senegal.
authors.forename: Raymond
authors.initials: R
authors.lastname: Bercion
authors.affiliation: Hôpital des Enfants Albert Royer, Laboratoire de Bactériologie, Avenue Cheikh Anta Diop, Dakar, Senegal.
authors.forename: Moussa Fafa
authors.initials: MF
authors.lastname: Cisse
authors.affiliation: Institut Pasteur, Unité de Biologie des Bactéries pathogènes à Gram-positif, 25-28 Rue du Dr Roux, 75015, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Glaser
authors.affiliation: Département de Pédiatrie, Centre Hospitalier Abass Ndao, BP 15872, Dakar, Senegal.
authors.forename: Ousmane
authors.initials: O
authors.lastname: Ndiaye
authors.affiliation: Département de Pédiatrie, Hôpital Principal, 1 avenue Nelson Mandela, BP3006, Dakar, Senegal.
authors.forename: Sidy
authors.initials: S
authors.lastname: Ka
authors.affiliation: Hôpital de la Croix-Rousse, Laboratoire de Bactériologie, 103 Grande rue de la Croix-Rousse, 69317, Lyon, France.
authors.forename: Helene
authors.initials: H
authors.lastname: Salord
authors.affiliation: Institut Pasteur, Laboratoire de Bactériologie, 36 Avenue Pasteur, BP220, Dakar, Senegal.
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Seck
authors.affiliation: Département de Pédiatrie, Hôpital des Enfants Albert Royer, Avenue Cheikh Anta Diop, Dakar, Senegal.
authors.forename: Haby Signate
authors.initials: HS
authors.lastname: Sy
authors.affiliation: Institut Pasteur de Dakar, Unité d'Epidémiologie, 36 Avenue Pasteur, BP220, Dakar, Senegal.
authors.forename: Remy
authors.initials: R
authors.lastname: Michel
authors.affiliation: Institut Pasteur, Laboratoire de Bactériologie, 36 Avenue Pasteur, BP220, Dakar, Senegal.
authors.forename: Benoit
authors.initials: B
authors.lastname: Garin
mesh_terms: D002511:Cephalosporins / Q000494:pharmacology*; D016972:Enterobacter cloacae / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification / Q000472:pathogenicity; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D008297:Male; D008826:Microbial Sensitivity Tests; D012675:Senegal / Q000453:epidemiology; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D018440:beta-Lactam Resistance / Q000187:drug effects* / Q000235:genetics; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D002511:Cephalosporins; D001618:beta-Lactamases
keywords: Africa; Antimicrobial resistance; CTX-M-15; Neonatal infections; Third-generation cephalosporin-resistant Enterobacteriaceae