title: Fecal Carriage of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Strains Is Associated with Worse Outcome in Patients Hospitalized in the Pediatric Oncology Unit of Beni-Messous Hospital in Algiers, Algeria.
abstract: OBJECTIVE
  The current study aimed to investigate extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) fecal carriage in children with different cancers admitted in the pediatric oncology unit of Beni-Messous Hospital (Algiers, Algeria).
  
  
  METHODS
  Rectal swabs from children with cancer were sampled from February 2012 to May 2013 within 48 hours following their admission. After species identification and detection of ESBL production by double-disk synergy test (DD test), antibiotic susceptibility was determined by the standard disk diffusion method. Antibiotic resistance genes, including bla genes and plasmid-mediated quinolone resistance (PMQR) genes, were investigated by polymerase chain reaction (PCR). The phylogenetic grouping of Escherichia coli strains was determined by PCR.
  
  
  RESULTS
  Of the 171 children studied, 93 (54%) were ESBL carriers. An antibiotic treatment for the last 3 months before admission (p = 0.01), hematological malignancies (p = 0.003), and death (p = 0.0003) were more frequent in the ESBL-E group than in the non-ESBL group. Multivariate analysis showed that hematological malignancies (odds ratio [OR]: 3.9; confidence interval [CI]: 1.1-14.1; p = 0.04) and ESBL-E carriage (OR: 6.2; CI: 1.7-22.00; p = 0.005) were two independent factors associated with increased risk of death. A total of 103 ESBL-E isolates were obtained. Klebsiella pneumoniae and E. coli isolates were the most frequently isolated. PCR amplification showed that all the isolates produced a CTX-M ESBL (CTX-M-15, CTX-M-14, and CTX-M-3). The PMQR genes detected were qnrB, qnrS, and aac(6')-Ib-cr. E. coli isolates were assigned to four major extraintestinal pathogenic E. coli phylogroups, including B2 and D.
  
  
  CONCLUSIONS
  This study provides, for the first time, insight into epidemiology of the ESBL-E fecal carriage among children with cancer in Algeria.
authors.affiliation: 1 Laboratoire d'Ecologie Microbienne , FSNV, Université de Bejaia, Bejaia, Algérie.
authors.forename: Chafiaa
authors.initials: C
authors.lastname: Medboua-Benbalagh
authors.affiliation: 1 Laboratoire d'Ecologie Microbienne , FSNV, Université de Bejaia, Bejaia, Algérie.
authors.forename: Abdelaziz
authors.initials: A
authors.lastname: Touati
authors.affiliation: 1 Laboratoire d'Ecologie Microbienne , FSNV, Université de Bejaia, Bejaia, Algérie.
authors.forename: Rachida
authors.initials: R
authors.lastname: Kermas
authors.affiliation: 1 Laboratoire d'Ecologie Microbienne , FSNV, Université de Bejaia, Bejaia, Algérie.
authors.forename: Alima
authors.initials: A
authors.lastname: Gharout-Sait
authors.affiliation: 2 Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière , CHU Reims, Hôpital Robert DEBRE, Reims, France .|3 EA4687 SFR CAP-Santé [FED 4231], Université de Reims-Champagne-Ardenne , Reims, France .
authors.forename: Lucien
authors.initials: L
authors.lastname: Brasme
authors.affiliation: 1 Laboratoire d'Ecologie Microbienne , FSNV, Université de Bejaia, Bejaia, Algérie.
authors.forename: Halima
authors.initials: H
authors.lastname: Mezhoud
authors.affiliation: 4 Laboratoire Mère et Enfant , CHU Beni-Messous, Alger, Algérie.
authors.forename: Djamila
authors.initials: D
authors.lastname: Touati
authors.affiliation: 2 Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière , CHU Reims, Hôpital Robert DEBRE, Reims, France .|3 EA4687 SFR CAP-Santé [FED 4231], Université de Reims-Champagne-Ardenne , Reims, France .
authors.forename: Thomas
authors.initials: T
authors.lastname: Guillard
authors.affiliation: 2 Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière , CHU Reims, Hôpital Robert DEBRE, Reims, France .|3 EA4687 SFR CAP-Santé [FED 4231], Université de Reims-Champagne-Ardenne , Reims, France .
authors.forename: Christophe
authors.initials: C
authors.lastname: de Champs
mesh_terms: D000293:Adolescent; D000462:Algeria; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial / Q000187:drug effects / Q000235:genetics; D004926:Escherichia coli / Q000187:drug effects / Q000235:genetics*; D005243:Feces / Q000382:microbiology*; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000235:genetics*; D008297:Male; D008826:Microbial Sensitivity Tests; D010802:Phylogeny; D010957:Plasmids / Q000235:genetics; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases
keywords: Algeria; ESBL; Enterobacteriaceae; fecal carriage; pediatric oncology