title: Very high prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae in bacteriemic patients hospitalized in teaching hospitals in Bamako, Mali.
abstract: The worldwide dissemination of extended-spectrum beta-lactamase producing Enterobacteriaceae, (ESBL-E) and their subset producing carbapenemases (CPE), is alarming. Limited data on the prevalence of such strains in infections from patients from Sub-Saharan Africa are currently available. We determined, here, the prevalence of ESBL-E/CPE in bacteriemic patients in two teaching hospitals from Bamako (Mali), which are at the top of the health care pyramid in the country. During one year, all Enterobacteriaceae isolated from bloodstream infections (E-BSI), were collected from patients hospitalized at the Point G University Teaching Hospital and the pediatric units of Gabriel Touré University Teaching Hospital. Antibiotic susceptibility testing, enzyme characterization and strain relatedness were determined. A total of 77 patients had an E-BSI and as many as 48 (62.3%) were infected with an ESBL-E. ESBL-E BSI were associated with a previous hospitalization (OR 3.97 95% IC [1.32; 13.21]) and were more frequent in hospital-acquired episodes (OR 3.66 95% IC [1.07; 13.38]). Among the 82 isolated Enterobacteriaceae, 58.5% were ESBL-E (20/31 Escherichia coli, 20/26 Klebsiella pneumoniae and 8/15 Enterobacter cloacae). The remaining (5 Salmonella Enteritidis, 3 Morganella morganii 1 Proteus mirabilis and 1 Leclercia adecarboxylata) were ESBL negative. CTX-M-1 group enzymes were highly prevalent (89.6%) among ESBLs; the remaining ones being SHV. One E. coli produced an OXA-181 carbapenemase, which is the first CPE described in Mali. The analysis of ESBL-E relatedness suggested a high rate of cross transmission between patients. In conclusion, even if CPE are still rare for the moment, the high rate of ESBL-BSI and frequent cross transmission probably impose a high medical and economic burden to Malian hospitals.
authors.affiliation: Bacteriology Laboratory, Centre Hospitalier Universitaire Gabriel Touré, Bamako, Mali.|Bacteriology Laboratory, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France.|Faculté de Pharmacie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali.
authors.forename: Samba Adama
authors.initials: SA
authors.lastname: Sangare
authors.affiliation: Bacteriology Laboratory, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France.|INSERM, IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Rondinaud
authors.affiliation: Bacteriology Laboratory, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France.|INSERM, IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Naouale
authors.initials: N
authors.lastname: Maataoui
authors.affiliation: Bacteriology Laboratory, Centre Hospitalier Universitaire Gabriel Touré, Bamako, Mali.|Faculté de Pharmacie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali.
authors.forename: Almoustapha Issiaka
authors.initials: AI
authors.lastname: Maiga
authors.affiliation: Faculté de Pharmacie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali.|Institut National de Recherche en Santé Publique, Bamako, Mali.
authors.forename: Ibrehima
authors.initials: I
authors.lastname: Guindo
authors.affiliation: Bacteriology Laboratory, Centre Hospitalier Universitaire du Point G, Bamako, Mali.
authors.forename: Aminata
authors.initials: A
authors.lastname: Maiga
authors.affiliation: Bacteriology Laboratory, Centre Hospitalier Universitaire Gabriel Touré, Bamako, Mali.
authors.forename: Namory
authors.initials: N
authors.lastname: Camara
authors.affiliation: Bacteriology Laboratory, Centre Hospitalier Universitaire du Point G, Bamako, Mali.
authors.forename: Oumar Agaly
authors.initials: OA
authors.lastname: Dicko
authors.affiliation: Faculté de Médecine et d'Odonto- stomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali.
authors.forename: Sounkalo
authors.initials: S
authors.lastname: Dao
authors.affiliation: Faculté de Pharmacie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali.|Centre d'Infectiologie Charles Mérieux, Bamako, Mali.
authors.forename: Souleymane
authors.initials: S
authors.lastname: Diallo
authors.affiliation: Faculté de Pharmacie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali.|Institut National de Recherche en Santé Publique, Bamako, Mali.
authors.forename: Flabou
authors.initials: F
authors.lastname: Bougoudogo
authors.affiliation: Bacteriology Laboratory, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France.|INSERM, IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Andremont
authors.affiliation: Bacteriology Laboratory, Centre Hospitalier Universitaire du Point G, Bamako, Mali.|Faculté de Médecine et d'Odonto- stomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali.
authors.forename: Ibrahim Izetiegouma
authors.initials: II
authors.lastname: Maiga
authors.affiliation: Bacteriology Laboratory, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France.|INSERM, IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Armand-Lefevre
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D016972:Enterobacter cloacae / Q000187:drug effects / Q000502:physiology; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology* / Q000302:isolation & purification / Q000502:physiology; D004926:Escherichia coli / Q000187:drug effects / Q000502:physiology; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000502:physiology; D008297:Male; D008302:Mali; D008875:Middle Aged; D020613:Morganella morganii / Q000187:drug effects / Q000502:physiology; D015995:Prevalence; D011446:Prospective Studies; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases