Fecal Carriage of Enterobacteriaceae Producing Extended-Spectrum Beta-Lactamases in Hospitalized Patients and Healthy Community Volunteers in Burkina Faso

Abstract

Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) have been described worldwide, but few reports focused on Burkina Faso. To assess the prevalence of digestive carriage of such bacteria in the community and in the hospital, 214 fecal samples, 101 from healthy volunteers and 113 from hospitalized patients without digestive pathology, were collected in Bobo Dioulasso, Burkina Faso economic capital, during July and August 2014. Stool samples were screened using ESBL agar plates. Strains were identified by mass spectrometry using the Biotyper MALDI-TOF. ESBL production was confirmed with the double-disc synergy test. Susceptibility was tested using the disk diffusion method on Müller-Hinton agar. The main ESBL genes were detected using multiplex PCR and bidirectional gene sequencing. Escherichia coli phylogenetic groups were identified using a PCR-based method. During the study period, prevalence of subjects with fecal ESBL-PE was 32% (69/214), 22% among healthy volunteers and 42% among inpatients. All but two ESBL, CTX-M-15 and ESBL-PE, were mostly E. coli (78%). Among the 60 ESBL-producing E. coli strains, 26% belonged to phylogenetic group D, 23.3% to group A, 20% to group B1, 6.6% to group B2, and 3.3% to the ST131 clone. Univariate analysis showed that history of hospitalization and previous antibiotic use were risk factors associated with ESBL-PE fecal carriage. In Burkina Faso, the prevalence of both healthy subjects from the community and hospitalized patients with fecal ESBL-PE is alarmingly high. This feature should be taken into consideration by both general practitioners and hospital doctors with regard to empirical treatments of infections, notably urinary tract infections.

Epidemiology and molecular characterization of Enterobacteriaceae producing Extended spectrum β-lactamase in extensive and extensive breeding animals in Burkina Faso

“…In the majority of the surveys, blaCTX-M-15 was the most common ESBL gene detected worlwide in animals and humans. [12,28,29] This result has been also found in Burkina Faso among human clinical samples and fecal carriage [30,31,32]. Then E. coli strains belonged majoritary to phylogroup A in our study.…”

“…Then E. coli strains belonged majoritary to phylogroup A in our study. The majority of the african studies showed also a dominance of phylogroups A and B1 among healthy animals, derived meat, human clinical samples and human fecal carriage [12,30,31].…”

Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) among travellers to Africa: destination-specific data pooled from three European prospective studies

“…Moreover, in the research by Frickmann et al, 27.1% (13/48) of European military personnel with diarrhoea in Mali became colonized by ESBL-PE [ 23 ]. As for local populations, colonization rates of 22% have been reported for healthy volunteers in Burkina Faso [ 24 ] and 33% for healthy community children in Guinea-Bissau [ 25 ].…”

Advocacy for Increased International Efforts for Antimicrobial Stewardship Actions in Low-and Middle-Income Countries on Behalf of Alliance for the Prudent Use of Antimicrobials (APUA), Under the Auspices of the International Society of Antimicrobial Chemotherapy (ISAC)

“…Sadly, the current status of the diagnostic microbiology laboratory in LMIC would very rarely allow such support for AMS programs (25). Although point-prevalence surveys have demonstrated MDR bacteria have emerged in many LMIC (26)(27)(28), with striking heterogeneity, in humans as well as in animals (29), such data remain scarce: Many colleagues in LMIC work in an environment where they have no, or limited information about the prevalence of resistance to the antibiotics they use in common situations. Even in countries where surveillance is in place, updated, communication to prescribers is sub-optimal.…”