Community faecal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae in French children

André Birgy, Robert Cohen, Corinne Levy, Philippe Bidet, Céline Courroux, Mohamed Benani, Franck Thollot, Edouard Bingen, André Birgy, Robert Cohen, Corinne Levy, Philippe Bidet, Céline Courroux, Mohamed Benani, Franck Thollot, Edouard Bingen

Abstract

Background: The increasing incidence of community acquired infection due to Extended-Spectrum Beta-Lactamase (ESBL) -Producing Enterobacteriaceae represent a great concern because there are few therapeutic alternatives. The fecal flora of children in the community can represent a reservoir for ESBLs genes which are located on highly transmissible plasmids and the spread of these genes among bacterial pathogens is concerning. Because intestinal carriage is a key factor in the epidemiology of ESBL-producing Enterobacteriaceae, the study of the prevalence of these resistant bacteria and risk factors in young children is of particular interest.

Methods: We assessed the prevalence and risk factors of community-acquired faecal carriage of extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae in children aged from 6 to 24 months, by means of rectal swabbing in community pediatric practices. Child's lifestyle and risk factors for carriage of resistant bacteria were noted.

Results: Among the 411 children enrolled, 4.6% carried ESBL-producing Enterobacteriaceae. CTX-M-1, CTX-M-15 and CTX-M-14 were the predominant ESBLs. The 18 E. coli isolates were genetically heterogeneous. Recent third-generation oral-cephalosporin exposure was associated with a higher risk of ESBL carriage (AOR=3.52, 95% CI[1.06-11.66], p=0.04).

Conclusions: The carriage rate of ESBL-producing Enterobacteriacae in young children in the French community setting is noteworthy, underlining the importance of this population as a reservoir. Exposure to third-generation oral cephalosporins was associated with a significant risk of ESBL carriage in our study. Because of the significant public health implications including the treatment of community-acquired urinary tract infections, the spread of organisms producing ESBLs in the community merits close monitoring with enhanced efforts for surveillance.

Figures

Figure 1
Figure 1
Genetic diversity of ESBL-producing E. coli. Dendrogram showing the genetic heterogeneity of ESBL-producing E. coli. 17 different profiles were found among the 18 isolates with a cut-off for genetic relation of 97%.

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