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dc.contributor.authorWoerther, P-Len
dc.contributor.authorAngebault, Cen
dc.contributor.authorJacquier, Hen
dc.contributor.authorHugede, H-Cen
dc.contributor.authorJanssens, A-Cen
dc.contributor.authorSayadi, Sen
dc.contributor.authorEl Mniai, Aen
dc.contributor.authorArmand-Lefèvre, Len
dc.contributor.authorRuppé, Een
dc.contributor.authorBarbier, Fen
dc.contributor.authorRaskine, Len
dc.contributor.authorPage, A-Len
dc.contributor.authorde Rekeneire, Nen
dc.contributor.authorAndremont, Aen
dc.date.accessioned2011-09-13T15:44:45Z
dc.date.available2011-09-13T15:44:45Z
dc.date.issued2011-10
dc.identifier.citationMassive Increase, Spread, and Exchange of Extended Spectrum {beta}-Lactamase-Encoding Genes Among Intestinal Enterobacteriaceae in Hospitalized Children With Severe Acute Malnutrition in Niger. 2011, 53 (7):677-85 Clin. Infect. Dis.en
dc.identifier.issn1537-6591
dc.identifier.pmid21890771
dc.identifier.doi10.1093/cid/cir522
dc.identifier.urihttp://hdl.handle.net/10144/142275
dc.description.abstractBackground. From the time of CTX-M emergence, extended-spectrum β-lactamase-producing enterobacteria (ESBL-E) have spread worldwide in community settings as well as in hospitals, particularly in developing countries. Although their dissemination appears linked to Escherichia coli intestinal carriage, precise paths of this dynamic are largely unknown. Methods. Children from a pediatric renutrition center were prospectively enrolled in a fecal carriage study. Antibiotic exposure was recorded. ESBL-E strains were isolated using selective media from fecal samples obtained at admission and, when negative, also at discharge. ESBL-encoding genes were identified, their environments and plasmids were characterized, and clonality was assessed with polymerase chain reaction-based methods and pulsed-field gel electrophoresis for E. coli and Klebsiella pneumoniae. E. coli strains were subjected to multilocus sequence typing. Results. The ESBL-E carriage rate was 31% at admission in the 55 children enrolled. All children enrolled received antibiotics during hospitalization. Among the ESBL-E-negative children, 16 were resampled at discharge, and the acquisition rate was 94%. The bla(CTX-M-15) gene was found in >90% of the carriers. Genetic environments and plasmid characterization evidenced the roles of a worldwide, previously described, multidrug-resistant region and of IncF plasmids in CTX-M-15 E. coli dissemination. Diversity of CTX-M-15-carrying genetic structures and clonality of acquired ESBL E. coli suggested horizontal genetic transfer and underlined the potential of some ST types for nosocomial cross-transmission. Conclusions. Cross-transmission and high selective pressure lead to very high acquisition of ESBL-E carriage, contributing to dissemination in the community. Strict hygiene measures as well as careful balancing of benefit-risk ratio of current antibiotic policies need to be reevaluated.
dc.language.isoenen
dc.rightsArchived with thanks to Clinical Infectious Diseases : an official publication of the Infectious Diseases Society of Americaen
dc.subjectdiarrheal diseaseen
dc.titleMassive Increase, Spread, and Exchange of Extended Spectrum {beta}-Lactamase-Encoding Genes Among Intestinal Enterobacteriaceae in Hospitalized Children With Severe Acute Malnutrition in Niger.en
dc.typeArticleen
dc.contributor.departmentFrench National Reference Center for Bacterial Resistance in Commensal Flora, Laboratory of Bacteriology, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris.en
dc.identifier.journalClinical Infectious Diseasesen
refterms.dateFOA2019-03-04T08:49:25Z
html.description.abstractBackground. From the time of CTX-M emergence, extended-spectrum β-lactamase-producing enterobacteria (ESBL-E) have spread worldwide in community settings as well as in hospitals, particularly in developing countries. Although their dissemination appears linked to Escherichia coli intestinal carriage, precise paths of this dynamic are largely unknown. Methods. Children from a pediatric renutrition center were prospectively enrolled in a fecal carriage study. Antibiotic exposure was recorded. ESBL-E strains were isolated using selective media from fecal samples obtained at admission and, when negative, also at discharge. ESBL-encoding genes were identified, their environments and plasmids were characterized, and clonality was assessed with polymerase chain reaction-based methods and pulsed-field gel electrophoresis for E. coli and Klebsiella pneumoniae. E. coli strains were subjected to multilocus sequence typing. Results. The ESBL-E carriage rate was 31% at admission in the 55 children enrolled. All children enrolled received antibiotics during hospitalization. Among the ESBL-E-negative children, 16 were resampled at discharge, and the acquisition rate was 94%. The bla(CTX-M-15) gene was found in >90% of the carriers. Genetic environments and plasmid characterization evidenced the roles of a worldwide, previously described, multidrug-resistant region and of IncF plasmids in CTX-M-15 E. coli dissemination. Diversity of CTX-M-15-carrying genetic structures and clonality of acquired ESBL E. coli suggested horizontal genetic transfer and underlined the potential of some ST types for nosocomial cross-transmission. Conclusions. Cross-transmission and high selective pressure lead to very high acquisition of ESBL-E carriage, contributing to dissemination in the community. Strict hygiene measures as well as careful balancing of benefit-risk ratio of current antibiotic policies need to be reevaluated.


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