Very high prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae in bacteriemic patients hospitalized in teaching hospitals in Bamako, Mali

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 determin...

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Veröffentlicht in:PloS one 2017-02, Vol.12 (2), p.e0172652-e0172652
Hauptverfasser: Sangare, Samba Adama, Rondinaud, Emilie, Maataoui, Naouale, Maiga, Almoustapha Issiaka, Guindo, Ibrehima, Maiga, Aminata, Camara, Namory, Dicko, Oumar Agaly, Dao, Sounkalo, Diallo, Souleymane, Bougoudogo, Flabou, Andremont, Antoine, Maiga, Ibrahim Izetiegouma, Armand-Lefevre, Laurence
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container_title PloS one
container_volume 12
creator Sangare, Samba Adama
Rondinaud, Emilie
Maataoui, Naouale
Maiga, Almoustapha Issiaka
Guindo, Ibrehima
Maiga, Aminata
Camara, Namory
Dicko, Oumar Agaly
Dao, Sounkalo
Diallo, Souleymane
Bougoudogo, Flabou
Andremont, Antoine
Maiga, Ibrahim Izetiegouma
Armand-Lefevre, Laurence
description 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.
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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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0172652</identifier><identifier>PMID: 28245252</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - pharmacology ; Antibiotics ; Bacteremia - microbiology ; Bacterial infections ; Bacteriology ; Bernard, Claude (1813-1878) ; Beta lactamases ; beta-Lactamases - metabolism ; Biology and Life Sciences ; Carbapenemase ; Drug Resistance, Bacterial ; E coli ; Enterobacter cloacae ; Enterobacter cloacae - drug effects ; Enterobacter cloacae - physiology ; Enterobacteriaceae ; Enterobacteriaceae - drug effects ; Enterobacteriaceae - enzymology ; Enterobacteriaceae - isolation &amp; purification ; Enterobacteriaceae - physiology ; Enzymes ; Escherichia coli ; Escherichia coli - drug effects ; Escherichia coli - physiology ; Female ; Genetic aspects ; Health aspects ; Health care ; Hospital patients ; Hospitalization ; Hospitals ; Hospitals, Teaching - statistics &amp; numerical data ; Humans ; Infections ; Klebsiella ; Klebsiella pneumoniae ; Klebsiella pneumoniae - drug effects ; Klebsiella pneumoniae - physiology ; Laboratories ; Leclercia adecarboxylata ; Male ; Mali ; Medicine and Health Sciences ; Middle Aged ; Morganella morganii ; Morganella morganii - drug effects ; Morganella morganii - physiology ; Nosocomial infections ; Patients ; Pediatrics ; Prevalence ; Prospective Studies ; Proteus mirabilis ; Salmonella ; Salmonella enteritidis ; Teaching hospitals ; Young Adult ; β Lactamase</subject><ispartof>PloS one, 2017-02, Vol.12 (2), p.e0172652-e0172652</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Sangare et al. 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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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Antibiotics</subject><subject>Bacteremia - microbiology</subject><subject>Bacterial infections</subject><subject>Bacteriology</subject><subject>Bernard, Claude (1813-1878)</subject><subject>Beta lactamases</subject><subject>beta-Lactamases - metabolism</subject><subject>Biology and Life Sciences</subject><subject>Carbapenemase</subject><subject>Drug Resistance, Bacterial</subject><subject>E coli</subject><subject>Enterobacter cloacae</subject><subject>Enterobacter cloacae - drug effects</subject><subject>Enterobacter cloacae - physiology</subject><subject>Enterobacteriaceae</subject><subject>Enterobacteriaceae - drug effects</subject><subject>Enterobacteriaceae - 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drug effects</subject><subject>Morganella morganii - physiology</subject><subject>Nosocomial infections</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Prevalence</subject><subject>Prospective Studies</subject><subject>Proteus mirabilis</subject><subject>Salmonella</subject><subject>Salmonella enteritidis</subject><subject>Teaching hospitals</subject><subject>Young Adult</subject><subject>β Lactamase</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk21r1TAUx4sobk6_gWhhIAr2moe2ad8Ic0wdTAY-7G1Ik5PbXHubmqTD-Wn8qKa7vWNX9mI00Pac3_nn5OScJHmO0QJTht-t7Oh60S0G28MCYUbKgjxI9nFNSVYSRB_e-t5Lnni_QqigVVk-TvZIRfKCFGQ_-XsB7iptzbJNBweXooNeQmp1Cr8D9ApU5geQwY3rtIEgsk7IINbCQzY4q0Zp-mV60gdwtokecEZIEJCaPp3_YW1kOohgoA8-ba0fTBCd-QNqggII2U4aW4efrB_iDj_t2_RLBJ8mj3Q0w7P5fZD8-Hjy_fhzdnb-6fT46CyTrMYhayirG4WQUmRahAGtMGhJcJUjpitUIcilLrDWFalqRIRqVE6ZLCmBkml6kLzc6A6d9Xwurue4YoRVdV3UkTjdEMqKFR-cWQt3xa0w_Npg3ZILF4zsgGvKhKC6aDQROZRCyJhViRrV1ERjnUet9_NuY7MGJWNxnOh2RHc9vWn50l7yglKUl2UUeD0LOPtrBB_42ngJXSd6sON13qyiNcbsPijNES7q6YiH_6F3F2KmlrFduOm1jSnKSZQf5RXNGSryiVrcQcVHTS0Rm1abaN8JeLMTEJkQu3ApRu_56bev92fPL3bZV7fYFkQXWm-7MRjb-10w34DSWe8d6Jv7wIhPM7etBp9mjs8zF8Ne3L7Lm6DtkNF__owq8Q</recordid><startdate>20170228</startdate><enddate>20170228</enddate><creator>Sangare, Samba Adama</creator><creator>Rondinaud, Emilie</creator><creator>Maataoui, Naouale</creator><creator>Maiga, Almoustapha Issiaka</creator><creator>Guindo, Ibrehima</creator><creator>Maiga, Aminata</creator><creator>Camara, Namory</creator><creator>Dicko, Oumar Agaly</creator><creator>Dao, Sounkalo</creator><creator>Diallo, Souleymane</creator><creator>Bougoudogo, Flabou</creator><creator>Andremont, Antoine</creator><creator>Maiga, Ibrahim Izetiegouma</creator><creator>Armand-Lefevre, Laurence</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20170228</creationdate><title>Very high prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae in bacteriemic patients hospitalized in teaching hospitals in Bamako, Mali</title><author>Sangare, Samba Adama ; Rondinaud, Emilie ; Maataoui, Naouale ; Maiga, Almoustapha Issiaka ; Guindo, Ibrehima ; Maiga, Aminata ; Camara, Namory ; Dicko, Oumar Agaly ; Dao, Sounkalo ; Diallo, Souleymane ; Bougoudogo, Flabou ; Andremont, Antoine ; Maiga, Ibrahim Izetiegouma ; Armand-Lefevre, Laurence</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c791t-b379bd00dd2dd2d27e381efc218407f8080e4cf51ff828902adbd437c632e67f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Antibiotics</topic><topic>Bacteremia - microbiology</topic><topic>Bacterial infections</topic><topic>Bacteriology</topic><topic>Bernard, Claude (1813-1878)</topic><topic>Beta lactamases</topic><topic>beta-Lactamases - metabolism</topic><topic>Biology and Life Sciences</topic><topic>Carbapenemase</topic><topic>Drug Resistance, Bacterial</topic><topic>E coli</topic><topic>Enterobacter cloacae</topic><topic>Enterobacter cloacae - drug effects</topic><topic>Enterobacter cloacae - physiology</topic><topic>Enterobacteriaceae</topic><topic>Enterobacteriaceae - drug effects</topic><topic>Enterobacteriaceae - enzymology</topic><topic>Enterobacteriaceae - isolation &amp; purification</topic><topic>Enterobacteriaceae - physiology</topic><topic>Enzymes</topic><topic>Escherichia coli</topic><topic>Escherichia coli - drug effects</topic><topic>Escherichia coli - physiology</topic><topic>Female</topic><topic>Genetic aspects</topic><topic>Health aspects</topic><topic>Health care</topic><topic>Hospital patients</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Hospitals, Teaching - statistics &amp; numerical data</topic><topic>Humans</topic><topic>Infections</topic><topic>Klebsiella</topic><topic>Klebsiella pneumoniae</topic><topic>Klebsiella pneumoniae - drug effects</topic><topic>Klebsiella pneumoniae - physiology</topic><topic>Laboratories</topic><topic>Leclercia adecarboxylata</topic><topic>Male</topic><topic>Mali</topic><topic>Medicine and Health Sciences</topic><topic>Middle Aged</topic><topic>Morganella morganii</topic><topic>Morganella morganii - drug effects</topic><topic>Morganella morganii - physiology</topic><topic>Nosocomial infections</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Prevalence</topic><topic>Prospective Studies</topic><topic>Proteus mirabilis</topic><topic>Salmonella</topic><topic>Salmonella enteritidis</topic><topic>Teaching hospitals</topic><topic>Young Adult</topic><topic>β Lactamase</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sangare, Samba Adama</creatorcontrib><creatorcontrib>Rondinaud, Emilie</creatorcontrib><creatorcontrib>Maataoui, Naouale</creatorcontrib><creatorcontrib>Maiga, Almoustapha Issiaka</creatorcontrib><creatorcontrib>Guindo, Ibrehima</creatorcontrib><creatorcontrib>Maiga, Aminata</creatorcontrib><creatorcontrib>Camara, Namory</creatorcontrib><creatorcontrib>Dicko, Oumar Agaly</creatorcontrib><creatorcontrib>Dao, Sounkalo</creatorcontrib><creatorcontrib>Diallo, Souleymane</creatorcontrib><creatorcontrib>Bougoudogo, Flabou</creatorcontrib><creatorcontrib>Andremont, Antoine</creatorcontrib><creatorcontrib>Maiga, Ibrahim Izetiegouma</creatorcontrib><creatorcontrib>Armand-Lefevre, Laurence</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing &amp; Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological &amp; Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science &amp; Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies &amp; Aerospace Collection</collection><collection>Agricultural &amp; Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection (ProQuest)</collection><collection>Natural Science Collection (ProQuest)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Meteorological &amp; Geoastrophysical Abstracts - Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agricultural Science Database</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>Advanced Technologies &amp; Aerospace Database</collection><collection>ProQuest Advanced Technologies &amp; Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sangare, Samba Adama</au><au>Rondinaud, Emilie</au><au>Maataoui, Naouale</au><au>Maiga, Almoustapha Issiaka</au><au>Guindo, Ibrehima</au><au>Maiga, Aminata</au><au>Camara, Namory</au><au>Dicko, Oumar Agaly</au><au>Dao, Sounkalo</au><au>Diallo, Souleymane</au><au>Bougoudogo, Flabou</au><au>Andremont, Antoine</au><au>Maiga, Ibrahim Izetiegouma</au><au>Armand-Lefevre, Laurence</au><au>Gonzalez-Bello, Concepción</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Very high prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae in bacteriemic patients hospitalized in teaching hospitals in Bamako, Mali</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2017-02-28</date><risdate>2017</risdate><volume>12</volume><issue>2</issue><spage>e0172652</spage><epage>e0172652</epage><pages>e0172652-e0172652</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28245252</pmid><doi>10.1371/journal.pone.0172652</doi><tpages>e0172652</tpages><oa>free_for_read</oa></addata></record>
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subjects Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - pharmacology
Antibiotics
Bacteremia - microbiology
Bacterial infections
Bacteriology
Bernard, Claude (1813-1878)
Beta lactamases
beta-Lactamases - metabolism
Biology and Life Sciences
Carbapenemase
Drug Resistance, Bacterial
E coli
Enterobacter cloacae
Enterobacter cloacae - drug effects
Enterobacter cloacae - physiology
Enterobacteriaceae
Enterobacteriaceae - drug effects
Enterobacteriaceae - enzymology
Enterobacteriaceae - isolation & purification
Enterobacteriaceae - physiology
Enzymes
Escherichia coli
Escherichia coli - drug effects
Escherichia coli - physiology
Female
Genetic aspects
Health aspects
Health care
Hospital patients
Hospitalization
Hospitals
Hospitals, Teaching - statistics & numerical data
Humans
Infections
Klebsiella
Klebsiella pneumoniae
Klebsiella pneumoniae - drug effects
Klebsiella pneumoniae - physiology
Laboratories
Leclercia adecarboxylata
Male
Mali
Medicine and Health Sciences
Middle Aged
Morganella morganii
Morganella morganii - drug effects
Morganella morganii - physiology
Nosocomial infections
Patients
Pediatrics
Prevalence
Prospective Studies
Proteus mirabilis
Salmonella
Salmonella enteritidis
Teaching hospitals
Young Adult
β Lactamase
title Very high prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae in bacteriemic patients hospitalized in teaching hospitals in Bamako, Mali
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