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Dikoumba AC, Onanga R, Mangouka LG, Boundenga L, Ngoungou EB, Godreuil S. Molecular epidemiology of antimicrobial resistance in central africa: A systematic review. Access Microbiol 2023; 5:acmi000556.v5. [PMID: 37691840 PMCID: PMC10484317 DOI: 10.1099/acmi.0.000556.v5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 07/21/2023] [Indexed: 09/12/2023] Open
Abstract
Background In Central Africa, it is difficult to tackle antibiotic resistance, because of a lack of data and information on bacterial resistance, due to the low number of studies carried out in the field. To fill this gap, we carried out a systematic review of the various studies, and devised a molecular epidemiology of antimicrobial resistance from humans, animals and the environmental samples. Method A systematic search of all publications from 2005 to 2020 on bacterial resistance in Central Africa (Gabon, Cameroon, Democratic Republic of Congo, Central African Republic, Chad, Republic of Congo, Equatorial Guinea, São Tomé and Príncipe, Angola) was performed on Pubmed, Google scholar and African Journals Online (AJOL). All circulating resistance genes, prevalence and genetic carriers of these resistances were collected. The study area was limited to the nine countries of Central Africa. Results A total of 517 studies were identified through a literature search, and 60 studies carried out in eight countries were included. Among all articles included, 43 articles were from humans. Our study revealed not only the circulation of beta-lactamase and carbapenemase genes, but also several other types of resistance genes. To finish, we noticed that some studies reported mobile genetic elements such as integrons, transposons, and plasmids. Conclusion The scarcity of data poses difficulties in the implementation of effective strategies against antibiotic resistance, which requires a health policy in a 'One Health' approach.
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Affiliation(s)
- Annicet-Clotaire Dikoumba
- Département de biologie médicale, Hôpital d’Instruction des Armées Omar Bongo Ondimba, B.P 20404 Libreville, Gabon
- Unité de recherche et d’Analyses Médicales (URAM), Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), B.P. 679 Franceville, Gabon
| | - Richard Onanga
- Unité de recherche et d’Analyses Médicales (URAM), Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), B.P. 679 Franceville, Gabon
| | - Laurette G. Mangouka
- Département de Médecine, Hôpital d’Instruction des Armées Omar Bongo Ondimba, B.P 20404 Libreville, Gabon
| | - Larson Boundenga
- Groupe Evolution et Transmission Inter-espèces des Pathogènes, Département de Parasitologie du Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
- Unité Maladies Émergentes Virales, Département de Virologie du Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Edgard-Brice Ngoungou
- Unité de Recherche en Epidémiologie des Maladies Chroniques et Santé Environnement (UREMCSE), Département d’Epidémiologie, Biostatistiques et Informatique Médicale (DEBIM), Faculté de Médecine, Université des Sciences de la Santé, BP 4009 Libreville, Gabon
| | - Sylvain Godreuil
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Montpellier, 191 Avenue du Doyen Gaston Giraud, 34 295 Montpellier Cedex 5, France
- MIVEGEC, IRD, CNRS, Université de Montpellier, Montpellier, France
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Tiemtoré RYW, Mètuor Dabiré A, Ouermi D, Sougué S, Benao S, Simporé J. Isolation and Identification of Escherichia coli and Klebsiella pneumoniae Strains Resistant to the Oxyimino-Cephalosporins and the Monobactam by Production of GES Type Extended Spectrum Bêta-Lactamase (ESBL) at Saint Camille Hospital Center in Ouagadougou, Burkina Faso. Infect Drug Resist 2022; 15:3191-3204. [PMID: 35754782 PMCID: PMC9231687 DOI: 10.2147/idr.s360945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022] Open
Abstract
Background Bacterial resistance to beta lactamins is a real public health problem as it complicates treatment strategies. Several types of beta lactamase confer this resistance. Numerous studies report a high prevalence of ESBL producers among Gram-negative bacilli. The objective of this work was to identify the presence of the resistance gene GES in strains of E. coli and K. pneumoniae in Burkina Faso. Methods During this study 39 strains of E. coli and K. pneumoniae resistant to oxyimino-cephalosporin and monobactam were collected in several samples and analyzed to determine the presence of the beta lactamase resistance gene BlaGES by classic PCR. Results In the present study, resistant strains were observed in 21 E. coli and 18 K. pneumoniae. Among producers of ESBL isolates, the presence of the GES gene was detected up to 63% in E. coli and 37% in K pneumoniae. Conclusion This study highlighted the presence of the GES gene in strains of E. coli and K. pneumoniae resistant to oxyimino-cephalosporin and monobactam in Burkina Faso. This highlights the presence of new ESBL in Burkina, which is of great interest for the proper care of patients and the control of resistance to antibiotics.
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Affiliation(s)
- Rahimatou Yasmine Wendkuni Tiemtoré
- Biomolecular and Genetic Laboratory (LABIOGENE), Pietro Annigoni Biomolecular Research Center (CERBA), Department of Biochemistry-Microbiology, University Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | - Amana Mètuor Dabiré
- Biomolecular and Genetic Laboratory (LABIOGENE), Pietro Annigoni Biomolecular Research Center (CERBA), Department of Biochemistry-Microbiology, University Joseph Ki Zerbo, Ouagadougou, Burkina Faso.,Department of Biochemistry-Microbiology, University of Dédougou, Dédougou, Burkina Faso
| | - Djénéba Ouermi
- Biomolecular and Genetic Laboratory (LABIOGENE), Pietro Annigoni Biomolecular Research Center (CERBA), Department of Biochemistry-Microbiology, University Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | - Serge Sougué
- Biomolecular and Genetic Laboratory (LABIOGENE), Pietro Annigoni Biomolecular Research Center (CERBA), Department of Biochemistry-Microbiology, University Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | - Stéphanie Benao
- Biomolecular and Genetic Laboratory (LABIOGENE), Pietro Annigoni Biomolecular Research Center (CERBA), Department of Biochemistry-Microbiology, University Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | - Jacques Simporé
- Biomolecular and Genetic Laboratory (LABIOGENE), Pietro Annigoni Biomolecular Research Center (CERBA), Department of Biochemistry-Microbiology, University Joseph Ki Zerbo, Ouagadougou, Burkina Faso
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Oueslati W, Rjeibi MR, Benyedem H, Mamlouk A, Souissi F, Selmi R, Ettriqui A. Salmonella Broiler Meat's Contamination in Tunisia: Prevalence, Serotypes, Antimicrobial Resistance and Molecular Characterization of Isolated Strains. Curr Microbiol 2022; 79:208. [PMID: 35639195 DOI: 10.1007/s00284-022-02900-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/09/2022] [Indexed: 11/03/2022]
Abstract
This study was conducted in north-eastern Tunisia to estimate the contamination prevalence of Salmonella in broilers' meat, to rank serotypes and to characterize the isolated multidrug-resistant (MDR) strains. A total number of 1288 meat samples were collected from 322 broiler batches; Salmonella isolates were identified by the alternative technique VIDAS Easy Salmonella. The susceptibility of Salmonella isolates was assessed against 21 antimicrobials using the disc diffusion method on Mueller-Hinton agar. Some antimicrobial resistance genes were identified using Polymerase Chain Reaction (PCR). The prevalence rates of Salmonella in the neck skin and the breast muscle contamination were estimated at 11.8% (38/322) and 0.9% (3/322), respectively. The prevalence rate of Salmonella in meat cutting parts contamination was estimated at 5.1% (33/644). Eight serotypes of Salmonella were identified, namely S. Enteritidis, S. Kentucky, S. Anatum, S. Infantis, S. Mbandaka, S. Zanzibar, S. Hadar and S. Agona. High rate of resistance was identified against amoxicillin (91.9%), nalidixic acid (83.8%), tetracycline (75.7%), streptomycin (73%), ciprofloxacin (70%), sulfamides (68.9%), cefalotin (68.9%), cefotaxim (67.6%) and cefoxitin (60.8%). The majority (90.5%; 67/74) of isolated strains was recognized as MDR. Nine MDR strains were identified as Extended-Spectrum β-Lactamase (ESBL) producers. The blaCTX-M gene was identified by PCR in all the nine ESBL strains. TetA, tetB and dfrA1 genes were amplified in 3.6% (2/56), 1.8% (1/56) and 19.3% (5/26) of tetracycline and trimethoprim-resistant strains, respectively. The integrase gene (class 2) was identified in only 8.1% (6/74) of the Salmonella-isolated strains. Our findings highlight the emergence of MDR Salmonella isolates in Tunisia.
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Affiliation(s)
- Walid Oueslati
- Laboratory of Management of Animal Production's Health and Quality, National School of Veterinary Medicine of Sidi Thabet, University Manouba (LR14AGR03), 2010, La Manouba, Tunisia. .,Department of Animal Production, National Agronomic Institute, University Carthage, 1054, Carthage, Tunisia.
| | - Mohamed Ridha Rjeibi
- Laboratory of Parasitology, National School of Veterinary Medicine of Sidi Thabet, University Manouba, 2010, La Manouba, Tunisia.,Laboratory of Parasitology, Veterinary Research Institute, University de Tunis El Manar, 1068, Tunis, Tunisia
| | - Hayet Benyedem
- Laboratory of Parasitology, National School of Veterinary Medicine of Sidi Thabet, University Manouba, 2010, La Manouba, Tunisia
| | - Aymen Mamlouk
- Laboratory of Microbiology, National School of Veterinary Medicine of Sidi Thabet, University Manouba, 2010, La Manouba, Tunisia
| | - Fatma Souissi
- Laboratory of Management of Animal Production's Health and Quality, National School of Veterinary Medicine of Sidi Thabet, University Manouba (LR14AGR03), 2010, La Manouba, Tunisia
| | - Rachid Selmi
- Laboratory of Microbiology, National School of Veterinary Medicine of Sidi Thabet, University Manouba, 2010, La Manouba, Tunisia
| | - Abdelfettah Ettriqui
- Laboratory of Management of Animal Production's Health and Quality, National School of Veterinary Medicine of Sidi Thabet, University Manouba (LR14AGR03), 2010, La Manouba, Tunisia
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Prevalence, Risk Factors, Antimicrobial Resistance and Molecular Characterization of Salmonella in Northeast Tunisia Broiler Flocks. Vet Sci 2021; 9:vetsci9010012. [PMID: 35051096 PMCID: PMC8780282 DOI: 10.3390/vetsci9010012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/27/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022] Open
Abstract
This study was conducted in northeastern Tunisia to estimate both the prevalence and the risk factors of Salmonella in broiler flocks as well as to characterize the isolated multidrug-resistant (MDR) Salmonella strains. In the present study, a total number of 124 farms were sampled; Salmonella isolates were identified by the alternative technique VIDAS Easy Salmonella. The susceptibility of Salmonella isolates was assessed against 21 antimicrobials using the disk diffusion method on Mueller–Hinton agar using antimicrobial discs. Some antimicrobial resistance genes were identified using PCR. The prevalence rate of Salmonella infection, in the sampled farms, was estimated at 19.9% (64/322). Moreover, a total number of 13 different serotypes were identified. High rate of resistance was identified against nalidixic acid (82.85%), amoxicillin (81.25%), streptomycin (75%), and ciprofloxacin (75%). Alarming level of resistance to ertapenem (12.5%) was noticed. A total of 87.5% (56/64) of isolated strains were recognized as MDR. Three MDR strains were extended-spectrum β-lactamases (ESBL)-producers and three MDR strains were cephalosporinase-producers. The blaCTX-M gene was amplified in all the three ESBL strains. The qnrB gene was not amplified in fluoroquinolones-resistant strains. The tetA and tetB genes were amplified in 5% (2/40) and 2.5% (1/40) of tetracycline-resistant strains, respectively. The dfrA1 gene was amplified in five of the 20 trimethoprim-resistant strains. The mcr-1, mcr-2, mcr-3, mcr-4, and mcr-5 genes were not amplified in any of the phenotypically colistin-resistant strains. In terms of integrase genes int1 and int2, only gene class 2 was amplified in 11% (7/64) of analyzed strains. Risk factors, such as the poor level of cleaning and disinfection, the lack of antimicrobial treatment at the start of the breeding, and a crawl space duration lower than 15 days, were associated with high Salmonella infection in birds. These data should be considered when preparing salmonellosis control programs in Tunisian broiler flocks.
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Guermazi-Toumi S, Boujlel S, Assoudi M, Issaoui R, Tlili S, Hlaiem ME. Susceptibility profiles of bacteria causing urinary tract infections in Southern Tunisia. J Glob Antimicrob Resist 2018; 12:48-52. [DOI: 10.1016/j.jgar.2017.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/02/2017] [Accepted: 09/04/2017] [Indexed: 01/18/2023] Open
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Rakotovao-Ravahatra ZD, Randriatsarafara FM, Rasoanandrasana S, Raverohanta L, Rakotovao AL. [Resistant phenotypes of Escherichia coli strains responsible for urinary tract infection in the laboratory of the University Hospital Joseph Raseta Befelatanana, Antananarivo]. Pan Afr Med J 2017; 26:166. [PMID: 28674559 PMCID: PMC5483373 DOI: 10.11604/pamj.2017.26.166.11828] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 03/02/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction I’infection urinaire à Escherichia coli est fréquente en milieu hospitalier. Cette étude se propose de décrire les différents phénotypes de résistance des souches d’Escherichia coli afin de surveiller leur émergence. Méthodes Il s’agit d’une étude rétrospective de type descriptif de 102 souches d’Escherchia coli responsables d’infection urinaire sur une période allant du mois de Janvier 2014 au mois d’Octobre 2016 au Laboratoire du Centre Hospitalo-Universitaire Befelatanana Antananarivo. Résultats La résistance aux béta-lactamines a identifié des pénicillinases de haut niveau 50% (n=51), des Escherichia coli sécrétrices de Béta-Lactamase à Spectre Etendu E-BLSE 22,5% (n=23), des céphalosporinases de haut niveau 14,7% (n=15), des pénicillinases de bas niveau 5,9% (n=6), des souches sauvages 5,9% (n=6) et une souche d’Escherichia coli hautement résistante émergente. La résistance aux aminosides a concerné 58 (56,9%) phénotypes sauvages, 29 (28,4%) souches sensibles à l’amikacine et 15 (14,7%) résistants à tous les aminosides. La résistance aux fluoroquinolones a identifiée 52 (51%) souches sauvages, 9 (8,8%) souches sensibles à la ciprofloxacine et 41 (40,2%) résistantes à tous les fluoroquinolones. Les femmes (25, 7%) (p= 0,25, NS), les sujets de plus de 60 ans (38,7%) (p=0,02), les sujets hospitalisés dans le service de néphrologie (53,8%) (p=0,04), ayant présenté des troubles urinaires et rénaux (29, 7%) (p= 0,2, NS), ont été les plus affectés par les E-BLSE. Conclusion La multi-résistance élevée des souches d’Escherichia coli interpelle sur une révision du traitement empirique des infections urinaires.
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Rossignol L, Maugat S, Blake A, Vaux S, Heym B, Le Strat Y, Kernéis S, Blanchon T, Coignard B, Hanslik T. Risk factors for resistance in urinary tract infections in women in general practice: A cross-sectional survey. J Infect 2015; 71:302-11. [DOI: 10.1016/j.jinf.2015.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/06/2015] [Accepted: 05/19/2015] [Indexed: 12/30/2022]
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Dananché C, Bénet T, Allaouchiche B, Hernu R, Argaud L, Dauwalder O, Vandenesch F, Vanhems P. Targeted screening for third-generation cephalosporin-resistant Enterobacteriaceae carriage among patients admitted to intensive care units: a quasi-experimental study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:38. [PMID: 25879192 PMCID: PMC4344746 DOI: 10.1186/s13054-015-0754-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/19/2015] [Indexed: 12/14/2022]
Abstract
Introduction Identification of third-generation, cephalosporin-resistant Enterobacteriaceae (3GC-RE) carriers by rectal screening at admission seems to be an important step in the prevention of transmission and outbreaks; however, little is known about its effectiveness. The aim of this study was to evaluate the impact of ‘targeted screening’ at patient admission to intensive care units (ICUs) on the incidence of 3GC-RE hospital-acquired infections (HAIs) and compare it to ‘universal screening’. Methods We undertook a quasi-experimental study of two ICUs (unit A: intervention group; unit B: control group) at a university-affiliated hospital between 1 January 2008 and 31 December 2011. In unit A, patients were screened universally for 3GC-RE at admission during period 1 (1 January 2008 through 30 September 2010). During period 2 (2011 calendar year), the intervention was implemented in unit A; patients transferred from another unit or hospital were screened selectively. In unit B, all patients were screened throughout periods 1 and 2. 3GC-RE-related HAI incidence rates were expressed per 1,000 patient-days. Incidence rate ratios (IRRs) were examined by multivariate Poisson regression modelling. Results In unit A, 3GC-RE-related HAI incidence rates decreased from 5.4 (95% confidence interval (CI), 4.1 to 7.0) during period 1 to 1.3 (95% CI, 0.5 to 2.9) during period 2 (P < 0.001). No changes were observed in unit B between periods 1 and 2 (P = 0.5). In unit A, the adjusted incidence of 3GC-RE-related HAIs decreased in period 2 compared with period 1 (adjusted IRR, 0.3; 95% CI, 0.1 to 0.9; P = 0.03) independently of temporal trend, trauma and age. No changes were seen in unit B (P = 0.4). The total number of rectal swabs taken showed an 85% decrease in unit A between period 1 and 2 (P < 0.001). Conclusions Targeted screening of 3GC-RE carriers at ICU admission was not associated with an increase in 3GC-RE-related HAI incidence compared with universal screening. Total number of rectal swabs decreased significantly. These findings suggest that targeted screening may be worth assessing as an alternative to universal screening.
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Affiliation(s)
- Cédric Dananché
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, Cedex 03, France.
| | - Thomas Bénet
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, Cedex 03, France. .,Epidemiology and Public Health Group, University of Lyon 1, 8, avenue Rockefeller, 69373, Lyon, Cedex 08, France.
| | - Bernard Allaouchiche
- Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, Cedex 03, France.
| | - Romain Hernu
- Medical Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, Cedex 03, France.
| | - Laurent Argaud
- Medical Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, Cedex 03, France.
| | - Olivier Dauwalder
- Institut of Microbiology, Department of Bacteriology, East Hospital Complex, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron, France.
| | - François Vandenesch
- Institut of Microbiology, Department of Bacteriology, East Hospital Complex, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron, France.
| | - Philippe Vanhems
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, Cedex 03, France. .,Epidemiology and Public Health Group, University of Lyon 1, 8, avenue Rockefeller, 69373, Lyon, Cedex 08, France.
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Moutachakkir M, Chinbo M, Elkhoudri N, Soraa N. La résistance aux antibiotiques chez les entérobactéries uropathogènes en milieu pédiatrique au CHU de Marrakech. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jpp.2014.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lepelletier D, Batard E, Berthelot P, Zahar JR, Lucet JC, Fournier S, Jarlier V, Grandbastien B. [Carbapenemase-producing enterobacteriae: epidemiology, strategies to control their spread and issues]. Rev Med Interne 2015; 36:474-9. [PMID: 25600328 DOI: 10.1016/j.revmed.2014.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 10/24/2022]
Abstract
The increasing bacterial resistance to antibiotics has become a major public health concern bringing the threat of therapeutic impasses. In this context, control of the spread of highly-resistant bacteria emerging antibiotics (BHRe), such as glycopeptide-resistant enterococci (VRE) and Enterobacteriaceae producing carbapenemases (CPE), is based on a dual strategy of reducing the prescription of antibiotics to limit the pressure selection and preventing the spread from carriers. Prevention strategy is based on three different levels such as standard precautions for all patients with a particular focus on the management of excreta, and additional precautions for BHRe carriers. What makes it difficult is that carriage is usually completely asymptomatic, enterobacteria and enterococci are normal commensal of gut microbiota. Explosive dissemination of Enterobacteriaceae producing extended spectrum beta-lactamases in hospital and community heralds the emergence of CPE whose import by patients with a history of hospitalization in abroad may be the main source of spread in France.
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Affiliation(s)
- D Lepelletier
- Unité de gestion du risque infectieux, université de Nantes, 6, rue du prof.-Yves-Boquien, 44093 Nantes cedex 01, France; EA3826, thérapeutiques cliniques et expérimentales des infections, université de Nantes, 44035 Nantes, France.
| | - E Batard
- EA3826, thérapeutiques cliniques et expérimentales des infections, université de Nantes, 44035 Nantes, France
| | - P Berthelot
- Unité d'hygiène inter-hospitalière, service des maladies infectieuses et de microbiologie, CHU de Saint-Étienne, 42100 Saint-Étienne, France
| | - J-R Zahar
- Unité de lutte contre les infections nosocomiales, CHU d'Angers, 49100 Angers, France
| | - J-C Lucet
- Unité hospitalière de lutte contre l'infection nosocomiale, groupe hospitalier Bichat-Claude-Bernard, AP-HP, 75877 Paris, France
| | - S Fournier
- CLIN central de l'AP-HP, 75004 Paris, France
| | - V Jarlier
- CLIN central de l'AP-HP, 75004 Paris, France; Laboratoire de bactériologie, hôpital La Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - B Grandbastien
- Unité de lutte contre les infections nosocomiales, service de gestion du risque infectieux, des vigilances et d'infectiologie, CHRU de Lille, 59000 Lille, France
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