Contributors: Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC); Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD Occitanie ); Centre Hospitalier Régional Universitaire Montpellier (CHRU Montpellier); Hôpital de la Mère et de l’Enfant N’Djaména, Tchad; Du gène à l'écosystème (MIVEGEC-GeneSys); Pathogènes, Environnement, Santé Humaine (EPATH); Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD Occitanie )-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD Occitanie )-Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC); Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD Occitanie )-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD Occitanie ); Université de N'Djaména; Hôpital Général des Références Nationale N'Djamena, Tchad (HGRN); L’hôpital de la Renaissance D'Jamena, Tchad; Universidad Andrés Bello Santiago (UNAB); Pôle Biologie-Pathologie CHRU Montpellier; Institut Pasteur du Cambodge; Pasteur Network (Réseau International des Instituts Pasteur); This study was supported by a grant from Islamic Development Bank (IDB).; We would like to thank IRD and CHU. We thank Elisabetta Andermarcher for assistance in preparing and editing the manuscript.
نبذة مختصرة : International audience ; BACKGROUND : Extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-PE) represent a major problem in the management of nosocomial infections. However, ESBL-PE are not systematically monitored in African countries. The aim of this study was to determine ESBL-PE prevalence in patients from three hospitals in N'Djamena, the capital city of Chad, and to characterize the genetic origin of the observed resistance.METHODS : From January to March 2017, 313 non-duplicate isolates were recovered from various clinical specimens obtained from 1713 patients in the three main hospitals of N'Djamena. Bacterial species were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Susceptibility to 28 antibiotics was tested using the disk diffusion method on Müller-Hinton agar, and ESBL production was confirmed with the double-disc synergy test. The most prevalent ESBL genes associated with the observed resistance were detected using multiplex PCR followed by double-stranded DNA sequencing.RESULTS : Among the 313 isolates, 197 belonged to the Enterobacteriaceae family. The overall ESBL-PE prevalence was 47.72% (n = 94/197), with a higher rate among inpatients compared with outpatients (54.13% vs. 34.37%). ESBL-PE prevalence was highest in older patients (≥60 years of age). E. coli was the most common ESBL-producer organism (63.8%), followed by K. pneumoniae (21.2%). ESBL-PE were mainly found in urine samples (75%). The CTX-M-1 group was dominant (96.7% of the 94 ESBL-PE isolates, CTX-M-15 enzyme), followed by the CTX-M-9 group (4.1%). 86% of resistant isolates harbored more than one ESBL-encoding gene. ESBL production was also associated with the highest levels of resistance to non-β-lactam drugs.CONCLUSIONS : The prevalence of ESBL-PE harboring resistant genes encoding ESBLs of the CTX-M-1 group was high (48%) among clinical isolates of three main hospitals in Chad, suggesting an alarming spread of ESBL-PE among patients.
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