High burden of extended-spectrum β-lactamase-producing Enterobacteriaceae in Gabon

Extended-spectrum -lactamase-producing Enterobacteriaceae (ESBL-E) are sporadically reported from infections in sub-Saharan Africa. Travellers returning from the tropics have a high risk of ESBL-E colonization, which suggests a high prevalence of ESBL-E in Africa. Our objective was to assess the burden of rectal ESBL-E colonization and associated risk factors in Gabon, Central Africa We performed a cross-sectional study on 200 hospitalized children in Gabon, Central Africa, on rectal ESBL-E colonization and applied a standardized questionnaire to assess risk factors. The antimicrobial resistance and the type of -lactamase (SHV, TEM and CTX-M) were analysed for each isolate. Isolates associated with nosocomial spread were further genotyped. The overall colonization rate of ESBL-E was 45 (n90) and increased from 33.6 (n37) at admission to 94.1 (n16) during hospitalization. Risk factors for ESBL-E carriage were age 5 years, hospitalization for 5 days and a hospital stay during the past year. All isolates were susceptible to meropenem, but non-susceptible to ciprofloxacin in 52.8 (n57). CTX-M-15 was the predominant -lactamase. Genotyping revealed a polyclonal structure of nosocomial isolates. ESBL colonization in hospitalized children in Gabon is high. The risk of nosocomial transmission of ESBL-E is a challenge in rural Africa and underlines the need for sentinel surveillance in the absence of a broad decentralized microbiology laboratory.