Broad spectrum β-lactam resistance in faecal Escherichia coli isolated from severely malnourished and nourished children attending Mbagathi district hospital, Nairobi: A case-control study

S. Njoroge, J. Kiiru, G. Kikuvi
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引用次数: 2

Abstract

Context: Severely malnourished children have increased risk of being put on antibiotics due to co-morbidities. Aim: The study's objective was to characterize the Escherichia coli β-lactamase mediated resistance to the broad spectrum β-lactam antimicrobials among this population and compare them with nourished children as controls. Settings and Design: In this case-control, hospital-based setup, 109 E. coli isolates were obtained from each group, one isolate per subject. Materials and Methods: Stool or anal swabs were collected, enriched in buffered peptone water and cultured on MacConkey and eosin methylene blue agars. Biochemical test were used to identify E. coli . antibiograms to determine phenotypic resistance were determined using a panel of 14 drugs. Only the isolates showing synergy between ampicillin-calvulanic acid and one or more third generation cephalosporins were picked as extended spectrum β-lactamase (ESBL) producers. Statistical Analysis: Differences in ESBL rates and susceptibility percentages between cases and controls were evaluated for significance using 2-tailed Fisher's exact test. Results: Prevalence of ESBL phenotype was higher in severely malnourished children (39%) as compared to the controls (7%). The plasmid-encoded AmpC's (pAmpC)-like phenotype was observed in 11% isolates. Conclusions: Isolation of ESBL- E. coli among severely malnourished children is high. Surveillance of ESBL producers, both in the community and hospital settings needs to be stepped up in Kenya.
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从内罗毕姆巴加西地区医院严重营养不良和营养不良儿童中分离出的粪便大肠杆菌中广谱β-内酰胺耐药性:一项病例对照研究
背景:严重营养不良的儿童由于合并症而使用抗生素的风险增加。目的:该研究的目的是表征大肠杆菌β-内酰胺酶介导的对广谱β-内酰胺抗菌剂的耐药性,并将其与营养儿童作为对照进行比较。设置和设计:在这个以医院为基础的病例对照设置中,从每组获得109株大肠杆菌分离株,每位受试者1株。材料和方法:收集粪便或肛门拭子,用缓冲蛋白胨水富集,在麦康基和伊红亚甲基蓝琼脂上培养。采用生化试验对大肠杆菌进行鉴定。使用一组14种药物确定用于确定表型抗性的抗生素图。只有氨苄西林-卡戊酸与一种或多种第三代头孢菌素具有协同作用的分离株被选为扩展谱β-内酰胺酶(ESBL)产生菌。统计分析:用双尾Fisher精确检验评估病例和对照组之间ESBL发病率和易感性百分比的差异。结果:严重营养不良儿童中ESBL表型的患病率(39%)高于对照组(7%)。在11%的分离株中观察到质粒编码的AmpC (pAmpC)样表型。结论:严重营养不良儿童中ESBL-大肠杆菌的分离率较高。在肯尼亚,需要加强对社区和医院环境中ESBL生产者的监测。
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