Multidrug-resistant ESBL-producing Enterobacteriaceae and associated risk factors in community infants in Lebanon

  • Soumaya Moustafa Hijazi Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
  • Mohamad Anwar Fawzi Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
  • Faten Moustafa Ali Faculty of Medicine, Ain Shams University, Cairo, Egypt
  • Khaled Hussein Abd El Galil Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
Keywords: extended-spectrum beta-lactamases, Enterobacteriaceae, risk factors, infant, CTX-M-9, Lebanon

Abstract

Introduction: Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) infections are a growing threat to children, and the treatment of these infections becomes more and more challenging. A huge reservoir for ESBLs in the community is the fecal flora of children. This study investigates the rectal colonization, associated risk factors, antimicrobial susceptibility, and molecular characterization of ESBL-PE in Lebanese community infants.

Methodology: A total of 117 rectal swabs were taken from healthy infants between 1 and 12 months of age. Detection of ESBLs was carried out using the double-disk synergy test, combination-disk method, and multiplex polymerase chain reaction (PCR). A questionnaire about the infant’s history and risk factors for carrying ESBL-PE was administered.

Results: In total, 58 (49.6%) of 117 participants were ESBL-PE carriers. Some significant important risk factors for colonization in this study were male gender, hospital birth, caesarean delivery, and being formula-fed. Observed decrease in colonization rate was associated with intimate hygiene habits. Carriers of multiple bla genes were the most common. CTX-M type was the major harbored, gene and CTX-M-9 was the most predominant, followed by CTX-M-15 type.

Conclusions: To the best of our knowledge, this is the first available data about the carriage rate of ESBL-PE in community infants in Lebanon and the Middle East, the first study showing that birth in hospital, caesarean delivery, and being formula-fed are all significantly associated risk factors for the high colonization rates in community – not hospitalized – infants, and showing the dominance of multiple resistance gene carriage and wide dissemination of CTX-M-9 ESBL.

Author Biographies

Soumaya Moustafa Hijazi, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
Department of Pharmaceutical Sciences (Pharmaceutical Microbiology), Faculty of pharmacy, Beirut Arab University, Beirut, Lebanon.
Mohamad Anwar Fawzi, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt

Professor in microbiology

Department of Pharmaceutical Microbiology, Faculty of pharmacy,Alexandria University, Alexandria, Egypt.

Faten Moustafa Ali, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Professor in microbiology and immunology

Department of Microbiology and Immunology, Infection control, Faculty of Medicine,Ain Shams University, Cairo, Egypt.

Khaled Hussein Abd El Galil, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon

Associate Professor in microbiology

Department of Pharmaceutical Sciences (Pharmaceutical Microbiology), Faculty of pharmacy,Beirut Arab University, Beirut, Lebanon.

 

 

Published
2016-09-30
How to Cite
1.
Hijazi SM, Fawzi MA, Ali FM, Abd El Galil KH (2016) Multidrug-resistant ESBL-producing Enterobacteriaceae and associated risk factors in community infants in Lebanon. J Infect Dev Ctries 10:947-955. doi: 10.3855/jidc.7593
Section
Original Articles