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Published on: February 17, 2023
Multidrug-resistant ESBL-producing Enterobacteriaceae and associated risk factors in community infants in Lebanon
Soumaya Moustafa Hijazi1, Mohamad Anwar Fawzi, Faten Moustafa Ali
1Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon. somayahijazi@yahoo.com.
Insights
This study found nearly half of Lebanese infants carry extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). Factors like male gender, hospital birth, and formula feeding increase colonization, with CTX-M-9 being the most common gene.
Area of Science:
- Microbiology
- Pediatrics
- Public Health
Background:
- Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) pose a growing threat to pediatric health.
- Infant fecal flora serves as a reservoir for ESBLs, necessitating investigation into community-level colonization.
Purpose of the Study:
- To investigate rectal colonization rates of ESBL-PE in Lebanese community infants.
- To identify associated risk factors, antimicrobial susceptibility, and molecular characteristics of ESBL-PE.
Main Methods:
- Rectal swabs collected from 117 infants aged 1-12 months.
- ESBL detection via double-disk synergy, combination-disk method, and multiplex PCR.
- Risk factor assessment using a standardized questionnaire.
Main Results:
- 58% (49.6%) of infants were ESBL-PE carriers.
- Significant risk factors included male gender, hospital birth, C-section delivery, and formula feeding.
- Multiple bla gene carriage was common, with CTX-M types (especially CTX-M-9) predominating.
Conclusions:
- This is the first study on ESBL-PE carriage in Lebanese community infants, providing crucial regional data.
- Hospital birth, C-section, and formula feeding are significant risk factors for colonization in non-hospitalized infants.
- The study highlights widespread CTX-M-9 ESBL dissemination and multiple resistance gene carriage.
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.
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