Nearly 59% of Central African children under 5 years, are asymptomatic carriers of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E); one of the highest prevalence ever described in the world. These bacteria are resistant to every antibiotics currently marketed in Central African Republic.
Alain Farra, Thierry Frank and Sébastien Breurec (1), from Bacteriology Laboratory at the Institut Pasteur in Bangui, have just published a study showing that nearly 59% of Central African children under 5 years, are asymptomatic carriers of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E); one of the highest prevalence ever described in the world.
The researchers determined the presence of ESBL in stool samples of 134 healthy children. Analysis of the results showed that 79 children were carriers of these bacteria that are resistant to every antibiotics currently marketed in the country. They also showed that 76% of Escherichia coli strains identified in these samples, come from an ultra-virulent pandemic strain (B2 - O25b - ST131).
In a study conducted in 2013, in hospital, the same team of researchers had isolated these ESBLE from surgical site infections (nosocomial infections). These new research work provides for the first time data on these bacteria fecal carriage, in the community in sub-Saharan Africa.
The samples studied here were previously collected in Bangui between 2011 and 2014 as part of the Torcadia project. This project had identified the pathogens responsible for infectious diarrhea in children. It particularly showed that rotavirus, against which there is a vaccine, were responsible for 40 % of infections. Thereby, it was calling for the provision of this vaccine to all Central African children. Torcadia had also highlighted the inappropriate use of antibiotics outside the WHO recommendations.
These new data describing extreme prevalence of fecal carriage of antibiotic-resistant Enterobacteriaceae reinforce the need for more awareness on a proper prescription and use of antibiotics. Drug whose quality is uncontrolled are freely available all over the country. Moreover, in most health centers, diagnosis based only on the observation of clinical signs leads to over-prescription of antibiotics. This, results in a non- appropriate care of children and a use that favours the emergence of resistance.
Ranked 180th out of 187 according to the Human Development Index, the Central African Republic already experience great poverty and precarious health conditions. Almost one child in six dies before the age of five.
Torcadia project was funded with support from the Total Foundation.
(1) Sébastien Breurec is now working at Centre Hospitalier Universitaire de Pointe-à-Pitre/les Abymes, Laboratoire de Microbiologie clinique et environnementale (France).
Mis à jour le 11/08/2016