High prevalence of extended-spectrum β-lactamase-producing Enterobacteriaceae carriage in a pediatric unit in Madagascar

words 148) Extended–spectrum β-lactamase (ESBL)-producing Enterobacteriaceae have spread worldwide but there are few reports on carriage in hospitals in low-income countries. As ESBL-producing Enterobacteriaceae (ESBL-PE) have been increasingly isolated from nosocomial infections in Antananarivo, Madagascar, we conducted a prevalence survey in a pediatric unit. Fecal carriage was detected in 21.2% of 259 infants on admission and 57.1% of 154 on discharge, after more than 48 hours of hospitalization (p <0.001). The species most frequently detected on admission was Escherichia coli (36.9%), whereas, on discharge, Klebsiella pneumoniae was the species most frequently detected (53.1%). ESBL-associated resistances were related to trimethoprim-sulfamethoxazole (91.3%), gentamicin (76.1%), ciprofloxacin (50.0%), but not to amikacin and imipenem. The increased prevalence of carriage during hospitalization was related to standard antimicrobial therapy. The significant emergence of multidrug-resistant enteric pathogens in Malagasy hospitals poses a serious health threat requiring the implementation of surveillance and control measures for nosocomial infections.