The emergence of extended spectrum beta-lactamases producing enterobacteriaceae (ESBL-E) to antimicrobials is a problem of public health. This study was a descriptive investigation of the intestinal carriage of ESBL-E within pediatric unit of the University Hospital Center Zafisaona Gabriel in Mahajanga. In whole, 46 individuals were enrolled, 37% (n=17) of whom were carriers of ESBL-E. No relation was established either between ESBL-E occurrence and gender, or age or previous admission (p>0,05). However the intake of antibiotics all along the past three months was associated with the ESBL-E carriage (p=0.02), 95%IC [23.0-50.9]. Isolates bacteria detected were Escherichia coli (47%), Klebsiella (41%) and Citrobacter koseri (12%). One out of three children admitted in pediatric unit carried ESBL-E. It reflects how antimicrobial drugs are managed on children.
Enterobacteria producing Extended Spectrum Beta-Lactamase (ESBL-E) are major problems in public health. The aims of this study were to find the prevalence rate of intestinal ESBLE carriage and to identify community or nosocomial origin of ESBL-E carriage. This is a cohort study performed between April to June 2015 in Surgery departement of the University Hospital Center Zafisaona Gabriel in Mahajanga which is a north west city of Madagascar.
In the first 48 hours after admission, and thanks to patients’ consent, a rectal swab is performed to identify the community carriage. Then, a second one is done before the exit of each patient. Seventy rectal swabs are performed in 35 patients. Five people (14.3%) have EBLS-E of community origin. Four patients (11.4%) acquired an EBLSE during their hospitalization of which 1 was positive on day 9th of admission, 1 to 12th days, 1 to 17th days and 1 to 25th days. Overall, nine patients (25.7%) had EBLS-E including 6 cases in Traumatology, 2 in Urology and 1 in Visceral Surgery. There is no association found between EBLS-E carriage and age, gender or service (p> 0.05). However, a significant association between EBLS-E carriage and length of hospital stay was observed (p <0.05). The identified bacteria are all E. coli.
This study is part of the activities of the hospital to improve the hygiene of the establishment while knowing that an important part of EBLS-E are of community origin and can contaminate hospital wards.
The main actor of antibiotic prescription in medicine in town is the general practitioner. The excessive consumption of antibiotic is a major public health problem, which participate in the emergence of resisting bacteria. This study was undertaking to evaluate the knowledge of the general practitioners in the town of Toamasina (Madagascar) about the use of antibiotics in children as well as their knowledge of multidrug-resistant bacteria so as to improve the daily practice.
It is about a prospective study, transversal and analytic done in the liberal general practitioners of the town of Toamasina concerning their knowledge on the antibiotic prescription in child as well as their perception and knowledge on the multidrug-resistant bacteria, by means of practical questionnaire.
Ninety six doctors agreed to answer the questionnaire. Doctors almost always prescribe antibiotics in the presence of an infectious syndrome. The amoxicillin and the amoxicillin + clavulanic acid association have been the most prescribed molecules prescribed by the doctors. Seventy percent of the general practitioners questioned have faced antibiomicrobial resistance and 48% said that they had difficulty. It appeared that the doctors didn`t know the MRSA as well as the VRE or the ESBL or the CPE (p<0.05). When they knew the CPE, they knew the VRE and the ESBL (p<0.05).
The prescription is not justified in some cases and that the molecules chosen by the general practitioners do not correspond to the suspected pathology. It is registered in a rich context of actuality on the need of the implementation of a national program so as to improve the good use of antibiotics, especially in town, to limit the emergence of resisting bacteria, with the main goal to elaborate documents of references about the prescription of antibiotics. The antibiomicrobial resistance is a real problem of public health but which still seems to be too abstract for the general practitioner in Toamasina.