AUTHOR=Sintondji Kevin , Fabiyi Kafayath , Hougbenou Jules , Koudokpon Hornel , Lègba Boris , Amoussou Hornella , Haukka Kaisa , Dougnon Victorien 

TITLE=Prevalence and characterization of ESBL-producing Escherichia coli in healthy pregnant women and hospital environments in Benin: an approach based on Tricycle

JOURNAL=Frontiers in Public Health

VOLUME=11

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1227000

DOI=10.3389/fpubh.2023.1227000

ISSN=2296-2565

ABSTRACT=<sec id="sec2001"><title>Introduction</title><p>Extended-Spectrum Beta-Lactamase (ESBL)-producing <italic>Enterobacterales</italic> are recognized as significant pathogens due to their resistance to multiple antibiotics. This study aimed to determine the prevalence of ESBL-producing <italic>Escherichia coli</italic> (<italic>E. coli</italic>) in different settings, including healthy pregnant women, the food chain, and the environment of tertiary hospitals in Benin.</p></sec><sec id="sec201"><title>Methods</title><p>Samples were collected from various sources, including fecal samples from healthy pregnant women, food samples from hospital canteens, and hospital effluents from four tertiary hospitals in southern Benin. Fecal samples were plated on MacConkey agar supplemented with cefotaxime (4 μg/mL), while food and water samples were plated on Tryptone Bile X agar supplemented with cefotaxime (4 μg/mL). Urea indole tests were used for preliminary identification of <italic>E. coli</italic> colonies, followed by confirmation of ESBL production using the double disk synergy technique. Antibiotic susceptibility testing of ESBL-producing <italic>E. coli</italic> strains was conducted using the disk diffusion method on MH agar. Polymerase Chain Reaction (PCR) was used to investigate the presence of ESBL-encoding genes.</p></sec><sec id="sec202"><title>Results</title><p>Among the 296 fecal samples collected from four tertiary hospitals, ESBL-producing <italic>E. coli</italic> was isolated from 22.30% (66) of the samples. All <italic>E. coli</italic> isolates from hospital effluents exhibited ESBL production, while ESBL-producing <italic>E. coli</italic> was not detected in food and drinking water samples. The analysis of variable associations showed no significant associations (<italic>p</italic> &gt; 0.05) for the studied factors. Antibiotic susceptibility testing revealed high resistance rates among the ESBL-<italic>Ec</italic> isolates against several tested antibiotics, including amoxicillin, aztreonam, ceftriaxone, ciprofloxacin, and trimethoprim-sulfamethoxazole. However, most isolates remained susceptible to ertapenem, amoxicillin-clavulanate, and imipenem. The most prevalent ESBL-encoding genes were <italic>bla<sub>TEM</sub></italic> (37.50%), <italic>bla<sub>OXA-1</sub></italic> (19.44%), and <italic>bla<sub>SHV</sub></italic> (11.11%), while a smaller proportion of isolates carried <italic>bla<sub>CTXM-1</sub></italic>/<italic>bla<sub>CTXM-15</sub></italic> (5.55%) and <italic>bla<sub>CTXM-9</sub></italic>.</p></sec><sec id="sec203"><title>Discussion</title><p>This study provides insights into the prevalence of ESBL-producing <italic>E. coli</italic> carriage in the feces of healthy pregnant women in southern Benin. Additionally, it highlights hospital wastewater as a potential reservoir of ESBL-producing bacteria in the environment. The detection of ESBL-producing <italic>E. coli</italic> in hospital effluents raises concerns about the dissemination of antibiotic resistance genes into the environment. The high resistance rates observed among ESBL-<italic>Ec</italic> isolates against commonly used antibiotics emphasize the urgent need for antimicrobial stewardship and infection control measures. The identification of prevalent ESBL-encoding genes contributes to understanding the genetic basis of ESBL resistance in the studied population. Further research is warranted to explore the mechanisms of transmission and potential interventions to mitigate the spread of ESBL-producing Enterobacterales.</p></sec>