MICROBIOLOGICAL SCREENING OF OTORRHOEA FROM PEOPLE COMING TO HOSPITAL IN MAHAJANGA

In whole, 56 patients were included. Amidst identified microorganisms were fungus (4,7%) and bacteria (95,3%) to which Gram negative bacilli represented 72,1% (n=44), Gram positive cocci 6,4% (n=10), Gram positive bacilli 8,2% (n=5) and Gram negative cocci 3,3% (n=2). Among these bacterias, Pseudomonas aeruginosa and Proteus sp were predominant, with respectively 41% (n=25), 23% (n=14). However, three cases of S. aureus reported, six with negative coagulase Staphylococcus, one with Escherichia coli, one with Klebsiella sp, one with Haemophilus sp, two cases with Neisseria sp and four cases with Corynebacterium sp. Two types of cultures were noticed, one of them monomorphic (91,1%, n=51) and the other polymorphic (8,9%, n=5) to which 3 associations of P. aeruginosa-Proteus sp, 1 association of P. aeruginosa- coagulase negative Staphylococcus and 1 association of P. aeruginosa- E. coli. No resistance to ciprofloxacin was observed with Pseudomonas, Neisseria sp, Haemophilus, and enterobacteria except for E. coli. No resistance to rifampicin was observed with S. aureus. However, the sensitivity of S. aureus to ciprofloxacin decreased (one bacterium out of three). The use of rifampicin or fluoroquinolones should be based on the type of ear infections

Prevalence, Risk Factors, and Genetic Characterization of Extended-Spectrum Beta-Lactamase Escherichia coli Isolated From Healthy Pregnant Women in Madagascar

Antimicrobial resistance is a major public health concern worldwide affecting humans, animals and the environment. However, data is lacking especially in developing countries. Thus, the World Health Organization developed a One-Health surveillance project called Tricycle focusing on the prevalence of ESBL-producing Escherichia coli in humans, animals, and the environment. Here we present the first results of the human community component of Tricycle in Madagascar. From July 2018 to April 2019, rectal swabs from 492 pregnant women from Antananarivo, Mahajanga, Ambatondrazaka, and Toamasina were tested for ESBL-E. coli carriage. Demographic, sociological and environmental risk factors were investigated, and E. coli isolates were characterized (antibiotic susceptibility, resistance and virulence genes, plasmids, and genomic diversity). ESBL-E. coli prevalence carriage in pregnant women was 34% varying from 12% (Toamasina) to 65% (Ambatondrazaka). The main risk factor associated with ESBL-E. coli carriage was the rainy season (OR = 2.9, 95% CI 1.3–5.6, p = 0.009). Whole genome sequencing was performed on 168 isolates from 144 participants. bla(CTX–M–15) was the most frequent ESBL gene (86%). One isolate was resistant to carbapenems and carried the bla(NDM–5) gene. Most isolates belonged to commensalism associated phylogenetic groups A, B1, and C (90%) and marginally to extra-intestinal virulence associated phylogenetic groups B2, D and F (10%). Multi locus sequence typing showed 67 different sequence types gathered in 17 clonal complexes (STc), the most frequent being STc10/phylogroup A (35%), followed distantly by the emerging STc155/phylogroup B1 (7%), STc38/phylogroup D (4%) and STc131/phylogroup B2 (3%). While a wide diversity of clones has been observed, SNP analysis revealed several genetically close isolates (n = 34/168) which suggests human-to-human transmissions. IncY plasmids were found with an unusual prevalence (23%), all carrying a bla(CTX–M–15). Most of them (85%) showed substantial homology (≥85%) suggesting a dissemination of IncY ESBL plasmids in Madagascar. This large-scale study reveals a high prevalence of ESBL-E. coli among pregnant women in four cities in Madagascar associated with warmth and rainfall. It shows the great diversity of E. coli disseminating throughout the country but also transmission of specific clones and spread of plasmids. This highlights the urgent need of public-health interventions to control antibiotic resistance in the country