{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:31:23Z","timestamp":1790317883447,"version":"4.1.0"},"reference-count":41,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,6,5]]},"abstract":"The diffusion of extended-spectrum beta-lactamase (E-ESBL)\u2013producing Enterobacteriaceae is a major concern worldwide, especially in low-income countries, where they may lead to therapeutic failures. In hospitals, where colonization is the highest, E-ESBL transmission is poorly understood, limiting the possibility of establishing effective control measures. We assessed E-ESBL\u2013acquisition routes in a neonatalogy ward in Madagascar. Individuals from a neonatology ward were longitudinally followed-up (August 2014\u2013March 2015). Newborns\u2019 family members\u2019 and health-care workers (HCWs) were stool-sampled and tested for E-ESBL colonization weekly. Several hypothetical acquisition routes of newborns\u2014e.g. direct contact with family members and HCWs and indirect contact with other newborns through environmental contamination, colonization pressure, or transient hand carriage\u2014were examined and compared using mathematical modeling and Bayesian inference. In our results, high E-ESBL acquisition rates were found, reaching > 70% for newborns, > 55% for family members, and > 75% for HCWs. Modeling analyses indicated transmission sources for newborn colonization to be species dependent. Health-care workers\u2019 route were selected for Klebsiella pneumoniae<\/jats:italic> and Escherichia coli<\/jats:italic>, with respective estimated transmission strengths of 0.05 (0.008; 0.14) and 0.008 (0.001; 0.021) ind\u22121<\/jats:sup> day\u22121<\/jats:sup>. Indirect transmissions associated with ward prevalence, e.g. through hand carriage or environment, were selected for Enterobacter cloacae<\/jats:italic>, E. coli<\/jats:italic>, and K. pneumoniae<\/jats:italic> (range 0.27\u20130.41 ind\u22121<\/jats:sup> day\u22121<\/jats:sup>). Importantly, family members were not identified as transmission source. To conclude, E-ESBL acquisition sources are strongly species dependent. Escherichia coli<\/jats:italic> and E. cloacae<\/jats:italic> involve more indirect contamination, whereas K. pneumoniae<\/jats:italic> also spreads through contact with colonized HCWs. These findings should help improve control measures to reduce in-hospital transmission.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0410","type":"journal-article","created":{"date-parts":[[2019,4,23]],"date-time":"2019-04-23T07:00:50Z","timestamp":1556002850000},"page":"1355-1362","source":"Crossref","is-referenced-by-count":13,"title":["Transmission Routes of Extended-Spectrum Beta-Lactamase\u2013Producing Enterobacteriaceae in a Neonatology Ward in Madagascar"],"prefix":"10.4269","volume":"100","author":[{"given":"M\u00e9lanie","family":"Bonneault","sequence":"first","affiliation":[{"name":"UMR1181 Biostatistique, Biomath\u00e9matique, Pharmaco-\u00e9pid\u00e9miologie et Maladies Infectieuses (B2PHI), Institut Pasteur, Universit\u00e9 de Versailles\u2013Saint-Quentin-en-Yvelines (UVSQ), Universit\u00e9 Paris-Saclay, Inserm Paris, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volasoa Herilalaina","family":"Andrianoelina","sequence":"additional","affiliation":[{"name":"Institut Pasteur Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Perlinot","family":"Herindrainy","sequence":"additional","affiliation":[{"name":"Institut Pasteur Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamitina Alain Noah","family":"Rabenandrasana","sequence":"additional","affiliation":[{"name":"Institut Pasteur Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benoit","family":"Garin","sequence":"additional","affiliation":[{"name":"Institut Pasteur Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastien","family":"Breurec","sequence":"additional","affiliation":[{"name":"Institut Pasteur de la Guadeloupe, Centre Hospitalier Universitaire de Pointe-\u00e0-Pitre\/les Abymes, Pointe-\u00e0-Pitre, France, Guadeloupe, Facult\u00e9 de M\u00e9decine, Pointe-\u00e0-Pitre, Guadeloupe;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Delarocque-Astagneau","sequence":"additional","affiliation":[{"name":"UMR1181 Biostatistique, Biomath\u00e9matique, Pharmaco-\u00e9pid\u00e9miologie et Maladies Infectieuses (B2PHI), Institut Pasteur, Universit\u00e9 de Versailles\u2013Saint-Quentin-en-Yvelines (UVSQ), Universit\u00e9 Paris-Saclay, Inserm Paris, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didier","family":"Guillemot","sequence":"additional","affiliation":[{"name":"UMR1181 Biostatistique, Biomath\u00e9matique, Pharmaco-\u00e9pid\u00e9miologie et Maladies Infectieuses (B2PHI), Institut Pasteur, Universit\u00e9 de Versailles\u2013Saint-Quentin-en-Yvelines (UVSQ), Universit\u00e9 Paris-Saclay, Inserm Paris, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zafitsara Zo","family":"Andrianirina","sequence":"additional","affiliation":[{"name":"Service de P\u00e9diatrie et N\u00e9onatologie, Centre Hospitalier de Soavinandriana, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Marc","family":"Collard","sequence":"additional","affiliation":[{"name":"Institut Pasteur Madagascar, Antananarivo, Madagascar;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bich-Tram","family":"Huynh","sequence":"additional","affiliation":[{"name":"UMR1181 Biostatistique, Biomath\u00e9matique, Pharmaco-\u00e9pid\u00e9miologie et Maladies Infectieuses (B2PHI), Institut Pasteur, Universit\u00e9 de Versailles\u2013Saint-Quentin-en-Yvelines (UVSQ), Universit\u00e9 Paris-Saclay, Inserm Paris, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lulla","family":"Opatowski","sequence":"additional","affiliation":[{"name":"UMR1181 Biostatistique, Biomath\u00e9matique, Pharmaco-\u00e9pid\u00e9miologie et Maladies Infectieuses (B2PHI), Institut Pasteur, Universit\u00e9 de Versailles\u2013Saint-Quentin-en-Yvelines (UVSQ), Universit\u00e9 Paris-Saclay, Inserm Paris, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Trop Med Int Health","first-page":"145","article-title":"Susceptibility of community-acquired pathogens to antibiotics in Africa and Asia in neonates\u2013an alarmingly short review","volume":"16","author":"Lubell","year":"2011"},{"key":"b2","series-title":"Lancet","first-page":"1988","article-title":"Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970\u20132010: a systematic analysis of progress towards Millennium Development Goal 4","volume":"375","author":"Rajaratnam","year":"2010"},{"key":"b3","series-title":"Rev Antimicrob Resist","first-page":"1","article-title":"Antimicrobial resistance: tackling a crisis for the health and wealth of nations","volume":"20","author":"O'Neill","year":"2014"},{"key":"b4","series-title":"BMC Infect Dis","first-page":"127","article-title":"Burden of bacterial resistance among neonatal infections in low income countries: how convincing is the epidemiological evidence?","volume":"15","author":"Huynh","year":"2015"},{"key":"b5","series-title":"Global Action Plan on Antimicrobial Resistance","author":"WHO","year":"2015"},{"key":"b6","series-title":"J Matern Fetal Neonatal Med","first-page":"23","article-title":"Prevention of nosocomial infections and surveillance of emerging resistances in NICU","volume":"24","author":"Cipolla","year":"2011"},{"key":"b7","series-title":"PLoS Med","first-page":"1","article-title":"Will 10 million people die a year due to antimicrobial resistance by 2050?","volume":"13","author":"de Kraker","year":"2016"},{"key":"b8","series-title":"Infection Control\u2013Update","first-page":"39","article-title":"Models of hospital acquired infection","author":"Coen","year":"2012"},{"key":"b9","series-title":"BMC Infect Dis","first-page":"294","article-title":"Modelling the transmission of healthcare associated infections: a systematic review","volume":"13","author":"van Kleef","year":"2013"},{"key":"b10","series-title":"Int J Technol Assess in Health Care","first-page":"146","article-title":"Systematic review of isolation policies in the hospital management of methicillin-resistant Staphylococcus aureus: a review of the literature with epidemiological and economic modelling","volume":"21","author":"Cooper","year":"2005"},{"key":"b11","series-title":"Lett Appl Microbiol","first-page":"704","article-title":"Evaluation of a chromogenic agar medium for the detection of extended spectrum \u03b2-lactamase-producing Enterobacteriaceae","volume":"51","author":"Saito","year":"2010"},{"key":"b12","series-title":"Int J Antimicrob Agents","first-page":"364","article-title":"Comit\u00e9 de l\u2019antibiogramme de la soci\u00e9t\u00e9 Fran\u00e7aise de microbiologie report 2003","volume":"21","author":"Members of the SFM Antibiogram Committee","year":"2003"},{"key":"b13","series-title":"Clin Microbiol Infect","first-page":"O879","article-title":"Assessment of five screening strategies for optimal detection of carriers of third-generation cephalosporin-resistant Enterobacteriaceae in intensive care units using daily sampling","volume":"20","author":"Grohs","year":"2014"},{"key":"b14","series-title":"Am J Epidemiol","first-page":"548","article-title":"An augmented data method for the analysis of nosocomial infection data","volume":"168","author":"Cooper","year":"2008"},{"key":"b15","series-title":"J R Statist Soc B","first-page":"583","article-title":"Bayesian measures of model complexity and fit","volume":"64","author":"Spiegelhalter","year":"2002"},{"key":"b16","series-title":"BMC Microbiol","first-page":"85","article-title":"Molecular characterization of multidrug-resistant extended-spectrum \u03b2-lactamase-producing Enterobacteriaceae isolated in Antananarivo, Madagascar","volume":"13","author":"Rakotonirina","year":"2013"},{"key":"b17","series-title":"J Antimicrob Chemother","first-page":"309","article-title":"Antimicrobial resistance among uropathogens that cause community-acquired urinary tract infections in Antananarivo, Madagascar","volume":"59","author":"Randrianirina","year":"2007"},{"key":"b18","series-title":"J Infect Dev Ctries","first-page":"074","article-title":"Antimicrobial resistance in pathogens causing nosocomial infections in surgery and intensive care wards in Antananarivo, Madagascar","volume":"4","author":"Randrianirina","year":"2010"},{"key":"b19","series-title":"J Hosp Infect","first-page":"23","article-title":"Role of contaminated aspiration tubes in nosocomial outbreak of Klebsiella pneumoniae producing SHV-2 and CTX-M-15 extended-spectrum beta-lactamases","volume":"72","author":"Randrianirina","year":"2009"},{"key":"b20","series-title":"Clin Infect Dis","first-page":"677","article-title":"Massive increase, spread, and exchange of extended spectrum \u03b2-lactamase-encoding genes among intestinal Enterobacteriaceae in hospitalized children with severe acute malnutrition in Niger","volume":"53","author":"Woerther","year":"2011"},{"key":"b21","series-title":"FEMS Microbiol Rev","first-page":"736","article-title":"Multiresistant Gram-negative bacteria: the role of high-risk clones in the dissemination of antibiotic resistance","volume":"35","author":"Woodford","year":"2011"},{"key":"b22","series-title":"J Antimicrob Chemother","first-page":"274","article-title":"Rapid detection of the O25b-ST131 clone of Escherichia coli encompassing the CTX-M-15-producing strains","volume":"64","author":"Clermont","year":"2009"},{"key":"b23","series-title":"Clin Microbiol Infect","first-page":"46.e1","article-title":"Quantifying within-household transmission of extended-spectrum \u03b2-lactamase-producing bacteria","volume":"23","author":"Haverkate","year":"2016"},{"key":"b24","series-title":"Am J Epidemiol","first-page":"841","article-title":"An algorithm to estimate the importance of bacterial acquisition routes in hospital settings","volume":"166","author":"Bootsma","year":"2007"},{"key":"b25","series-title":"BMC Infect Dis","first-page":"187","article-title":"Limits of patient isolation measures to control extended-spectrum beta-lactamase-producing Enterobacteriaceae: model-based analysis of clinical data in a pediatric ward","volume":"13","author":"Domenech de Cell\u00e8s","year":"2013"},{"key":"b26","series-title":"Am J Infect Control","first-page":"97","article-title":"How important is patient-to-patient transmission in extended-spectrum \u03b2-lactamase Escherichia coli acquisition","volume":"35","author":"Harris","year":"2007"},{"key":"b27","series-title":"Swiss Med Wkly","first-page":"747","article-title":"Surveillance of extended-spectrum-beta-lactamase-producing Enterobacteriaceae in a Swiss tertiary care hospital","volume":"139","author":"Fankhauser","year":"2009"},{"key":"b28","series-title":"Clin Infect Dis","first-page":"967","article-title":"Transmission dynamics of extended-spectrum \u03b2-lactamase\u2013producing Enterobacteriaceae in the tertiary care hospital and the household setting","volume":"55","author":"Hilty","year":"2012"},{"key":"b29","series-title":"Antimicrob Agents Chemother","first-page":"3652","article-title":"Colonization of extended-spectrum-\u03b2-lactamase- and NDM-1-producing Enterobacteriaceae among pregnant women in the community in a low-income country: a potential reservoir for transmission of multiresistant Enterobacteriaceae to neonates","volume":"59","author":"Chereau","year":"2015"},{"key":"b30","series-title":"Clin Infect Dis","first-page":"489","article-title":"The transmissibility of antibiotic-resistant Enterobacteriaceae in intensive care units","volume":"66","author":"Gurieva","year":"2018"},{"key":"b31","series-title":"Front Microbiol","first-page":"1197","article-title":"Transmission dynamics of hyper-endemic multi-drug resistant Klebsiella pneumoniae in a southeast Asian neonatal unit: a longitudinal study with whole genome sequencing","volume":"9","author":"Smit","year":"2018"},{"key":"b32","series-title":"Clin Infect Dis","first-page":"1347","article-title":"Patient-to-patient transmission is important in extended-spectrum -lactamase-producing Klebsiella pneumoniae acquisition","volume":"45","author":"Harris","year":"2007"},{"key":"b33","series-title":"Clin Infect Dis","first-page":"126","article-title":"Control of an outbreak of infection due to extended\u2010spectrum \u03b2\u2010lactamase\u2013producing Escherichia coli in a liver transplantation unit","volume":"33","author":"Paterson","year":"2001"},{"key":"b34","series-title":"J Egypt Soc Parasitol","first-page":"71","article-title":"Antimicrobial resistant bacteria among health care workers in intensive care units at Ain Shams University Hospitals","volume":"40","author":"Abdel","year":"2010"},{"key":"b35","series-title":"J Paediatr Child Health","first-page":"548","article-title":"Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in paediatric wards: a nested case-control study","volume":"44","author":"Demir","year":"2008"},{"key":"b36","series-title":"Infect Control Hosp Epidemiol","first-page":"56","article-title":"Anatomic sites of patient colonization and evironmental contamination with Klebsiella pneumoniae carbapenemase\u2013producing Enterobacteriaceae at long-term acute care hospitals","volume":"34","author":"Thurlow","year":"2013"},{"key":"b37","series-title":"Trends Mol Med","first-page":"109","article-title":"HHS public access","volume":"21","author":"Mueller","year":"2015"},{"key":"b38","series-title":"PLoS One","first-page":"e0193325","article-title":"Acquisition of extended spectrum beta-lactamase-producing Enterobacteriaceae in neonates: a community based cohort in Madagascar","volume":"13","author":"Herindrainy","year":"2018"},{"key":"b39","series-title":"Pediatr Infect Dis J","first-page":"856","article-title":"High prevalence of antimicrobial-resistant gram-negative colonization in hospitalized Cambodian infants","volume":"35","author":"Turner","year":"2016"},{"key":"b40","series-title":"BMC Infect Dis","first-page":"130","article-title":"How long do nosocomial pathogens persist on inanimate surfaces? A systematic review","volume":"6","author":"Kramer","year":"2006"},{"key":"b41","series-title":"BMJ","first-page":"1151","article-title":"Reducing length of stay in hospital for very low birthweight infants by involving mothers in a stepdown unit: an experience from Karachi (Pakistan)","volume":"329","author":"Bhutta","year":"2004"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/100\/6\/article-p1355.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/100\/6\/article-p1355.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/100\/6\/article-p1355.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T21:11:16Z","timestamp":1722460276000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/100\/6\/article-p1355.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,5]]},"references-count":41,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.18-0410","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,5]]}}}