Epidemiology and prevention of Mayotte island imported broad-spectrum beta-lactamases (bsbl)  in Réunion island

X. Roblin, B-A. Gaüzère, J-C Sally, N. Lugagne, X. Coulaud *, F. Paganin.

Centre Hospitalier Départemental Félix Guyon, CLIN, Saint-Denis, Réunion, France.

* Hopital, Mamudzu, Mayotte.

Objective :Epidemiological surveillance and prevention of BSBL in patients from Mayotte, referred to Reunion for further treatement.

Method and Population :   From January 1994 to September 1995, 20 cases of BSBL (15 children, 5 adults) were retrospectively studied  in patients referred from Mayotte, resulting in five patients from Reunion being contaminated: 12 Klebsiella sp, 5 Enterobacter sp, 2 E. coli, 1 Citrobacter, from blood cultures (10 cases), urine (5), pus (3), stools (3), result. An epidemiological survey was also conducted in Mayotte.

Results: Major increase of MIC (724 mg/l) for Cefotaxime, Ceftazidime and Azatreonam, rare resistance to Aminoglycosides (2 cases), normal susceptibility to Penems. Prior to study, BSBL were never looked for in Mayotte, as Amoxillin-Clavulanic acid (ACA) disks were not in use. Therefore germs were said to be sensitive to 3rd Generation Cephalosporins (3CG) and patients were not isolated, antibiotic prescription was empirical and relied largely  on small doses of 3CG. A dramatic decrease in cases ( 1 case in 6 months) was achieved in Mayotte, through several simples measures: surveillance system, use of ACA disks, treatement protocols, isolation of patients.

Conclusion: Referral of patients not known for bearing BSBL is hazardous. BSBL emergence was largely induced by bad prescription habits and lack of proper laboratory facilities. Awareness of the problem and simple procedures,  helped solve the problem rapidly.