Introduction. Sickle cell disease (SCD) children have a high susceptibility to pneumococcal infection. For this reason, they are routinely immunized with pneumococcal vaccines and use antibiotic prophylaxis (AP). Hypothesis/Gap Statement. Yet, little is known about SCD children’s gut microbiota. If antibiotic-resistant Enterobacterales may colonize people on AP, we hypothesized that SCD children on AP are colonized by resistant enterobacteria species. Objective. To evaluate the effect of continuous AP on Enterobacterales gut colonization from children with SCD. Methodology. We analysed 30 faecal swabs from SCD children on AP and 21 swabs from children without the same condition. Enterobacterales was isolated on MacConkey agar plates and identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) (bioMérieux, Marcy l'Etoile, France). We performed the antibiogram by Vitek 2 system (bioMérieux, Marcy l'Etoile, France), and the resistance genes were identified by multiplex PCR. Results. We found four different species with resistance to one or more different antibiotic types in the AP-SCD children’s group: Escherichia coli , Klebsiella pneumoniae , Citrobacter freundii , and Citrobacter farmeri . Colonization by resistant E. coli was associated with AP (prevalence ratio 2.69, 95 % confidence interval [CI], 1.98–3.67, P<0.001). Strains producing extended-spectrum β-lactamases (ESBL) were identified only in SCD children, E. coli , 4/30 (13 %), and K. pneumoniae , 2/30 (7 %). The ESBL-producing Enterobacterales were associated with penicillin G benzathine use (95 % CI, 22.91–86.71, P<0.001). CTX-M-1 was the most prevalent among ESBL-producers (3/6, 50 %), followed by CTX-M-9 (2/6, 33 %), and CTX-M-2 (1/6, 17 %). Conclusion. Resistant enterobacteria colonize SCD children on AP, and this therapy raises the chance of ESBL-producing Enterobacterales colonization. Future studies should focus on prophylactic vaccines as exclusive therapy against pneumococcal infections.

中文翻译：

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镰状细胞病儿童肠道由产超广谱 β-内酰胺酶 (ESBL) 的肠杆菌属定植：抗生素预防作用？

介绍。镰状细胞病 (SCD) 儿童极易感染肺炎球菌。出于这个原因，他们定期接种肺炎球菌疫苗并使用抗生素预防 (AP)。假设/差距陈述。然而，人们对 SCD 儿童的肠道微生物群知之甚少。如果抗生素抗性肠杆菌可能在 AP 上定植，我们假设 AP 上的 SCD 儿童定植了耐药肠杆菌。客观的。评估连续 AP 对SCD 儿童肠杆菌肠道定植的影响。方法。我们分析了来自 AP 的 SCD 儿童的 30 份粪便拭子和 21 份未患有相同疾病的儿童的粪便拭子。 在 MacConkey 琼脂平板上分离肠杆菌并通过基质辅助激光解吸/电离飞行时间质谱 (MALDI-TOF MS) (bioMérieux, Marcy l'Etoile, France) 进行鉴定。我们通过 Vitek 2 系统 (bioMérieux, Marcy l'Etoile, France) 进行了抗菌谱分析，并通过多重 PCR 鉴定了抗性基因。结果。我们在 AP-SCD 儿童组中发现了四种对一种或多种不同抗生素类型具有抗性的不同物种：大肠杆菌、肺炎克雷伯菌、弗氏柠檬酸杆菌和农家柠檬酸杆菌。抗性大肠杆菌的定植 与 AP 相关（患病率 2.69，95% 置信区间 [CI]，1.98-3.67，P <0.001）。仅在 SCD 儿童、大肠杆菌4/30 (13 %) 和肺炎克雷伯菌2/30 (7 %)中鉴定出产生超广谱 β-内酰胺酶 (ESBL) 的菌株。产生 ESBL 的肠杆菌与青霉素 G 苄星的使用有关（95 % CI，22.91–86.71，P <0.001）。CTX-M-1 在 ESBL 生产者中最为普遍 (3/6, 50 %)，其次是 CTX-M-9 (2/6, 33 %) 和 CTX-M-2 (1/6, 17 %）。结论。耐药肠杆菌定植于 AP 的 SCD 儿童，这种疗法增加了产生 ESBL 的肠杆菌的机会 殖民化。未来的研究应侧重于预防性疫苗作为针对肺炎球菌感染的唯一疗法。