EPIDEMIOLOGY Fecal Carriage of Extended-Spectrum b-Lactamase-Producing Enterobacteriaceae Strains Is Associated with Worse Outcome in Patients Hospitalized in the Pediatric Oncology Unit of Beni-Messous Hospital in Algiers, Algeria Chafiaa Medboua-Benbalagh, 1 Abdelaziz Touati, 1 Rachida Kermas, 1 Alima Gharout-Sait, 1 Lucien Brasme, 2,3 Halima Mezhoud, 1 Djamila Touati, 4 Thomas Guillard, 2,3 and Christophe de Champs 2,3 Objectives: The current study aimed to investigate extended-spectrum b-lactamase-producing En- terobacteriaceae (ESBL-E) fecal carriage in children with different cancers admitted in the pediatric oncology unit of Beni-Messous Hospital (Algiers, Algeria). Materials and Methods: Rectal swabs from children with cancer were sampled from February 2012 to May 2013 within 48 hours following their admission. After species identification and detection of ESBL production by double-disk synergy test (DD test), antibiotic susceptibility was determined by the standard disk diffusion method. Antibiotic resistance genes, including bla genes and plasmid-mediated quinolone resistance (PMQR) genes, were investigated by polymerase chain reaction (PCR). The phylogenetic grouping of Escherichia coli strains was determined by PCR. Results: Of the 171 children studied, 93 (54%) were ESBL carriers. An antibiotic treatment for the last 3 months before admission ( p = 0.01), hematological malignancies ( p = 0.003), and death ( p = 0.0003) were more frequent in the ESBL-E group than in the non-ESBL group. Multivariate analysis showed that hematological malignancies (odds ratio [OR]: 3.9; confidence interval [CI]: 1.1–14.1; p = 0.04) and ESBL-E carriage (OR: 6.2; CI: 1.7–22.00; p = 0.005) were two independent factors associated with increased risk of death. A total of 103 ESBL-E isolates were obtained. Klebsiella pneumoniae and E. coli isolates were the most frequently isolated. PCR amplification showed that all the isolates produced a CTX-M ESBL (CTX-M-15, CTX-M-14, and CTX- M-3). The PMQR genes detected were qnrB, qnrS, and aac(6¢)-Ib-cr. E. coli isolates were assigned to four major extraintestinal pathogenic E. coli phylogroups, including B2 and D. Conclusion: This study provides, for the first time, insight into epidemiology of the ESBL-E fecal carriage among children with cancer in Algeria. Keywords: Algeria, Enterobacteriaceae, ESBL, fecal carriage, pediatric oncology Introduction A ntimicrobial resistance is of particular concern in cancer patients especially in relation to infection ther- apy and prevention. 1 The wide spread of extended-spectrum b-lactamase-producing Enterobacteriaceae (ESBL-E) is of special importance since it raises doubts about the efficacy of some noncarbapenem b-lactams as first-line treatment in cancer patients. 2,3 Recently, a significant increase in the prevalence of ESBL-E fecal carriage has been reported in a variety of settings, including community, 4 hospitalized patients, 5 newborns, infants, 6 and healthy children, 7 as well as in pe- diatric emergency. 8 1 Laboratoire d’Ecologie Microbienne, FSNV, Universite ´ de Bejaia, Bejaia, Alge ´rie. 2 Laboratoire de Bacte ´riologie–Virologie-Hygie `ne Hospitalie `re, CHU Reims, Ho ˆpital Robert DEBRE, Reims, France. 3 EA4687 SFR CAP-Sante ´ [FED 4231], Universite ´ de Reims-Champagne-Ardenne, Reims, France. 4 Laboratoire Me `re et Enfant, CHU Beni-Messous, Alger, Alge ´rie. MICROBIAL DRUG RESISTANCE Volume 00, Number 00, 2017 ª Mary Ann Liebert, Inc. DOI: 10.1089/mdr.2016.0153 1