INTEGRATED APPROACH FOR THE DETECTION OF BACTERIAL RESISTANCE IN MALI USING CHROMOGENIC MEDIA

This study, focusing on bloodstream infections and conducted in a rural setting in Mali, aimed to assess bacterial resistance using a two-step diagnostic approach. The first step consisted of preliminary on-site detection of bacteria using manually prepared CHRO Magar media, providing a simple, rapid, and cost-effective method. The second step involved phenotypic and genotypic confirmation of isolates in a reference laboratory using advanced techniques such as MALDI-TOF MS, VITEK 2, and conventional PCR to validate resistance profiles. Among the 508 blood cultures analyzed, 29.1% (148/508; 95% CI [25-33]) were positive, identifying 16.9% (86/508; 95% CI [13.7-20.2]) resistant strains. Of these, 75.6% (65/86; 95% CI [66.6-84.6]) were Enterobacteriaceae resistant to β-lactams and carbapenems, 13.9% (12/86; 95% CI [6.5-21.3]) corresponded to methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), and 10.5% (9/86; 95% CI [4-16.9]) to other bacterial species.The most frequently detected resistance genes included CTX-M in 39% (49/126; 95% CI [30.3-47.5]), TEM/SHV in 26% (32/123; 95% CI [18.2-33.8]), genes encoding carbapenemases (KPC, VIM, NDM, OXA-48) in 15% (19/127; 95% CI [8.7-21.3]), and genes encoding other B-lactamases (OXA-1, bla-BEL, bla-ADCb, FOX-1) in 9% (11/122; 95% CI [4-14]).