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Hide M, Meng S, Cheng S, Bañuls AL, Ky S, Yay C, Laurent D, Delvallez G. Colistin resistance in ESBL- and Carbapenemase-producing Escherichia coli and Klebsiella pneumoniae clinical isolates in Cambodia. J Glob Antimicrob Resist 2024; 38:236-244. [PMID: 39004342 DOI: 10.1016/j.jgar.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 05/31/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024] Open
Abstract
OBJECTIVES Despite the critical importance of colistin as a last-resort antibiotic, limited studies have investigated colistin resistance in human infections in Cambodia. This study aimed to investigate the colistin resistance and its molecular determinants among Extended-spectrum beta-lactamase (ESBL)- and carbapenemase-producing (CP) Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli) isolated in Cambodia between 2016 and 2020. METHODS E. coli (n = 223) and K. pneumoniae (n = 39) were tested for colistin minimum inhibitory concentration (MIC) by broth microdilution. Resistant isolates were subjected to polymerase chain reaction (PCR) for detection of mobile colistin resistance genes (mcr) and chromosomal mutations in the two-component system (TCS). RESULTS Eighteen isolates (10 K. pneumoniae and 8 E. coli) revealed colistin resistance with a rate of 5.9% in E. coli and 34.8% in K. pneumoniae among ESBL isolates, and 1% in E. coli and 12.5% in K. pneumoniae among CP isolates. The resistance was associated with mcr variants (13/18 isolates, mcr-1, mcr-3, and mcr-8.2) and TCS mutations within E. coli and K. pneumoniae, with the first detection of mcr-8.2 in Cambodia, the discovery of new mutations potentially associated to colistin resistance in the TCS of E. coli (PhoP I47V, PhoQ N352K, PmrB G19R, and PmrD G85R) and the co-occurrence of mcr genes and colistin resistance conferring TCS mutations in 11 of 18 isolates. CONCLUSIONS The findings highlight the presence of colistin resistance in ESBL- and CP- Enterobacteriaceae involved in human infections in Cambodia as well as chromosomal mutations in TCS and the emergence of mcr-8.2 in E. coli and K. pneumoniae. It underscores the need for continuous surveillance, antimicrobial stewardship, and control measures to mitigate the spread of colistin resistance.
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Affiliation(s)
- Mallorie Hide
- MIVEGEC, Montpellier University, CNRS, IRD, Montpellier, France; Medical Biology Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; LMI Drug Resistance in Southeast Asia, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
| | - Soda Meng
- Medical Biology Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Sokleaph Cheng
- Medical Biology Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; LMI Drug Resistance in Southeast Asia, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Anne-Laure Bañuls
- MIVEGEC, Montpellier University, CNRS, IRD, Montpellier, France; LMI Drug Resistance in Southeast Asia, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Santy Ky
- Kantha Bopha Hospital, Phnom Penh, Cambodia
| | | | - Denis Laurent
- Kantha Bopha Hospital, Phnom Penh, Cambodia; Jayavarman VII Hospital, Siem Reap, Cambodia
| | - Gauthier Delvallez
- Medical Biology Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
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Milijasevic M, Veskovic-Moracanin S, Babic Milijasevic J, Petrovic J, Nastasijevic I. Antimicrobial Resistance in Aquaculture: Risk Mitigation within the One Health Context. Foods 2024; 13:2448. [PMID: 39123639 PMCID: PMC11311770 DOI: 10.3390/foods13152448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
The application of antimicrobials in aquaculture primarily aims to prevent and treat bacterial infections in fish, but their inappropriate use may result in the emergence of zoonotic antibiotic-resistant bacteria and the subsequent transmission of resistant strains to humans via food consumption. The aquatic environment serves as a potential reservoir for resistant bacteria, providing an ideal breeding ground for development of antimicrobial resistance (AMR). The mutual inter-connection of intensive fish-farming systems with terrestrial environments, the food processing industry and human population creates pathways for the transmission of resistant bacteria, exacerbating the problem further. The aim of this study was to provide an overview of the most effective and available risk mitigation strategies to tackle AMR in aquaculture, based on the One Health (OH) concept. The stringent antimicrobial use guidelines, promoting disease control methods like enhanced farm biosecurity measures and vaccinations, alternatives to antibiotics (ABs) (prebiotics, probiotics, immunostimulants, essential oils (EOs), peptides and phage therapy), feeding practices, genetics, monitoring water quality, and improving wastewater treatment, rather than applying excessive use of antimicrobials, can effectively prevent the development of AMR and release of resistant bacteria into the environment and food. The contribution of the environment to AMR development traditionally receives less attention, and, therefore, environmental aspects should be included more prominently in OH efforts to predict, detect and prevent the risks to health. This is of particular importance for low and middle-income countries with a lack of integration of the national AMR action plans (NAPs) with the aquaculture-producing environment. Integrated control of AMR in fisheries based on the OH approach can contribute to substantial decrease in resistance, and such is the case in Asia, where in aquaculture, the percentage of antimicrobial compounds with resistance exceeding 50% (P50) decreased from 52% to 22% within the period of the previous two decades.
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Affiliation(s)
- Milan Milijasevic
- Institute of Meat Hygiene and Technology, 11000 Belgrade, Serbia; (M.M.); (S.V.-M.); (J.B.M.)
| | | | | | - Jelena Petrovic
- Scientific Veterinary Institute ‘Novi Sad’, 21113 Novi Sad, Serbia;
| | - Ivan Nastasijevic
- Institute of Meat Hygiene and Technology, 11000 Belgrade, Serbia; (M.M.); (S.V.-M.); (J.B.M.)
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Peng C, Moniroth S, Khy P, Chea S, Thanh C, Heng O, Sarter S, Cheng S, Caruso D. Antibiotic resistance profiles of sentinel bacteria isolated from aquaculture in Cambodia. JOURNAL OF WATER AND HEALTH 2024; 22:1033-1043. [PMID: 38935454 DOI: 10.2166/wh.2024.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/25/2024] [Indexed: 06/29/2024]
Abstract
The misuse of antibiotics and the emergence of antimicrobial resistance (AMR) is a concern in the aquaculture industry because it contributes to global health risks and impacts the environment. This study analyzed the AMR of sentinel bacteria associated with striped catfish (Pangasisanodon hypophthalmus) and giant snakehead (Channa micropeltes), the two main fish species reared in the pond culture in Cambodia. Phenotypic and genotypic characterization of the recovered isolates from fish, water, and sediment samples revealed the presence of bacteria, such as 22 species belonging to families Aeromonadaceae, Enterobacteriaceae, and Pseudomonadaceae. Among 48 isolates, Aeromonas caviae (n = 2), Aeromonas hydrophila (n = 2), Aeromonas ichthiosmia (n = 1), Aeromonas salmonicida (n = 4) were detected. A. salmonicida and A. hydrophilla are known as fish pathogens that occur worldwide in both fresh and marine water aquaculture. Antibiotic susceptibility testing revealed antibiotic resistance patterns of 24 (50 %) isolates among 48 isolates with higher multiple antibiotic resistance index (> 0.2). All the isolates of Enterobacteriaceae were susceptible to ciprofloxacin. Ciprofloxacin is a frontline antibiotic that is not recommended to use in aquaculture. Therefore, its use has to be strictly controlled. This study expands our knowledge of the AMR status in aquaculture farms which is very limited in Cambodia.
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Affiliation(s)
- Chanthol Peng
- Research and Innovation Center, Institute of Technology of Cambodia, Russian Federation Blvd., P.O Box 86, Phnom Penh, Cambodia E-mail:
| | - Sopheavattey Moniroth
- Research and Innovation Center, Institute of Technology of Cambodia, Russian Federation Blvd., P.O Box 86, Phnom Penh, Cambodia
| | - Panha Khy
- Research and Innovation Center, Institute of Technology of Cambodia, Russian Federation Blvd., P.O Box 86, Phnom Penh, Cambodia
| | - Sopheaktra Chea
- Research and Innovation Center, Institute of Technology of Cambodia, Russian Federation Blvd., P.O Box 86, Phnom Penh, Cambodia
| | - Channmuny Thanh
- Research and Innovation Center, Institute of Technology of Cambodia, Russian Federation Blvd., P.O Box 86, Phnom Penh, Cambodia
| | - Oudam Heng
- Research and Innovation Center, Institute of Technology of Cambodia, Russian Federation Blvd., P.O Box 86, Phnom Penh, Cambodia
| | - Samira Sarter
- ISEM, Univ Montpellier, CNRS, IRD, CIRAD, Montpellier, France
| | - Sokleaph Cheng
- Bacteriology and Antibiotic resistance group, Medical Biology Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
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Nhu NTK, Phan MD, Hancock SJ, Peters KM, Alvarez-Fraga L, Forde BM, Andersen SB, Miliya T, Harris PNA, Beatson SA, Schlebusch S, Bergh H, Turner P, Brauner A, Westerlund-Wikström B, Irwin AD, Schembri MA. High-risk Escherichia coli clones that cause neonatal meningitis and association with recrudescent infection. eLife 2024; 12:RP91853. [PMID: 38622998 PMCID: PMC11021048 DOI: 10.7554/elife.91853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
Neonatal meningitis is a devastating disease associated with high mortality and neurological sequelae. Escherichia coli is the second most common cause of neonatal meningitis in full-term infants (herein NMEC) and the most common cause of meningitis in preterm neonates. Here, we investigated the genomic relatedness of a collection of 58 NMEC isolates spanning 1974-2020 and isolated from seven different geographic regions. We show NMEC are comprised of diverse sequence types (STs), with ST95 (34.5%) and ST1193 (15.5%) the most common. No single virulence gene profile was conserved in all isolates; however, genes encoding fimbrial adhesins, iron acquisition systems, the K1 capsule, and O antigen types O18, O75, and O2 were most prevalent. Antibiotic resistance genes occurred infrequently in our collection. We also monitored the infection dynamics in three patients that suffered recrudescent invasive infection caused by the original infecting isolate despite appropriate antibiotic treatment based on antibiogram profile and resistance genotype. These patients exhibited severe gut dysbiosis. In one patient, the causative NMEC isolate was also detected in the fecal flora at the time of the second infection episode and after treatment. Thus, although antibiotics are the standard of care for NMEC treatment, our data suggest that failure to eliminate the causative NMEC that resides intestinally can lead to the existence of a refractory reservoir that may seed recrudescent infection.
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Affiliation(s)
- Nguyen Thi Khanh Nhu
- Institute for Molecular Bioscience (IMB), The University of QueenslandBrisbaneAustralia
- School of Chemistry and Molecular Biosciences, The University of QueenslandBrisbaneAustralia
- Australian Infectious Diseases Research Centre, The University of QueenslandBrisbaneAustralia
| | - Minh-Duy Phan
- Institute for Molecular Bioscience (IMB), The University of QueenslandBrisbaneAustralia
- School of Chemistry and Molecular Biosciences, The University of QueenslandBrisbaneAustralia
- Australian Infectious Diseases Research Centre, The University of QueenslandBrisbaneAustralia
| | - Steven J Hancock
- School of Chemistry and Molecular Biosciences, The University of QueenslandBrisbaneAustralia
- Australian Infectious Diseases Research Centre, The University of QueenslandBrisbaneAustralia
| | - Kate M Peters
- Institute for Molecular Bioscience (IMB), The University of QueenslandBrisbaneAustralia
- School of Chemistry and Molecular Biosciences, The University of QueenslandBrisbaneAustralia
- Australian Infectious Diseases Research Centre, The University of QueenslandBrisbaneAustralia
| | - Laura Alvarez-Fraga
- School of Chemistry and Molecular Biosciences, The University of QueenslandBrisbaneAustralia
- Australian Infectious Diseases Research Centre, The University of QueenslandBrisbaneAustralia
| | - Brian M Forde
- Australian Infectious Diseases Research Centre, The University of QueenslandBrisbaneAustralia
- University of Queensland Centre for Clinical Research, The University of QueenslandBrisbaneAustralia
| | - Stacey B Andersen
- Genome Innovation Hub, The University of QueenslandBrisbaneAustralia
| | - Thyl Miliya
- Cambodia Oxford Medical Research Unit, Angkor Hospital for ChildrenSiem ReapCambodia
| | - Patrick NA Harris
- University of Queensland Centre for Clinical Research, The University of QueenslandBrisbaneAustralia
- Pathology Queensland, Queensland HealthBrisbaneAustralia
| | - Scott A Beatson
- School of Chemistry and Molecular Biosciences, The University of QueenslandBrisbaneAustralia
- Australian Infectious Diseases Research Centre, The University of QueenslandBrisbaneAustralia
| | - Sanmarie Schlebusch
- University of Queensland Centre for Clinical Research, The University of QueenslandBrisbaneAustralia
- Pathology Queensland, Queensland HealthBrisbaneAustralia
- Q-PHIRE Genomics and Public Health Microbiology, Forensic and Scientific Services, Coopers PlainsBrisbaneAustralia
| | - Haakon Bergh
- Pathology Queensland, Queensland HealthBrisbaneAustralia
| | - Paul Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for ChildrenSiem ReapCambodia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Annelie Brauner
- Department of Microbiology, Tumor and Cell Biology, Division of Clinical Microbiology, Karolinska Institutet and Karolinska University HospitalStockholmSweden
| | | | - Adam D Irwin
- Australian Infectious Diseases Research Centre, The University of QueenslandBrisbaneAustralia
- University of Queensland Centre for Clinical Research, The University of QueenslandBrisbaneAustralia
- Infection Management Prevention Service, Queensland Children's HospitalBrisbaneAustralia
| | - Mark A Schembri
- Institute for Molecular Bioscience (IMB), The University of QueenslandBrisbaneAustralia
- School of Chemistry and Molecular Biosciences, The University of QueenslandBrisbaneAustralia
- Australian Infectious Diseases Research Centre, The University of QueenslandBrisbaneAustralia
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Mao S, Soputhy C, Lay S, Jacobs J, Ku GM, Chau D, Chhea C, Ir P. The barriers and facilitators of implementing a national laboratory-based AMR surveillance system in Cambodia: key informants' perspectives and assessments of microbiology laboratories. Front Public Health 2023; 11:1332423. [PMID: 38179556 PMCID: PMC10764616 DOI: 10.3389/fpubh.2023.1332423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
Background Collecting data on antimicrobial resistance (AMR) is an essential approach for defining the scope of the AMR problem, developing evidence-based interventions and detecting new and emerging resistances. Our study aimed to identify key factors influencing the implementation of a laboratory-based AMR surveillance system in Cambodia. This will add additional insights to the development of a sustainable and effective national AMR surveillance system in Cambodia and other low- and middle-income countries. Methods Key informants with a role in governing or contributing data to the laboratory-based surveillance system were interviewed. Emerging themes were identified using the framework analysis method. Laboratories contributing to the AMR surveillance system were assessed on their capacity to conduct quality testing and report data. The laboratory assessment tool (LAT), developed by the World Health Organisation (WHO), was adapted for assessment of a diagnostic microbiology laboratory covering quality management, financial and human resources, data management, microbiology testing performance and surveillance capacity. Results Key informants identified inadequate access to laboratory supplies, an unsustainable financing system, limited capacity to collect representative data and a weak workforce to be the main barriers to implementing an effective surveillance system. Consistent engagement between microbiology staff and clinicians were reported to be a key factor in generating more representative data for the surveillance system. The laboratory assessments identified issues with quality assurance and data analysis which may reduce the quality of data being sent to the surveillance system and limit the facility-level utilisation of aggregated data. A weak surveillance network and poor guidance for outbreak response were also identified, which can reduce the laboratories' opportunities in detecting critical or emerging resistance occurring in the community or outside of the hospital's geographical coverage. Conclusion This study identified two primary concerns: ensuring a sustainable and quality functioning of microbiology services at public healthcare facilities and overcoming sampling bias at sentinel sites. These issues hinder Cambodia's national AMR surveillance system from generating reliable evidence to incorporate into public health measures or clinical interventions. These findings suggest that more investments need to be made into microbiology diagnostics and to reform current surveillance strategies for enhanced sampling of AMR cases at hospitals.
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Affiliation(s)
- Sovathiro Mao
- National Institute of Public Health, Phnom Penh, Cambodia
| | | | - Sokreaksa Lay
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Jan Jacobs
- Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Grace Marie Ku
- Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Department of Frailty in Ageing Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Darapheak Chau
- National Institute of Public Health, Phnom Penh, Cambodia
| | | | - Por Ir
- National Institute of Public Health, Phnom Penh, Cambodia
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Wong W, Bak VS, Luo W, Hoksear S, Rith P, Gollogly J. Methicillin resistant Staphylococcus aureus isolated from surgical patients in Cambodia over a 10-year period. Trop Doct 2023:494755231174261. [PMID: 37157819 DOI: 10.1177/00494755231174261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) related surgical infections are a global challenge. The burden of antimicrobial resistance is high throughout South-East Asia, and this is reflected in our local institution in Cambodia. Between 2011 and 2013, we analysed 251 wound swab samples at the Children's Surgical Centre, Phnom Penh; 52.5% of the Staphylococcus aureus isolates (n = 52/99) were MRSA positive. Ten years on, we have sought to investigate whether there is a difference in MRSA rates within our adult and paediatric patient population. Between 2020 and 2022, MRSA rates in our patient population have remained similar at 53.8% (n = 42/78). Resistance profiles of MRSA isolates have also remained similar with a significant proportion of MRSA still showing sensitivity to trimethoprim-sulfamethoxazole and tetracycline. We also find that patients presenting with wound infection secondary to trauma or orthopaedic implants had greater propensity to yield MRSA.
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Affiliation(s)
- William Wong
- Medical School, University of Oxford, Oxford, UK
| | - Vi-Seth Bak
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Weisang Luo
- Children's Surgical Centre, Phnom Penh, Cambodia
| | - Suon Hoksear
- Children's Surgical Centre, Phnom Penh, Cambodia
| | - Prum Rith
- Children's Surgical Centre, Phnom Penh, Cambodia
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Setiawan E, Cotta MO, Abdul-Aziz MH, Widjanarko D, Sosilya H, Lukas DL, Wallis SC, Parker S, Roberts JA. Population Pharmacokinetics and Dosing Simulations of Ampicillin and Sulbactam in Hospitalised Adult Patients. Clin Pharmacokinet 2023; 62:573-586. [PMID: 36853585 PMCID: PMC10085897 DOI: 10.1007/s40262-023-01219-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND The pharmacokinetic variability of ampicillin-sulbactam in adults has not been extensively described, particularly in patients with a reduced renal function (i.e., < 60 mL/min). OBJECTIVE This study investigated the population pharmacokinetics of ampicillin and sulbactam in patients with a wide range of renal functions and sought to define dosing approaches that have a high likelihood for optimising drug exposure. METHODS Serial blood samples were collected from 16 adult patients receiving intravenous ampicillin-sulbactam in general wards. Total ampicillin and sulbactam concentrations were measured by chromatographic assay and pharmacokinetic parameters were estimated using Pmetrics®. Monte Carlo simulations were used to evaluate the probability of target attainment (PTA) of free ampicillin and sulbactam concentrations exceeding the minimum inhibitory concentration (MIC) for 60% and 100% of the dosing interval. Fractional target attainment (FTA) was calculated against MIC distributions of common hospital pathogens. A threshold of ≥ 90% and ≥ 95% was used to define both optimal PTA and FTA, respectively. RESULTS The median (range) age, weight, and serum creatinine of the study population was 68 (40-82) years, 62 (40-82) kg, and 1.4 (0.6-6.4) mg/dL, respectively. The pharmacokinetics of ampicillin and sulbactam were best described by a two-compartment model with serum creatinine most closely associated with clearance for both drugs. The estimated ampicillin and sulbactam clearances were 5.58 L/h and 4.79 L/h, respectively, while the volumes of distribution were 12.6 L and 15.36 L, respectively. Approved dosing regimens of ampicillin-sulbactam were sufficient against MICs ≤ 8 and ≤ 4 mg/L, respectively. A 4-h infusion enabled optimal PTA at higher MICs. For both dosing targets, optimal FTAs were obtained against Streptococcus pneumoniae. CONCLUSION Optimal FTAs were obtained against the susceptible MIC distributions of Escherichia coli, Klebsiella pneumoniae, and Acinetobacter baumannii. Applying a 4-h infusion will enhance PTA and FTA, particularly at higher MICs.
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Affiliation(s)
- Eko Setiawan
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia
- Department of Clinical and Community Pharmacy, Center for Medicines Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, University of Surabaya, Surabaya, East Java, 60293, Indonesia
| | - Menino Osbert Cotta
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia
| | - Mohd-Hafiz Abdul-Aziz
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia.
| | - Doddy Widjanarko
- Dr Mohamad Soewandhie Public Hospital, Surabaya, East Java, 60142, Indonesia
| | - Hernycane Sosilya
- Dr Mohamad Soewandhie Public Hospital, Surabaya, East Java, 60142, Indonesia
| | - Dwi Lily Lukas
- Dr Mohamad Soewandhie Public Hospital, Surabaya, East Java, 60142, Indonesia
| | - Steven C Wallis
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia
| | - Suzanne Parker
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, 4029, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, 30029, Nîmes, France
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Chomkatekaew C, Thaipadungpanit J, Hearn P, Soeng S, Pol S, Neou L, Hopkins J, Turner P, Batty EM. Detection of maternal transmission of resistant Gram-negative bacteria in a Cambodian hospital setting. Front Microbiol 2023; 14:1158056. [PMID: 37125167 PMCID: PMC10140293 DOI: 10.3389/fmicb.2023.1158056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/23/2023] [Indexed: 05/02/2023] Open
Abstract
Infection with Extended-spectrum beta-lactamase -producing Enterobacterales (ESBL-E) is common in infants and leads to increased intensive care unit admission and mortality, but the role of maternal transmission in colonization of infants is unclear. Using paired isolates from 50 pairs of mothers and neonates admitted to a Cambodian hospital, we investigated antimicrobial resistance in Escherichia coli and Klebsiella pneumoniae using whole genome sequencing. We detected a wide variety of ESBL-E genes present in this population along with high levels of multidrug resistance. From 21 pairs where the same organism was present in both mother and neonate, we identified eight pairs with identical or near-identical isolates from both individuals suggestive of transmission at or around birth, including a pair with transmission of multiple strains. We found no evidence for transmission of plasmids only from mother to infant. This suggests vertical transmission outside hospitals as a common cause of ESBL-E colonization in neonates.
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Affiliation(s)
- Chalita Chomkatekaew
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Janjira Thaipadungpanit
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pasco Hearn
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Sona Soeng
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Sreymom Pol
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Leakhena Neou
- Neonatal Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Jill Hopkins
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Paul Turner
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Elizabeth M. Batty
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- *Correspondence: Elizabeth M. Batty,
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Diversity and Dissemination of Methicillin-Resistant Staphylococcus aureus (MRSA) Genotypes in Southeast Asia. Trop Med Infect Dis 2022; 7:tropicalmed7120438. [PMID: 36548693 PMCID: PMC9781663 DOI: 10.3390/tropicalmed7120438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a successful pathogen that has achieved global dissemination, with high prevalence rates in Southeast Asia. A huge diversity of clones has been reported in this region, with MRSA ST239 being the most successful lineage. Nonetheless, description of MRSA genotypes circulating in the Southeast Asia region has, until now, remained poorly compiled. In this review, we aim to provide a better understanding of the molecular epidemiology and distribution of MRSA clones in 11 Southeast Asian countries: Singapore, Malaysia, Thailand, Vietnam, Cambodia, Lao People's Democratic Republic (PDR), Myanmar, Philippines, Indonesia, Brunei Darussalam, and Timor-Leste. Notably, while archaic multidrug-resistant hospital-associated (HA) MRSAs, such as the ST239-III and ST241-III, were prominent in the region during earlier observations, these were then largely replaced by the more antibiotic-susceptible community-acquired (CA) MRSAs, such as ST22-IV and PVL-positive ST30-IV, in recent years after the turn of the century. Nonetheless, reports of livestock-associated (LA) MRSAs remain few in the region.
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Nejjari C, El Achhab Y, Benaouda A, Abdelfattah C. Antimicrobial resistance among GLASS pathogens in Morocco: an epidemiological scoping review. BMC Infect Dis 2022; 22:438. [PMID: 35525923 PMCID: PMC9077917 DOI: 10.1186/s12879-022-07412-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monitoring of antimicrobial resistance (AMR) is of great importance due to the frequency of strains becoming increasingly resistant to antibiotics. This review, using a public health focused approach, which aims to understand and describe the current status of AMR in Morocco in relation to WHO priority pathogens and treatment guidelines. METHODS PubMed, ScienceDirect and Google Scholar Databases and grey literature are searched published articles on antimicrobial drug resistance data for GLASS priority pathogens isolated from Morocco between January 2011 and December 2021. Articles are screened using strict inclusion/exclusion criteria. AMR data is extracted with medians and IQR of resistance rates. RESULTS Forty-nine articles are included in the final analysis. The most reported bacterium is Escherichia coli with median resistance rates of 90.9%, 64.0%, and 56.0%, for amoxicillin, amoxicillin-clavulanic acid, and co-trimoxazole, respectively. Colistin had the lowest median resistance with 0.1%. A median resistance of 63.0% is calculated for amoxicillin-clavulanic acid in Klebsiella pneumonia. Imipenem resistance with a median of 74.5% is reported for Acinetobacter baumannii. AMR data for Streptococcus pneumonie does not exceed 50.0% as a median. CONCLUSIONS Whilst resistance rates are high for most of GLASS pathogens, there are deficient data to draw vigorous conclusions about the current status AMR in Morocco. The recently join to the GLASS system surveillance will begin to address this data gap.
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Affiliation(s)
- Chakib Nejjari
- International School of Public Health, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Youness El Achhab
- Laboratory of Epidemiology, Clinical Research and Community Health, Faculty of Medicine and Pharmacy of Fez, University Sidi Mohamed Ben Abdellah, Km 2.2 Rte Sidi Harazem, B.P 1893, Fez, Morocco. .,CRMEF Fez-Meknes, Rue Kuwait, B.P 49, Fez, Morocco.
| | - Amina Benaouda
- Department of Microbiology, Cheikh Zayed International University Hospital, Rabat, Morocco
| | - Chakib Abdelfattah
- Department of Infectious Diseases, Faculty of Medicine, University Hassan II, Casablanca, Morocco
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11
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A New Colorimetric Method for Rapid Detection of Antibiotic Resistance in Escherichia coli Isolates. Jundishapur J Microbiol 2022. [DOI: 10.5812/jjm.119858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The quick diagnosis and early initiation of antibiotic therapy in bacteria-induced infections is of paramount importance. Accordingly, the rapid identification of the causative agent, the short-term results of antibiotic sensitivity, the selection and use of right antibiotics for treatment further highlights the significance of this issue. Objectives: This study aimed to develop a new susceptibility testing method to provide rapid results in Escherichia coli clinical isolates and report the antibiotic susceptibility test results to clinicians in a short period. Methods: In the study, one hundred and ten E. coli clinical isolates were tested. In this regard, antibiotics recommended by the "Clinical and Laboratory Standards Institute (CLSI)" for testing the sensitivity of E. coli isolates, including amoxicillin-clavulanate, cefixime, ceftriaxone, ertapenem, ciprofloxacin, gentamicin, trimethoprim-sulfamethoxazole, and nitrofurantoin were tested. For quality control, E. coli ATCC25922, E. coli ATCC35218, Staphylococcus aureus ATCC29213, and E. coli 13846NTCC strains were used. The broth microdilution method recommended by CLSI was used as the reference method. Minimum inhibitory concentration values were determined, and antimicrobial susceptibilities were then determined according to the “European Committee on Antimicrobial Susceptibility Testing (EUCAST)” criteria. In the next phase, the results of the resazurin microplate method (RMM) were compared. Results: The comparison of the RMM developed in the present study with the reference method revealed that the calculated essential agreement ratios for eight antibiotics varied from 82.72 to 100%, and the categorical agreement values ranged from 95.45 to100%. Conclusions: According to the findings, the RMM results were highly in agreement with the results of the reference method. RMM allows the detection of antibiotic susceptibility quickly (e.g., within 5 hours) as such it is preferred, especially for laboratories with limited facilities. However, further multi-center studies are recommended to use this method in routine laboratories.
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12
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Kamel HL, Hanora A, Solyman SM. Metataxanomic, bioactivity and microbiome analysis of Red Sea marine sponges from Egypt. Mar Genomics 2021; 61:100920. [PMID: 34973527 DOI: 10.1016/j.margen.2021.100920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
Red Sea marine sponges (phylum Porifera) and associated microorganisms harbor a wide range of microorganisms, which are considered an essential source of bioactive products. In this study, we screened both the crude extracts of Red Sea marine sponges and their associated bacterial extract for antimicrobial activity and antiviral activity. Molecular characterization of bioactive producers was performed using16S rRNA sequencing, in addition to metagenomic analysis of three representative sponges utilizing the 16S rRNA gene V3-V4 region sequencing in two different seasons. Twelve samples were collected from five different sponge species by scuba diving, and all the crude extracts of sponges showed antimicrobial activity except Negombata corticata. Moreover, 84 out of 110 bacterial isolates extracts demonstrated antimicrobial activity against at least one tested microorganism. These results revealed the bioactivity and biodiversity of the Red Sea marine invertebrates-associated bacteria. It was found that the bioactive isolates belong to several bacterial groups. The bacterial communities of Negombata magnifica, Negombata corticata, and Siphonochalina siphonella were shown with great diversity and differences in the bacterial percentage, diversity, and unique community composition at different seasons in each sponge species. Unique microenvironment for each sponge species may be linked to the production of specific bioactive product.
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Affiliation(s)
- Hasnaa L Kamel
- Department of Microbiology & Immunology, College of Pharmacy, Suez Canal University, Ismailia, Egypt; Department of Microbiology & Immunology, College of Pharmacy, Sinai University, Ismailia, Egypt.
| | - Amro Hanora
- Department of Microbiology & Immunology, College of Pharmacy, Suez Canal University, Ismailia, Egypt.
| | - Samar M Solyman
- Department of Microbiology & Immunology, College of Pharmacy, Suez Canal University, Ismailia, Egypt; Department of Microbiology & Immunology, College of Pharmacy, Sinai University, Ismailia, Egypt.
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13
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Ribeiro CP, Lourenço LM. Overview of cationic phthalocyanines for effective photoinactivation of pathogenic microorganisms. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY C: PHOTOCHEMISTRY REVIEWS 2021. [DOI: 10.1016/j.jphotochemrev.2021.100422] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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14
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Update on Shigella and nontyphoidal Salmonella antimicrobial drug resistance: Implications on empiric treatment of acute infectious diarrhea in Cambodia. Antimicrob Agents Chemother 2021; 65:e0067121. [PMID: 34398671 DOI: 10.1128/aac.00671-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Information on causative diarrheal pathogens and their associated antimicrobial susceptibility remains limited for Cambodia. This study describes antimicrobial resistance patterns for Shigella and nontyphoidal Salmonella isolates collected in Cambodia over a five-year period. Multidrug resistance was shown in 98% of Shigella isolates, with 70%, 11%, and 29% of isolates being resistant to fluoroquinolones, azithromycin, and cephalosporin, respectively. As many as 11% of Shigella isolates were resistant to nearly all oral and parenteral drugs typically used for shigellosis, demonstrating extreme drug-resistance phenotypes. Although a vast majority of nontyphoidal Salmonella isolates remained susceptible to cephalosporins (99%) and macrolides (98%), decreased susceptibility to ciprofloxacin was found in 67% of isolates, which is notably higher than previous reports. In conclusion, increasing antimicrobial resistance of Shigella and nontyphoidal Salmonella is a major concern for selecting empiric treatment of acute infectious diarrhea in Cambodia. Treatment practices should be updated and follow local antimicrobial resistance data for the identified pathogens.
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15
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Miyazaki A, Tung R, Taing B, Matsui M, Iwamoto A, Cox SE. Frequent unregulated use of antibiotics in rural Cambodian infants. Trans R Soc Trop Med Hyg 2021; 114:401-407. [PMID: 32307551 PMCID: PMC7266683 DOI: 10.1093/trstmh/traa020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 10/25/2019] [Accepted: 03/17/2020] [Indexed: 01/26/2023] Open
Abstract
Background Despite a high prevalence of antibiotic resistance in Cambodia, few studies have assessed health-seeking behaviour and the use of antibiotics by caregivers of young children in Cambodia. Methods We conducted a cross-sectional survey of infants <12 months of age and their caregivers, assessing the frequency of reported illness, common symptoms and associated health-seeking behaviour through structured questionnaires administered by trained fieldworkers at a home visit. In a subset of these participants, ages 4–8 months with no acute malnutrition, we conducted a 3-month surveillance with fortnightly home visits. Results Of 149 infants (ages 1–11 months, 54.4% male) enrolled in the cross-sectional study, 76 (51.4%) reported symptoms of diarrhoea, fever or cough in the previous 14 d, with associated use of antibiotics reported in 22 (14.8%) infants. In 47 infants enrolled in the longitudinal surveillance, there were 141 reported episodes of illness in 44 (94%) infants with 21 infants (45%) reported to have received antibiotics in 32/141 (22.7%) episodes. Amoxicillin was the most commonly reported antibiotic in both surveys (68% [40/59 episodes reporting the use of antibiotics]). Conclusions Antibiotic usage is high in this population and appears to be occurring largely outside of the formal healthcare system.
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Affiliation(s)
- Asuka Miyazaki
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Rathavy Tung
- National Maternal and Child Health Centre, Ministry of Health, Phnom Penh, Cambodia
| | | | - Mitsuaki Matsui
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Azusa Iwamoto
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Sharon E Cox
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.,Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Dept of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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16
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Parashar S, Sharma MK, Garg C, Garg M. Green synthesized Silver Nanoparticles as Silver Lining in Antimicrobial Resistance: A Review. Curr Drug Deliv 2021; 19:170-181. [PMID: 33797368 DOI: 10.2174/1567201818666210331123022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/18/2020] [Accepted: 01/25/2021] [Indexed: 11/22/2022]
Abstract
Unprincipled use of antibiotics has led to the antimicrobial resistance (AMR) against mostly available compounds and now become a major cause of concern for the scientific community. However, in the past decade, green synthesized silver nanoparticles (AgNPs) have received greater attention for the development of newer therapies as antimicrobials by virtue of their unique physico-chemical properties. Unlike traditional antibiotics, AgNPs exert their action by acting on multiple mechanisms which make them potential candidates against AMR. Green synthesis of AgNPs using various medicinal plants has demonstrated broader spectrum of action against several microbes in a number of attempts. The present paper provides an insight into the scientific studies that have elucidated the positive role of plant extracts/phytochemicals during green synthesis of AgNPs and their future perspectives. The studies conducted so far seem promising still, a few factors like, the precise mechanism of action of AgNPs, their synergistic interaction with biomolecules, and industrial scalability need to be explored further till effective drug development using green synthesized AgNPs in healthcare systems against AMR is established.
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Affiliation(s)
- Sonia Parashar
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak 124001, Haryana. India
| | - Manish Kumar Sharma
- Department of Chemistry, Deenbandhu Chhotu Ram University of Science and Technology, Murthal (Sonipat) 131039, Haryana. India
| | - Chanchal Garg
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak 124001, Haryana. India
| | - Munish Garg
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak 124001, Haryana. India
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17
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Cheng S, Hide M, Pheng SH, Kerléguer A, Delvallez G, Sam S, Mao TE, Nguyen TVA, Bañuls AL. Resistance to Second-Line Anti-TB Drugs in Cambodia: A Phenotypic and Genetic Study. Infect Drug Resist 2021; 14:1089-1104. [PMID: 33762833 PMCID: PMC7982564 DOI: 10.2147/idr.s289907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/06/2021] [Indexed: 12/25/2022] Open
Abstract
Background Due to the emergence of Mycobacterium tuberculosis (M.tb) clinical isolates resistant to most potent first-line drugs (FLD), second-line drugs (SLD) are being prescribed more frequently. We explore the genetic characteristics and molecular mechanisms of M.tb isolates phenotypically resistant to SLD, including pre-extensively drug-resistant (pre-XDR) and extensively drug-resistant (XDR) isolates. Methods Drug-resistant (DR) M.tb isolates collected from 2012 to 2017 were tested using sequencing and phenotypic drug susceptibility testing. Genotypes were determined to explore their links with SLD resistance patterns. Results Of the 272 DR M.tb isolates, 6 non-multidrug resistant (non-MDR) isolates were fluoroquinolones (FQ)-resistant, 3 were XDR and 16 were pre-XDR (14 resistant to FQ and 2 to second-line injectable drugs). The most frequent mutations in FQ-resistant and second-line injectable drugs resistant isolates were gyrA D94G (15/23) and rrs a1401g (3/5), respectively. Seventy-five percent of pre-XDR isolates and 100% of XDR isolates harbored mutations conferring resistance to pyrazinamide. All XDR isolates belonged to the Beijing genotype, of which one, named XDR+, was resistant to all drugs tested. One cluster including pre-XDR and XDR isolates was observed. Conclusion This is the first description of SLD resistance in Cambodia. The data suggest that the proportion of XDR and pre-XDR isolates remains low but is on the rise compared to previous reports. The characterization of the XDR+ isolate in a patient who refused treatment underlines the risk of transmission in the population. In addition, genotypic results show, as expected, that the Beijing family is the main involved in pre-XDR and XDR isolates and that the spread of the Beijing pre-XDR strain is capable of evolving into XDR strain. This study strongly indicates the need for rapid interventions in terms of diagnostic and treatment to prevent the spread of the pre-XDR and XDR strains and the emergence of more resistant ones.
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Affiliation(s)
- Sokleaph Cheng
- Institut Pasteur du Cambodge and Ministry of Health, Phnom Penh, Cambodia.,Medical Biology Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.,LMI Drug Resistance in South East Asia, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Mallorie Hide
- LMI Drug Resistance in South East Asia, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.,MIVEGEC, University of Montpellier, Institute of Research for Development, Centre National de la Recherche Scientifique, Montpellier, France.,CREES (Centre de Recherche En Écologie Et Évolution de la Santé), Montpellier, France
| | - Sok Heng Pheng
- National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Alexandra Kerléguer
- Medical Biology Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Gauthier Delvallez
- Medical Biology Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Sophan Sam
- Cambodian Health Committee, Phnom Penh, Cambodia
| | - Tan Eang Mao
- National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Thi Van Anh Nguyen
- LMI Drug Resistance in South East Asia, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.,Department of Bacteriology, National Institute of Hygiene and Epidemiology, Hanoi, Martinique, Vietnam
| | - Anne-Laure Bañuls
- LMI Drug Resistance in South East Asia, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.,MIVEGEC, University of Montpellier, Institute of Research for Development, Centre National de la Recherche Scientifique, Montpellier, France.,CREES (Centre de Recherche En Écologie Et Évolution de la Santé), Montpellier, France
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18
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Lim JM, Chhoun P, Tuot S, Om C, Krang S, Ly S, Hsu LY, Yi S, Tam CC. Public knowledge, attitudes and practices surrounding antibiotic use and resistance in Cambodia. JAC Antimicrob Resist 2021; 3:dlaa115. [PMID: 34223067 PMCID: PMC8210153 DOI: 10.1093/jacamr/dlaa115] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/01/2020] [Indexed: 11/14/2022] Open
Abstract
Background WHO's Global Action Plan on Antimicrobial Resistance includes as a priority to increase public education surrounding antibiotic use and resistance. Monitoring population-level antibiotic behaviours is crucial for informing intervention strategies, but data from a broad range of settings, particularly lower-resourced countries, are lacking. Objectives We measured public knowledge, attitudes and practices regarding antibiotics and antibiotic resistance in Cambodia, providing baseline information against which to monitor the progress of future interventions. Methods Between September and October 2018, we conducted a household survey of knowledge, attitudes and practices related to antibiotic use in urban and rural populations of three Cambodian provinces: Phnom Penh, Siem Reap and Prey Veng. Response rates were respectively 79%, 86% and 86%. Results Among the 2005 participants, we found high levels of awareness of terms relating to antibiotics (86.5%) and antibiotic resistance; most participants also recognized that antibiotic resistance is a problem (58.4%). However, few understood that antibiotics are effective only against bacterial infections (1.2%). We also found province-specific differences in participants' sources of antibiotics and their sources of AMR-related information. In regression analyses, more favourable antibiotic practice scores were associated with higher knowledge (β = 0.18; 95% CI: 0.14-0.22) and attitude (β = 0.16; 95% CI: 0.11-0.22) scores, as well as trust in healthcare sources to obtain antibiotics and antibiotic information. Conclusions This study highlights the importance of interventions and public communication on antibiotic use and resistance that is effectively targeted to the local context through trusted healthcare providers.
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Affiliation(s)
- Jane Mingjie Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Chhorvoin Om
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sidonn Krang
- Department of Communicable Diseases Control, Ministry of Health, Phnom Penh, Cambodia
| | - Sovann Ly
- Department of Communicable Diseases Control, Ministry of Health, Phnom Penh, Cambodia
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Center for Global Health Research, Touro University California, Vallejo, CA, USA.,School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Clarence C Tam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,London School of Hygiene & Tropical Medicine, London, England, UK
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19
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Singh SR, Mao B, Evdokimov K, Tan P, Leab P, Ong R, Vonthanak S, Tam CC, Hsu LY, Turner P. Prevalence of MDR organism (MDRO) carriage in children and their household members in Siem Reap Province, Cambodia. JAC Antimicrob Resist 2020; 2:dlaa097. [PMID: 34223049 PMCID: PMC8210010 DOI: 10.1093/jacamr/dlaa097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/06/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The rising incidence of infections caused by MDR organisms (MDROs) poses a significant public health threat. However, little has been reported regarding community MDRO carriage in low- and middle-income countries. METHODS We conducted a cross-sectional study in Siem Reap, Cambodia comparing hospital-associated households, in which an index child (age: 2-14 years) had been hospitalized for at least 48 h in the preceding 2-4 weeks, with matched community households on the same street, in which no other child had a recent history of hospitalization. Participants were interviewed using a survey questionnaire and tested for carriage of MRSA, ESBL-producing Enterobacterales (ESBL-E) and carbapenemase-producing Enterobacterales (CPE) by culture followed by antibiotic susceptibility testing. We used logistic regression analysis to analyse associations between collected variables and MDRO carriage. RESULTS Forty-two pairs of households including 376 participants with 376 nasal swabs and 290 stool specimens were included in final analysis. MRSA was isolated from 26 specimens (6.9%). ESBL-producing Escherichia coli was detected in 269 specimens (92.8%) whereas ESBL-producing Klebsiella pneumoniae was isolated from 128 specimens (44.1%), of which 123 (42.4%) were co-colonized with ESBL-producing E. coli. Six (2.1%) specimens tested positive for CPE (4 E. coli and 2 K. pneumoniae). The prevalence ratios for MRSA, ESBL-producing E. coli and ESBL-producing K. pneumoniae carriage did not differ significantly in hospital-associated households and hospitalized children compared with their counterparts. CONCLUSIONS The high prevalence of ESBL-E across both household types suggests that MDRO reservoirs are common in the community. Ongoing genomic analyses will help to understand the epidemiology and course of MDRO spread.
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Affiliation(s)
- Shweta R Singh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Bunsoth Mao
- University of Health Sciences, Phnom Penh, Cambodia
| | - Konstantin Evdokimov
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Pisey Tan
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Phana Leab
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Rick Ong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Clarence C Tam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Paul Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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20
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Gandra S, Alvarez-Uria G, Turner P, Joshi J, Limmathurotsakul D, van Doorn HR. Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries. Clin Microbiol Rev 2020; 33:e00048-19. [PMID: 32522747 PMCID: PMC7289787 DOI: 10.1128/cmr.00048-19] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Antimicrobial resistance (AMR) is a serious global health threat and is predicted to cause significant health and economic impacts, particularly in low- and middle-income countries (LMICs). AMR surveillance is critical in LMICs due to high burden of bacterial infections; however, conducting AMR surveillance in resource-limited settings is constrained by poorly functioning health systems, scarce financial resources, and lack of skilled personnel. In 2015, the United Nations World Health Assembly endorsed the World Health Organization's Global Action Plan to tackle AMR; thus, several countries are striving to improve their AMR surveillance capacity, including making significant investments and establishing and expanding surveillance networks. Initial data generated from AMR surveillance networks in LMICs suggest the high prevalence of resistance, but these data exhibit several shortcomings, such as a lack of representativeness, lack of standardized laboratory practices, and underutilization of microbiology services. Despite significant progress, AMR surveillance networks in LMICs face several challenges in expansion and sustainability due to limited financial resources and technical capacity. This review summarizes the existing health infrastructure affecting the establishment of AMR surveillance programs, the burden of bacterial infections demonstrating the need for AMR surveillance, and current progress and challenges in AMR surveillance efforts in eight South and Southeast Asian countries.
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Affiliation(s)
- Sumanth Gandra
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gerardo Alvarez-Uria
- Department of Infectious Diseases, Rural Development Trust Hospital, Bathalapalli, Anantapur, Andhra Pradesh, India
| | - Paul Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jyoti Joshi
- Center for Disease Dynamics, Economics and Policy, New Delhi, India
| | - Direk Limmathurotsakul
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - H Rogier van Doorn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Hanoi, Vietnam
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21
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Ribeiro CP, Gamelas SR, Faustino MA, Gomes AT, Tomé JP, Almeida A, Lourenço LM. Unsymmetrical cationic porphyrin-cyclodextrin bioconjugates for photoinactivation of Escherichia coli. Photodiagnosis Photodyn Ther 2020; 31:101788. [DOI: 10.1016/j.pdpdt.2020.101788] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 01/23/2023]
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22
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Aydın S, Patil A, Desai M, Simforoosh N. Five compelling UTI questions after kidney transplant. World J Urol 2020; 38:2733-2742. [PMID: 32266510 DOI: 10.1007/s00345-020-03173-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/17/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Urinary tract infection (UTI) is the most common bacterial infection among infectious complications in kidney transplant recipients (KTR). After transplantation, infections can result from surgical complications, donor-derived infections, pre-existing recipient infections, and nosocomial infections. Post-transplant infection is still a major cause of morbidity, mortality, graft dysfunction and rejection. In this paper, we aimed to review a few compelling questions in kidney transplantation (KTX). METHODS To identify relevant clinical questions regarding KTX and UTI a meeting was conducted among physicians involved in the KT program in our hospital. After discussion, several clinically relevant questions related to UTI after KTX. The 5 first rated in importance were judged generalizable to other clinical settings and selected for the purposes of this review. RESULTS Nearly half of the patients present in the first three months of transplant with UTI. The most common uropathogens in post-transplant UTIs are Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis. Risk factors for UTI include female sex, advanced age, recurrent UTI before transplant, prolonged urethral catheterization, delayed graft function, and cadaveric kidney transplant. CONCLUSION The incidence of post-transplant UTI is similar in both developed and developing countries. E.coli is the most common pathogen in most of studies. Cadaveric donor and post-dialysis transplantation are defined as independent risk factors for post-transplant UTI. Further studies are still required to identify risk factors after kidney transplantation and UTI's importance for graft function and patient outcome.
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Affiliation(s)
- Selda Aydın
- Infectious Diseases and Clinical Microbiology, Medipol Mega Hospital, Istanbul Medipol University School of Medicine, Bağcılar, Istanbul, Turkey.
| | - Abhijit Patil
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Mahesh Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Nasser Simforoosh
- Department of Urology, Shahid Labbafinejad Medical Center, Tehran, Iran
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Ashaolu TJ. RETRACTED: From farm to fork: global surveillance trends of animal-food-human antimicrobial resistance. FOOD QUALITY AND SAFETY 2020. [DOI: 10.1093/fqsafe/fyz041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objectives
Global surveillance measures keep trending with antimicrobial resistance (AMR) from farm to the final consumer. It is intended to review these trends within the past few decades.
Materials and Methods
This short communication showcases AMR surveillance basics, methods, processes, technicalities and milestones within recent decades in relationship to AMR emergence from farm to fork.
Results and Conclusions
Antibiotics and antimicrobial agents contribute to AMR dynamics. Passive and active AMR surveillance strategies continuously render data-driven robust systems for monitoring resistance levels and thereof changes across all geographical regions.
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