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Strasheim W, Lowe M, Smith AM, Etter EMC, Perovic O. Whole-Genome Sequencing of Human and Porcine Escherichia coli Isolates on a Commercial Pig Farm in South Africa. Antibiotics (Basel) 2024; 13:543. [PMID: 38927209 PMCID: PMC11200671 DOI: 10.3390/antibiotics13060543] [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: 05/12/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Escherichia coli is an indicator micro-organism in One Health antibiotic resistance surveillance programs. The purpose of the study was to describe and compare E. coli isolates obtained from pigs and human contacts from a commercial farm in South Africa using conventional methods and whole-genome sequencing (WGS). Porcine E. coli isolates were proportionally more resistant phenotypically and harbored a richer diversity of antibiotic resistance genes as compared to human E. coli isolates. Different pathovars, namely ExPEC (12.43%, 21/169), ETEC (4.14%, 7/169), EPEC (2.96%, 5/169), EAEC (2.96%, 5/169) and STEC (1.18%, 2/169), were detected at low frequencies. Sequence type complex (STc) 10 was the most prevalent (85.51%, 59/169) among human and porcine isolates. Six STcs (STc10, STc86, STc168, STc206, STc278 and STc469) were shared at the human-livestock interface according to multilocus sequence typing (MLST). Core-genome MLST and hierarchical clustering (HC) showed that human and porcine isolates were overall genetically diverse, but some clustering at HC2-HC200 was observed. In conclusion, even though the isolates shared a spatiotemporal relationship, there were still differences in the virulence potential, antibiotic resistance profiles and cgMLST and HC according to the source of isolation.
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Affiliation(s)
- Wilhelmina Strasheim
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases (NICD), a Division of the National Health Laboratory Service (NHLS), Johannesburg 2192, South Africa
- Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria 0110, South Africa
| | - Michelle Lowe
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases (NICD), a Division of the National Health Laboratory Service (NHLS), Johannesburg 2192, South Africa
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa
| | - Anthony M. Smith
- Centre for Enteric Diseases, National Institute for Communicable Diseases (NICD), a Division of the National Health Laboratory Service (NHLS), Johannesburg 2192, South Africa;
- Department of Medical Microbiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0084, South Africa
| | - Eric M. C. Etter
- Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria 0110, South Africa
- CIRAD, UMR Animal, Santé, Territoires, Risque et Ecosystèmes (ASTRE), 97170 Petit-Bourg, France
- ASTRE, University of Montpellier, CIRAD, INRAE, 34398 Montpellier, France
| | - Olga Perovic
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases (NICD), a Division of the National Health Laboratory Service (NHLS), Johannesburg 2192, South Africa
- Department of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa
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Sarker S, Neeloy RM, Habib MB, Urmi UL, Al Asad M, Mosaddek ASM, Khan MRK, Nahar S, Godman B, Islam S. Mobile Colistin-Resistant Genes mcr-1, mcr-2, and mcr-3 Identified in Diarrheal Pathogens among Infants, Children, and Adults in Bangladesh: Implications for the Future. Antibiotics (Basel) 2024; 13:534. [PMID: 38927200 PMCID: PMC11200974 DOI: 10.3390/antibiotics13060534] [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: 03/26/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Colistin is a last-resort antimicrobial for treating multidrug-resistant Gram-negative bacteria. Phenotypic colistin resistance is highly associated with plasmid-mediated mobile colistin resistance (mcr) genes. mcr-bearing Enterobacteriaceae have been detected in many countries, with the emergence of colistin-resistant pathogens a global concern. This study assessed the distribution of mcr-1, mcr-2, mcr-3, mcr-4, and mcr-5 genes with phenotypic colistin resistance in isolates from diarrheal infants and children in Bangladesh. Bacteria were identified using the API-20E biochemical panel and 16s rDNA gene sequencing. Polymerase chain reactions detected mcr gene variants in the isolates. Their susceptibilities to colistin were determined by agar dilution and E-test by minimal inhibitory concentration (MIC) measurements. Over 31.6% (71/225) of isolates showed colistin resistance according to agar dilution assessment (MIC > 2 μg/mL). Overall, 15.5% of isolates carried mcr genes (7, mcr-1; 17, mcr-2; 13, and mcr-3, with co-occurrence occurring in two isolates). Clinical breakout MIC values (≥4 μg/mL) were associated with 91.3% of mcr-positive isolates. The mcr-positive pathogens included twenty Escherichia spp., five Shigella flexneri, five Citrobacter spp., two Klebsiella pneumoniae, and three Pseudomonas parafulva. The mcr-genes appeared to be significantly associated with phenotypic colistin resistance phenomena (p = 0.000), with 100% colistin-resistant isolates showing MDR phenomena. The age and sex of patients showed no significant association with detected mcr variants. Overall, mcr-associated colistin-resistant bacteria have emerged in Bangladesh, which warrants further research to determine their spread and instigate activities to reduce resistance.
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Affiliation(s)
- Shafiuzzaman Sarker
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (S.S.); (R.M.N.); (M.B.H.); (U.L.U.); (M.A.A.); (S.N.)
| | - Reeashat Muhit Neeloy
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (S.S.); (R.M.N.); (M.B.H.); (U.L.U.); (M.A.A.); (S.N.)
| | - Marnusa Binte Habib
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (S.S.); (R.M.N.); (M.B.H.); (U.L.U.); (M.A.A.); (S.N.)
| | - Umme Laila Urmi
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (S.S.); (R.M.N.); (M.B.H.); (U.L.U.); (M.A.A.); (S.N.)
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Mamun Al Asad
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (S.S.); (R.M.N.); (M.B.H.); (U.L.U.); (M.A.A.); (S.N.)
| | | | | | - Shamsun Nahar
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (S.S.); (R.M.N.); (M.B.H.); (U.L.U.); (M.A.A.); (S.N.)
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK;
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh; (S.S.); (R.M.N.); (M.B.H.); (U.L.U.); (M.A.A.); (S.N.)
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW 2052, Australia
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Lencina FA, Bertona M, Stegmayer MA, Olivero CR, Frizzo LS, Zimmermann JA, Signorini ML, Soto LP, Zbrun MV. Prevalence of colistin-resistant Escherichia coli in foods and food-producing animals through the food chain: A worldwide systematic review and meta-analysis. Heliyon 2024; 10:e26579. [PMID: 38434325 PMCID: PMC10904249 DOI: 10.1016/j.heliyon.2024.e26579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/31/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
The purpose of this systematic review and meta-analysis was to summarize the available scientific evidence on the prevalence of colistin-resistant Escherichia coli strains isolated from foods and food-producing animals, the mobile colistin-resistant genes involved, and the impact of the associated variables. A systematic review was carried out in databases according to selection criteria and search strategies established a priori. Random-effect meta-analysis models were fitted to estimate the prevalence of colistin-resistant Escherichia coli and to identify the factors associated with the outcome. In general, 4.79% (95% CI: 3.98%-5.76%) of the food and food-producing animal samples harbored colistin-resistant Escherichia coli (total number of colistin-resistant Escherichia coli/total number of samples), while 5.70% (95% confidence interval: 4.97%-6.52%) of the E. coli strains isolated from food and food-producing animal samples harbored colistin resistance (total number of colistin-resistant Escherichia coli/total number of Escherichia coli isolated samples). The prevalence of colistin-resistant Escherichia coli increased over time (P < 0.001). On the other hand, 65.30% (95% confidence interval: 57.77%-72.14%) of colistin resistance was mediated by the mobile colistin resistance-1 gene. The mobile colistin resistance-1 gene prevalence did not show increases over time (P = 0.640). According to the findings, other allelic variants (mobile colistin resistance 2-10 genes) seem to have less impact on prevalence. A higher prevalence of colistin resistance was estimated in developing countries (P < 0.001), especially in samples (feces and intestinal content, meat, and viscera) derived from poultry and pigs (P < 0.001). The mobile colistin resistance-1 gene showed a global distribution with a high prevalence in most of the regions analyzed (>50%). The prevalence of colistin-resistant Escherichia coli and the mobile colistin resistance-1 gene has a strong impact on the entire food chain. The high prevalence estimated in the retail market represents a potential risk for consumers' health. There is an urgent need to implement based-evidence risk management measures under the "One Health" approach to guarantee public health, food safety, and a sustainable future.
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Affiliation(s)
- Florencia Aylen Lencina
- Laboratory of Food Analysis, Institute of Veterinary Science (ICiVet Litoral), National University of the Litoral, National Council of Scientific and Technical Research (UNL/CONICET), Esperanza, Argentina
| | - Matías Bertona
- Department of Public Health, Faculty of Veterinary Science – Litoral National University, Esperanza, Argentina
| | - María Angeles Stegmayer
- Laboratory of Food Analysis, Institute of Veterinary Science (ICiVet Litoral), National University of the Litoral, National Council of Scientific and Technical Research (UNL/CONICET), Esperanza, Argentina
| | - Carolina Raquel Olivero
- Laboratory of Food Analysis, Institute of Veterinary Science (ICiVet Litoral), National University of the Litoral, National Council of Scientific and Technical Research (UNL/CONICET), Esperanza, Argentina
| | - Laureano Sebastián Frizzo
- Laboratory of Food Analysis, Institute of Veterinary Science (ICiVet Litoral), National University of the Litoral, National Council of Scientific and Technical Research (UNL/CONICET), Esperanza, Argentina
- Department of Public Health, Faculty of Veterinary Science – Litoral National University, Esperanza, Argentina
| | - Jorge Alberto Zimmermann
- Laboratory of Food Analysis, Institute of Veterinary Science (ICiVet Litoral), National University of the Litoral, National Council of Scientific and Technical Research (UNL/CONICET), Esperanza, Argentina
| | - Marcelo Lisandro Signorini
- Department of Public Health, Faculty of Veterinary Science – Litoral National University, Esperanza, Argentina
- Instituto de Investigación de la Cadena Láctea (INTA-CONICET), Estación Experimental Agropecuaria Rafaela, Ruta 34 Km 227, Rafaela, Santa Fe, Argentina
| | - Lorena Paola Soto
- Laboratory of Food Analysis, Institute of Veterinary Science (ICiVet Litoral), National University of the Litoral, National Council of Scientific and Technical Research (UNL/CONICET), Esperanza, Argentina
- Department of Public Health, Faculty of Veterinary Science – Litoral National University, Esperanza, Argentina
| | - María Virginia Zbrun
- Department of Public Health, Faculty of Veterinary Science – Litoral National University, Esperanza, Argentina
- Instituto de Investigación de la Cadena Láctea (INTA-CONICET), Estación Experimental Agropecuaria Rafaela, Ruta 34 Km 227, Rafaela, Santa Fe, Argentina
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Hassan IZ, Qekwana DN, Naidoo V. Prevalence of colistin resistance and antibacterial resistance in commensal Escherichia coli from chickens: An assessment of the impact of regulatory intervention in South Africa. Vet Med Sci 2024; 10:e1315. [PMID: 37929776 PMCID: PMC10766030 DOI: 10.1002/vms3.1315] [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: 07/22/2023] [Revised: 10/07/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a global health problem largely due to the overuse of antimicrobials. In recognition of this, the World Health Assembly in 2015 agreed on a global action plan to tackle AMR. Following the global emergence of the mcr-1-associated colistin resistance gene in the livestock industry in 2016, several countries including South Africa restricted the veterinary use of colistin as the gene threatens the clinical utility of the drug. This study is a follow-up to the restriction in place in order to evaluate the impact of such policy adoption. OBJECTIVE To assess the prevalence of antibacterial resistance (ABR), and the mcr-1 colistin resistance gene in broiler chicken over a 2-year period, as a follow-up to the veterinary ban on colistin use in South Africa. METHODS A total of 520 swab samples were obtained during 2019 (March-April) and 2020 (February-March), from healthy broiler chicken carcasses (n = 20) and chicken droppings in transport crates (n = 20) at various poultry abattoirs (N = 7) in the Gauteng province of South Africa. Escherichia coli organisms were isolated and subjected to a panel of 24 antibacterials using the MicroScan machine. Screening for mcr-1 colistin resistance gene was undertaken using PCR. RESULT Four hundred and thirty-eight (438) E. coli strains were recovered and none demonstrated phenotypic resistance towards colistin, amikacin, carbapenems, tigecycline and piperacillin/tazobactam. The mcr-1 gene was not detected in any of the isolates tested. Resistances to the aminoglycosides (0%-9.8%) and fluoroquinolones (0%-18.9%) were generally low. Resistances to ampicillin (32%-39.3%) and trimethoprim/sulphamethoxazole (30.6%-3.6%) were fairly high. A significant (p < 0.05) increase in cephalosporins and cephamycin resistance was noted in the year 2020 (February-March) when compared with the year 2019 (March-April). CONCLUSION The absence of mcr-1 gene and colistin resistance suggests that mitigation strategies adopted were effective and clearly demonstrated the significance of regulatory interventions in reducing resistance to critical drugs. Despite the drawback in regulatory framework such as free farmers access to antimicrobials OTC and a dual registration system in place, there is a general decline in the prevalence of ABR when the present data are compared with the last national veterinary surveillance on AMR (SANVAD 2007). To further drive resistance down, mitigation strategies should focus on strengthening regulatory framework, the withdrawal of OTC dispensing of antimicrobials, capping volumes of antimicrobials, banning growth promoters and investing on routine surveillance/monitoring of AMR and antimicrobial consumption.
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Affiliation(s)
- Ibrahim Z. Hassan
- Department of Paraclinical SciencesFaculty of Veterinary ScienceUniversity of PretoriaPretoriaSouth Africa
- Present address:
DSI/NWU Preclinical Drug Development PlatformNorth‐West UniversityPotchefstroomSouth Africa
| | - Daniel N. Qekwana
- Department of Paraclinical SciencesFaculty of Veterinary ScienceUniversity of PretoriaPretoriaSouth Africa
| | - Vinny Naidoo
- Department of Paraclinical SciencesFaculty of Veterinary ScienceUniversity of PretoriaPretoriaSouth Africa
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Chibabhai V, Bekker A, Black M, Demopoulos D, Dramowski A, du Plessis NM, Lorente VPF, Nana T, Rabie H, Reubenson G, Thomas R. Appropriate use of colistin in neonates, infants and children: Interim guidance. S Afr J Infect Dis 2023; 38:555. [PMID: 38223435 PMCID: PMC10784269 DOI: 10.4102/sajid.v38i1.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/24/2023] [Indexed: 01/16/2024] Open
Affiliation(s)
- Vindana Chibabhai
- Division of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Microbiology, National Health Laboratory Service, Johannesburg, South Africa
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marianne Black
- Division of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Microbiology, Lancet Laboratories, Johannesburg, South Africa
| | - Despina Demopoulos
- Department of Paediatrics, Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nicolette M. du Plessis
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Veshni Pillay-Fuentes Lorente
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Trusha Nana
- Division of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Microbiology, Lancet Laboratories, Johannesburg, South Africa
| | - Helena Rabie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gary Reubenson
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Reenu Thomas
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics and Child Health, Christ Hani Baragwanath Academic Hospital, Johannesburg, South Africa
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Chigome A, Ramdas N, Skosana P, Cook A, Schellack N, Campbell S, Lorenzetti G, Saleem Z, Godman B, Meyer JC. A Narrative Review of Antibiotic Prescribing Practices in Primary Care Settings in South Africa and Potential Ways Forward to Reduce Antimicrobial Resistance. Antibiotics (Basel) 2023; 12:1540. [PMID: 37887241 PMCID: PMC10604704 DOI: 10.3390/antibiotics12101540] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
There are concerns with the current prescribing of antibiotics in both the private and public primary care settings in South Africa. These concerns need to be addressed going forward to reduce rising antimicrobial resistance (AMR) rates in South Africa. Concerns include adherence to current prescribing guidelines. Consequently, there is a need to comprehensively summarise current antibiotic utilization patterns from published studies as well as potential activities to improve prescribing, including indicators and antimicrobial stewardship programs (ASPs). Published studies showed that there was an appreciable prescribing of antibiotics for patients with acute respiratory infections, i.e., 52.9% to 78% or more across the sectors. However, this was not universal, with appreciable adherence to prescribing guidelines in community health centres. Encouragingly, the majority of antibiotics prescribed, albeit often inappropriately, were from the 'Access' group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than 'Watch' antibiotics to limit AMR. Inappropriate prescribing of antibiotics in primary care is not helped by concerns with current knowledge regarding antibiotics, AMR and ASPs among prescribers and patients in primary care. This needs to be addressed going forward. However, studies have shown it is crucial for prescribers to use a language that patients understand when discussing key aspects to enhance appropriate antibiotic use. Recommended activities for the future include improved education for all groups as well as regularly monitoring prescribing against agreed-upon guidelines and indicators.
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Affiliation(s)
- Audrey Chigome
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
| | - Nishana Ramdas
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
| | - Phumzile Skosana
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa;
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.)
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria 0084, South Africa;
| | - Stephen Campbell
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.)
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan;
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; (N.R.); (S.C.); (J.C.M.)
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Pretoria 0208, South Africa
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Hassan IZ, Qekwana DN, Naidoo V. Do Pathogenic Escherichia coli Isolated from Gallus gallus in South Africa Carry Co-Resistance Toward Colistin and Carbapenem Antimicrobials? Foodborne Pathog Dis 2023; 20:388-397. [PMID: 37471208 DOI: 10.1089/fpd.2023.0047] [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] [Indexed: 07/22/2023] Open
Abstract
Colistin and carbapenems are critically important antimicrobials often used as a last resort to manage multidrug-resistant bacterial infections in humans. With limited alternatives, resistance to these antimicrobials is of concern as organisms could potentially spread horizontally rendering treatments ineffective. The aim of this study was to investigate co-resistance to colistin and carbapenems among Escherichia coli isolated from poultry in South Africa. Forty-six E. coli strains obtained from clinical cases of breeder and broiler chickens were used. In addition to other antibiotics, all the isolates were tested against colistin and carbapenems using broth microdilution. Multiplex polymerase chain reactions were used to investigate the presence of colistin (mcr-1 to 5) and carbapenem (blaOXA-48, blaNDM-1, and blaVIM) resistance genes. Isolates exhibiting colistin resistance (>2 μg/mL) underwent a whole-genome sequencing analysis. Resistance to colistin (10.9%) and cefepime (6.5%) was noted with all colistin-resistant strains harboring the mcr-1 gene. None of the E. coli isolates were resistant to carbapenems nor carried the other resistant genes (mcr-2 to 5, blaOXA-48, blaNDM-1, and blaVIM). The mcr-1-positive strains belonged to sequence types ST117 and ST156 and carried virulence genes ompA, aslA, fdeC, fimH, iroN, iutA, tsh, pic, ast A and set 1A/1B. In conclusion, clinical E. coli strains from chickens in this study possessed mobile resistance genes for colistin and several other clinically relevant antimicrobials but not carbapenems. Additionally, they belonged to sequence types in addition to carrying virulence factors often associated with human extraintestinal pathogenic E. coli infections. Thus, the potential risk of transmitting these strains to humans cannot be underestimated especially if sick birds are dispatched into the thriving poorly regulated Cornish hen industry. The need for routine veterinary surveillance and monitoring of antimicrobial resistance, antimicrobial use and the importance of strengthening regulations guiding the informal poultry sector remains important.
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Affiliation(s)
- Ibrahim Zubairu Hassan
- Department of Paraclinical Sciences, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
| | - Daniel N Qekwana
- Department of Paraclinical Sciences, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
| | - Vinny Naidoo
- Department of Paraclinical Sciences, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
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Zhao H, Zhong LL, Yang C, Tang N, He Y, He W, Zhao Z, Wu C, Yuan P, Yang YY, Tian GB, Ding X. Antibiotic-Polymer Self-Assembled Nanocomplex to Reverse Phenotypic Resistance of Bacteria toward Last-Resort Antibiotic Colistin. ACS NANO 2023; 17:15411-15423. [PMID: 37534992 DOI: 10.1021/acsnano.3c00981] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Colistin is the last-resort antibiotic to treat multidrug-resistant (MDR) Gram-negative bacterial infections that are untreatable by other clinically available antibiotics. However, the recently merged plasmid-borne gene mobilized colistin resistance (mcr) leads to modification of the colistin target (i.e., bacterial membrane), greatly compromising the therapy outcome of colistin. To address this unmet clinical need, a nanocomplex (CMS-pEt_20 NP) of anionic prodrug colistin methanesulfonate (CMS) and guanidinium-functionalized cationic polymer pEt_20 is developed through facile self-assembly for co-delivering an antibiotic and antimicrobial polymer with membrane affinity to reverse colistin resistance. The CMS-pEt_20 NP formation enables reversal of colistin resistance and complete killing of clinically isolated mcr-positive colistin-resistant bacteria including MDR E. coli and K. pneumoniae, while monotreatment of polymer or antibiotic at equivalent doses exhibits no antibacterial activity. Mechanistic studies reveal that the CMS-pEt_20 NP enhanced the affinity of delivered CMS to the modified membrane of colistin-resistant bacteria, reviving the membrane lytic property of colistin. The increased membrane permeability caused by colistin in turn promotes an influx of pEt_20 to generate intracellular ROS stress, resulting in elimination of colistin-resistant bacteria. More importantly, a colistin-resistant mouse peritonitis-sepsis infection model demonstrates the excellent therapeutic efficacy of CMS-pEt_20 NP with 100% survival of the infected mouse. In addition, the nanocomplex is proven not toxic both in vitro and in vivo. Taken together, the self-assembled antibiotic-polymer nanocomplex with two complementary antibacterial mechanisms successfully reverses the colistin resistance phenotype in bacteria, and it can be a potential strategy to treat untreatable colistin-resistant MDR bacterial infections.
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Affiliation(s)
- Huimin Zhao
- School of Pharmaceutical Sciences (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
| | - Lan-Lan Zhong
- Department of Immunology and Microbiology, Advanced Medical Technology Center, The First Affiliated Hospital, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory of Tropical Diseases Control (Sun Yat-sen University), Ministry of Education, Guangzhou 510080, China
| | - Chuan Yang
- Bioprocessing Technology Institute, Agency for Science, Technology and Research (A*STAR), 20 Biopolis Way, Centros #06-01, Singapore 138669, Singapore
| | - Ning Tang
- School of Pharmaceutical Sciences (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
| | - Yanwei He
- School of Pharmaceutical Sciences (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
| | - Wan He
- Chengdu Medical College, Chengdu 610000, China
| | - Zihan Zhao
- Department of Immunology and Microbiology, Advanced Medical Technology Center, The First Affiliated Hospital, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory of Tropical Diseases Control (Sun Yat-sen University), Ministry of Education, Guangzhou 510080, China
| | - Changbu Wu
- Department of Immunology and Microbiology, Advanced Medical Technology Center, The First Affiliated Hospital, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory of Tropical Diseases Control (Sun Yat-sen University), Ministry of Education, Guangzhou 510080, China
| | - Peiyan Yuan
- School of Pharmaceutical Sciences (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
| | - Yi Yan Yang
- Bioprocessing Technology Institute, Agency for Science, Technology and Research (A*STAR), 20 Biopolis Way, Centros #06-01, Singapore 138669, Singapore
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119288, Singapore
| | - Guo-Bao Tian
- Department of Immunology and Microbiology, Advanced Medical Technology Center, The First Affiliated Hospital, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory of Tropical Diseases Control (Sun Yat-sen University), Ministry of Education, Guangzhou 510080, China
- Department of Immunology, School of Medicine, Sun Yat-Sen University, Shenzhen 518107, China
| | - Xin Ding
- School of Pharmaceutical Sciences (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China
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9
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Anyanwu MU, Jaja IF, Okpala COR, Njoga EO, Okafor NA, Oguttu JW. Mobile Colistin Resistance ( mcr) Gene-Containing Organisms in Poultry Sector in Low- and Middle-Income Countries: Epidemiology, Characteristics, and One Health Control Strategies. Antibiotics (Basel) 2023; 12:1117. [PMID: 37508213 PMCID: PMC10376608 DOI: 10.3390/antibiotics12071117] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/30/2023] Open
Abstract
Mobile colistin resistance (mcr) genes (mcr-1 to mcr-10) are plasmid-encoded genes that threaten the clinical utility of colistin (COL), one of the highest-priority critically important antibiotics (HP-CIAs) used to treat infections caused by multidrug-resistant and extensively drug-resistant bacteria in humans and animals. For more than six decades, COL has been used largely unregulated in the poultry sector in low- and middle-income countries (LMICs), and this has led to the development/spread of mcr gene-containing bacteria (MGCB). The prevalence rates of mcr-positive organisms from the poultry sector in LMICs between January 1970 and May 2023 range between 0.51% and 58.8%. Through horizontal gene transfer, conjugative plasmids possessing insertion sequences (ISs) (especially ISApl1), transposons (predominantly Tn6330), and integrons have enhanced the spread of mcr-1, mcr-2, mcr-3, mcr-4, mcr-5, mcr-7, mcr-8, mcr-9, and mcr-10 in the poultry sector in LMICs. These genes are harboured by Escherichia, Klebsiella, Proteus, Salmonella, Cronobacter, Citrobacter, Enterobacter, Shigella, Providencia, Aeromonas, Raoultella, Pseudomonas, and Acinetobacter species, belonging to diverse clones. The mcr-1, mcr-3, and mcr-10 genes have also been integrated into the chromosomes of these bacteria and are mobilizable by ISs and integrative conjugative elements. These bacteria often coexpress mcr with virulence genes and other genes conferring resistance to HP-CIAs, such as extended-spectrum cephalosporins, carbapenems, fosfomycin, fluoroquinolone, and tigecycline. The transmission routes and dynamics of MGCB from the poultry sector in LMICs within the One Health triad include contact with poultry birds, feed/drinking water, manure, poultry farmers and their farm workwear, farming equipment, the consumption and sale of contaminated poultry meat/egg and associated products, etc. The use of pre/probiotics and other non-antimicrobial alternatives in the raising of birds, the judicious use of non-critically important antibiotics for therapy, the banning of nontherapeutic COL use, improved vaccination, biosecurity, hand hygiene and sanitization, the development of rapid diagnostic test kits, and the intensified surveillance of mcr genes, among others, could effectively control the spread of MGCB from the poultry sector in LMICs.
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Affiliation(s)
| | - Ishmael Festus Jaja
- Department of Livestock and Pasture Science, University of Fort Hare, Alice 5700, South Africa
| | - Charles Odilichukwu R Okpala
- Department of Functional Food Products Development, Faculty of Biotechnology and Food Science, Wrocław University of Environmental and Life Sciences, 50-375 Wrocław, Poland
- UGA Cooperative Extension, College of Agricultural and Environmental Sciences, University of Georgia, Athens, GA 30602, USA
| | - Emmanuel Okechukwu Njoga
- Department of Veterinary Public Health and Preventive Medicine, University of Nigeria, Nsukka 400001, Nigeria
| | | | - James Wabwire Oguttu
- Department of Agriculture and Animal Health, Florida Campus, University of South Africa, Johannesburg 1709, South Africa
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10
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Seethalakshmi PS, Rajeev R, Prabhakaran A, Kiran GS, Selvin J. The menace of colistin resistance across globe: Obstacles and opportunities in curbing its spread. Microbiol Res 2023; 270:127316. [PMID: 36812837 DOI: 10.1016/j.micres.2023.127316] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 11/27/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
Colistin-resistance in bacteria is a big concern for public health, since it is a last resort antibiotic to treat infectious diseases of multidrug resistant and carbapenem resistant Gram-negative pathogens in clinical settings. The emergence of colistin resistance in aquaculture and poultry settings has escalated the risks associated with colistin resistance in environment as well. The staggering number of reports pertaining to the rise of colistin resistance in bacteria from clinical and non-clinical settings is disconcerting. The co-existence of colistin resistant genes with other antibiotic resistant genes introduces new challenges in combatting antimicrobial resistance. Some countries have banned the manufacture, sale and distribution of colistin and its formulations for food producing animals. However, to tackle the issue of antimicrobial resistance, a one health approach initiative, inclusive of human, animal, and environmental health needs to be developed. Herein, we review the recent reports in colistin resistance in bacteria of clinical and non-clinical settings, deliberating on the new findings obtained regarding the development of colistin resistance. This review also discusses the initiatives implemented globally in mitigating colistin resistance, their strength and weakness.
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Affiliation(s)
- P S Seethalakshmi
- Department of Microbiology, Pondicherry University, Puducherry 605014, India.
| | - Riya Rajeev
- Department of Microbiology, Pondicherry University, Puducherry 605014, India.
| | | | - George Seghal Kiran
- Department of Food Science and Technology, Pondicherry University, Puducherry 605014, India.
| | - Joseph Selvin
- Department of Microbiology, Pondicherry University, Puducherry 605014, India.
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11
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Venne DM, Hartley DM, Malchione MD, Koch M, Britto AY, Goodman JL. Review and analysis of the overlapping threats of carbapenem and polymyxin resistant E. coli and Klebsiella in Africa. Antimicrob Resist Infect Control 2023; 12:29. [PMID: 37013626 PMCID: PMC10071777 DOI: 10.1186/s13756-023-01220-4] [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] [Received: 11/10/2022] [Accepted: 02/18/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Carbapenem-resistant Enterobacterales are among the most serious antimicrobial resistance (AMR) threats. Emerging resistance to polymyxins raises the specter of untreatable infections. These resistant organisms have spread globally but, as indicated in WHO reports, the surveillance needed to identify and track them is insufficient, particularly in less resourced countries. This study employs comprehensive search strategies with data extraction, meta-analysis and mapping to help address gaps in the understanding of the risks of carbapenem and polymyxin resistance in the nations of Africa. METHODS Three comprehensive Boolean searches were constructed and utilized to query scientific and medical databases as well as grey literature sources through the end of 2019. Search results were screened to exclude irrelevant results and remaining studies were examined for relevant information regarding carbapenem and/or polymyxin(s) susceptibility and/or resistance amongst E. coli and Klebsiella isolates from humans. Such data and study characteristics were extracted and coded, and the resulting data was analyzed and geographically mapped. RESULTS Our analysis yielded 1341 reports documenting carbapenem resistance in 40 of 54 nations. Resistance among E. coli was estimated as high (> 5%) in 3, moderate (1-5%) in 8 and low (< 1%) in 14 nations with at least 100 representative isolates from 2010 to 2019, while present in 9 others with insufficient isolates to support estimates. Carbapenem resistance was generally higher among Klebsiella: high in 10 nations, moderate in 6, low in 6, and present in 11 with insufficient isolates for estimates. While much less information was available concerning polymyxins, we found 341 reports from 33 of 54 nations, documenting resistance in 23. Resistance among E. coli was high in 2 nations, moderate in 1 and low in 6, while present in 10 with insufficient isolates for estimates. Among Klebsiella, resistance was low in 8 nations and present in 8 with insufficient isolates for estimates. The most widespread associated genotypes were, for carbapenems, blaOXA-48, blaNDM-1 and blaOXA-181 and, for polymyxins, mcr-1, mgrB, and phoPQ/pmrAB. Overlapping carbapenem and polymyxin resistance was documented in 23 nations. CONCLUSIONS While numerous data gaps remain, these data show that significant carbapenem resistance is widespread in Africa and polymyxin resistance is also widely distributed, indicating the need to support robust AMR surveillance, antimicrobial stewardship and infection control in a manner that also addresses broader animal and environmental health dimensions.
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Affiliation(s)
- Danielle M Venne
- Center on Medical Product Access, Safety and Stewardship, Georgetown University, 3900 Reservoir Road, Washington, DC, 20057, USA
| | - David M Hartley
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, 45229, USA
| | - Marissa D Malchione
- Center on Medical Product Access, Safety and Stewardship, Georgetown University, 3900 Reservoir Road, Washington, DC, 20057, USA
- Sabin Vaccine Institute, Influenza Vaccine Innovation, 2175 K St NW, Washington, DC, 20037, USA
| | - Michala Koch
- Center on Medical Product Access, Safety and Stewardship, Georgetown University, 3900 Reservoir Road, Washington, DC, 20057, USA
| | - Anjali Y Britto
- Center on Medical Product Access, Safety and Stewardship, Georgetown University, 3900 Reservoir Road, Washington, DC, 20057, USA
| | - Jesse L Goodman
- Center on Medical Product Access, Safety and Stewardship, Georgetown University, 3900 Reservoir Road, Washington, DC, 20057, USA.
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12
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Guarneri F, Bertasio C, Romeo C, Formenti N, Scali F, Parisio G, Canziani S, Boifava C, Guadagno F, Boniotti MB, Alborali GL. First Detection of mcr-9 in a Multidrug-Resistant Escherichia coli of Animal Origin in Italy Is Not Related to Colistin Usage on a Pig Farm. Antibiotics (Basel) 2023; 12:antibiotics12040689. [PMID: 37107051 PMCID: PMC10134971 DOI: 10.3390/antibiotics12040689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
The emergence of colistin resistance raises growing concerns because of its use as a last-resort antimicrobial for the treatment of severe gram-negative bacterial infections in humans. Plasmid-borne mobile colistin resistance genes (mcr) are particularly worrisome due to their high propensity to spread. An mcr-9-positive Escherichia coli was isolated from a piglet in Italy, representing the first isolation of this gene from an E. coli of animal origin in the country. Whole genome sequencing (WGS) revealed that mcr-9 was borne by an IncHI2 plasmid carrying several other resistance genes. The strain was indeed phenotypically resistant to six different antimicrobial classes, including 3rd and 4th generation cephalosporins. Despite the presence of mcr-9, the isolate was susceptible to colistin, probably because of a genetic background unfavourable to mcr-9 expression. The lack of colistin resistance, coupled with the fact that the farm of origin had not used colistin in years, suggests that mcr-9 in such a multidrug-resistant strain can be maintained thanks to the co-selection of neighbouring resistance genes, following usage of different antimicrobials. Our findings highlight how a comprehensive approach, integrating phenotypical testing, targeted PCR, WGS-based techniques, and information on antimicrobial usage is crucial to shed light on antimicrobial resistance.
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Affiliation(s)
- Flavia Guarneri
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna—IZSLER, v. Bianchi 9, 25124 Brescia, Italy
| | - Cristina Bertasio
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna—IZSLER, v. Bianchi 9, 25124 Brescia, Italy
| | - Claudia Romeo
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna—IZSLER, v. Bianchi 9, 25124 Brescia, Italy
| | - Nicoletta Formenti
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna—IZSLER, v. Bianchi 9, 25124 Brescia, Italy
| | - Federico Scali
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna—IZSLER, v. Bianchi 9, 25124 Brescia, Italy
| | - Giovanni Parisio
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna—IZSLER, v. Bianchi 9, 25124 Brescia, Italy
| | - Sabrina Canziani
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna—IZSLER, v. Bianchi 9, 25124 Brescia, Italy
| | - Chiara Boifava
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna—IZSLER, v. Bianchi 9, 25124 Brescia, Italy
| | - Federica Guadagno
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna—IZSLER, v. Bianchi 9, 25124 Brescia, Italy
| | - Maria Beatrice Boniotti
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna—IZSLER, v. Bianchi 9, 25124 Brescia, Italy
| | - Giovanni Loris Alborali
- Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna—IZSLER, v. Bianchi 9, 25124 Brescia, Italy
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13
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Rhouma M, Madec JY, Laxminarayan R. Colistin: from the shadows to a One Health approach for addressing antimicrobial resistance. Int J Antimicrob Agents 2023; 61:106713. [PMID: 36640846 DOI: 10.1016/j.ijantimicag.2023.106713] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/26/2022] [Accepted: 12/31/2022] [Indexed: 01/13/2023]
Abstract
Antimicrobial resistance (AMR) poses a serious threat to human, animal and environmental health worldwide. Colistin has regained importance as a last-resort treatment against multi-drug-resistant Gram-negative bacteria. However, colistin resistance has been reported in various Enterobacteriaceae species isolated from several sources. The 2015 discovery of the plasmid-mediated mcr-1 (mobile colistin resistance) gene conferring resistance to colistin was a major concern within the scientific community worldwide. The global spread of this plasmid - as well as the subsequent identification of 10 MCR-family genes and their variants that catalyse the addition of phosphoethanolamine to the phosphate group of lipid A - underscores the urgent need to regulate the use of colistin, particularly in animal production. This review traces the history of colistin resistance and mcr-like gene identification, and examines the impact of policy changes regarding the use of colistin on the prevalence of mcr-1-positive Escherichia coli and colistin-resistant E. coli from a One Health perspective. The withdrawal of colistin as a livestock growth promoter in several countries reduced the prevalence of colistin-resistant bacteria and its resistance determinants (e.g. mcr-1 gene) in farm animals, humans and the environment. This reduction was certainly favoured by the significant fitness cost associated with acquisition and expression of the mcr-1 gene in enterobacterial species. The success of this One Health intervention could be used to accelerate regulation of other important antimicrobials, especially those associated with bacterial resistance mechanisms linked to high fitness cost. The development of global collaborations and the implementation of sustainable solutions like the One Health approach are essential to manage AMR.
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Affiliation(s)
- Mohamed Rhouma
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Quebec, Canada; Groupe de Recherche et d'Enseignement en Salubrité Alimentaire, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Quebec, Canada; Swine and Poultry Infectious Diseases Research Center, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Quebec, Canada.
| | - Jean-Yves Madec
- Unité Antibiorésistance et Virulence Bactériennes - Agence Nationale de Sécurité Sanitaire, Université de Lyon, Lyon, France
| | - Ramanan Laxminarayan
- One Health Trust, Washington, DC 20005, Princeton University, Princeton NJ 08544, USA
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14
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Calero-Cáceres W, Rodríguez K, Medina A, Medina J, Ortuño-Gutiérrez N, Sunyoto T, Dias CAG, Bastidas-Caldes C, Ramírez MS, Harries AD. Genomic insights of mcr-1 harboring Escherichia coli by geographical region and a One-Health perspective. Front Microbiol 2023; 13:1032753. [PMID: 36726572 PMCID: PMC9884825 DOI: 10.3389/fmicb.2022.1032753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023] Open
Abstract
The importance of the One Health concept in attempting to deal with the increasing levels of multidrug-resistant bacteria in both human and animal health is a challenge for the scientific community, policymakers, and the industry. The discovery of the plasmid-borne mobile colistin resistance (mcr) in 2015 poses a significant threat because of the ability of these plasmids to move between different bacterial species through horizontal gene transfer. In light of these findings, the World Health Organization (WHO) recommends that countries implement surveillance strategies to detect the presence of plasmid-mediated colistin-resistant microorganisms and take suitable measures to control and prevent their dissemination. Seven years later, ten different variants of the mcr gene (mcr-1 to mcr-10) have been detected worldwide in bacteria isolated from humans, animals, foods, the environment, and farms. However, the possible transmission mechanisms of the mcr gene among isolates from different geographical origins and sources are largely unknown. This article presents an analysis of whole-genome sequences of Escherichia coli that harbor mcr-1 gene from different origins (human, animal, food, or environment) and geographical location, to identify specific patterns related to virulence genes, plasmid content and antibiotic resistance genes, as well as their phylogeny and their distribution with their origin. In general, E. coli isolates that harbor mcr-1 showed a wide plethora of ARGs. Regarding the plasmid content, the highest concentration of plasmids was found in animal samples. In turn, Asia was the continent that led with the largest diversity and occurrence of these plasmids. Finally, about virulence genes, terC, gad, and traT represent the most frequent virulence genes detected. These findings highlight the relevance of analyzing the environmental settings as an integrative part of the surveillance programs to understand the origins and dissemination of antimicrobial resistance.
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Affiliation(s)
- William Calero-Cáceres
- UTA RAM One Health, Department of Food and Biotechnology Science and Engineering, Universidad Técnica de Ambato, Ambato, Ecuador,Bacteriophage Research Association, Ambato, Ecuador,*Correspondence: William Calero-Cáceres,
| | | | - Anabell Medina
- UTA RAM One Health, Department of Food and Biotechnology Science and Engineering, Universidad Técnica de Ambato, Ambato, Ecuador
| | - Jennifer Medina
- UTA RAM One Health, Department of Food and Biotechnology Science and Engineering, Universidad Técnica de Ambato, Ambato, Ecuador
| | | | - Temmy Sunyoto
- MSFOCB Luxembourg Operational Research (LuxOR) Unit, Luxembourg, Luxembourg
| | - Cícero Armídio Gomes Dias
- Department of Basic Health Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Carlos Bastidas-Caldes
- One Health Research Group, Biotecnología, Facultad de Ingeniería y Ciencias Aplicadas (FICA), Universidad de las Américas (UDLA), Quito, Ecuador
| | - Maria Soledad Ramírez
- Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA, United States
| | - Anthony David Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France,London School of Hygiene and Tropical Medicine, London, United Kingdom
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15
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Saleem Z, Godman B, Cook A, Khan MA, Campbell SM, Seaton RA, Siachalinga L, Haseeb A, Amir A, Kurdi A, Mwita JC, Sefah IA, Opanga SA, Fadare JO, Ogunleye OO, Meyer JC, Massele A, Kibuule D, Kalungia AC, Shahwan M, Nabayiga H, Pichierri G, Moore CE. Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future. Antibiotics (Basel) 2022; 11:1824. [PMID: 36551481 PMCID: PMC9774141 DOI: 10.3390/antibiotics11121824] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
There are serious concerns with rising antimicrobial resistance (AMR) across countries increasing morbidity, mortality and costs. These concerns have resulted in a plethora of initiatives globally and nationally including national action plans (NAPs) to reduce AMR. Africa is no exception, especially with the highest rates of AMR globally. Key activities in NAPs include gaining a greater understanding of current antimicrobial utilization patterns through point prevalence surveys (PPS) and subsequently instigating antimicrobial stewardship programs (ASPs). Consequently, there is a need to comprehensively document current utilization patterns among hospitals across Africa coupled with ASP studies. In total, 33 PPS studies ranging from single up to 18 hospitals were documented from a narrative review with typically over 50% of in-patients prescribed antimicrobials, up to 97.6% in Nigeria. The penicillins, ceftriaxone and metronidazole, were the most prescribed antibiotics. Appreciable extended prescribing of antibiotics up to 6 days or more post-operatively was seen across Africa to prevent surgical site infections. At least 19 ASPs have been instigated across Africa in recent years to improve future prescribing utilizing a range of prescribing indicators. The various findings resulted in a range of suggested activities that key stakeholders, including governments and healthcare professionals, should undertake in the short, medium and long term to improve future antimicrobial prescribing and reduce AMR across Africa.
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Affiliation(s)
- Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | | | - Stephen M. Campbell
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Ronald Andrew Seaton
- Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK
| | - Linda Siachalinga
- College of Pharmacy, Yeungnam University, Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Afreenish Amir
- Department of Microbiology, Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi 46000, Pakistan
| | - Amanj Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil 44001, Iraq
- Center of Research and Strategic Studies, Lebanese French University, Erbil 44001, Iraq
| | - Julius C. Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Private Bag 0713 UB, Gaborone 00704, Botswana
| | - Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Hohoe PMB 31, Ghana
| | - Sylvia A. Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 19676-00202, Kenya
| | - Joseph O. Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado Ekiti 362103, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado Ekiti 360211, Nigeria
| | - Olayinka O. Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos 100271, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja 100271, Nigeria
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania
| | - Dan Kibuule
- Department of Pharmacology & Therapeutics, Busitema University, Mbale P.O. Box 236, Uganda
| | - Aubrey C. Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Moyad Shahwan
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman 346, United Arab Emirates
| | - Hellen Nabayiga
- Management Science Department, Strathclyde Business School, University of Strathclyde, 199 Cathedral Street, Glasgow G4 0QU, UK
| | - Giuseppe Pichierri
- Microbiology Department, Torbay and South Devon Foundation Trust, Lowes Bridge Torbay Hospital, Torquay TQ2 7AA, UK
| | - Catrin E. Moore
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK
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Brink AJ, Coetzee J, Richards GA, Feldman C, Lowman W, Tootla HD, Miller MGA, Niehaus AJ, Wasserman S, Perovic O, Govind CN, Schellack N, Mendelson M. Best practices: Appropriate use of the new β-lactam/β-lactamase inhibitor combinations, ceftazidime-avibactam and ceftolozane-tazobactam in South Africa. S Afr J Infect Dis 2022; 37:453. [PMID: 36338193 PMCID: PMC9634826 DOI: 10.4102/sajid.v37i1.453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/14/2022] [Indexed: 06/16/2023] Open
Abstract
Antibiotic stewardship of hospital-acquired infections because of difficult-to-treat resistant (DTR) Gram-negative bacteria is a global challenge. Their increasing prevalence in South Africa has required a shift in prescribing in recent years towards colistin, an antibiotic of last resort. High toxicity levels and developing resistance to colistin are narrowing treatment options further. Recently, two new β-lactam/β-lactamase inhibitor combinations, ceftazidime-avibactam and ceftolozane-tazobactam were registered in South Africa, bringing hope of new options for management of these life-threatening infections. However, with increased use in the private sector, increasing levels of resistance to ceftazidime-avibactam are already being witnessed, putting their long-term viability as treatment options of last resort, in jeopardy. This review focuses on how these two vital new antibiotics should be stewarded within a framework that recognises the resistance mechanisms currently predominant in South Africa's multi-drug and DTR Gram-negative bacteria. Moreover, the withholding of their use for resistant infections that can be treated with currently available antibiotics is a critical part of stewardship, if these antibiotics are to be conserved in the long term.
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Affiliation(s)
- Adrian J Brink
- Division of Medical Microbiology, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jennifer Coetzee
- Division of Microbiology, Ampath National Reference Laboratory, Centurion, South Africa
| | - Guy A Richards
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Warren Lowman
- Department of Clinical Microbiology, Pathcare/Vermaak Pathologists, Gauteng, South Africa, South Africa
- Department Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Clinical Microbiology and Infection Prevention and Control, Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Hafsah D Tootla
- Division of Medical Microbiology, National Health Laboratory Service, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Malcolm G A Miller
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Abraham J Niehaus
- Department of Medical Microbiology, Ampath Laboratory Services, Cape Town, South Africa
| | - Sean Wasserman
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Olga Perovic
- National Institute for Communicable Disease, National Health Laboratory Services, Johannesburg, South Africa
- School of Pathology, Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chetna N Govind
- Department of Medical Microbiology, Lancet Laboratories, KwaZulu-Natal, Durban, South Africa
- Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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17
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Acinetobacter baumannii complex, national laboratory-based surveillance in South Africa, 2017 to 2019. PLoS One 2022; 17:e0271355. [PMID: 35926057 PMCID: PMC9352035 DOI: 10.1371/journal.pone.0271355] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/28/2022] [Indexed: 11/19/2022] Open
Abstract
Objective We aimed to provide an analysis of A. baumannii complex (ABC) isolated from blood cultures in South Africa. Materials and methods ABC surveillance was conducted from 1 April 2017 to 30 September 2019 at 19 hospital sites from blood cultures of any age and sex. Organism identification was performed using the MALDI-TOF MS and antimicrobial susceptibility testing (AST), MicroScan Walkaway System. We confirmed colistin resistance with Sensititre, FRCOL panel, and selected for whole-genome sequencing. Results During the study period, we identified 4822 cases of ABC, of which 2152 cases were from 19 enhanced surveillance sites were reported during the enhanced surveillance period (1 August 2018 to 30 September 2019). Males accounted for 54% (2611/4822). Of the cases with known age, 41% (1968/4822) were infants (< 1-year-old). Seventy-eight percent (1688/2152) of cases had a known hospital outcome, of which 36% (602/1688) died. HIV status was known for 69% (1168/1688) of cases, and 14% (238/1688) were positive. Eighty-two percent (1389/1688) received antimicrobial treatment in admission. Three percent (35/1389) of cases received single colistin. Four percent (75/2033) were resistant to colistin. At least 75% of the isolates (1530/2033) can be classified as extensively drug-resistant (XDR), with resistance to most antibiotics except for colistin. The majority, 83% (20/24), of the colistin-resistant isolates were of the sequence type (ST) 1. Resistance genes, both plasmid- and chromosomal- mediated were not observed. Although all isolates had, nine efflux pump genes related to antimicrobial resistance. Conclusion Our surveillance data contributed to a better understanding of the natural course of A. baumannii disease, the patient characteristics among infants, and the level of resistance. At least two-thirds of the isolates were extensively drug-resistant, and four percent of isolates were resistant to colistin.
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Gwebu PC, Meyer JC, Schellack N, Matsebula-Myeni ZC, Godman B. A web-based point prevalence survey of antimicrobial use and quality indicators at Raleigh Fitkin Memorial Hospital in the Kingdom of Eswatini and the implications. Hosp Pract (1995) 2022; 50:214-221. [PMID: 35450508 DOI: 10.1080/21548331.2022.2069247] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Currently there is limited knowledge regarding antimicrobial utilization patterns among public hospitals in Eswatini. This is a concern given rising resistance rates among African countries. This study aimed to address this by determining antimicrobial utilization patterns using a point prevalence survey (PPS) methodology at Raleigh Fitkin Memorial (RFM) Hospital. The findings would be used to identify potential interventions to improve future antimicrobial utilization. METHOD A PPS was conducted using a web-based application (App). Antimicrobials were categorized according to the World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) classification. Each ward in the hospital was surveyed in one day using patient files. All patients in the ward, admitted by 08h30 on the day of the survey, were included. Ethical clearance was granted by the university and at country level. RESULTS Overall, 68 patient files in 12 wards were surveyed, with 88.2% (60/68) receiving at least one antimicrobial. The most widely prescribed antimicrobials were amoxicillin (24.3%), and ceftriaxone IV (21.6%), mostly from the Access group (69.9%), and zero from the Reserve group. In the past 90 days prior to admission, most patients (60.3%; 41/68) were not receiving any antimicrobials. Of concern was that antimicrobial use was empirical for all patients (100%) with mostly parenteral administration (88.3%; 91/103). In addition, the majority of surgical prophylaxis patients (80%; 12/15) were given an extended course post surgery. There was also no documented switch or stop dates, or patient culture and drug sensitivity results. CONCLUSION Antimicrobial utilization is high at RFM hospital. Identified targets for quality improvement programs include encouraging earlier switching to oral antimicrobials, reducing extended use for surgical prophylaxis and encouraging greater sensitivity testing and documentation stop dates. The development of the App appreciably reduced data collection times and analysis, and would be recommended for use in other public hospitals.
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Affiliation(s)
- Prudence C Gwebu
- Department of Pharmacy, Raleigh Fitkin Memorial Hospital, Manzini, Eswatini
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Gauteng, South Africa
| | - Zinhle C Matsebula-Myeni
- Department of Pharmacy, Raleigh Fitkin Memorial Hospital, Manzini, Eswatini
- Cerium Scientific, Matsapha, Eswatini
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
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Godman B, Egwuenu A, Wesangula E, Schellack N, Kalungia AC, Tiroyakgosi C, Kgatlwane J, Mwita JC, Patrick O, Niba LL, Amu AA, Oguntade RT, Alabi ME, Ncube NBQ, Sefah IA, Acolatse J, Incoom R, Guantai AN, Oluka M, Opanga S, Chikowe I, Khuluza F, Chiumia FK, Jana CE, Kalemeera F, Hango E, Fadare J, Ogunleye OO, Ebruke BE, Meyer JC, Massele A, Malande OO, Kibuule D, Kapona O, Zaranyika T, Bwakura-Dangarembizi M, Kujinga T, Saleem Z, Kurdi A, Shahwan M, Jairoun AA, Wale J, Brink AJ. Tackling antimicrobial resistance across sub-Saharan Africa: current challenges and implications for the future. Expert Opin Drug Saf 2022; 21:1089-1111. [PMID: 35876080 DOI: 10.1080/14740338.2022.2106368] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a concern as this increases morbidity, mortality, and costs, with sub-Saharan Africa having the highest rates globally. Concerns with rising AMR have resulted in international, Pan-African, and country activities including the development of national action plans (NAPs). However, there is variable implementation across Africa with key challenges persisting. AREAS COVERED Consequently, there is an urgent need to document current NAP activities and challenges across sub-Saharan Africa to provide future guidance. This builds on a narrative review of the literature. EXPERT OPINION All surveyed sub-Saharan African countries have developed their NAPs; however, there is variable implementation. Countries including Botswana and Namibia are yet to officially launch their NAPs with Eswatini only recently launching its NAP. Cameroon is further ahead with its NAP than these countries; though there are concerns with implementation. South Africa appears to have made the greatest strides with implementing its NAP including regular monitoring of activities and instigation of antimicrobial stewardship programs. Key challenges remain across Africa. These include available personnel, expertise, capacity, and resources to undertake agreed NAP activities including active surveillance, lack of focal points to drive NAPs, and competing demands and priorities including among donors. These challenges are being addressed, with further co-ordinated efforts needed to reduce AMR.
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Affiliation(s)
- Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Abiodun Egwuenu
- AMR Programme, Nigeria Centre for Disease Control, Jabi, Abuja, Nigeria
| | - Evelyn Wesangula
- Patient and Health Workers Safety Division, AMR Focal Point, Ministry of Health, Nairobi, Kenya
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | | | - Joyce Kgatlwane
- Department of Pharmacy, University of Botswana, Gaborone, Botswana
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Okwen Patrick
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon, Africa
- Faculty of Health and Medical Sciences, Adelaide University, Adelaide, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon, Africa
- Department of Public Health, University of Bamenda, Bambili, Cameroon
| | - Adefolarin A Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Eswatini
| | | | - Mobolaji Eniola Alabi
- School of Pharmaceutical Sciences, College of Health Sciences, University of Kwazulu-natal (UKZN), Durban, South Africa
| | - Nondumiso B Q Ncube
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Israel Abebrese Sefah
- Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | - Joseph Acolatse
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - Robert Incoom
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - Anastasia Nkatha Guantai
- Department of Pharmacology & Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Margaret Oluka
- Department of Pharmacology & Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Ibrahim Chikowe
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Felix Khuluza
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Francis K Chiumia
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Collins Edward Jana
- Division of Biochemistry, Biomedical Sciences Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Ester Hango
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Bernard E Ebruke
- International Foundation Against Infectious Disease in Nigeria (IFAIN), Abuja, Nigeria
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Oliver Ombeva Malande
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Child Health and Paediatrics, Egerton University, Nakuru, Kenya
- East Africa Centre for Vaccines and Immunization (ECAVI), Kampala, Uganda
| | - Dan Kibuule
- Department of Pharmacology & Therapeutics, Busitema University, Mbale, Tororo, Uganda
| | | | - Trust Zaranyika
- Department Of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Mutsa Bwakura-Dangarembizi
- Department of Paediatrics and Child Health, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Amanj Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Center of Research and Strategic Studies, Lebanese French University, Erbil, Iraq
| | - Moyad Shahwan
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- College of Pharmacy and Health Science, Ajman University, Ajman, United Arab Emirates
| | | | - Janney Wale
- Independent consumer advocate, Brunswick, Australia
| | - Adrian J Brink
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Services, Cape Town, South Africa
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Kaupitwa CJ, Nowaseb S, Godman B, Kibuule D. Analysis of policies for use of medically important antibiotics in animals in Namibia: implications for antimicrobial stewardship. Expert Rev Anti Infect Ther 2022; 20:1365-1379. [PMID: 35912881 DOI: 10.1080/14787210.2022.2108404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND In Namibia, overuse of medically important antibiotics in animals is common and is a considerable driver of antimicrobial resistance. The study aims to analyze policies, resistance patterns and consumption of these antibiotics used in animals in Namibia. RESEARCH DESIGN AND METHODS A scoping review and retrospective descriptive analysis of policies, resistance patterns and use of these antibiotics in Namibia was conducted, and assessed against the AWaRe (Access, Watch and Reserve) antimicrobial use guidance. RESULTS Of the forty-five antibiotic products registered for use in animals, 77.8% are Access antibiotics, 68.9% are broad-spectrum and 60% are over-the-counter antibiotics- mainly tetracyclines, penicillins and sulfonamides. There is misalignment of antibiotic use policies for animals and humans and no guideline for antibiotic use in animals. Most medically important antibiotics are indicated for control of gastrointestinal (77.7%), musculoskeletal (71.1%) and respiratory (46.7%) infections, and for growth promotion (4.4%). There is high resistance to AWaRe Access antibiotics- sulfonamides (19.5%-100%), tetracyclines (56%-100%) and penicillin (13.5%-100%). CONCLUSION Whilst Namibia banned the use of antibiotics in farming, current policy frameworks are inconsistent across sectors, and promote overuse of broad-spectrum important antibiotics in animals. A multi-sectoral one health approach is required to harmonize antibiotic use policies and reduce resistance.
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Affiliation(s)
- Coleen Jennifer Kaupitwa
- Department of Pharmacy Practice and Policy, School of Pharmacy, University of Namibia, Box 13301, Windhoek, Namibia
| | - Seth Nowaseb
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Namibia, Box 13301, Bach Street, Windhoek, Namibia
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, United Kingdom.,of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Dan Kibuule
- Department of Pharmacology and Therapeutics, Faculty of Health Sciences, Busitema University, Mbale City, Uganda
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Strasheim W, Etter EMC, Lowe M, Perovic O. Method to Assess Farm-Level Vaccine and Antibiotic Usage Utilizing Financial Documentation: A Pilot Study in a Commercial Pig Farm in South Africa From 2016 to 2018. Front Vet Sci 2022; 9:856729. [PMID: 35909688 PMCID: PMC9326393 DOI: 10.3389/fvets.2022.856729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
The purpose of the study was to develop a blueprint using financial documentation to describe and quantify vaccine and antibiotic usage (ABU). This method was piloted in a commercial pig farm in South Africa, with the ultimate hope to serve as a tool in a future species-specific vaccine and ABU surveillance system. Data collection was based on templates from the European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) network and the World Organisation for Animal Health (WOAH). Invoices from 2016 to 2018 were used as the main data source. In addition, monthly statement of accounts were used to check for missing invoices. An inventory check was done to ensure that the correct antibiotic concentrations were used in subsequent calculations. Livestock counts and slaughter statistics were also collected to be used as denominator data. Cost calculations for the procurement of antibiotics and vaccines were also done. The study showed that veterinary medicinal products were purchased only from a single veterinary practice. A total of 291 invoices were issued over 3 years, of which 2.75% (8/291) were missing and could therefore not be used in quantification. Tetracyclines (453.65 ± 25.49 kg and 135.16 ± 3.31 mg/kg), followed by quinoxalines (258.33 ± 8.04 kg and 77.07 ± 3.93 mg/kg) were used in the highest amounts, both in terms of weight (kg) and adjusted for animal biomass (mg/kg). Vaccines used on the farm targeted seven different diseases, namely enzootic pneumonia, erysipelas, ileitis, infectious infertility, leptospirosis, neonatal pig diarrhea and porcine circovirus disease. An average of 103 546 vaccine dosages was purchased for ZAR1 302,727 ($ 84,6201) per year, whereas the average cost for the procurement of antibiotics was ZAR 907,372 ($ 69,561) per year. The study showed that invoices and monthly statement of accounts, in combination with an inventory check and on-farm production statistics, are useful data sources to quantify vaccine and ABU in the absence of veterinary prescriptions. In addition, vaccinating pigs were more expensive than administering antibiotics.
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Affiliation(s)
- Wilhelmina Strasheim
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
- *Correspondence: Wilhelmina Strasheim
| | - Eric M. C. Etter
- Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
- Centre de Coopération Internationale en Recherche Agronomique Pour le Développement (CIRAD), UMR Animal, Santé, Territoires, Risque et Ecosystèmes (ASTRE), Montpellier, France
- UMR Animal, Santé, Territoires, Risque et Ecosystèmes (ASTRE), University of Montpellier, Centre de Coopération Internationale en Recherche Agronomique Pour le Développement (CIRAD), Institut National de la Recherche Agronomique (INRA), Montpellier, France
| | - Michelle Lowe
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Olga Perovic
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, South Africa
- Division of Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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22
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Phenotypic and Genotypic Screening of Colistin Resistance Associated with Emerging Pathogenic Escherichia coli Isolated from Poultry. Vet Sci 2022; 9:vetsci9060282. [PMID: 35737334 PMCID: PMC9229556 DOI: 10.3390/vetsci9060282] [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: 05/21/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
Chickens continue to be an important reservoir of zoonotic multidrug-resistant illnesses. Antimicrobial resistance correlated with colistin has emerged as a critical concern worldwide in the veterinary field and the public health sector. The current study investigated the prevalence of multidrug-resistant avian pathogenic Escherichia coli among chicken farms in three Egyptian governorates, focusing on colistin resistance assessment. A total of 56 Escherichia coli isolates were recovered out of 120 pooled samples obtained from diseased chicken broilers (46.7%). The E. coli isolates were serotyped to nine different serotypes; the highest incidence was for O125 (n = 18). The E. coli isolates demonstrated multidrug-resistant patterns against 10 antibiotics, especially clindamycin, tetracycline, streptomycin and ampicillin, by 100, 100, 96.4 and 92.9%, respectively. On the other hand, colistin resistance was 41.1% using AST. All E. coli isolates displayed positive colistin resistance growth on chromogenic medium, but only 25% represented this positivity via MIC estimation and Sensititre kit. PCR results revealed that all isolates harbored mcr-1, but no isolates harbored the other 2–5 mcr genes. In conclusion, the study demonstrated the emergence of multidrug-resistant, especially colistin-resistant, E. coli among chicken broiler flocks, and mcr-1 is the master gene of the colistin resistance feature.
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23
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Pan-genome and resistome analysis of extended-spectrum ß-lactamase-producing Escherichia coli: A multi-setting epidemiological surveillance study from Malaysia. PLoS One 2022; 17:e0265142. [PMID: 35271656 PMCID: PMC8912130 DOI: 10.1371/journal.pone.0265142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/23/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives
This study profiled the prevalence of extended-spectrum ß-lactamase-producing Escherichia coli (ESBL-EC) in the community and compared their resistome and genomic profiles with isolates from clinical patients through whole-genome sequencing.
Methods
Fecal samples from 233 community dwellers from Segamat, a town in southern Malaysia, were obtained between May through August 2018. Putative ESBL strains were screened and tested using antibiotic susceptibility tests. Additionally, eight clinical ESBL-EC were obtained from a hospital in the same district between June through October 2020. Whole-genome sequencing was then conducted on selected ESBL-EC from both settings (n = 40) for pan-genome comparison, cluster analysis, and resistome profiling.
Results
A mean ESBL-EC carriage rate of 17.82% (95% CI: 10.48%– 24.11%) was observed in the community and was consistent across demographic factors. Whole-genome sequences of the ESBL-EC (n = 40) enabled the detection of multiple plasmid replicon groups (n = 28), resistance genes (n = 34) and virulence factors (n = 335), with no significant difference in the number of genes carried between the community and clinical isolates (plasmid replicon groups, p = 0.13; resistance genes, p = 0.47; virulence factors, p = 0.94). Virulence gene marker analysis detected the presence of extraintestinal pathogenic E. coli (ExPEC), uropathogenic E. coli (UPEC), and enteroaggregative E. coli (EAEC) in both the community and clinical isolates. Multiple blaCTX-M variants were observed, dominated by blaCTX-M-27 (n = 12), blaCTX-M-65 (n = 10), and blaCTX-M-15 (n = 9). The clinical and community isolates did not cluster together based on the pan-genome comparison, suggesting isolates from the two settings were clonally unrelated. However, cluster analysis based on carried plasmids, resistance genes and phenotypic susceptibility profiles identified four distinct clusters, with similar patterns between the community and clinical isolates.
Conclusion
ESBL-EC from the clinical and community settings shared similar resistome profiles, suggesting the frequent exchange of genetic materials through horizontal gene transfer.
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Molecular Detection of Integrons, Colistin and β-lactamase Resistant Genes in Salmonella enterica Serovars Enteritidis and Typhimurium Isolated from Chickens and Rats Inhabiting Poultry Farms. Microorganisms 2022; 10:microorganisms10020313. [PMID: 35208768 PMCID: PMC8876313 DOI: 10.3390/microorganisms10020313] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 12/24/2022] Open
Abstract
The rapid growth of multidrug-resistant Salmonella is a global public health concern. The aim of this study was to detect integrons, colistin and β-lactamase resistance genes in Salmonella enteritidis and typhimurium. A total of 63 isolates of S. enteritidis (n = 18) and S. typhimurium (n = 45) from fecal samples of layers and rats at chicken farms were screened for antibiotic resistant genes. Conventional PCR was performed for the detection of integrons (classes 1, 2, and 3), colistin (mcr-1-5) and β-lactamase (blaCTX-M, blaCTX-M-1, blaCTX-M-2, blaCTX-M-9, blaCTX-M-15, blaTEM, blaSHV, and blaOXA) resistant genes. Of these isolates, 77% and 27% of S. typhimurium and S. enteritidis harboured the mcr-4 encoded gene for colistin, respectively. The prevalence of class 1 integrons for S. typhimurium and S. enteritidis was 100% for each serovar, while for class 2 integrons of S. typhimurium and S. enteritidis it was 49% and 33% respectively, while class 3 integron genes was not detected. Our study also detected high levels of β-lactamase encoding genes (bla gene), namely blaCTX-M, blaCTX-M-1, blaCTX-M-9 and blaTEM from both S. typhimurium and S. enteritidis. This, to our knowledge, is the first report of mcr-4 resistance gene detection in Salmonella serovars in South Africa. This study also highlights the importance of controlling rats at poultry farms in order to reduce the risk of transmission of antibiotic resistance to chickens and eventually to humans.
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Hassan IZ, Wandrag B, Gouws JJ, Qekwana DN, Naidoo V. Antimicrobial resistance and mcr-1 gene in Escherichia coli isolated from poultry samples submitted to a bacteriology laboratory in South Africa. Vet World 2021; 14:2662-2669. [PMID: 34903923 PMCID: PMC8654743 DOI: 10.14202/vetworld.2021.2662-2669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Aim Antimicrobial resistance (AMR) and recently mobilized colistin resistance (mcr-1) associated colistin resistance among Escherichia coli isolates have been attributed to the overuse of antimicrobials in livestock production. E. coli remains an important pathogen, often associated with mortality and low carcass weight in poultry medicine; therefore, the need to use antimicrobials is common. The study aimed to determine the AMR profile and presence of mcr-1 and mcr-2 genes in avian pathogenic E. coli from poultry samples tested at a bacteriology laboratory for routine diagnosis. This is a first step in understanding the effectiveness of mitigation strategies. Materials and Methods Fifty E. coli strains were assessed for resistance against ten antimicrobial drugs using broth microdilution. All isolates with a colistin minimum inhibitory concentration (MIC) of 2 μg/mL were analyzed for the presence of mcr-1 and mcr-2 genes by employing the polymerase chain reaction. For each isolate, the following farm information was obtained: farm location, type of farm, and on-farm use of colistin. Results Sixty-eight percent of the strains were resistant to at least one antimicrobial; 44% were multiple drug-resistant (MDR). Most E. coli isolates were resistant to doxycycline (44%), trimethoprim-sulfamethoxazole (38%), ampicillin (32%), and enrofloxacin (32%). None of the E. coli strains was resistant to colistin sulfate (MIC90 of 2 μg/mL). Only one E. coli isolate held the mcr-1 gene; none carried the mcr-2 gene. Conclusion Resistance among E. coli isolates in this study was fairly high. Resistance to commonly used antimicrobials was observed, such as doxycycline, trimethoprim-sulfamethoxazole, and enrofloxacin. Only a single E. coli strain carried the mcr-1 gene, suggesting that mcr-1 and mcr-2 genes are common among isolates in this study. The prevalence of AMR, however, suggests that farmers must implement standard biosecurity measures to reduce E. coli burden, and antimicrobial use to prolong the efficacy life span of some of these drugs.
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Affiliation(s)
- Ibrahim Z Hassan
- Department of Paraclinical Sciences, Veterinary Pharmacology/Toxicology Section, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Buks Wandrag
- Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Johan J Gouws
- Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Daniel N Qekwana
- Department of Paraclinical Sciences, Veterinary Public Health Section, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Vinny Naidoo
- Department of Paraclinical Sciences, Veterinary Pharmacology/Toxicology Section, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
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Majavie L, Johnston D, Messina A. A retrospective review of colistin utilisation at a tertiary care academic hospital in South Africa. S Afr J Infect Dis 2021; 36:205. [PMID: 34485491 PMCID: PMC8378127 DOI: 10.4102/sajid.v36i1.205] [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: 04/09/2020] [Accepted: 04/15/2021] [Indexed: 11/12/2022] Open
Abstract
Background The use of the antibiotic colistin was increasing as a treatment option for multidrug-resistant (MDR) infections. Standardisation of colistin dosing and more appropriate record-keeping practices were required to fully assess the optimal usage of colistin. The aim of this study was to determine how and why colistin was used in the treatment of MDR infections in a tertiary care public hospital in South Africa (SA). Methods This cross-sectional retrospective record review described adult and paediatric patients who received colistin intravenously from 01 May 2016 to 31 April 2017. Information from patient records were captured on a data collection tool and analysed using descriptive statistics. Ethical approval was obtained from the Human Research Ethics Committee of the University of the Witwatersrand. Results A total of 43 patient records were reviewed. Acinetobacter baumannii was the most common organism isolated (85.2% adults and 62.5% paediatrics). Colistin was mostly prescribed for sepsis (18 adults and 15 paediatrics). Most adults (66.7%) received loading doses as recommended; however, there was a great variation in maintenance doses. Paediatric patients reviewed also showed varying dosing according to weight. The mean duration of colistin therapy was 10 days. Carbapenems were most commonly co-administered with colistin (58%). Conclusion The findings suggested that although colistin usage was restricted in the hospital, it was not adequately monitored or controlled. Doses prescribed were made at the discretion of prescribing doctors and differed to currently accepted guidelines. Improved record-keeping practices related to the monitoring of colistin use were required.
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Affiliation(s)
- Liezl Majavie
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Deanne Johnston
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angeliki Messina
- Antimicrobial Stewardship unit, Netcare hospitals, Johannesburg, South Africa
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Snyman Y, Whitelaw AC, Maloba MRB, Hesseling AC, Newton-Foot M. Carriage of colistin-resistant Gram-negative bacteria in children from communities in Cape Town (Tuberculosis child multidrug-resistant preventive therapy trial sub-study). S Afr J Infect Dis 2021; 36:241. [PMID: 34485500 PMCID: PMC8378148 DOI: 10.4102/sajid.v36i1.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/10/2020] [Indexed: 11/16/2022] Open
Abstract
Colistin is a last-resort antibiotic against multidrug-resistant, Gram-negative bacteria. Colistin resistance has been described in the clinical settings in South Africa. However, information on carriage of these bacteria in communities is limited. This study investigated gastrointestinal carriage of colistin-resistant Escherichia coli and Klebsiella spp. and mcr genes in children from communities in Cape Town. Colistin-resistant E. coli was isolated from two participants (4%, 2/50), and mcr-1-mcr-9 genes were not detected. Gastrointestinal carriage of colistin-resistant Enterobacterales was rare; however, continuous extensive surveillance is necessary to determine the extent of carriage and its contribution to resistance observed in clinical settings.
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Affiliation(s)
- Yolandi Snyman
- Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andrew C Whitelaw
- Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Motlatji R B Maloba
- Department of Medical Microbiology, Faculty of Health Science, University of the Free State, Bloemfontein, South Africa.,National Health Laboratory Service, Universitas Hospital, Bloemfontein, South Africa
| | - Anneke C Hesseling
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Mae Newton-Foot
- Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
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Snyman Y, Whitelaw AC, Barnes JM, Maloba MRB, Newton-Foot M. Characterisation of mobile colistin resistance genes (mcr-3 and mcr-5) in river and storm water in regions of the Western Cape of South Africa. Antimicrob Resist Infect Control 2021; 10:96. [PMID: 34187559 PMCID: PMC8244157 DOI: 10.1186/s13756-021-00963-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/26/2021] [Indexed: 11/21/2022] Open
Abstract
Background Colistin is regarded as a last-resort antimicrobial against multi-drug resistant Gram-negative bacteria (GNB), therefore the dissemination of colistin resistance in the environment is of great concern. Horizontal transfer of mobile colistin resistance (mcr) genes to potential pathogens poses a serious problem. This study aimed to describe the presence of colistin resistant GNB and mcr genes in river and storm water in regions of the Western Cape. Methods Water samples were collected from three rivers during May 2019 and January 2020 and two storm water samples were collected in November 2019. Colistin resistant GNB were cultured on MacConkey agar containing colistin and identified by MALDI-TOF. Colistin resistance was confirmed using broth microdilution (BMD). mcr-1-5 genes were detected by PCR performed directly on the water samples and on the colistin resistant isolates. mcr functionality was assessed by BMD after cloning the mcr genes into pET-48b(+) and expression in SHuffle T7 E. coli. Results mcr-5.1 and various mcr-3 gene variants were detected in the Plankenburg-, Eerste- and Berg rivers and in storm water from Muizenberg, and only mcr-5.1 was detected in storm water from Fish Hoek. Colistin resistant GNB were isolated from all of the water sources. Aeromonas spp. were the most common colistin resistant organisms detected in the water sources; 25% (6/24) of colistin resistant Aeromonas spp. isolated from the Berg river contained novel mcr-3 variants; mcr-3.33 (n = 1), mcr-3.34 (n = 1) mcr-3.35 (n = 1) mcr-3.36 (n = 2) and mcr-3.37 (n = 1), which were confirmed to confer colistin resistance. Conclusions The mcr-5.1 and mcr-3 colistin resistance gene variants were present in widely dispersed water sources in regions of the Western Cape. The mcr genes were only detected in water sampled downstream of and alongside communities, suggesting that their presence is driven by human influence/contamination. This is the first documentation of mcr-3 and mcr-5 gene variants in any setting in South Africa. Spill-over of these genes to communities could result in horizontal gene transfer to pathogenic bacteria, exacerbating the challenge of controlling multidrug resistant GNB infections. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-00963-2.
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Affiliation(s)
- Yolandi Snyman
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University, Cape Town, South Africa.
| | - Andrew C Whitelaw
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Jo M Barnes
- Division of Community Health, Department Epidemiology, Stellenbosch University, Cape Town, South Africa
| | - Motlatji R B Maloba
- Department of Medical Microbiology, University of the Free State, Bloemfontein, South Africa.,National Health Laboratory Service, Universitas Hospital, Bloemfontein, South Africa
| | - Mae Newton-Foot
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
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Kansak N, Aksaray S, Aslan M, Adaleti R, Gönüllü N. Detection of colistin resistance among multidrug-resistant Klebsiella pneumoniae and Escherichia coli clinical isolates in Turkey. Acta Microbiol Immunol Hung 2021; 68:99-106. [PMID: 33512332 DOI: 10.1556/030.2021.01328] [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: 10/20/2020] [Accepted: 11/30/2020] [Indexed: 11/19/2022]
Abstract
In this study investigation of plasmid-mediated mcr 1-5 resistance genes was performed among multidrug-resistant (MDR) colistin sensitive and resistant Klebsiella pneumoniae and Escherichia coli strains isolated in our laboratory. We aimed to evaluate automated system (Vitek-2), broth microdilution (BMD) reference method and chromogenic media performance. Totally 94 MDR K. pneumoniae and six E. coli isolates were included in the study. CHROMID® Colistin R agar (COLR) (bioMerieux, France) was used to determine the colistin resistance by chromogenic method. Standard PCR amplification was performed using specific primers to screen the plasmid-mediated mcr 1-5 genes. Sixty-one isolates were resistant to colistin and 39 were susceptible with reference BMD. The essential and categorical agreement of Vitek-2 was determined as 100 and 99%. The sensitivity of COLR medium was 100%, the specificity was 97.5%. In our study mcr-1 was detected in eight isolates, while other mcr genes were not detected. Due to the high sensitivity and specificity of the COLR medium, it can be used in routine diagnostics for the detection of colistin resistance. In our study we detected 8% prevalence of mcr-1 among MDR strains however, two mcr-1 positive isolates were found sensitive to colistin by BMD.
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Affiliation(s)
- Nilgün Kansak
- 1Medical Microbiology Laboratory, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sebahat Aksaray
- 2Department of Medical Microbiology, University of Health Sciences-Hamidiye Medical Faculty, Istanbul, Turkey
| | - Müge Aslan
- 1Medical Microbiology Laboratory, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Rıza Adaleti
- 1Medical Microbiology Laboratory, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nevriye Gönüllü
- 3Department of Medical Microbiology, Istanbul University-Cerrahpasa School of Medicine, Istanbul, Turkey
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Naidoo S, Bangalee V, Oosthuizen F. Antibiotic use amongst pregnant women in a public hospital in KwaZulu-Natal. Health SA 2021; 26:1516. [PMID: 34192065 PMCID: PMC8182570 DOI: 10.4102/hsag.v26i0.1516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 02/27/2021] [Indexed: 11/09/2022] Open
Abstract
Background Antibiotics are amongst the more frequently prescribed medicines in pregnant women and the use of antibiotics is increasing. However, with limited studies available in this population, the safe use of antibiotics in pregnancy remains a concern. Aim To evaluate the use of antibiotics amongst pregnant women attending a public health care facility. The main objective of this study was to quantify the types of antibiotics used in pregnant women. Setting A public hospital classified as a referral hospital located in Durban, KwaZulu-Natal. Methods Demographic and treatment information of women were collected retrospectively from January 2019 to July 2019. A total of 184 pregnant patients, who received antibiotic therapy, were included in this study. Descriptive and analytical measures were used to analyse both patient demographics and treatment variables. Results A total of 416 antibiotic prescriptions, issued to 184 patients, were reviewed. Penicillins (39.7%), macrolides (13.0%) and combination penicillin- and beta-lactam inhibitors (12.3%) were reported as the most commonly prescribed antibiotics. Rifamycin (2.9%), hydrazides (2.2%) and aminoglycosides (1.9%) were less frequently prescribed. Most antibiotics were prescribed for diseases of the circulatory system (36.1%). Conclusion Several classes of antibiotics were used in pregnancy despite the lack of available safety data and clinical evidence. Informing women of the potential side effects and keeping abreast with new information played an important role in the safe, rational and effective use of medicines that contributed to improving maternal health.
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Affiliation(s)
- Sasha Naidoo
- Discipline of Pharmaceutical Sciences, College of Health Sciences, Faculty of Pharmacy, University of KwaZulu-Natal, Durban, South Africa
| | - Varsha Bangalee
- Discipline of Pharmaceutical Sciences, College of Health Sciences, Faculty of Pharmacy, University of KwaZulu-Natal, Durban, South Africa
| | - Frasia Oosthuizen
- Discipline of Pharmaceutical Sciences, College of Health Sciences, Faculty of Pharmacy, University of KwaZulu-Natal, Durban, South Africa
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The MCR-3 inside linker appears as a facilitator of colistin resistance. Cell Rep 2021; 35:109135. [PMID: 34010644 DOI: 10.1016/j.celrep.2021.109135] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/23/2020] [Accepted: 04/23/2021] [Indexed: 01/08/2023] Open
Abstract
An evolving family of mobile colistin resistance (MCR) enzymes is threatening public health. However, the molecular mechanism by which the MCR enzyme as a rare member of lipid A-phosphoethanolamine (PEA) transferases gains the ability to confer phenotypic colistin resistance remains enigmatic. Here, we report an unusual example that genetic duplication and amplification produce a functional variant (Ah762) of MCR-3 in certain Aeromonas species. The lipid A-binding cavity of Ah762 is functionally defined. Intriguingly, we locate a hinge linker of Ah762 (termed Linker 59) that determines the MCR. Genetic and biochemical characterization reveals that Linker 59 behaves as a facilitator to render inactive MCR variants to regain the ability of colistin resistance. Along with molecular dynamics (MD) simulation, isothermal titration calorimetry (ITC) suggests that this facilitator guarantees the formation of substrate phosphatidylethanolamine (PE)-accessible pocket within MCR-3-like enzymes. Therefore, our finding defines an MCR-3 inside facilitator for colistin resistance.
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Ara B, Urmi UL, Haque TA, Nahar S, Rumnaz A, Ali T, Alam MS, Mosaddek ASM, Rahman NAA, Haque M, Islam S. Detection of mobile colistin-resistance gene variants ( mcr-1 and mcr-2) in urinary tract pathogens in Bangladesh: the last resort of infectious disease management colistin efficacy is under threat. Expert Rev Clin Pharmacol 2021; 14:513-522. [PMID: 33691556 DOI: 10.1080/17512433.2021.1901577] [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] [Indexed: 02/05/2023]
Abstract
Background: Currently, colistin-resistant pathogens emerged has become a global health concern. This study assessed the distribution of mcr-1 to mcr-5 variants with the phenotypic colistin-resistance in bacterial isolates from urinary tract infection (UTI) patients in Bangladesh.Methods: A cross-sectional study was conducted between April 2017 and March 2018 to enroll uncomplicated UTI patients, and 142 urine samples were analyzed. Uropathogens were identified using the API-20E biochemical panel and 16s rRNA gene sequencing. Polymerase chain reactions detected the mcr gene variants in the UTI isolates. The phenotypic colistin-susceptibility was determined by the Kirby-Bauer disc-diffusion method and the minimal inhibitory concentration (MIC) measurement.Results: The combined carriage of mcr-1 and mcr-2 genes in 11.4% (14/123) of urinary tract pathogens. The mcr-positive pathogens include five Escherichia coli, three Klebsiella pneumoniae, three Pseudomonas putida, two Enterobacter cloacae, and one Enterobacter hormaechei. The mcr-positive variant showed significantly higher phenotypic colistin resistance with MIC between >16 µg/mL and >128 µg/mL (p< 0.001). Over 85% of colistin-resistant isolates showed MDR phenomena.Conclusions: The emergence of the clinical MDR pathogens with resistance to a highly selective drug may lead to a lack of treatment options for the infectious diseases and spread of infection to the unaffected cohorts.
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Affiliation(s)
- Bayasrin Ara
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Umme Laila Urmi
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Tanjum Ara Haque
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Shamsun Nahar
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Adity Rumnaz
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Tamanna Ali
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | | | | | - Nor Azlina A Rahman
- Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, Malaysia
| | - Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
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Adesiyun AA, Fasina FO, Abafe OA, Mokgoatlheng-Mamogobo M, Adigun O, Mokgophi T, Phosa M, Majokweni Z. Occurrence and Concentrations of Residues of Tetracyclines, Polyether Ionophores, and Anthelmintics in Livers of Chickens Sold in the Informal Market in Gauteng Province, South Africa. J Food Prot 2021; 84:655-663. [PMID: 33159443 DOI: 10.4315/jfp-20-312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/30/2020] [Indexed: 02/05/2023]
Abstract
ABSTRACT The occurrence, concentrations, and variables associated with tetracycline, polyether ionophore, and anthelmintic residues in the livers of chickens sold in the informal market in South Africa were determined. Ultrahigh-performance liquid chromatography-tandem mass spectrometry was used to simultaneously analyze for four tetracyclines, five polyether ionophores, and six anthelmintic residues. The study determined the presence of residues in liver samples at both the limit of quantifications (LOQ) and concentrations over the maximum residue limit (MRL), i.e., noncompliant. Doxycycline (tetracycline group) was detected in 24 (24.5%) of 98 chicken livers, and 15 (15.3%) of the 98 were noncompliant. Mean ± standard deviation (SD) concentrations of 919.04 ± 1,081.30 ppb (LOQ) and 1,410.57 ± 108.89 ppb (MRL) were obtained. Maduramicin was detected in 27 (27.6%) of 98 chicken livers, and 19 (19.4%) of 98 were noncompliant. The mean ± SD for LOQ was 117.96 ± 84.56 ppb, and MRL was 153.21 ± 76.29 ppb. The concentrations of residues of doxycycline and maduramicin in chicken livers varied significantly across townships. Lasalocid was found in 31 (31.6%) of 98 samples, of which 5 (5.1%) had concentrations above the MRL. The mean ± SD concentration of lasalocid was 62.90 ± 170.84 ppb for samples in which lasalocid was quantified and 310.16 ± 356.68 ppb for noncompliant samples. Detectable concentrations of praziquantel, closantel, and rafoxanide (anthelmintics) residues were found in 3 (3.1%), 1 (1.0%), and 2 (2.0%) of 98 chicken livers, respectively. The presence of residues of three classes of veterinary drugs in chicken livers poses food safety implications to consumers and indicates a need for enhanced regulatory enforcement in controlling these drugs in South Africa.
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Affiliation(s)
- Abiodun A Adesiyun
- Department of Production Animal Studies, Faculty of Veterinary Sciences, University of Pretoria, Onderstepoort, Pretoria, 0110, South Africa
- (ORCID: https://orcid.org/0000-0001-9470-9421 [A.A.A.])
- Department of Basic Veterinary Sciences, School of Veterinary Medicine, Faculty of Medical Science, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Folorunso O Fasina
- Department of Veterinary Tropical Diseases, Faculty of Veterinary Sciences, University of Pretoria, Onderstepoort, Pretoria, 0110, South Africa
- Food and Agriculture Organization-ECTAD, House H SIDA, Ali Hassan Mwinyi Road, Ada Estate, Dar es Salaam, Tanzania
- (ORCID: https://orcid.org/0000-0003-3088-8752 [F.O.F.])
| | - Ovokeroye A Abafe
- Chemical and Drug Residue Analysis Laboratory, Public Health and Zoonoses Programme, Agricultural Research Council-Onderstepoort Veterinary Research, Soutpan Road (M35), Onderstepoort, 0110, South Africa (ORCID: https://orcid.org/0000-0002-5672-6463 [O.A.A.])
- School of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa 4041; and
| | - Malesedi Mokgoatlheng-Mamogobo
- Department of Production Animal Studies, Faculty of Veterinary Sciences, University of Pretoria, Onderstepoort, Pretoria, 0110, South Africa
- Poultry Disease Management Agency, South African Poultry Association (SAPA), 1494 Cranberry Street, Honeydew, Randburg, 2170, South Africa
| | - Oluwatola Adigun
- Department of Production Animal Studies, Faculty of Veterinary Sciences, University of Pretoria, Onderstepoort, Pretoria, 0110, South Africa
| | - Thelma Mokgophi
- Department of Production Animal Studies, Faculty of Veterinary Sciences, University of Pretoria, Onderstepoort, Pretoria, 0110, South Africa
| | - Matshie Phosa
- Department of Veterinary Tropical Diseases, Faculty of Veterinary Sciences, University of Pretoria, Onderstepoort, Pretoria, 0110, South Africa
| | - Ziyanda Majokweni
- Poultry Disease Management Agency, South African Poultry Association (SAPA), 1494 Cranberry Street, Honeydew, Randburg, 2170, South Africa
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Snyman Y, Reuter S, Whitelaw AC, Stein L, Maloba MRB, Newton-Foot M. Characterisation of mcr-4.3 in a colistin-resistant Acinetobacter nosocomialis clinical isolate from Cape Town, South Africa. J Glob Antimicrob Resist 2021; 25:102-106. [PMID: 33757821 DOI: 10.1016/j.jgar.2021.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/11/2021] [Accepted: 03/01/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Colistin resistance in Acinetobacter spp. is increasing, resulting in potentially untreatable nosocomial infections. Plasmid-mediated colistin resistance is of particular concern due to its low fitness cost and potential transferability to other bacterial strains and species. This study investigated the colistin resistance mechanism in a clinical Acinetobacter nosocomialis isolate from Cape Town, South Africa. METHODS A colistin-resistant A. nosocomialis isolate was identified from a blood culture in 2017. PCR and Illumina whole-genome sequencing (WGS) were performed to identify genes and mutations conferring resistance to colistin. Plasmid sequencing was performed on an Oxford Nanopore platform. mcr functionality was assessed by broth microdilution after cloning the mcr gene into pET-48b(+) and expressing it in SHuffle® T7 Escherichia coli and after curing the plasmid using 62.5 mg/L acridine orange. RESULTS The colistin minimum inhibitory concentration (MIC) of the A. nosocomialis isolate was 16 mg/L. The mcr-4.3 gene was detected by PCR and WGS. No other previously described colistin resistance mechanism was found by WGS. The mcr-4.3 gene was identified on a 24 024-bp RepB plasmid (pCAC13a). Functionality studies showed that recombinant mcr-4.3 did not confer colistin resistance in E. coli. However, plasmid curing of pCAC13a restored colistin susceptibility in A. nosocomialis. CONCLUSION We describe the first detection of a plasmid-mediated mcr-4.3 gene encoding colistin resistance in A. nosocomialis and the first detection of mcr-4.3 in a clinical isolate in Africa. Recombinant expression of mcr-4.3 did not confer colistin resistance in E. coli, suggesting that its functionality may be RepB plasmid-dependent or species-specific.
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Affiliation(s)
- Yolandi Snyman
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University, Cape Town, South Africa.
| | - Sandra Reuter
- Institute for Infection Prevention and Hospital Epidemiology, Medical Center University of Freiburg, Freiburg, Germany
| | - Andrew Christopher Whitelaw
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University, Cape Town, South Africa; National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Lisa Stein
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University, Cape Town, South Africa
| | - Motlatji Reratilwe Bonnie Maloba
- Department of Medical Microbiology, University of the Free State, Bloemfontein, South Africa; National Health Laboratory Service, Universitas Hospital, Bloemfontein, South Africa
| | - Mae Newton-Foot
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University, Cape Town, South Africa; National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
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Mokgophi TM, Gcebe N, Fasina F, Adesiyun AA. Antimicrobial Resistance Profiles of Salmonella Isolates on Chickens Processed and Retailed at Outlets of the Informal Market in Gauteng Province, South Africa. Pathogens 2021; 10:pathogens10030273. [PMID: 33804304 PMCID: PMC8000370 DOI: 10.3390/pathogens10030273] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 02/05/2023] Open
Abstract
The study determined the antimicrobial resistance profiles of Salmonella on chickens processed and retailed at outlets of the informal markets in Gauteng province, South Africa. The study also investigated the relationship of antimicrobial resistant Salmonella to the source and type of samples and their serotypes. Carcass swabs, cloacal swabs and carcass drips were randomly collected from each of 151 slaughtered chickens from six townships. Isolation and identification were performed using standard and polymerase chain reaction (PCR) methods. The disc diffusion method was used to determine the resistance of Salmonella isolates to 16 antimicrobial agents and PCR to determine their serovars. Ninety-eight (64.9%) of the 151 chickens were contaminated with Salmonella of which 94.9% (93/98) were resistant serovars. The frequency of antimicrobial resistance of Salmonella isolates was high to erythromycin (94.9%) and spectinomycin (82.7%) but was low to ciprofloxacin (1.0%) and norfloxacin (1.0%) (p < 0.05). All 170 isolates of Salmonella tested exhibited resistance to one or more antimicrobial agents and the frequency varied significantly (p < 0.05) across the townships, the type of samples and the serovars. The prevalence of multidrug resistance (MDR) in Salmonella was 81.8% (139/170). Our findings pose zoonotic, food safety and therapeutic risks to workers and consumers of undercooked, contaminated chickens from these outlets.
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Affiliation(s)
- Thelma M. Mokgophi
- Department of Production Animal Studies, University of Pretoria, Private Bag X 04, Onderstepoort, Pretoria 0110, South Africa;
| | - Nomakorinte Gcebe
- Agricultural Research Council–Bacteriology and Zoonotic Diseases Diagnostic Laboratory, Onderstepoort Veterinary Research, Private Bag X 05, Onderstepoort, Pretoria 0110, South Africa;
| | - Folorunso Fasina
- ECTAD, Food and Agriculture Organization of the UN, Dar es Salaam 14111, Tanzania & Department of Vet-erinary Tropical Diseases, University of Pretoria, Onderstepoort, Pretoria 0110, South Africa;
| | - Abiodun A. Adesiyun
- Department of Production Animal Studies, University of Pretoria, Private Bag X 04, Onderstepoort, Pretoria 0110, South Africa;
- Department of Paraclinical Sciences, School of Veterinary Medicine, University of the West Indies, St. Augustine, Trinidad and Tobago
- Correspondence:
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Snyman Y, Whitelaw AC, Reuter S, Maloba MRB, Newton-Foot M. Colistin Resistance Mechanisms in Clinical Escherichia coli and Klebsiella spp. Isolates from the Western Cape of South Africa. Microb Drug Resist 2021; 27:1249-1258. [PMID: 33571049 DOI: 10.1089/mdr.2020.0479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objectives: Colistin is a last-resort antibiotic for the treatment of carbapenem-resistant Gram-negative infections. Colistin resistance thus poses a threat to human health. Colistin resistance is most commonly encoded by mutations in chromosomal pmrA, pmrB, phoP, phoQ, ccrB, and mgrB genes, and the presence of plasmid-mediated mcr genes. This study describes colistin resistance mechanisms in clinical Enterobacterales isolates from the Western Cape, South Africa. Results: Escherichia coli (n = 22) and Klebsiella spp. (n = 7) isolates, from nine health care facilities, were confirmed to be colistin resistant during 2016 and 2017. mcr-1 was present in 55% (12/22) of E. coli and 71% (5/7) of Klebsiella spp. isolates. Colistin resistance mutations in pmrB were identified in 8/10 mcr-negative E. coli isolates using whole-genome sequencing, with pmrB Pro-94→Gln being the most frequent with presence in 4 isolates. One mcr-negative Klebsiella spp. isolate had a complete deletion of the mgrB and one contained an insertion sequence (IS1) in mgrB. Conclusion: A reduction in the proportion of colistin-resistant isolates harboring mcr-1 from 2016 to 2017 was observed. Colistin-resistant E. coli attributed by chromosomal mutations in pmrB in 2017 were mostly clonal related, which contrasts with the 2016 unrelated mcr-1-positive isolates. The diverse strains, hospitals, and resistance mechanisms may suggest that selective pressure is the main driver of colistin resistance.
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Affiliation(s)
- Yolandi Snyman
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University, Cape Town, South Africa
| | - Andrew Christopher Whitelaw
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Sandra Reuter
- Institute for Infection Prevention and Hospital Epidemiology, Medical Center University of Freiburg, Freiburg, Germany
| | - Motlatji Reratilwe Bonnie Maloba
- Department of Medical Microbiology, University of the Free State, Bloemfontein, South Africa.,National Health Laboratory Service, Universitas Hospital, Bloemfontein, South Africa
| | - Mae Newton-Foot
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
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Anyanwu MU, Okpala COR, Chah KF, Shoyinka VS. Prevalence and Traits of Mobile Colistin Resistance Gene Harbouring Isolates from Different Ecosystems in Africa. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6630379. [PMID: 33553426 PMCID: PMC7847340 DOI: 10.1155/2021/6630379] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 12/13/2022]
Abstract
The mobile colistin resistance (mcr) gene threatens the efficacy of colistin (COL), a last-line antibiotic used in treating deadly infections. For more than six decades, COL is used in livestock around the globe, including Africa. The use of critically important antimicrobial agents, like COL, is largely unregulated in Africa, and many other factors militate against effective antimicrobial stewardship in the continent. Currently, ten mcr genes (mcr-1 to mcr-10) have been described. In Africa, mcr-1, mcr-2, mcr-3, mcr-5, mcr-8, and mcr-9 have been detected in isolates from humans, animals, foods of animal origin, and the environment. These genes are harboured by Escherichia coli, Klebsiella, Salmonella, Citrobacter, Enterobacter, Pseudomonas, Aeromonas, Alcaligenes, and Acinetobacter baumannii isolates. Different conjugative and nonconjugative plasmids form the backbone for mcr in these isolates; however, mcr-1 and mcr-3 have also been integrated into the chromosome of some African strains. Insertion sequences (ISs) (especially ISApl1), either located upstream or downstream of mcr, class 1 integrons, and transposons, are drivers of mcr in Africa. Genes coding multi/extensive drug resistance and virulence are colocated with mcr on plasmids in African strains. Transmission of mcr to/among African strains is nonclonal. Contact with mcr-habouring reservoirs, the consumption of contaminated foods of animal/plant origin or fluid, animal-/plant-based food trade and travel serve as exportation, importation, and transmission routes of mcr gene-containing bacteria in Africa. Herein, the current status of plasmid-mediated COL resistance in humans, food-producing animals, foods of animal origin, and environment in Africa is discussed.
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Affiliation(s)
- Madubuike Umunna Anyanwu
- Department of Veterinary Pathology and Microbiology, University of Nigeria, Nsukka 400001, Nigeria
| | - Charles Odilichukwu R. Okpala
- Department of Functional Food Products Development, Faculty of Biotechnology and Food Science, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Kennedy Foinkfu Chah
- Department of Veterinary Pathology and Microbiology, University of Nigeria, Nsukka 400001, Nigeria
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Bacteria Broadly-Resistant to Last Resort Antibiotics Detected in Commercial Chicken Farms. Microorganisms 2021; 9:microorganisms9010141. [PMID: 33435450 PMCID: PMC7826917 DOI: 10.3390/microorganisms9010141] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/27/2022] Open
Abstract
Resistance to last resort antibiotics in bacteria is an emerging threat to human and animal health. It is important to identify the source of these antimicrobial resistant (AMR) bacteria that are resistant to clinically important antibiotics and evaluate their potential transfer among bacteria. The objectives of this study were to (i) detect bacteria resistant to colistin, carbapenems, and β-lactams in commercial poultry farms, (ii) characterize phylogenetic and virulence markers of E. coli isolates to potentiate virulence risk, and (iii) assess potential transfer of AMR from these isolates via conjugation. Ceca contents from laying hens from conventional cage (CC) and cage-free (CF) farms at three maturity stages were randomly sampled and screened for extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, carbapenem-resistant Acinetobacter (CRA), and colistin resistant Escherichia coli (CRE) using CHROMagar™ selective media. We found a wide-spread abundance of CRE in both CC and CF hens across all three maturity stages. Extraintestinal pathogenic Escherichia coli phylogenetic groups B2 and D, as well as plasmidic virulence markers iss and iutA, were widely associated with AMR E. coli isolates. ESBL-producing Enterobacteriaceae were uniquely detected in the early lay period of both CC and CF, while multidrug resistant (MDR) Acinetobacter were found in peak and late lay periods of both CC and CF. CRA was detected in CF hens only. blaCMY
was detected in ESBL-producing E. coli in CC and CF and MDR Acinetobacter spp. in CC. Finally, the blaCMY
was shown to be transferrable via an IncK/B plasmid in CC. The presence of MDR to the last-resort antibiotics that are transferable between bacteria in food-producing animals is alarming and warrants studies to develop strategies for their mitigation in the environment.
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High prevalence of mcr-1-encoded colistin resistance in commensal Escherichia coli from broiler chicken in Bangladesh. Sci Rep 2020; 10:18637. [PMID: 33122817 PMCID: PMC7596488 DOI: 10.1038/s41598-020-75608-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 10/16/2020] [Indexed: 12/21/2022] Open
Abstract
Colistin is a last-resort antimicrobial used for the treatment of human infections caused by multidrug-resistant Gram-negative bacteria. However, colistin is still widely used in intensive poultry production in Bangladesh. We aimed to investigate the dynamics and genetic diversity of colistin-resistant commensal Escherichia coli from broiler chickens. A total of 1200 E. coli strains were characterized from 20 broiler farms at three-time points along the production period. All strains were screened for mcr-1 to mcr-5 genes by a multiplex PCR, and their genetic diversity was measured by repetitive extragenic palindromic (REP)-PCR fingerprinting. Genomic diversity and characterization were performed by whole genome sequencing (WGS). Twenty-five percent of the commensal E. coli strains harbored mcr-1 genes. Frequency of mcr-1 gene detection correlated positively (odds ratio 1.71; 95% CI 0.96-3.06; p = 0.068) with the use of colistin in poultry flocks. REP-PCR profiles and WGS analysis showed diverse E. coli population carrying multiple antimicrobial resistance genes. Phylogenetic comparison of mcr-1-bearing strains recovered from this study with a global strain collection revealed wide phylogenetic relationship. This study identified a high prevalence of mcr-1 gene among genetically diverse E. coli populations from broiler chickens in Bangladesh suggesting a massive horizontal spread of mcr-1 rather than by clonal expansion.
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Nusrat T, Akter N, Rahman NAA, Godman B, D Rozario DT, Haque M. Antibiotic resistance and sensitivity pattern of Metallo-β-Lactamase Producing Gram-Negative Bacilli in ventilator-associated pneumonia in the intensive care unit of a public medical school hospital in Bangladesh. Hosp Pract (1995) 2020; 48:128-136. [PMID: 32271642 DOI: 10.1080/21548331.2020.1754687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICU), accounting for 25% of all ICU infections. Antimicrobial resistance is increasing and becoming a significant health problem worldwide, increasing hospital length of stay, mortality and costs. Identifying antibiotic resistance patterns in VAP is important as this can cause outbreaks in ICUs. To date, there have been limited studies assessing this in Bangladesh. Consequently, the primary objective of this research was to study the species of bacterial growth and to determine the antibiotic resistance patterns of Metallo-β-Lactamase (MBL) producing gram-negative bacilli among ICU patients with VAP in a public medical school hospital, Bangladesh. In addition, identify the factors associated with a positive culture to provide future guidance. METHOD Cross-sectional study performed in the Chattogram Medical College Hospital, Bangladesh. Mueller Hinton agar plates were used for antibiotic sensitivity testing by the Kirby-Buer disc diffusion test. RESULTS Among 105 clinically suspected VAP cases, qualitative cultures were positive in 95 (90%) of them. The most common bacteria identified were Acinetobacter spp. (43.2%), Klebsiella spp. (20%) and Pseudomonas spp. (18.9%). A positive culture was not associated with patients' age or gender. Among 41 isolated Acinetobacter spp., 38 (92.7%) were resistant to gentamicin followed by 36 (87.8%) to ceftriaxone. Among 24 isolated Klebsiella spp., 22 (83.3%) were resistant to ceftriaxone. Among 18 isolated Pseudomonas spp., 16 (88.8%) were resistant to ciprofloxacin, and 13 (72.2%) were resistant to ceftriaxone. Among nine isolated E. coli, all were resistant to ceftriaxone and ciprofloxacin. All four Proteus spp. (100%) isolated were resistant to ciprofloxacin. Additionally, phenotype MBL producing was 65.22% and genotype was 45.65% among imipenem resistant pathogens. Imipenem resistant pathogens were sensitive to amoxyclav, amikacin¸ azithromycin, ceftazidime, ceftriaxone, colistin and gentamycin. CONCLUSION A positive culture was detected in 90% of VAP patients, but it was not associated with the patients' age and gender. The most common bacteria identified were Acinetobacter spp., Klebsiella spp. and Pseudomonas spp., where the majority of these were resistant to ceftriaxone. The results are being used to provide future guidance on the empiric management of VAP in this hospital.
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Affiliation(s)
- Tanzina Nusrat
- Department of Microbiology, Chittagong Medical College , Panchlaish, Chattogram, Bangladesh
| | - Nasima Akter
- Department of Microbiology, Chittagong Medical College , Panchlaish, Chattogram, Bangladesh
| | - Nor Azlina A Rahman
- Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia , Bandar Indera Mahkota, Kuantan, Malaysia
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow, UK
- Department of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University , Pretoria, South Africa
- Health Economics Centre, University of Liverpool , Liverpool, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge , Stockholm, Sweden
| | | | - Mainul Haque
- Faculty of Medicine and Defense Health, Universiti Pertahanan Nasional Malaysia (National Defense University of Malaysia) , Kem Sungai Besi, Kuala Lumpur, Malaysia
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Lupande-Mwenebitu D, Baron SA, Nabti LZ, Lunguya-Metila O, Lavigne JP, Rolain JM, Diene SM. Current status of resistance to antibiotics in the Democratic Republic of the Congo: A review. J Glob Antimicrob Resist 2020; 22:818-825. [PMID: 32688007 DOI: 10.1016/j.jgar.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/23/2020] [Accepted: 07/04/2020] [Indexed: 11/29/2022] Open
Abstract
A review of literature was conducted to assess the prevalence and mechanisms of antibiotic resistance to date, mainly to β-lactam antibiotics, cephalosporins, carbapenems, colistin, and tigecycline in the Democratic Republic of the Congo (DRC). English and French publications were listed and analysed using PubMed/Medline, Google Scholar, and African Journals database between 1 January 1990 and 31 December 2019. For the 30 published articles found: (1) bacterial resistance to antibiotics concerned both Gram-negative and Gram-positive bacteria; (2) multidrug resistance prevalence was the same in half of Streptococcus pneumoniae isolates; (3) a worrying prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was noted, which is associated with co-resistance to several other antibiotics; and (4) resistance to third-generation cephalosporins was very high in Enterobacteriaceae, mainly because of blaCTX-M-1 group and blaSHV genes. Data on carbapenem and colistin resistance were not available in DRC until recently. Further work is required to set up a surveillance system for antibiotic resistance in DRC.
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Affiliation(s)
- David Lupande-Mwenebitu
- Faculté de Pharmacie, IRD, APHM, MEPHI, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385 Marseille, France; Université Catholique de Bukavu (UCB), Hôpital Provincial Général de Référence de Bukavu, Bukavu, Congo
| | - Sophie Alexandra Baron
- Faculté de Pharmacie, IRD, APHM, MEPHI, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385 Marseille, France
| | - Larbi Zakaria Nabti
- Faculté de Pharmacie, IRD, APHM, MEPHI, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385 Marseille, France
| | | | - Jean-Philippe Lavigne
- Service de Microbiologie et Hygiène hospitalière, VBMI, INSERM U1047, Université de Montpellier, CHU Nîmes, Nîmes, France
| | - Jean-Marc Rolain
- Faculté de Pharmacie, IRD, APHM, MEPHI, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385 Marseille, France; IHU Méditerranée Infection, 19-21 boulevard Jean Moulin, 13385 Marseille, France.
| | - Seydina Mouhamadou Diene
- Faculté de Pharmacie, IRD, APHM, MEPHI, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385 Marseille, France; IHU Méditerranée Infection, 19-21 boulevard Jean Moulin, 13385 Marseille, France.
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Goff DA, Bauer KA, Brink A, Kolman S, Mendelson M, Messina AP, Schellack N, Bergh D. International Train the Trainer antibiotic stewardship program for pharmacists: Implementation, sustainability, and outcomes. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Debra A. Goff
- Department of Pharmacy, The Ohio State University Wexner Medical Center Columbus Ohio USA
- Department of Pharmacy Practice The Ohio State University College of Pharmacy Columbus Ohio USA
| | | | - Adrian Brink
- Division of Medical Microbiology, Faculty of Health Sciences University of Cape Town Cape Town South Africa
| | - Sonya Kolman
- Department of Pharmacy Nelson Mandela Children's Hospital Johannesburg South Africa
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine Groote Schuur Hospital University of Cape Town Cape Town South Africa
| | - Angeliki P. Messina
- Division of Pharmacy Netcare Hospitals Ltd Johannesburg South Africa
- Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Natalie Schellack
- Department of Pharmacy, School of Pharmacy, Faculty of Health Care Sciences Sefako Makgatho Health Sciences University Pretoria South Africa
| | - Dena Bergh
- Division of Infectious Diseases and HIV Medicine, Department of Medicine Groote Schuur Hospital University of Cape Town Cape Town South Africa
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Laxminarayan R, Van Boeckel T, Frost I, Kariuki S, Khan EA, Limmathurotsakul D, Larsson DGJ, Levy-Hara G, Mendelson M, Outterson K, Peacock SJ, Zhu YG. The Lancet Infectious Diseases Commission on antimicrobial resistance: 6 years later. THE LANCET. INFECTIOUS DISEASES 2020; 20:e51-e60. [PMID: 32059790 DOI: 10.1016/s1473-3099(20)30003-7] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/02/2020] [Accepted: 01/06/2020] [Indexed: 12/21/2022]
Abstract
In 2013, a Lancet Infectious Diseases Commission described the state of antimicrobial resistance worldwide. Since then, greater awareness of the public health ramifications of antimicrobial resistance has led to national actions and global initiatives, including a resolution at the high-level meeting of the UN General Assembly in 2016. Progress in addressing this issue has ranged from a ban on irrational drug combinations in India to commitments to ban colistin as a growth promoter in animals, improve hospital infection control, and implement better antimicrobial stewardship. Funds have been mobilised, and regulatory barriers to new antibiotic development have been relaxed. These efforts have been episodic and uneven across countries, however. Sustained funding for antimicrobial resistance and globally harmonised targets to monitor progress are still urgently needed. Except for in a few leading countries, antimicrobial resistance has not captured the sustained focus of national leaders and country-level actors, including care providers.
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Affiliation(s)
- Ramanan Laxminarayan
- Centre for Disease Dynamics, Economics & Policy, New Delhi, India; Princeton Environmental Institute, Princeton University, Princeton, NJ, USA.
| | - Thomas Van Boeckel
- Institute for Environmental Decisions, Swiss Federal Institute of Technology in Zurich, Zurich, Switzerland
| | - Isabel Frost
- Centre for Disease Dynamics, Economics & Policy, New Delhi, India; Faculty of Medicine, Department of Infectious Disease, Imperial College, London, UK
| | | | - Ejaz Ahmed Khan
- Shifa International Hospital, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | - D G Joakim Larsson
- Institute for Biomedicine, Department of Infectious Diseases, Centre for Antibiotic Resistance Research, University of Gothenburg, Gothenburg, Sweden
| | - Gabriel Levy-Hara
- Infectious Disease Unit, Hospital Carlos G Durand, Buenos Aires, Argentina
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | | | | | - Yong-Guan Zhu
- State Key Lab of Urban and Regional Ecology, Research Centre for Eco-environmental Sciences, Chinese Academy of Sciences, Beijing, China
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Godman B, Haque M, McKimm J, Abu Bakar M, Sneddon J, Wale J, Campbell S, Martin AP, Hoxha I, Abilova V, Anand Paramadhas BD, Mpinda-Joseph P, Matome M, de Lemos LLP, Sefah I, Kurdi A, Opanga S, Jakupi A, Saleem Z, Hassali MA, Kibuule D, Fadare J, Bochenek T, Rothe C, Furst J, Markovic-Pekovic V, Bojanić L, Schellack N, Meyer JC, Matsebula Z, Phuong TNT, Thanh BN, Jan S, Kalungia A, Mtapuri-Zinyowera S, Sartelli M, Hill R. Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future. Curr Med Res Opin 2020; 36:301-327. [PMID: 31794332 DOI: 10.1080/03007995.2019.1700947] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Introduction: Antibiotics are indispensable to maintaining human health; however, their overuse has resulted in resistant organisms, increasing morbidity, mortality and costs. Increasing antimicrobial resistance (AMR) is a major public health threat, resulting in multiple campaigns across countries to improve appropriate antimicrobial use. This includes addressing the overuse of antimicrobials for self-limiting infections, such as upper respiratory tract infections (URTIs), particularly in lower- and middle-income countries (LMICs) where there is the greatest inappropriate use and where antibiotic utilization has increased the most in recent years. Consequently, there is a need to document current practices and successful initiatives in LMICs to improve future antimicrobial use.Methodology: Documentation of current epidemiology and management of URTIs, particularly in LMICs, as well as campaigns to improve future antimicrobial use and their influence where known.Results: Much concern remains regarding the prescribing and dispensing of antibiotics for URTIs among LMICs. This includes considerable self-purchasing, up to 100% of pharmacies in some LMICs. However, multiple activities are now ongoing to improve future use. These incorporate educational initiatives among all key stakeholder groups, as well as legislation and other activities to reduce self-purchasing as part of National Action Plans (NAPs). Further activities are still needed however. These include increased physician and pharmacist education, starting in medical and pharmacy schools; greater monitoring of prescribing and dispensing practices, including the development of pertinent quality indicators; and targeted patient information and health education campaigns. It is recognized that such activities are more challenging in LMICs given more limited resources and a lack of healthcare professionals.Conclusion: Initiatives will grow across LMICs to reduce inappropriate prescribing and dispensing of antimicrobials for URTIs as part of NAPs and other activities, and these will be monitored.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Health Economics Centre, University of Liverpool, Liverpool, UK
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Judy McKimm
- Swansea University School of Medicine, Grove Building, Swansea University, Wales UK
| | - Muhamad Abu Bakar
- Unit of Otolaryngology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | | | - Janney Wale
- Independent Consumer Advocate, Brunswick, Victoria, Australia
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Antony P Martin
- Health Economics Centre, University of Liverpool, Liverpool, UK
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Tirana, Albania
| | - Vafa Abilova
- Analytical Expertise Center, Ministry of Health, Baku, Azerbaijan Republic
| | | | - Pinkie Mpinda-Joseph
- Department of Infection Prevention and Control, Nyangabgwe Hospital, Francistown, Botswana
| | | | - Livia Lovato Pires de Lemos
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, sala, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, Campus Pampulha, Minas Gerais, CEP, Brazil
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Minas Gerais, CEP, Brazil
| | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Sylvia Opanga
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Hamdard Institute of Pharmaceutical Sciences, Hamdard University, Islamabad, Pakistan
| | | | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
| | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Celia Rothe
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Jurij Furst
- Health Insurance Institute, Ljubljana, Slovenia
| | - Vanda Markovic-Pekovic
- Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Ljubica Bojanić
- Public Health Institute, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Natalie Schellack
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Thuy Nguyen Thi Phuong
- Department of Pharmaceutical Administration and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Binh Nguyen Thanh
- Department of Pharmaceutical Administration and PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Saira Jan
- Department of Clinical Pharmacy, Rutgers State University of New Jersey, Piscataway, NJ, USA
- Department of Pharmacy Strategy and Clinical Integration, Horizon Blue Cross Blue Shield of New Jersey, Newark, NJ, USA
| | - Aubrey Kalungia
- Department of Pharmacy, University of Zambia, Lusaka, Zambia
| | | | - Massimo Sartelli
- Department of Surgery, University of Macerata, Macerata Hospital, Macerata, MC, Italy
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Liverpool University, Liverpool, UK
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Bolukaoto JY, Kock MM, Strydom KA, Mbelle NM, Ehlers MM. Molecular characteristics and genotypic diversity of enterohaemorrhagic Escherichia coli O157:H7 isolates in Gauteng region, South Africa. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 692:297-304. [PMID: 31351277 DOI: 10.1016/j.scitotenv.2019.07.119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/04/2019] [Accepted: 07/08/2019] [Indexed: 06/10/2023]
Abstract
Enterohaemorrhagic Escherichia coli (EHEC) O157:H7 is one of the major foodborne and waterborne pathogens causing severe diseases and outbreaks worldwide. There is scarcity of EHEC O157:H7 data in South Africa. This study was carried out to determine the molecular characteristics and genotypic diversity of EHEC O157:H7 isolates in the Gauteng region, South Africa. Samples were cultured on selective chromogenic media. Antibiotic susceptibility profile of isolates was determined using the VITEK®-2 automated system. Isolates were characterised using multiplex PCR assays and the genetic diversity was determined using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). A total of 520 samples of which 270 environmental water samples and 250 stool specimens were collected and analysed. Overall, EHEC O157:H7 was recovered from 2.3% (12/520) of samples collected. Environmental water samples and clinical stool specimens showed a prevalence of 4.07% (11/270) and 0.4% (1/250) respectively. Antibiotic susceptibility profile varied from isolates with full susceptibility to isolates with resistance to multiple antibiotics. Most resistance was detected to the penicillins, specifically ampicillin (7/12), amoxicillin (3/12) and piperacillin/Tazobactam (3/12) followed by one of the folate inhibitors, trimethoprim (3/12) and the carbapenems, imipenem and meropenem (2/12) each. Three isolates harboured a combination of Shiga-toxins (Stx)-2, intimin (eae) and enterohaemolysin (hlyA) genes, while two isolates harboured the Stx-1, Stx-2 and hlyA genes. The PFGE performed showed that EHEC O157:H7 isolates were genetically diverse, with two minor pulsotypes and eight singletons. The MLST analysis identified three sequence types (STs) (ST10, ST11 and ST1204) that have been previously reported associated with outbreaks. The STs identified in this study pose a potential public health risk to consumers of untreated environmental water and closed human contacts. There is necessity to enhance surveillance in reducing the propagation of this bacterium which is a public health problem.
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Affiliation(s)
- John Y Bolukaoto
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, South Africa
| | - Marleen M Kock
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, South Africa; National Health Laboratory Service, Tshwane Academic Division, Pretoria, South Africa
| | - Kathy-Anne Strydom
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, South Africa; Ampath National Laboratory Service, Pretoria, South Africa
| | - Nontombi M Mbelle
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, South Africa; National Health Laboratory Service, Tshwane Academic Division, Pretoria, South Africa
| | - Marthie M Ehlers
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, South Africa; National Health Laboratory Service, Tshwane Academic Division, Pretoria, South Africa.
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The added value of the selective SuperPolymyxin™ medium in detecting rectal carriage of Gram-negative bacteria with acquired colistin resistance in intensive care unit patients receiving selective digestive decontamination. Eur J Clin Microbiol Infect Dis 2019; 39:265-271. [PMID: 31691864 PMCID: PMC7010615 DOI: 10.1007/s10096-019-03718-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/20/2019] [Indexed: 12/02/2022]
Abstract
The objective of this study was to determine the value of using SuperPolymyxin™ selective medium (ELITech Group, Puteaux, France) in addition to conventional non-selective inoculation methods in the detection of acquired colistin resistance in a Dutch intensive care unit (ICU) that routinely uses selective decontamination of the digestive tract (SDD). We performed a cross-sectional study with prospective data collection in a tertiary-care ICU. All consecutive surveillance rectal swabs of ICU-patients receiving SDD were included and cultured in an observer-blinded approach using (1) a conventional culture method using non-selective media and (2) SuperPolymyxin™ selective medium. MIC values for colistin of non-intrinsically colistin-resistant Gram-negative isolates were determined with broth microdilution (BMD) using Sensititre™ and colistin resistance was confirmed using BMD according to EUCAST guidelines. One thousand one hundred five rectal swabs of 428 unique ICU-patients were inoculated using both culture methods, yielding 346 and 84 Gram-negative isolates for BMD testing with the conventional method and SuperPolymyxin™ medium, of which 308 and 80 underwent BMD, respectively. The number of identified rectal carriers of isolates with acquired colistin resistance was 3 (0.7%) for the conventional method, 4 (0.9%) for SuperPolymyxin™, and 5 (1.2%) for both methods combined. The number of isolates with acquired colistin resistance was 4 (1.0%) for the conventional method, 8 (2.1%) for SuperPolymyxin™ and 9 (2.3%) for both methods combined. In a surveillance setting of low prevalence of acquired colistin resistance in patients that receive SDD in a Dutch tertiary-care ICU, SuperPolymyxin™ had a higher diagnostic yield than conventional inoculation methods, but the combination of both had the highest diagnostic yield.
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47
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Gazel D, Tatman Otkun M, Akçalı A. In vitro activity of methylene blue and eosin methylene blue agar on colistin-resistant A. baumannii: an experimental study. J Med Microbiol 2019; 68:1607-1613. [PMID: 31535963 DOI: 10.1099/jmm.0.001078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction. Colistin is a last-resort antibiotic used against carbapenem-resistant Acinetobacter baumannii (AB); however, colistin resistance has been reported recently. Methylene blue (MB) is used in microbiology for staining, and in medicine as an antidote drug.Aim. We aimed to investigate the antimicrobial effects of MB and eosin methylene blue (EMB) agar against colistin-resistant AB strains.Methodology. Firstly, a standard strain and AB clinical isolate were included in the study. After determining MICs, two strains were transformed into colistin-resistant forms, using Li's method. At each step, new MICs were determined and subcultures were inoculated onto EMB and sheep blood agar (SBA). Colistin MICs of the subcultures were also determined using Mueller-Hinton agar (MHA) containing MB. Secondly, colistin-resistant clones from 31 multidrug-resistant AB clinical isolates were screened to investigate their susceptibilities to EMB agar.Results. In the first round, MICs of both strains had risen to 64 μg ml-1. Subpopulations with high colistin resistance were inhibited by MB and EMB agar, but could grow well on SBA. In MHA plates containing MB, the MICs decreased to 0.5 μg ml-1 for colistin-susceptible or moderately resistant clones. Additionally, clones with high colistin resistance showed atypical colony morphology on SBA. In the second round, 35 % of the clinical isolates, which had gained resistance to colistin, were inhibited by EMB agar.Conclusion. MB may have inhibitory effects against colistin-resistant AB. Secondly, using only EMB agar for subculturing may cause missing of colistin-resistant strains.
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Affiliation(s)
- Deniz Gazel
- Department of Medical Microbiology, Gaziantep University, Faculty of Medicine, Gaziantep, Turkey
| | - Müşerref Tatman Otkun
- Department of Medical Microbiology, Çanakkale Onsekiz Mart University, Faculty of Medicine, Çanakkale, Turkey
| | - Alper Akçalı
- Department of Medical Microbiology, Çanakkale Onsekiz Mart University, Faculty of Medicine, Çanakkale, Turkey
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48
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Rule R, Mbelle N, Sekyere JO, Kock M, Hoosen A, Said M. A rare case of Colistin-resistant Salmonella Enteritidis meningitis in an HIV-seropositive patient. BMC Infect Dis 2019; 19:806. [PMID: 31521113 PMCID: PMC6744686 DOI: 10.1186/s12879-019-4391-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 08/19/2019] [Indexed: 11/22/2022] Open
Abstract
Background Non-typhoidal salmonellae (NTS) have been associated with invasive disease, notably meningitis, in immunocompromised individuals. Infections of this nature carry high rates of morbidity and mortality. Colistin resistance in salmonellae is a rare finding, more so in an invasive isolate such as cerebrospinal fluid (CSF). Colistin resistance has important infection control implications and failure to manage this phenomenon may lead to the loss of our last line of defence against multi-drug resistant Gram-negative organisms. To our knowledge, this is the first reported clinical case of colistin-resistant Salmonella Enteritidis meningitis in South Africa. Case presentation We report a case of a young male patient with advanced human immunodeficiency virus (HIV) infection who presented to hospital with symptoms of meningitis. Cerebrospinal fluid (CSF) cultured a Salmonella Enteritidis strain. Antimicrobial susceptibility testing (AST) of the isolate, revealed the strain to be colistin resistant. Despite early and aggressive antimicrobial therapy, the patient succumbed to the illness after a short stay in hospital. Subsequent genomic analysis of the isolate showed no presence of the mcr genes or resistance-conferring mutations in phoPQ, pmrAB, pmrHFIJKLME/arnBCADTEF, mgrB, and acrAB genes, suggesting the presence of a novel colistin resistance mechanism. Conclusion Invasive non-typhoidal salmonellae infection should be suspected in patients with advanced immunosuppression who present with clinical features of meningitis. Despite early and appropriate empiric therapy, these infections are commonly associated with adverse outcomes to the patient. Combination therapy with two active anti-Salmonella agents may be a consideration in the future to overcome the high mortality associated with NTS meningitis. Colistin resistance in clinical Salmonella isolates, although a rare finding at present, has significant public health and infection control implications. The causative mechanism of resistance should be sought in all cases. Electronic supplementary material The online version of this article (10.1186/s12879-019-4391-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roxanne Rule
- Department of Medical Microbiology, Pathology Building, University of Pretoria, Prinshof Campus, Corner of Steve Biko Road and Dr Savage Road, Pretoria, 0084, South Africa. .,Tshwane Academic Division, National Health Laboratory Service, Corner of Steve Biko Road and Dr Savage Road, Pretoria, 0084, South Africa.
| | - Nontombi Mbelle
- Department of Medical Microbiology, Pathology Building, University of Pretoria, Prinshof Campus, Corner of Steve Biko Road and Dr Savage Road, Pretoria, 0084, South Africa.,Tshwane Academic Division, National Health Laboratory Service, Corner of Steve Biko Road and Dr Savage Road, Pretoria, 0084, South Africa
| | - John Osei Sekyere
- Department of Medical Microbiology, Pathology Building, University of Pretoria, Prinshof Campus, Corner of Steve Biko Road and Dr Savage Road, Pretoria, 0084, South Africa
| | - Marleen Kock
- Department of Medical Microbiology, Pathology Building, University of Pretoria, Prinshof Campus, Corner of Steve Biko Road and Dr Savage Road, Pretoria, 0084, South Africa.,Tshwane Academic Division, National Health Laboratory Service, Corner of Steve Biko Road and Dr Savage Road, Pretoria, 0084, South Africa
| | - Anwar Hoosen
- Vermaak and Partners Pathologists, Unitas Hospital, Corner of Rabie Street and Clifton Avenue, Lyttelton Manor, Pretoria, 0157, South Africa
| | - Mohamed Said
- Department of Medical Microbiology, Pathology Building, University of Pretoria, Prinshof Campus, Corner of Steve Biko Road and Dr Savage Road, Pretoria, 0084, South Africa.,Tshwane Academic Division, National Health Laboratory Service, Corner of Steve Biko Road and Dr Savage Road, Pretoria, 0084, South Africa
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49
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Zhang H, Srinivas S, Xu Y, Wei W, Feng Y. Genetic and Biochemical Mechanisms for Bacterial Lipid A Modifiers Associated with Polymyxin Resistance. Trends Biochem Sci 2019; 44:973-988. [PMID: 31279652 DOI: 10.1016/j.tibs.2019.06.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/02/2019] [Accepted: 06/05/2019] [Indexed: 01/29/2023]
Abstract
Polymyxins are a group of detergent-like antimicrobial peptides that are the ultimate line of defense against carbapenem-resistant pathogens in clinical settings. Polymyxin resistance primarily originates from structural remodeling of lipid A anchored on bacterial surfaces. We integrate genetic, structural, and biochemical aspects of three major types of lipid A modifiers that have been shown to confer intrinsic colistin resistance. Namely, we highlight ArnT, a glycosyltransferase, EptA, a phosphoethanolamine transferase, and the AlmEFG tripartite system, which is restricted to EI Tor biotype of Vibrio cholerae O1. We also discuss the growing family of mobile colistin resistance (MCR) enzymes, each of which is analogous to EptA, and which pose great challenges to global public health.
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Affiliation(s)
- Huimin Zhang
- Department of Pathogen Biology and Microbiology, and Department of General Intensive Care Unit of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China; Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Swaminath Srinivas
- Department of Pathogen Biology and Microbiology, and Department of General Intensive Care Unit of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China; Department of Biochemistry, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Yongchang Xu
- Department of Pathogen Biology and Microbiology, and Department of General Intensive Care Unit of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China
| | - Wenhui Wei
- Department of Pathogen Biology and Microbiology, and Department of General Intensive Care Unit of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China
| | - Youjun Feng
- Department of Pathogen Biology and Microbiology, and Department of General Intensive Care Unit of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China; College of Animal Sciences, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China.
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50
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Anand Paramadhas BD, Tiroyakgosi C, Mpinda-Joseph P, Morokotso M, Matome M, Sinkala F, Gaolebe M, Malone B, Molosiwa E, Shanmugam MG, Raseatlholo GP, Masilo J, Oyeniran Y, Marumoloa S, Maakelo OG, Katjakae I, Kgatlwane J, Godman B, Massele A. Point prevalence study of antimicrobial use among hospitals across Botswana; findings and implications. Expert Rev Anti Infect Ther 2019; 17:535-546. [PMID: 31257952 DOI: 10.1080/14787210.2019.1629288] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: There is an urgent need to undertake Point Prevalence Surveys (PPS) across Africa to document antimicrobial utilisation rates given high rates of infectious diseases and growing resistance rates. This is the case in Botswana along with high empiric use and extended prophylaxis to prevent surgical site infections (SSIs) Method: PPS was conducted among all hospital sectors in Botswana using forms based on Global and European PPS studies adapted for Botswana, including rates of HIV, TB, malaria, and malnutrition. Quantitative study to assess the capacity to promote appropriate antibiotic prescribing. Results: 711 patients were enrolled with high antimicrobial use (70.6%) reflecting an appreciable number transferred from other hospitals (42.9%), high HIV rates (40.04% among those with known HIV) and TB (25.4%), and high use of catheters. Most infections were community acquired (61.7%). Cefotaxime and metronidazole were the most prescribed in public hospitals with ceftriaxone the most prescribed antimicrobial in private hospitals. Concerns with missed antibiotic doses (1.96 per patient), high empiric use, extended use to prevent SSIs, high use of IV antibiotics, and variable infrastructures in hospitals to improve future antibiotic use. Conclusion: High antibiotic use reflects high rates of infectious diseases observed in Botswana. A number of concerns have been identified, which are being addressed.
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Affiliation(s)
| | - Celda Tiroyakgosi
- b Botswana Essential Drugs Action Program , Ministry of Health and Wellness , Gaborone , Botswana
| | - Pinkie Mpinda-Joseph
- c Infection Prevention and Control Program , Nyangabgwe Hospital , Francistown , Botswana
| | - Mathudi Morokotso
- b Botswana Essential Drugs Action Program , Ministry of Health and Wellness , Gaborone , Botswana
| | | | - Fatima Sinkala
- e Department of Pharmacy , Letsholathebe II Memorial Hospital , Maun , Botswana
| | - Mavis Gaolebe
- e Department of Pharmacy , Letsholathebe II Memorial Hospital , Maun , Botswana
| | | | - Emmanuel Molosiwa
- g Department of Pharmacy , Mahalapye District Hospital , Mahalapye , Botswana
| | | | | | - Joyce Masilo
- j Department of Pharmacy , Bobonong Primary Hospital , Bobonong , Botswana
| | - Yomi Oyeniran
- k Department of Pharmacy , Goodhope Primary Hospital , Gaborone , Botswana
| | - Stella Marumoloa
- l Department of Pharmacy , Lethlakane Primary Hospital , Letlhakane , Botswana
| | | | - Ishmael Katjakae
- m Department of Pharmacy , Gweta Primary Hospital , Gweta , Botswana
| | - Joyce Kgatlwane
- n School of Pharmacy , University of Botswana , Gaborone , Botswana
| | - Brian Godman
- o Division of Clinical Pharmacology, Karolinska Institute , Karolinska University Hospital Huddinge , Huddinge , Sweden.,p Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK.,q Health Economics Centre , Liverpool University Management School , Liverpool , UK.,r School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa , South Africa
| | - Amos Massele
- s Department of Biomedical Sciences, Faculty of Medicine , University of Botswana , Gaborone , Botswana
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