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Gahimbare L, Muvunyi CM, Guessennd NAK, Rutanga JP, Gashema P, Fuller W, Mwamelo AJ, Coulibaly SO, Mosha FS, Perovic O, Tali-Maamar H, Yahaya AA. Antimicrobial Resistance in the WHO African Region: A Systematic Literature Review 2016-2020. Antibiotics (Basel) 2024; 13:659. [PMID: 39061341 PMCID: PMC11273377 DOI: 10.3390/antibiotics13070659] [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: 04/11/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 07/28/2024] Open
Abstract
Antimicrobial resistance (AMR) is a significant global public health threat. This review presents the most recent in-depth review of the situation of the main AMR types in relation to the most commonly prescribed antibiotics in the World Health Organization (WHO) African Region. Underlying genes of resistance have been analyzed where possible. A search to capture published research data on AMR from articles published between 2016 and 2020 was done using PubMed and Google Scholar, with rigorous inclusion/exclusion criteria. Out of 48003 articles, only 167 were included. Among the tested gram-negative bacteria species, Klebsiella spp. remain the most tested, and generally the most resistant. The highest overall phenotypic resistance for imipenem was reported in E. coli, whereas for meropenem, E. coli and Haemophilus spp. showed an equal resistance proportion at 2.5%. For gram-positive bacteria, Streptococcus pneumoniae displayed high resistance percentages to trimethoprim/sulfamethoxazole (64.3%), oxacillin (32.2%), penicillin (23.2%), and tetracycline (28.3%), whereas Staphylococcus aureus contributed to 22.8% and 10% resistance to penicillin and oxacillin, respectively. This review shows that AMR remains a major public health threat. The present findings will help public health decision-makers in developing efficient preventive strategies and adequate policies for antibiotic stewardship and surveillance in line with the global action plan for AMR.
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Affiliation(s)
- Laetitia Gahimbare
- World Health Organization Regional Office for Africa Cité du Djoué, Brazzaville P.O. Box 06, Congo; (W.F.); (A.J.M.); (S.O.C.); (F.S.M.); (A.A.Y.)
| | - Claude Mambo Muvunyi
- AMR Consultants, Kigali P.O. Box 3286, Rwanda; (C.M.M.); (N.A.K.G.)
- Rwanda Biomedical Center, Kigali P.O. Box 7162, Rwanda
| | - Nathalie Aya Kouadio Guessennd
- AMR Consultants, Kigali P.O. Box 3286, Rwanda; (C.M.M.); (N.A.K.G.)
- UFR des Sciences Médicales, Université Félix Houphouet Boigny-Institut Pasteur de Côte d’Ivoire, Abidjan P.O. Box, 1563, Côte d’Ivoire
| | - Jean Pierre Rutanga
- CHU de Québec-Université Laval, L’ Hôtel-Dieu de Québec, Laboratoire de Microbiologie, Québec City, QC G1R 2J6, Canada;
| | - Pierre Gashema
- Repolicy Research Centre, Kigali P.O. Box 7584, Rwanda;
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh EH8 9YL, UK
| | - Walter Fuller
- World Health Organization Regional Office for Africa Cité du Djoué, Brazzaville P.O. Box 06, Congo; (W.F.); (A.J.M.); (S.O.C.); (F.S.M.); (A.A.Y.)
| | - Ambele Judith Mwamelo
- World Health Organization Regional Office for Africa Cité du Djoué, Brazzaville P.O. Box 06, Congo; (W.F.); (A.J.M.); (S.O.C.); (F.S.M.); (A.A.Y.)
| | - Sheick Oumar Coulibaly
- World Health Organization Regional Office for Africa Cité du Djoué, Brazzaville P.O. Box 06, Congo; (W.F.); (A.J.M.); (S.O.C.); (F.S.M.); (A.A.Y.)
| | - Fausta Shakiwa Mosha
- World Health Organization Regional Office for Africa Cité du Djoué, Brazzaville P.O. Box 06, Congo; (W.F.); (A.J.M.); (S.O.C.); (F.S.M.); (A.A.Y.)
| | - Olga Perovic
- WHO Collaborating Centre for AMR, National Institute for Communicable Diseases (NICD), a Division of National Health Laboratory Service, Johannesburg 2192, South Africa;
| | | | - Ali Ahmed Yahaya
- World Health Organization Regional Office for Africa Cité du Djoué, Brazzaville P.O. Box 06, Congo; (W.F.); (A.J.M.); (S.O.C.); (F.S.M.); (A.A.Y.)
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da Costa RC, Serrano I, Chambel L, Oliveira M. The importance of "one health approach" to the AMR study and surveillance in Angola and other African countries. One Health 2024; 18:100691. [PMID: 39010949 PMCID: PMC11247297 DOI: 10.1016/j.onehlt.2024.100691] [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: 09/29/2023] [Accepted: 01/29/2024] [Indexed: 07/17/2024] Open
Abstract
The dissemination of multidrug-resistant (MDR) bacterial isolates in low- and middle-income countries, including several African countries, is a major concern. The poor sanitary conditions of rural and urban families observed in certain regions may favor the transmission of bacterial infections between animals and humans, including those promoted by strains resistant to practically all available antibiotics. In Angola, in particular, the presence of these strains in human hospitals has already been described. Nevertheless, the information on antimicrobial resistance (AMR) prevalence in Angola is still scarce, especially regarding veterinary isolates. This review aimed to synthesize data on antimicrobial resistance in African countries, with a special focus on Angola, from a One Health perspective. The main goals were to identify research gaps that may require further analysis, and to draw attention to the importance of the conscious use of antimicrobials and the establishment of preventive strategies, aiming to guarantee the safeguarding of public health. To understand these issues, the available literature on AMR in Africa was reviewed. We searched PubMed for articles pertinent to AMR in relevant pathogens in Angola and other African countries. In this review, we focused on AMR rates and surveillance capacity. The principal findings were that, in Africa, especially in sub-Saharan countries, AMR incidence is high due to the lack of legislation on antibiotics, to the close interaction of humans with animals and the environment, and to poverty. The information about current resistance patterns of common pathogenic bacteria is sparse, and the number of quality studies is limited in Angola and in some other Sub-Saharan African countries. Also, studies on the "One Health Approach" focusing on the environment, animals, and humans, are scarce in Africa. The surveillance capacity is minimal, and only a low number of AMR surveillance programs and national health programs are implemented. Most international and cooperative surveillance programs, when implemented, are not properly followed, concluded, nor reported. In Angola, the national health plan does not include AMR control, and there is a consistent omission of data submitted to international surveillance programs. By identifying One Health strengths of each country, AMR can be controlled with a multisectoral approach and governmental commitment.
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Affiliation(s)
- Romay Coragem da Costa
- CIISA-Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisboa, Portugal
- Department of Animal Health, Faculty of Veterinary Medicine, University José Eduardo dos Santos, Huambo, Angola
| | - Isa Serrano
- CIISA-Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisboa, Portugal
| | - Lélia Chambel
- BioISI-Biosystems and Integrative Sciences Institute, Faculty of Sciences, University of Lisbon, 1749-016 Lisboa, Portugal
| | - Manuela Oliveira
- CIISA-Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisboa, Portugal
- cE3c - Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, 1749-016 Lisboa, Portugal
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Monari C, Onorato L, Coppola N, Raviglione MCB, Gon G. Burden of Antimicrobial Resistance Among Women with Post-Partum Infections in Low-Middle Income Countries: A Systematic Review. J Epidemiol Glob Health 2024; 14:274-290. [PMID: 38630391 PMCID: PMC11176113 DOI: 10.1007/s44197-024-00222-8] [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: 12/22/2023] [Accepted: 03/26/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Due to the rising incidence of multidrug-resistant (MDR) pathogens, especially in Low-Middle-Income Countries (LMIC), post-partum infections represent a significant treatment challenge. METHODS We performed a systematic review of the literature from January 2005 to February 2023 to quantify the frequency of maternal post-partum infections due to MDR pathogens in LMICs, focusing on methicillin-resistant Staphylococcus aureus (MRSA) and/or extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales. SECONDARY OBJECTIVES description of antimicrobials' prescriptions. FINDINGS We included 22 studies with 14,804 total bacterial isolates from 12 countries, mostly from WHO African-Region. Twelve papers described wound- and 10 puerperal-infections. Seven were high-quality articles. Seventeen studies reported data on MRSA, and 18 on ESBL-producing Enterobacterales. Among high-quality studies, MRSA ranged from 9.8% in Ghana to 91.2% in Uganda; ESBL-producing Enterobacterales ranged from 22.8% in Ukraine to 95.2% in Uganda. Nine articles, mostly on C-sections, described different protocols for antibiotic prophylaxis and/or post-partum treatment. INTERPRETATION We described a high burden of post-partum infections caused by MRSA and/or ESBL-producing Enterobacterales in LMICs, but only a few studies met quality standards. There is an urgent need for high-quality studies to better describe the real burden of antimicrobial resistance in low-resource settings and inform policies to contain the spread of multidrug-resistant organisms.
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Affiliation(s)
- Caterina Monari
- Infectious Diseases Unit, AOU Luigi Vanvitelli, Naples, Italy
| | - Lorenzo Onorato
- Section of Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy
| | - Nicola Coppola
- Section of Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy.
| | | | - Giorgia Gon
- Department of Infectious Disease Epidemiology, London School Hygiene and Tropical Medicine, London, UK
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Sisay A, Seid A, Tadesse S, Abebe W, Shibabaw A. Assessment of bacterial profile, antimicrobial susceptibility status, and associated factors of isolates among hospitalized patients at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia. BMC Microbiol 2024; 24:116. [PMID: 38575901 PMCID: PMC10993541 DOI: 10.1186/s12866-024-03224-5] [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: 09/16/2023] [Accepted: 02/13/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Antimicrobial resistant bacteria among hospitalized patients are becoming a major public health threat worldwide, mainly in developing countries. Infections by these multidrug resistant pathogens cause high rate of mortality, prolong hospital stays, and affect individual and country economies in greater amounts. Thus, this study aimed to assess the bacterial profile, antimicrobial susceptibility status, and associated factors of isolates from hospitalized patients at the Dessie Comprehensive Specialized Hospital. METHODOLOGY This hospital-based cross-sectional study was conducted between February and April 2021. Consecutive sampling was used to select the study participants. All bacterial isolates were identified using standard bacteriological techniques. Antibiotic susceptibility testing was performed using disk diffusion technique. The data was analyzed using SPSS version 25. Descriptive statistics and logistic regression were used. A P-value of less than 0.05 was considered statistically significant. RESULTS Of 384 clinical samples (blood, urine, stool, wound, vaginal discharge, and ear discharge) processed 180 (46.9%) were culture positive. Overall, Escherichia coli was the predominant isolate (41; 22.8%), followed by Staphylococcus aureus (36; 20%). Most of the isolates were from blood (70; 38.9%). The level of overall drug resistance of the gram-negative bacteria isolates for ampicillin, tetracycline, and cotrimoxazole was (104; 88.1%), (79; 75.9%), and (78; 75.0%), respectively. The overall multidrug rate of isolates was 143 (79.4%). Variables such as history of invasive procedures, chronic underlying diseases, history of hospitalization, and habit of eating raw animal products were statistically significant for the acquisition of bacterial infection. CONCLUSIONS AND RECOMMENDATION E. Coli and S. aureus were the most common isolates. Most of the isolates were resistant to commonly prescribed antibiotics. And also, consumption of raw animal products, chronic underlying disease, previous hospitalization, history of invasive procedures, and educational status were associated with the acquisition of bacterial infections. Therefore, routine antimicrobial susceptibility testing, proper patient management, wise use of antibiotics in clinical settings and health education are recommended.
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Affiliation(s)
- Assefa Sisay
- Department of Medical Laboratory Science, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Abdurahaman Seid
- Department of Medical Laboratory Science, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Selamyhun Tadesse
- Department of Medical Laboratory Science, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Wagaw Abebe
- Department of Medical Laboratory Science, College of Health Science, Woldia University, Woldia, Ethiopia.
| | - Agumas Shibabaw
- Department of Medical Laboratory Science, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Feiz-Haddad MH, Radfar A, Khorami S. Isolated Balantidium coli in a 1.5-Year-Old Boy: A Case Report. Acta Parasitol 2024; 69:1078-1081. [PMID: 38150066 DOI: 10.1007/s11686-023-00755-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 11/20/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Balantidium coli, is a protozoa that can infect humans. Balantidium coli infection is mostly asymptomatic, but can cause of diarrhea, abdominal pain and sometimes perforated colon. There are only few previous reports regarding the infant balantidiasis and there is a little information about its clinical signs and treatment. In Islamic countries pig farming and consumption is prohibited and reservoir host is unknown. METHODS 1.5 years old boy showed sever anorexia and diarrhea. The affected infant was depressed. The evaluation of fecal examination revealed a large number of B. coli trophozoites and cysts leaded us to an uncommon presentation of B. coli in the infant. RESULTS A few reports of human balantidiasis from Iran seems quite extraordinary. Wild boars have been proposed the responsible for transmission of human infection in Iran. CONCLUSION However, this report as the first report of infant balantidiasis in Iran supports the role of other sources and domestic or wild animals as reservoir hosts for B. coli in Iran.
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Affiliation(s)
- Mohammad Hossein Feiz-Haddad
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Parasitology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amir Radfar
- Department of Parasitology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Soleiman Khorami
- Department of Parasitology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Sado K, Keenan K, Manataki A, Kesby M, Mushi MF, Mshana SE, Mwanga JR, Neema S, Asiimwe B, Bazira J, Kiiru J, Green DL, Ke X, Maldonado-Barragán A, Abed Al Ahad M, Fredricks KJ, Gillespie SH, Sabiiti W, Mmbaga BT, Kibiki G, Aanensen D, Smith VA, Sandeman A, Sloan DJ, Holden MTG. Treatment seeking behaviours, antibiotic use and relationships to multi-drug resistance: A study of urinary tract infection patients in Kenya, Tanzania and Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002709. [PMID: 38363770 PMCID: PMC10871516 DOI: 10.1371/journal.pgph.0002709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/17/2023] [Indexed: 02/18/2024]
Abstract
Antibacterial resistance (ABR) is a major public health threat. An important accelerating factor is treatment-seeking behaviour, including inappropriate antibiotic (AB) use. In many low- and middle-income countries (LMICs) this includes taking ABs with and without prescription sourced from various providers, including health facilities and community drug sellers. However, investigations of complex treatment-seeking, AB use and drug resistance in LMICs are scarce. The Holistic Approach to Unravel Antibacterial Resistance in East Africa (HATUA) Consortium collected questionnaire and microbiological data from adult outpatients with urinary tract infection (UTI)-like symptoms presenting at healthcare facilities in Kenya, Tanzania and Uganda. Using data from 6,388 patients, we analysed patterns of self-reported treatment seeking behaviours ('patient pathways') using process mining and single-channel sequence analysis. Among those with microbiologically confirmed UTI (n = 1,946), we used logistic regression to assess the relationship between treatment seeking behaviour, AB use, and the likelihood of having a multi-drug resistant (MDR) UTI. The most common treatment pathway for UTI-like symptoms in this sample involved attending health facilities, rather than other providers like drug sellers. Patients from sites in Tanzania and Uganda, where over 50% of patients had an MDR UTI, were more likely to report treatment failures, and have repeat visits to providers than those from Kenyan sites, where MDR UTI proportions were lower (33%). There was no strong or consistent relationship between individual AB use and likelihood of MDR UTI, after accounting for country context. The results highlight the hurdles East African patients face in accessing effective UTI care. These challenges are exacerbated by high rates of MDR UTI, suggesting a vicious cycle of failed treatment attempts and sustained selection for drug resistance. Whilst individual AB use may contribute to the risk of MDR UTI, our data show that factors related to context are stronger drivers of variations in ABR.
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Affiliation(s)
- Keina Sado
- University of St Andrews, St Andrews, United Kingdom
| | | | | | - Mike Kesby
- University of St Andrews, St Andrews, United Kingdom
| | - Martha F. Mushi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | - Joseph R. Mwanga
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | | | - Joel Bazira
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - John Kiiru
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Xuejia Ke
- University of St Andrews, St Andrews, United Kingdom
| | | | | | | | | | | | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Gibson Kibiki
- Africa Excellence Research Fund, London, United Kingdom
| | | | - V. Anne Smith
- University of St Andrews, St Andrews, United Kingdom
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Maveke SM, Aboge GO, Kanja LW, Mainga AO, Gachau N, Muchira BW, Moriasi GA. Phenotypic and Genotypic Characterization of Extended Spectrum Beta-Lactamase-Producing Clinical Isolates of Escherichia coli and Klebsiella pneumoniae in Two Kenyan Facilities: A National Referral and a Level Five Hospital. Int J Microbiol 2024; 2024:7463899. [PMID: 38384586 PMCID: PMC10881238 DOI: 10.1155/2024/7463899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/10/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
Background The emergence of antimicrobial resistance (AMR) and multidrug resistance (MDR) among Escherichia coli and Klebsiella pneumoniae, especially through the production of extended spectrum β-lactamases (ESBLs), limits therapeutic options and poses a significant public health threat. Objective The aim of this study was to assess the phenotypic and genetic determinants of antimicrobial resistance of ESBL-producing Escherichia coli and Klebsiella pneumoniae isolates from patient samples in two Kenyan Hospitals. Methods We collected 138 E. coli and 127 K. pneumoniae isolates from various clinical specimens at the two health facilities from January 2020 to February 2021. The isolates' ESBL production and antibiotic susceptibility were phenotypically confirmed using a standard procedure. Molecular analysis was done through conventional polymerase chain reaction (PCR) with appropriate primers for gadA, rpoB, blaTEM, blaSHV, blaOXA, blaCTX-M-group-1, blaCTX-M-group-2, blaCTX-M-group-9, and blaCTX-M-group-8/25 genes, sequencing and BLASTn analysis. Results Most E. coli (82.6%) and K. pneumoniae (92.9%) isolates were ESBL producers, with the highest resistance was against ceftriaxone (69.6% among E. coli and 91.3% among K. pneumoniae) and amoxicillin/clavulanic acid (70.9% among K. pneumoniae). The frequency of MDR was 39.9% among E. coli and 13.4% among K. pneumoniae isolates. The commonest MDR phenotypes among the E. coli isolates were CRO-FEP-AZM-LVX and CRO-AZM-LVX, while the FOX-CRO-AMC-MI-TGC-FM, FOX-CRO-FEP-AMC-TZP-AZM-LVX-MI and CRO-AMC-TZP-AZM-MI were the most frequent among K. pneumoniae isolates. Notably, the FOX-CRO-FEP-AMC-TZP-AZM-LVX-MI phenotype was observed in ESBL-positive and ESBL-negative K. pneumoniae isolates. The most frequent ESBL genes were blaTEM (42%), blaSHV (40.6%), and blaOXA (36.2%) among E. coli, and blaTEM (89%), blaSHV (82.7%), blaOXA (76.4%), and blaCTX-M-group-1 (72.5%) were most frequent ESBL genes among K. pneumoniae isolates. The blaSHV and blaOXA and blaTEM genotypes were predominantly associated with FOX-CRO-FEP-MEM and CRO-FEP multidrug resistance (MDR) and CRO antimicrobial resistance (AMR) phenotypes, among E. coli isolates from Embu Level V (16.7%) and Kenyatta National Hospital (7.0%), respectively. Conclusions The high proportion of ESBL-producing E. coli and K. pneumoniae isolates increases the utilization of last-resort antibiotics, jeopardizing antimicrobial chemotherapy. Furthermore, the antimicrobial resistance patterns exhibited towards extended-spectrum cephalosporins, beta-lactam/beta-lactamase inhibitor combinations, fluoroquinolones, and macrolides show the risk of co-resistance associated with ESBL-producing isolates responsible for MDR. Hence, there is a need for regular surveillance and implementation of infection prevention and control strategies and antimicrobial stewardship programs.
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Affiliation(s)
- Sylvia M. Maveke
- Department of Public Health, Pharmacology, and Toxicology, University of Nairobi, P.O. Box 29053-00625, Nairobi, Kenya
| | - Gabriel O. Aboge
- Department of Public Health, Pharmacology, and Toxicology, University of Nairobi, P.O. Box 29053-00625, Nairobi, Kenya
| | - Laetitia W. Kanja
- Department of Public Health, Pharmacology, and Toxicology, University of Nairobi, P.O. Box 29053-00625, Nairobi, Kenya
| | - Alfred O. Mainga
- Department of Public Health, Pharmacology, and Toxicology, University of Nairobi, P.O. Box 29053-00625, Nairobi, Kenya
| | - Naftaly Gachau
- Department of Laboratory Medicine, Microbiology, Kenyatta National Hospital, P.O. Box 20723-00202, Nairobi, Kenya
| | - Beatrice W. Muchira
- Department of Public Health, Pharmacology, and Toxicology, University of Nairobi, P.O. Box 29053-00625, Nairobi, Kenya
| | - Gervason A. Moriasi
- Department of Biochemistry, Microbiology and Biotechnology, Kenyatta University, P.O. Box 43844-00100-GPO, Nairobi, Kenya
- Department of Medical Biochemistry, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya
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Kungu JM, Tegule SS, Awke IA, Namayanja J, Namyalo E, Oposhia J, Olum W, Nyakarahuka L, Kankya C, Dahourou D, Odoi A. Antimicrobial susceptibility profiles of Staphylococcus aureus in cattle and humans in farming communities of Isingiro and Kamuli districts, Uganda. Sci Rep 2024; 14:1900. [PMID: 38253756 PMCID: PMC10803302 DOI: 10.1038/s41598-024-52035-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
Bacterial resistance to antimicrobials is fast becoming a big challenge as resistance to multiple drugs is rising rapidly. The emergence of resistant Staphylococcus aureus worldwide is life-threatening in both humans and animals and yet little is known about the burden of antimicrobial resistance (AMR) in developing countries including Uganda. Therefore, the aims of this study were to determine the prevalence of antimicrobial resistant S. aureus among humans and animals as well as assess the perceptions and practices of farmers in Kamuli and Isingiro districts in Uganda regarding AMR of S. aureus. A cross-sectional study was conducted between July and September 2020 in 147 randomly selected cattle-keeping households in Isingiro and Kamuli districts. A structured questionnaire uploaded in the Kobo-collect online data collection tool was used to assess farmers' perceptions and practices pertaining to AMR in each of the selected households. Nasal swabs (n = 147) were collected from both cattle and humans (farmers). Bacterial isolation and confirmation was done using Gram-staining and biochemical tests. This was followed by antimicrobial susceptibility testing (AST) using the Kirby Bauer disc diffusion method. Only 14/147 (9.5%) cattle samples and 45/147(30.6%) human samples tested positive for S. aureus. All cattle S. aureus isolates were resistant to Nitroimidazoles while 92.9% were resistant to Penicillins. None of the isolates were resistant to Fluoroquinolones and Aminoglycosides. All the 14 isolates exhibited AMR to at least one of the assessed antibiotics and 92.9% (13/14) showed evidence of multidrug resistance (MDR). Likewise, S. aureus human isolates showed high levels of resistance to Nitroimidazoles (100%) and Penicillins (93.3%), with none of the isolates having resistance to Aminoglycosides, and only one exhibiting resistance to Fluoroquinolones (2.2%). All the 45 human isolates exhibited AMR to at least one antibiotic while 93% (42/45) had MDR. Most farmers had good perceptions of AMR, with a significantly higher proportion of respondents from Isingiro than Kamuli showing a better understanding of AMR. Antibiotic prophylaxis was reported to be the least practiced measure of diseases and parasites control (17.0%), with more farmers in Isingiro (33.3%) undertaking it than those in Kamuli (1.3%) (p < 0.001). Penicillins and Nitroimidazoles were reported to be the most used antibiotics among cattle and humans. This study provides evidence of occurrence of S. aureus resistance to antimicrobials commonly used in both humans and livestock in Isingiro and Kamuli districts. Farmers had good perceptions regarding AMR as well as good antimicrobial use practices which can form a basis for mitigation of AMR.
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Affiliation(s)
- Joseph M Kungu
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda.
| | - Sarah S Tegule
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Ilyas A Awke
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | - Edity Namyalo
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | | | - Luke Nyakarahuka
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Clovice Kankya
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | - Agricola Odoi
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, USA
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Attram N, Dela H, Behene E, Kyei NNA, Ocansey K, Yanney JN, Nyarko EO, Addo KK, Koram KA, Fox A, Letizia A, Sanders T. Antimicrobial use of patients with sexually transmitted infection symptoms prior to presentation at five health facilities in Southern Ghana. Antimicrob Resist Infect Control 2023; 12:146. [PMID: 38093385 PMCID: PMC10720218 DOI: 10.1186/s13756-023-01351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Unregulated and inappropriate antimicrobial use are major contributors to the evolution of antimicrobial resistance worldwide. It is important to monitor and collect data on the use of antibiotics at health facilities and in the general population in order to support antimicrobial stewardship programs. METHODS As part of a gonorrhea surveillance study that was conducted from June 2012 to Jan 2018, we administered a questionnaire to elicit information on the types of antimicrobials used by individuals to treat symptoms of a gonorrhea infection prior to presenting at five health facilities in Southern Ghana. RESULTS Almost one-third (383/1,349; 28%) of study participants admitted taking one or more antimicrobial types before hospital presentation, while 138/383 (36%) of those who took antimicrobials could not remember what they ingested. A greater percentage of individuals who reported prior antimicrobial use before presentation at a health facility tested positive for gonorrhea by NAAT (30%), in contrast to 24% for those without prior treatment (p = 0.004). Penicillin and its derivatives, as well as ciprofloxacin and doxycycline, were the most used, while a few individuals reported taking drugs such as kanamycin and rifampin. Males were more likely than females to take an antimicrobial prior to attending a health center. CONCLUSION In order to curb excessive and inappropriate antimicrobial use, antibiotics used by patients before presenting at hospitals ought to be investigated by healthcare providers. It is recommended that health professionals receive continuing education on the consequences of unregulated antimicrobial use.
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Affiliation(s)
- Naiki Attram
- Naval Medical Research Unit-EURAFCENT, Accra, Ghana.
| | - Helena Dela
- Naval Medical Research Unit-EURAFCENT, Accra, Ghana
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Eric Behene
- Naval Medical Research Unit-EURAFCENT, Accra, Ghana
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Nicholas N A Kyei
- Ghana Armed Forces Health Directorate, 37 Military Hospital, Accra, Ghana
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Karen Ocansey
- Naval Medical Research Unit-EURAFCENT, Accra, Ghana
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Jennifer N Yanney
- Naval Medical Research Unit-EURAFCENT, Accra, Ghana
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Edward O Nyarko
- Ghana Armed Forces Health Directorate, 37 Military Hospital, Accra, Ghana
| | - Kennedy K Addo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Kwadwo A Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Anne Fox
- Naval Medical Research Unit-EURAFCENT, Accra, Ghana
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Mzumara GW, Mambiya M, Iroh Tam PY. Protocols, policies and practices for antimicrobial stewardship in hospitalized patients in least-developed and low-income countries: a systematic review. Antimicrob Resist Infect Control 2023; 12:131. [PMID: 37993964 PMCID: PMC10666353 DOI: 10.1186/s13756-023-01335-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND We aimed to identify interventions used to implement antimicrobial stewardship practices among hospitalized patients in least-developed countries. METHODS The research team searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials for studies of AMS interventions in the least developed and low-income countries, published between 2000 and 2023. Included studies had a population of hospitalized patients of all age groups in least-developed countries, implemented an AMS intervention, and reported its impact on prescription practices, clinical outcomes, or microbiological results. The risk of bias was assessed using the integrated quality criteria for review of multiple study designs. A total of 443 articles were identified, 386 articles were screened, 16 full-text papers were reviewed, and 10 studies were included in the analysis. RESULTS The ten studies included three controlled before and after, two qualitative, one controlled interrupted time series, two non-controlled interrupted time series, one quasi-experimental study, and one randomized controlled trial. Three studies implemented either enabling, persuasive, or structural interventions respectively. The rest used bundled strategies, including a combination of persuasive, enabling, structural, and restrictive interventions. Bundled interventions using enabling and persuasive strategies were the most common. These involved creating a prescription guideline, training prescribers on updated methods, and subsequent review and feedback of patient files by members of an AMS team. Improved microbiological surveillance was important to most studies but, sustained improvement in appropriate prescriptions was dependent on enabling or persuasive efforts. Studies noted significant improvements in appropriate prescriptions and savings on the costs of antibiotics. None evaluated the impact of AMS on AMR. CONCLUSION AMS practices generally involve multiple strategies to improve prescription practices. In the setting of least-developed countries, enabling and persuasive interventions are popular AMS measures. However, measured outcomes are heterogeneous, and we suggest that further studies assessing the impact of AMS should report changes in AMR patterns (microbiological outcomes), patient length of stay and mortality (patient outcomes), and changes in prescription practices (prescription outcomes). Reporting on these as outcomes of AMS interventions could make it easier for policymakers to compare which interventions have desirable outcomes that can be generalized to similar settings.
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Affiliation(s)
- Grace Wezi Mzumara
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
- Kamuzu University of Health Sciences, P/Bag 320, Blantyre, Malawi.
| | - Michael Mambiya
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Pui-Ying Iroh Tam
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Kamuzu University of Health Sciences, P/Bag 320, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
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11
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Gebremeskel L, Teklu T, Kasahun GG, Tuem KB. Antimicrobial resistance pattern of Klebsiella isolated from various clinical samples in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:643. [PMID: 37784058 PMCID: PMC10544621 DOI: 10.1186/s12879-023-08633-x] [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: 05/05/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The burden of Klebsiella drug resistance to antimicrobials is a major public health concern worldwide; particularly the problem is severe in developing countries including Ethiopia. Therefore, the aim of this systematic review and meta-analysis is to establish the pooled estimate of Klebsiella drug resistance; and antimicrobial-specific resistance pattern among Klebsiella clinical isoaltes in Ethiopia. METHODS Articles were searched from PubMed, Google Scholar, and Science direct and grey literature from 2009 to 2019. Four authors have independently extracted data on the prevalence and antimicrobial resistance pattern of the isolates. Statistical analysis was conducted by using Open meta-analyst (version 3.13) and Comprehensive meta-analysis (version 3.3). The main outcome measures were the overall Klebsiella resistance; and drug-specific resistance patterns. A random-effects model was used to determine the pooled resistance prevalence with 95% confidence interval (CI), and significant heterogeneity was considered at p < 0.1; and I2 > 50% using DerSimonian and Laird method. In addition, subgroup analyses were conducted to improve the outcome. RESULT We obtained 174 potentially relevant studies through searching electronic databases, and finally, 35 eligible studies were included for meta-analysis. A total of 13,269 study samples participated, from which 1017 Klebsiella species were isolated. The overall Klebsiella resistance in Ethiopia was found to stand at 53.75% (95% CI: 48.35-58.94%). Based on the subgroup analyses; the highest (64.39%); and lowest (46.16%) values were seen in Southern Nations, Nationalities, and Peoples of Ethiopia; and Tigray regions respectively; and the highest Klebsiella resistance was reported to ampicillin (90.56%), followed by amoxicillin (76.01%) and trimethoprim-sulfamethoxazole (66.91%). A relatively low level of resistance rate was observed to amikacin (16.74%) and cefoxitin (29.73%). CONCLUSION The pooled Klebsiella resistance was found to be considerably high (53.75%) to most of the essential antibiotics in Ethiopia. Klebsiella was highly resistant to ampicillin and amoxicillin but relatively lower to amikacin. Therefore, appropriate interventional strategies need to be taken to address the emerging resistance of Klebsiella species.
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Affiliation(s)
- Leake Gebremeskel
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Tewolde Teklu
- Department of Pharmacy, College of health sciences, Aksum University, Aksum, Ethiopia
| | | | - Kald Beshir Tuem
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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12
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Ragueh AA, Aboubaker MH, Mohamed SI, Rolain JM, Diene SM. Emergence of Carbapenem-Resistant Gram-Negative Isolates in Hospital Settings in Djibouti. Antibiotics (Basel) 2023; 12:1132. [PMID: 37508230 PMCID: PMC10376901 DOI: 10.3390/antibiotics12071132] [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: 05/16/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
Introduction: The antimicrobial resistance (AMR) of bacteria is increasing rapidly against all classes of antibiotics, with the increasing detection of carbapenem-resistant isolates. However, while growing prevalence has been reported around the world, data on the prevalence of carbapenem resistance in developing countries are fairly limited. In this study, we investigated and determined the resistance rate to carbapenems among multidrug-resistant Gram-negative bacteria (MDR-GNB) isolated in Djibouti and characterized their resistance mechanisms. Results: Of the 256 isolates, 235 (91.8%) were identified as Gram-negative bacteria (GNB). Of these GNBs, 225 (95.7%) isolates exhibited a multidrug resistance phenotype, and 20 (8.5%) isolates were resistant to carbapenems, including 13 Escherichia coli, 4 Acinetobacter baumannii, 2 Klebsiella pneumoniae and 1 Proteus mirabilis. The most predominant GNB in this hospital setting were E. coli and K. pneumoniae species. Carbapenemase genes such as blaOXA-48 and blaNDM-5 were identified, respectively, in six and four E. coli isolates, whereas the carbapenemase blaNDM-1 was identified in three E. coli, two K. pneumoniae, one P. mirabilis and one A. baumannii. Moreover, three A. baumannii isolates co-hosted blaOXA-23 and blaNDM-1. Materials and Methods: A total of 256 clinical strains collected between 2019 and 2020 were identified using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF). Antibiotic susceptibility testing was performed using disk diffusion and E-test methods. Real-time polymerase chain reaction (RT-PCR), standard PCR and sequencing were used to investigate genes encoding for extended-spectrum-β-lactamases, carbapenemases and colistin resistance genes. Conclusions: We report, for the first time, the presence of MDR-GNB clinical isolates and the emergence of carbapenem-resistant isolates in Djibouti. In addition to performing antimicrobial susceptibility testing, we recommend phenotypic and molecular screening to track the spread of carbapenemase genes among clinical GNB isolates.
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Affiliation(s)
- Ayan Ali Ragueh
- Campus Balbala Croisement RN2-RN5, Université de Djibouti, Djibouti 1904, Djibouti
- MEPHI, IRD, AP-HM, IHU-Méditerranée Infection, Faculté de Pharmacie, Aix-Marseille Universite, 19-21 Boulevard Jean Moulin, CEDEX 05, 13385 Marseille, France
| | | | - Sitani Idriss Mohamed
- Laboratoire de Biologie et de Biochimie Clinique de L'hôpital Général Peltier, 1323, Avenue Maréchal, Djibouti 1119, Djibouti
| | - Jean-Marc Rolain
- MEPHI, IRD, AP-HM, IHU-Méditerranée Infection, Faculté de Pharmacie, Aix-Marseille Universite, 19-21 Boulevard Jean Moulin, CEDEX 05, 13385 Marseille, France
| | - Seydina M Diene
- MEPHI, IRD, AP-HM, IHU-Méditerranée Infection, Faculté de Pharmacie, Aix-Marseille Universite, 19-21 Boulevard Jean Moulin, CEDEX 05, 13385 Marseille, France
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13
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Owusu FA, Obeng-Nkrumah N, Gyinae E, Kodom S, Tagoe R, Tabi BKA, Dayie NTKD, Opintan JA, Egyir B. Occurrence of Carbapenemases, Extended-Spectrum Beta-Lactamases and AmpCs among Beta-Lactamase-Producing Gram-Negative Bacteria from Clinical Sources in Accra, Ghana. Antibiotics (Basel) 2023; 12:1016. [PMID: 37370334 DOI: 10.3390/antibiotics12061016] [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: 03/25/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Beta-lactamase (β-lactamase)-producing Gram-negative bacteria (GNB) are of public health concern due to their resistance to routine antimicrobials. We investigated the antimicrobial resistance and occurrence of carbapenemases, extended-spectrum β-lactamases (ESBLs) and AmpCs among GNB from clinical sources. GNB were identified using matrix-assisted laser desorption/ionization time of flight-mass spectrometry (MALDITOF-MS). Antimicrobial susceptibility testing was performed via Kirby-Bauer disk diffusion and a microscan autoSCAN system. β-lactamase genes were determined via multiplex polymerase chain reactions. Of the 181 archived GNB analyzed, Escherichia coli and Klebsiella pneumoniae constituted 46% (n = 83) and 17% (n = 30), respectively. Resistance to ampicillin (51%), third-generation cephalosporins (21%), and ertapenem (21%) was observed among the isolates, with 44% being multi-drug resistant (MDR). β-lactamase genes such as AmpCs ((blaFOX-M (64%) and blaDHA-M and blaEDC-M (27%)), ESBLs ((blaCTX-M (81%), other β-lactamase genes blaTEM (73%) and blaSHV (27%)) and carbapenemase ((blaOXA-48 (60%) and blaNDM and blaKPC (40%)) were also detected. One K. pneumoniae co-harbored AmpC (blaFOX-M and blaEBC-M) and carbapenemase (blaKPC and blaOXA-48) genes. blaOXA-48 gene was detected in one carbapenem-resistant Acinetobacter baumannii. Overall, isolates were resistant to a wide range of antimicrobials including last-line treatment options. This underpins the need for continuous surveillance for effective management of infections caused by these pathogens in our settings.
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Affiliation(s)
- Felicia A Owusu
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra 00233, Ghana
| | - Noah Obeng-Nkrumah
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra 00233, Ghana
| | - Esther Gyinae
- Department of Microbiology, Korle-Bu Teaching Hospital, Accra 00233, Ghana
| | | | - Rhodalyn Tagoe
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra 00233, Ghana
| | - Blessing Kofi Adu Tabi
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra 00233, Ghana
| | - Nicholas T K D Dayie
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Accra 00233, Ghana
| | - Japheth A Opintan
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Accra 00233, Ghana
| | - Beverly Egyir
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra 00233, Ghana
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14
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Joshi MP, Alombah F, Konduri N, Ndiaye A, Kusu N, Kiggundu R, Lusaya EP, Tuala Tuala R, Embrey M, Hafner T, Traore O, Mbaye M, Akinola B, Namburete D, Acho A, Hema Y, Getahun W, Sayem MA, Nfor E. Moving from assessments to implementation: promising practices for strengthening multisectoral antimicrobial resistance containment capacity. ONE HEALTH OUTLOOK 2023; 5:7. [PMID: 37055845 PMCID: PMC10101730 DOI: 10.1186/s42522-023-00081-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/01/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Antimicrobial resistance (AMR) poses a global threat to human, animal, and environmental health. AMR is a technical area in the Global Health Security Agenda initiative which uses the Joint External Evaluation tool to evaluate national AMR containment capacity. This paper describes four promising practices for strengthening national antimicrobial resistance containment capacity based on the experiences of the US Agency for International Development's Medicines, Technologies, and Pharmaceutical Services Program work with 13 countries to implement their national action plans on AMR in the areas of multisectoral coordination, infection prevention and control, and antimicrobial stewardship. METHODS We use the World Health Organization (WHO) Benchmarks on International Health Regulations Capacities (2019) to guide national, subnational, and facility actions that advance Joint External Evaluation capacity levels from 1 (no capacity) to 5 (sustainable capacity). Our technical approach is based on scoping visits, baseline Joint External Evaluation scores, benchmarks tool guidance, and country resources and priorities. RESULTS We gleaned four promising practices to achieve AMR containment objectives: (1) implement appropriate actions using the WHO benchmarks tool, which prioritizes actions, making it easier for countries to incrementally increase their Joint External Evaluation capacity from level 1 to 5; (2) integrate AMR into national and global agendas. Ongoing agendas and programs at international, regional, and national levels provide opportunities to mainstream and interlink AMR containment efforts; (3) improve governance through multisectoral coordination on AMR. Strengthening multisectoral bodies' and their technical working groups' governance improved functioning, which led to better engagement with animal/agricultural sectors and a more coordinated COVID-19 pandemic response; and (4) mobilize and diversify funding for AMR containment. Long-term funding from diversified funding streams is vital for advancing and sustaining countries' Joint External Evaluation capacities. CONCLUSIONS The Global Health Security Agenda work has provided practical support to countries to frame and conduct AMR containment actions in terms of pandemic preparedness and health security. The WHO benchmarks tool that Global Health Security Agenda uses serves as a standardized organizing framework to prioritize capacity-appropriate AMR containment actions and transfer skills to help operationalize national action plans on AMR.
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Affiliation(s)
- Mohan P. Joshi
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA USA
| | - Fozo Alombah
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA USA
| | - Niranjan Konduri
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA USA
| | - Antoine Ndiaye
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Abidjan, Côte d’Ivoire
| | - Ndinda Kusu
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Nairobi, Kenya
| | - Reuben Kiggundu
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kampala, Uganda
| | - Edgar Peter Lusaya
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Dar Es Salaam, Tanzania
| | - Robert Tuala Tuala
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kinshasa, Democratic Republic of the Congo
| | | | - Tamara Hafner
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA USA
| | - Ousmane Traore
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Bamako, Mali
| | - Mame Mbaye
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Dakar, Senegal
| | - Babatunde Akinola
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Abuja, Nigeria
| | - Denylson Namburete
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Maputo, Mozambique
| | - Alphonse Acho
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Yaoundé, Cameroon
| | - Yacouba Hema
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Ouagadougou, Burkina Faso
| | - Workineh Getahun
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Addis Ababa, Ethiopia
| | - Md Abu Sayem
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Dhaka, Bangladesh
| | - Emmanuel Nfor
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA USA
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Sado K, Keenan K, Manataki A, Kesby M, Mushi MF, Mshana SE, Mwanga J, Neema S, Asiimwe B, Bazira J, Kiiru J, Green DL, Ke X, Maldonado-Barragán A, Abed Al Ahad M, Fredricks K, Gillespie SH, Sabiiti W, Mmbaga BT, Kibiki G, Aanensen D, Smith VA, Sandeman A, Sloan DJ, Holden MT. Treatment seeking behaviours, antibiotic use and relationships to multi-drug resistance: A study of urinary tract infection patients in Kenya, Tanzania and Uganda. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.04.23286801. [PMID: 36945627 PMCID: PMC10029025 DOI: 10.1101/2023.03.04.23286801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Antibacterial resistance (ABR) is a major public health threat. An important accelerating factor is treatment-seeking behaviours, including inappropriate antibiotic (AB) use. In many low- and middle-income countries (LMICs) this includes taking ABs with and without prescription sourced from various providers, including health facilities and community drug sellers. However, investigations of complex treatment-seeking, AB use and drug resistance in LMICs are scarce. The Holistic Approach to Unravel Antibacterial Resistance in East Africa (HATUA) Consortium collected questionnaire and microbiological data from 6,827 adult outpatients with urinary tract infection (UTI)-like symptoms presenting at healthcare facilities in Kenya, Tanzania and Uganda. Among 6,388 patients we analysed patterns of self-reported treatment seeking behaviours ('patient pathways') using process mining and single-channel sequence analysis. Of those with microbiologically confirmed UTI (n=1,946), we used logistic regression to assessed the relationship between treatment seeking behaviour, AB use, and likelihood of having a multi-drug resistant (MDR) UTI. The most common treatment pathways for UTI-like symptoms included attending health facilities, rather than other providers (e.g. drug sellers). Patients from the sites sampled in Tanzania and Uganda, where prevalence of MDR UTI was over 50%, were more likely to report treatment failures, and have repeated visits to clinics/other providers, than those from Kenyan sites, where MDR UTI rates were lower (33%). There was no strong or consistent relationship between individual AB use and risk of MDR UTI, after accounting for country context. The results highlight challenges East African patients face in accessing effective UTI treatment. These challenges increase where rates of MDR UTI are higher, suggesting a reinforcing circle of failed treatment attempts and sustained selection for drug resistance. Whilst individual behaviours may contribute to the risk of MDR UTI, our data show that factors related to context are stronger drivers of ABR.
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Affiliation(s)
- Keina Sado
- University of St Andrews, St Andrews, UK
| | | | | | - Mike Kesby
- University of St Andrews, St Andrews, UK
| | - Martha F Mushi
- Catholic University Of Health And Allied Sciences, Mwanza, Tanzania
| | - Stephen E Mshana
- Catholic University Of Health And Allied Sciences, Mwanza, Tanzania
| | - Joseph Mwanga
- Catholic University Of Health And Allied Sciences, Mwanza, Tanzania
| | | | | | - Joel Bazira
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - John Kiiru
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Xuejia Ke
- University of St Andrews, St Andrews, UK
| | | | | | | | | | | | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi Tanzania
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Dessale M, Mengistu G, Mengist HM. Prevalence, antimicrobial resistance pattern, and associated factors of Salmonella and Shigella among under five diarrheic children attending public health facilities in Debre Markos town, Northwest Ethiopia. Front Public Health 2023; 11:1114223. [PMID: 36815155 PMCID: PMC9939529 DOI: 10.3389/fpubh.2023.1114223] [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: 12/02/2022] [Accepted: 01/20/2023] [Indexed: 02/09/2023] Open
Abstract
Background Under five children are at risk of diarrhea-associated morbidity and mortality. Salmonella and Shigella are major causes of diarrhea in under-five children, especially in developing countries. This study aimed to assess the prevalence, antimicrobial resistance pattern, and associated factors of Salmonella and Shigella among under-five diarrheic children in Debre Markos town public health facilities. Methods A cross-sectional study was conducted at public health facilities in Debre Markos town using a consecutive convenient sampling technique. Data on socio-demographic and associated factors were collected using a structured questionnaire. Salmonella serovars and Shigella species were identified using MacConkey, Xylose Lysine Deoxycholate, Salmonella Shigella agar, and biochemical tests. The antimicrobial resistance pattern was determined by using the modified Kirby-Bauer disk diffusion technique. Results The overall prevalence of Salmonella and Shigella was 11.7% (26/222; 95% CI = 7.2-17.5%). Isolated Salmonella serovars showed a higher rate of resistance (85.7%, 6/7) for both Ampicillin and Amoxicillin/Clavulanic acid while Shigella isolates showed a higher resistance rate to Amoxicillin/Clavulanic acid (78.9%, 15/19) and Ampicillin (73.7%, 14/19). The overall multidrug resistance (MDR) rate of Salmonella and Shigella isolates was 88.5% (23/26). Parent/guardian educational status ≤ elementary school (AOR = 3.783; 95% CI = 1.28-11.19; P = 0.016), presence of two or more under-five children in the family (AOR = 8.999; 95% CI = 2.93-27.69; P < 0.001), unimproved source of drinking water (AOR = 5.010; 95% CI = 1.56-16.10; P = 0.007), the habit of storing cooked foods for later use (AOR = 3.199; 95% CI = 1.07-9.54; P = 0.037), attendance of the child at social gatherings (AOR = 5.387; 95% CI = 1.78-16.35; P = 0.003), and infrequent child fingernail trimming (every ≥ 2 weeks; AOR = 4.693; 95% CI = 1.47-14.94; P = 0.009) showed statistically significant association with the prevalence of culture-confirmed Salmonella and Shigella isolates. Conclusion The prevalence of culture-confirmed Salmonella and Shigella isolates was significantly high in the study area. Salmonella and Shigella isolates exhibited a high rate of MDR pattern. Parent/guardian education level below the elementary school, the presence of two or more under-five children in the family, using unimproved water source, a habit of storing cooked food, and infrequent fingernail trimming were independent predictors of culture-confirmed Salmonella and Shigella. Therefore, besides public health measures, regular surveillance of the prevalence and antimicrobial resistance pattern of Salmonella and Shigella should be routinely practiced in the study setting.
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Affiliation(s)
- Mesfin Dessale
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia,Gidan Health Center, Gidan Woreda Health Office, Gidan, Ethiopia
| | - Getachew Mengistu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Hylemariam Mihiretie Mengist
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia,*Correspondence: Hylemariam Mihiretie Mengist ✉
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Yeboaa C, Odoi H, Owusu Ntim R, Boakye YD, Kwakye-Nuako G, Agyare C, Boamah VE, Badu K. Diversity and antibiograms of bacteria isolated from cutaneous leishmaniasis wounds in the Nkwanta South District of Ghana. Arch Microbiol 2023; 205:74. [PMID: 36707480 DOI: 10.1007/s00203-023-03411-4] [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: 08/25/2022] [Revised: 10/10/2022] [Accepted: 01/09/2023] [Indexed: 01/29/2023]
Abstract
Leishmaniasis is a vector-borne disease caused by an intracellular protozoan parasite. The presence of secondary bacterial infections in cutaneous leishmaniasis wounds exacerbate lesion development and could lead to delay in the healing process. This study sought to determine the resistance patterns of bacteria co-infecting cutaneous leishmaniasis wounds from selected communities in the Nkwanta district. Various bacteria were isolated and characterized from exudates obtained from wound swabs collected with sterile cotton tipped applicators. Confirmation of bacterial identity was done using the analytical profile index and the matrix-assisted laser desorption/ionization time of flight mass spectrometry. Antibiotic susceptibility tests were performed using agar disc diffusion method according to the Clinical and Laboratory Standards Institute breakpoint values. A total of eleven (11) secondary bacterial species (spp) were isolated from the 33 wound samples that tested positive for Leishmania kinetoplast DNA, among which Staphylococcus aureus was the most predominant (31%). The pathogenic bacteria that colonized the wounds included Bacillus subtilis (23.8%), Pantoea species (11.9%), Klebsiella pneumoniea (7.1%), Enterobacter cloacae (7.1%), Aeromonas species (4.8%), Serratia marcescens (4.8%), Serratia liquefacien (2.4%), Serratia plymutheca (2.4%), Providencia rettgeri (2.4%) and Cronobacter species (2.4%). Most of the isolates were resistant to beta-lactam antibiotics and the third-generation cephalosporin. Notably, 84.6% of the S. aureus isolates were methicillin and ciprofloxacin resistant whilst 92.3% were resistant to ampicillin. About sixty-nine percent (69.2%) showed intermediate susceptibility to Erythromycin. Additionally, S. plymutheca was resistant to all the test antibiotics. This study suggests colonization of cutaneous leishmaniasis wounds with varied bacterial species that are mostly resistant to beta-lactam group of antibiotics.
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Affiliation(s)
- Comfort Yeboaa
- Pharmaceutical Microbiology Section, Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Hayford Odoi
- Department of Pharmaceutical Microbiology, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - Rhoda Owusu Ntim
- Vector-Borne Infectious Diseases Lab, Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yaw Duah Boakye
- Pharmaceutical Microbiology Section, Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Godwin Kwakye-Nuako
- Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Christian Agyare
- Pharmaceutical Microbiology Section, Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Vivian Etsiapa Boamah
- Pharmaceutical Microbiology Section, Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Kingsley Badu
- Vector-Borne Infectious Diseases Lab, Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Manyi-Loh CE, Okoh AI, Lues R. Prevalence of Multidrug-Resistant Bacteria (Enteropathogens) Recovered from a Blend of Pig Manure and Pinewood Saw Dust during Anaerobic Co-Digestion in a Steel Biodigester. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:984. [PMID: 36673737 PMCID: PMC9859553 DOI: 10.3390/ijerph20020984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/19/2022] [Accepted: 01/02/2023] [Indexed: 06/17/2023]
Abstract
South Africa adopts intensive livestock farming, embracing the employment of huge quantities of antibiotics to meet the increased demand for meat. Therefore, bacteria occurring in the animal products and manure might develop antibiotic resistance, a scenario which threatens public health. The study investigated the occurrence of Gram-negative bacteria from eighteen pooled samples withdrawn from a single-stage steel biodigester co-digesting pig manure (75%) and pine wood saw dust (25%). The viable counts for each bacterium were determined using the spread plate technique. The bacterial isolates were characterised based on cultural, morphological and biochemical characteristics, using the Analytical Profile Index 20 e test kit. In addition, isolates were characterised based on susceptibility to 14 conventional antibiotics via the disc diffusion method. The MAR index was calculated for each bacterial isolate. The bacterial counts ranged from 104 to 106 cfu/mL, indicating manure as a potential source of contamination. Overall, 159 bacterial isolates were recovered, which displayed diverse susceptibility patterns with marked sensitivity to amoxicillin (100% E. coli), streptomycin (96.15% for Yersinia spp.; 93.33% for Salmonella spp.) and 75% Campylobacter spp. to nitrofurantoin. Varying resistance rates were equally observed, but a common resistance was demonstrated to erythromycin (100% of Salmonella and Yersinia spp.), 90.63% of E. coli and 78.57% of Campylobacter spp. A total of 91.19% of the bacterial isolates had a MAR index > 0.2, represented by 94 MAR phenotypes. The findings revealed multidrug resistance in bacteria from the piggery source, suggesting they can contribute immensely to the spread of multidrug resistance; thus, it serves as a pointer to the need for the enforcement of regulatory antibiotic use in piggery farms. Therefore, to curb the level of multidrug resistance, the piggery farm should implement control measures in the study area.
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Affiliation(s)
- Christy Echakachi Manyi-Loh
- Centre of Applied Food Sustainability and Biotechnology (CAFSaB), Central University of Technology, Bloemfontein 9301, South Africa
| | - Anthony Ifeanyin Okoh
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice 5700, South Africa
- Department of Environmental Health Sciences, College of Health Sciences, University of Sharjah, Sharjah P.O. Box 26666, United Arab Emirates
| | - Ryk Lues
- Centre of Applied Food Sustainability and Biotechnology (CAFSaB), Central University of Technology, Bloemfontein 9301, South Africa
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Fordjour FA, Kwarteng A. The filarial and the antibiotics: Single or combination therapy using antibiotics for filariasis. Front Cell Infect Microbiol 2022; 12:1044412. [PMID: 36467729 PMCID: PMC9712956 DOI: 10.3389/fcimb.2022.1044412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/24/2022] [Indexed: 12/01/2023] Open
Abstract
Filarial infections caused by nematodes are one of the major neglected tropical diseases with public health concern. Although there is significant decrease in microfilariae (mf) prevalence following mass drug administration (IVM/DEC/ALB administration), this is transient, in that there is reported microfilaria repopulation 6-12 months after treatment. Wolbachia bacteria have been recommended as a novel target presenting antibiotic-based treatment for filarial disease. Potency of antibiotics against filarial diseases is undoubtful, however, the duration for treatment remains a hurdle yet to be overcome in filarial disease treatment.
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Affiliation(s)
- Fatima Amponsah Fordjour
- Department of Microbiology, University for Development Studies (UDS), Tamale, Ghana
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Alexander Kwarteng
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
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Chukwu EE, Awoderu OB, Enwuru CA, Afocha EE, Lawal RG, Ahmed RA, Olanrewaju I, Onwuamah CK, Audu RA, Ogunsola FT. High prevalence of resistance to third-generation cephalosporins detected among clinical isolates from sentinel healthcare facilities in Lagos, Nigeria. Antimicrob Resist Infect Control 2022; 11:134. [PMID: 36348431 PMCID: PMC9640893 DOI: 10.1186/s13756-022-01171-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022] Open
Abstract
Background Antimicrobial resistance (AMR) in bacterial pathogens is a worldwide concern that demands immediate attention. Most information on AMR originates from high-income countries and little is known about the burden in Africa, particularly Nigeria. Using four sentinel sites (General hospitals) in Lagos State, this study sought to estimate the burden of AMR. Methods This is a hospital-based surveillance using secondary health care centres. Four sites were randomly selected and included in the study. Clinical isolates were collected over a period of 6 months for each site from August 2020 to March 2021. All isolates were characterised and analysed for resistance to 15 antibiotics using the Kirby-Baur method. Multiplex PCR assay was used for the detection of Extended spectrum beta lactamase genes. Data analysis was done using SPSS version 27.0. Results Four hundred and ninety-nine (499) patients consented and participated in this study, consisting of 412 (82.6%) females and 87 (17.4%) males. The mean age ± SD of the participants was 33.9 ± 13.8 with a range of 1–89 years. The majority (90.8%) of the participants were outpatients. Two hundred and thirty-two (232) isolates were obtained from 219 samples, comprising of 120 (51.7%) Gram positive and 112 (48.3%) Gram negative organisms. Key bacterial pathogens isolated from this study included Staphylococcus aureus (22.8%), Escherichia coli (16.4%), Staphylococcus spp. (15.9%), Enterococcus spp. (7.3%) and Klebsiella pneumoniae (6.5%). There was high prevalence of multi-drug resistance (79.3%) among the isolates with 73.6% of Staphylococcus aureus phenotypically resistant to methicillin and 70% possessed the MecA gene. 76.5% of Enterococcus spp. isolated were Vancomycin resistant. Overall, resistance to Cephalosporins was most frequently/commonly observed (Cefotaxime 87.5%). Conclusion A high incidence of AMR was identified in clinical bacteria isolates from selected general hospitals in Lagos State, highlighting the necessity for the implementation of national action plans to limit the prevalence of AMR. Surveillance via collection of isolates has a lot of promise, especially in resource-limited environments. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01171-2.
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Affiliation(s)
- Emelda E. Chukwu
- grid.416197.c0000 0001 0247 1197Antimicrobial Resistance Research group, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria
| | - Oluwatoyin B. Awoderu
- grid.416197.c0000 0001 0247 1197Antimicrobial Resistance Research group, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria
| | - Christian A. Enwuru
- grid.416197.c0000 0001 0247 1197Antimicrobial Resistance Research group, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria
| | - Ebelechukwu E. Afocha
- grid.416197.c0000 0001 0247 1197Antimicrobial Resistance Research group, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria
| | - Rahman G. Lawal
- grid.416197.c0000 0001 0247 1197Antimicrobial Resistance Research group, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria
| | - Rahaman A. Ahmed
- grid.416197.c0000 0001 0247 1197Center for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria
| | - Ishola Olanrewaju
- grid.416197.c0000 0001 0247 1197Antimicrobial Resistance Research group, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria
| | - Chika K. Onwuamah
- grid.416197.c0000 0001 0247 1197Center for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria
| | - Rosemary A. Audu
- grid.416197.c0000 0001 0247 1197Antimicrobial Resistance Research group, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria ,grid.416197.c0000 0001 0247 1197Center for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria
| | - Folasade T. Ogunsola
- grid.416197.c0000 0001 0247 1197Antimicrobial Resistance Research group, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria ,grid.411782.90000 0004 1803 1817Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Idi-Araba, Nigeria
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Antibiotic-Resistant Bacteria and Resistance Genes in Isolates from Ghanaian Drinking Water Sources. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:2850165. [PMID: 36246472 PMCID: PMC9560817 DOI: 10.1155/2022/2850165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/04/2022] [Accepted: 09/10/2022] [Indexed: 11/17/2022]
Abstract
The control of infectious diseases is seriously threatened by the increase in the number of microorganisms resistant to antimicrobial agents. Antibiotic-resistant bacteria have also been identified in the water environment. A field study was performed sampling drinking water sources in seven districts of southern Ghana targeting boreholes, dams, hand-dug wells, and streams during baseflow conditions. Bacteria were isolated (N = 110) from a total of 67 water samples to investigate their antimicrobial susceptibility and to determine their carriage of select antibiotic resistance genes. Bacterial identification was performed using conventional selective media methods and the analytical profile index (API) method. Antibiotic susceptibility tests were carried out using the Kirby–Bauer method. Results indicated that all water sources tested were of poor quality based on the presence of fecal indicator organisms. The most commonly occurring bacterium isolated from water was Klebsiella spp. (N = 24, 21.8%), followed by E. coli (N = 23, 20.9%). Gram-negative bacteria isolates were most commonly resistant to cefuroxime (24.5%), while the Gram-positives were most commonly resistant to meropenem (21.3%). The highest rates of bacterial resistances to more than one antibiotic were observed in Klebsiella spp. (30.0%) followed by E. coli (27.8%). PCR was used to detect the presence of a select antibiotic resistance genes in the Gram-negative isolates. The presence of blaNDM-1, sull, tet(O), and tet(W) were observed in isolates from all water sources. In contrast, ermF was not detected in any of the Gram-negative isolates from any water source. Most (28.7%) of the resistance genes were observed in E. coli isolates. Reducing microbial contamination of the various water sources is needed to protect public health and to ensure the sustainability of this resource. This further calls for education of the citizenry.
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Abstract
Neurocritical care (NCC) is an emerging field within critical care medicine, reflecting the widespread prevalence of neurologic injury in critically ill patients. Morbidity and mortality from neurocritical illness (NCI) have been reduced substantially in resource-rich settings (RRS), owing to the development of advanced technologies, neuro-specific units, and subspecialized medical training. Despite shouldering much of the burden of NCI worldwide, resource-limited settings (RLS) face immense hurdles when implementing guidelines generated in RRS. This review summarizes the current epidemiology, management, and outcomes of the most common NCIs in RLS and offers commentary on future directions in NCC practiced in RLS.
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Tornimbene B, Eremin S, Abednego R, Abualas EO, Boutiba I, Egwuenu A, Fuller W, Gahimbare L, Githii S, Kasambara W, Lukwesa-Musyani C, Miamina FA, Mtapuri-Zinyowera S, Najjuka G, Perovic O, Zayed B, Ahmed YA, Ismail MT, Pessoa da Silva CL. Global Antimicrobial Resistance and Use Surveillance System on the African continent: Early implementation 2017–2019. Afr J Lab Med 2022; 11:1594. [PMID: 36091353 PMCID: PMC9453120 DOI: 10.4102/ajlm.v11i1.1594] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/20/2022] [Indexed: 11/06/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is becoming a critical public health issue globally. The World Health Organization launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) to support the strengthening of the AMR evidence base. Objective The article describes the evolution of national AMR surveillance systems and AMR data reporting of countries in the African continent between 2017 and 2019, and the constraints, perceived impact and value of the participation in GLASS. Methods Data on implementation of national surveillance systems and AMR rates were submitted to GLASS between 2017 and 2019 and summarised though descriptive statistics. The information on constraints and perceived impact and value in GLASS participation was collected though a set of questionnaires. Results Between 2017 and 2019, Egypt, Ethiopia, Madagascar, Malawi, Mali, Mozambique, Nigeria, South Africa, Sudan, Tunisia, Uganda and Zambia submitted data to GLASS. The main constraints listed are linked to scarce laboratory capacity and capability, limited staffing, budget issues, and data management. Moreover, while the data are not yet nationally representative, high resistance rates were reported to commonly-used antibiotics, as the emerging resistance to last treatment options. Conclusion Despite the limitations, more and more countries in the African continent are working towards reaching a status that will enable them to report AMR data in a complete and systematic manner. Future improvements involve the expansion of routine surveillance capacity for several countries and the implementation of surveys that allow to effectively define the magnitude of AMR in the continent.
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Affiliation(s)
- Barbara Tornimbene
- AMR Division, Surveillance, Prevention and Control Department, World Health Organization, Geneva, Switzerland
| | - Sergey Eremin
- AMR Division, Surveillance, Prevention and Control Department, World Health Organization, Geneva, Switzerland
| | - Reuben Abednego
- National Health Laboratory Quality Assurance and Training Centre (NHLQATC), Tanzania, Dar es Salaam, United Republic of Tanzania
| | - Elamin O. Abualas
- National Public Health Laboratory, Federal Ministry of Health, Khartoum, Sudan
| | - Ilhem Boutiba
- Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | | | - Walter Fuller
- Antimicrobial Resistance (AMR) World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Laetitia Gahimbare
- Antimicrobial Resistance (AMR) World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Susan Githii
- National Microbiology Reference Lab, National Public Health Laboratories, Nairobi, Kenya
| | | | | | - Fidy A. Miamina
- Department of Health Watch, Epidemiological Surveillance and Response (DVSSER), Antananarivo, Madagascar
| | | | - Grace Najjuka
- Department of Microbiology, Joint Clinical Research Centre (JCRC), Kampala, Uganda
| | - Olga Perovic
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses (CHARM), Johannesburg, South Africa
| | - Bassem Zayed
- World Health Organization, Regional Office for East Mediterranean, Cairo, Egypt
| | - Yahaya A. Ahmed
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Maha T. Ismail
- World Health Organization, Regional Office for East Mediterranean, Cairo, Egypt
| | - Carmem L. Pessoa da Silva
- AMR Division, Surveillance, Prevention and Control Department, World Health Organization, Geneva, Switzerland
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Ruekit S, Srijan A, Serichantalergs O, Margulieux KR, Mc Gann P, Mills EG, Stribling WC, Pimsawat T, Kormanee R, Nakornchai S, Sakdinava C, Sukhchat P, Wojnarski M, Demons ST, Crawford JM, Lertsethtakarn P, Swierczewski BE. Molecular characterization of multidrug-resistant ESKAPEE pathogens from clinical samples in Chonburi, Thailand (2017-2018). BMC Infect Dis 2022; 22:695. [PMID: 35978294 PMCID: PMC9386987 DOI: 10.1186/s12879-022-07678-8] [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: 02/23/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND ESKAPEE pathogens Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp. and Escherichia coli are multi-drug resistant (MDR) bacteria that present increasing treatment challenges for healthcare institutions and public health worldwide. METHODS 431 MDR ESKAPEE pathogens were collected from Queen Sirikit Naval Hospital, Chonburi, Thailand between 2017 and 2018. Species identification and antimicrobial resistance (AMR) phenotype were determined following CLSI and EUCAST guidelines on the BD Phoenix System. Molecular identification of antibiotic resistant genes was performed by polymerase chain reaction (PCR), real-time PCR assays, and whole genome sequencing (WGS). RESULTS Of the 431 MDR isolates collected, 1.2% were E. faecium, 5.8% were S. aureus, 23.7% were K. pneumoniae, 22.5% were A. baumannii, 4.6% were P. aeruginosa, 0.9% were Enterobacter spp., and 41.3% were E. coli. Of the 401 Gram-negative MDR isolates, 51% were carbapenem resistant, 45% were ESBL producers only, 2% were colistin resistance and ESBLs producers (2%), and 2% were non-ESBLs producers. The most prevalent carbapenemase genes were blaOXA-23 (23%), which was only identified in A. baumannii, followed by blaNDM (17%), and blaOXA-48-like (13%). Beta-lactamase genes detected included blaTEM, blaSHV, blaOXA, blaCTX-M, blaDHA, blaCMY, blaPER and blaVEB. Seven E. coli and K. pneumoniae isolates showed resistance to colistin and carried mcr-1 or mcr-3, with 2 E. coli strains carrying both genes. Among 30 Gram-positive MDR ESKAPEE, all VRE isolates carried the vanA gene (100%) and 84% S. aureus isolates carried the mecA gene. CONCLUSIONS This report highlights the prevalence of AMR among clinical ESKAPEE pathogens in eastern Thailand. E. coli was the most common MDR pathogen collected, followed by K. pneumoniae, and A. baumannii. Carbapenem-resistant Enterobacteriaceae (CRE) and extended spectrum beta-lactamases (ESBLs) producers were the most common resistance profiles. The co-occurrence of mcr-1 and mcr-3 in 2 E. coli strains, which did not affect the level of colistin resistance, is also reported. The participation of global stakeholders and surveillance of MDR remain essential for the control and management of MDR ESKAPEE pathogens.
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Affiliation(s)
- Sirigade Ruekit
- Bacterial and Parasitic Diseases Department, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, 10400, Thailand
| | - Apichai Srijan
- Bacterial and Parasitic Diseases Department, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, 10400, Thailand
| | - Oralak Serichantalergs
- Bacterial and Parasitic Diseases Department, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, 10400, Thailand
| | - Katie R Margulieux
- Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Patrick Mc Gann
- Multidrug-Resistant Organism Repository and Surveillance Network (MRSN), Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Emma G Mills
- Multidrug-Resistant Organism Repository and Surveillance Network (MRSN), Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - William C Stribling
- Multidrug-Resistant Organism Repository and Surveillance Network (MRSN), Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | | | | | | | | | | - Mariusz Wojnarski
- Bacterial and Parasitic Diseases Department, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, 10400, Thailand
| | - Samandra T Demons
- Bacterial and Parasitic Diseases Department, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, 10400, Thailand
| | - John M Crawford
- US Army Medical Research Institute of Chemical Defense, Gunpowder, MD, USA
| | - Paphavee Lertsethtakarn
- Bacterial and Parasitic Diseases Department, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, 10400, Thailand.
| | - Brett E Swierczewski
- Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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Siachalinga L, Mufwambi W, Lee LH. Impact of Antimicrobial Stewardship Interventions to Improve Antibiotic Prescribing for Hospital Inpatients in Africa: A Systematic Review and Meta-analysis. J Hosp Infect 2022; 129:124-143. [PMID: 35970382 DOI: 10.1016/j.jhin.2022.07.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Antimicrobial stewardship (AMS) interventions to improve antibiotic use are being implemented in Africa, but their impact is not fully known. AIM To estimate the effectiveness of interventions to improve antibiotic prescribing for hospital inpatients. METHODS Systematically searched for studies from PubMed, Embase, African Journals online and Google scholar from January 2010 to July 2022. Studies were included if they reported the impact of AMS interventions on outcomes of interest for hospital inpatients in Africa. Risk of bias was evaluated using the Cochrane Effective Practice and Organization of Care guidelines and the National Heart, Lung and Blood Institute tool. Findings were summarized in tables and meta-analyses were performed using random-effects models. FINDINGS Twenty-eight studies were included, 89% being uncontrolled before and after studies. Most interventions employed were multifaceted and found to be effective, evidenced by increased compliance, reduction in antibiotic utilization and cost, and slight reduction or no difference in mortality and length of hospital stay (LOS). Meta-analysis generated a relative risk of 0.82 (95% CI: 0.70∼0.97) for mortality, and a standard mean difference of -0.30 (95% CI: -0.41∼-0.19) for LOS. Generally, a decrease in resistance to most microorganisms was observed. Despite an increase in the number of AMS studies conducted in Africa, the studies lack in most quality design features for AMS studies. CONCLUSION Antimicrobial stewardship interventions are likely to be effective, however efforts are still required to align the study design with the quality design features required for validity and to inform practice.
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Affiliation(s)
- Linda Siachalinga
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Webrod Mufwambi
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, 50110, Zambia
| | - Lyn-Hyang Lee
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea.
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Machongo RB, Mipando ALN. "I don't hesitate to use the left-over antibiotics for my child" practices and experiences with antibiotic use among caregivers of paediatric patients at Zomba central hospital in Malawi. BMC Pediatr 2022; 22:466. [PMID: 35918686 PMCID: PMC9347074 DOI: 10.1186/s12887-022-03528-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background Inappropriate use of antibiotics is among the major causes of the global emergency of antibiotic resistance among children. The problem of inappropriate use of antibiotics among children is of special concern because they are still developing immunological systems, hence they are susceptible to many infectious diseases. As such, they receive a considerable disproportional amount of antibiotics which exposes them to antibiotic resistance. This study explored the lived experiences of caregivers of children under the age of five years on the use of antibiotics at Zomba central hospital. Objective The main aim of this study was to explore the lived experiences of caregivers of children under the age of five years on antibiotic usage at Zomba Central Hospital, Zomba-Malawi. Methodology This was a descriptive qualitative study with a phenomenological approach to explore the lived experience of caregivers of paediatric patients on antibiotic usage from May 2019 to July 2020. The study used interview guides to conduct in-depth interviews with 16 caregivers and purposive sampling was used to select the participants from the children’s ward. All interviews were audio-recorded and qualitative data was transcribed verbatim and thematically analysed manually to extract major themes and concepts on the subject matter. Results Caregivers had little knowledge about antibiotic use and its resistance. most caregivers use the antibiotics inappropriately through self-medication, use of left-over antibiotics, buying antibiotics without prescription, and sharing of antibiotics. Conclusion Based on the findings of this study, investment in public awareness and organising community-led interventions in antibiotic use related information is key to improve the quality use of antibiotics. The Government should focus on promoting interventions that lessen the indiscriminate use of antibiotics among the caregivers. Stringent laws need to be enforced by the government to restrict the access of antibiotics to parents without a prescription.
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Affiliation(s)
- Redson Biswick Machongo
- Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi.
| | - Alinane Linda Nyondo Mipando
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi.,Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi
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Trollip A, Gadde R, Datema T, Gatwechi K, Oskam L, Katz Z, Whitelaw A, Kinyanjui P, Njukeng P, Wendifraw DA, Mugerwa I, Najjuka G, Dayie N, Opintan JA, Albert H. Implementation of a customised antimicrobial resistance laboratory scorecard in Cameroon, Ethiopia and Kenya. Afr J Lab Med 2022; 11:1476. [PMID: 35811751 PMCID: PMC9257829 DOI: 10.4102/ajlm.v11i1.1476] [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: 11/30/2020] [Accepted: 03/11/2022] [Indexed: 11/08/2022] Open
Abstract
Background In low-resource settings, antimicrobial resistance (AMR) is detected by traditional culture-based methods and ensuring the quality of such services is a challenge. The AMR Scorecard provides laboratories with a technical assessment tool for strengthening the quality of bacterial culture, identification, and antimicrobial testing procedures. Objective To evaluate the performance of the AMR Scorecard in 11 pilot laboratory evaluations in three countries also assessed with the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. Methods Pilot laboratory evaluations were conducted in Cameroon, Ethiopia and Kenya between February 2019 and March 2019. Assessors with previous SLIPTA and microbiology experience were trained. Assessors performed the laboratory assessments using the SLIPTA and AMR Scorecard tools. Results Weaknesses in technical procedures and the quality management systems were identified in all areas and all laboratories. Safety had the highest mean performance score (SLIPTA: 68%; AMR Scorecard: 73%) while management review had the lowest (SLIPTA: 32%; AMR Scorecard: 8%) across all laboratories. The AMR Scorecard scores were generally consistent with SLIPTA scores. The AMR Scorecard identified technical weaknesses in AMR testing, and SLIPTA identified weaknesses in the quality management systems in the laboratories. Conclusion Since the AMR Scorecard identified important gaps in AMR testing not detected by SLIPTA, it is recommended that microbiology laboratories use SLIPTA and the AMR Scorecard in parallel when preparing for accreditation. Expanding the use of the AMR Scorecard is a priority to address the need for quality clinical microbiology laboratory services in support of optimal patient care and AMR surveillance.
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Affiliation(s)
- André Trollip
- Foundation for Innovative New Diagnostics (FIND) South Africa, Cape Town, South Africa
| | - Renuka Gadde
- Becton, Dickinson & Company, Franklin Lakes, New Jersey, United States
| | | | | | | | - Zachary Katz
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Andrew Whitelaw
- Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Peter Kinyanjui
- National Public Health Laboratory, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Dawit A. Wendifraw
- National Clinical Bacteriology and Mycology Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ibrahimm Mugerwa
- Ministry of Health, National Health Laboratories and Diagnostic Services-AMR-National Coordination Centre, Kampala, Uganda
| | - Grace Najjuka
- National Health Laboratories and Diagnostic Services, Kampala, Uganda
| | - Nicholas Dayie
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Japheth A. Opintan
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Heidi Albert
- Foundation for Innovative New Diagnostics (FIND) South Africa, Cape Town, South Africa
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Asaduzzaman M, Rodland EK, Mekonnen Z, Gradmann C, Winkler AS. Understanding transmission pathways and integrated digital surveillance potential of antimicrobial resistance in Ethiopia in a One Health approach: a mixed-method study protocol. BMJ Open 2022; 12:e051022. [PMID: 35680276 PMCID: PMC9185398 DOI: 10.1136/bmjopen-2021-051022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) has a critical global impact, mostly affecting low- and middle-income countries. A major knowledge gap exists in understanding the transmission pathway of the gut colonisation with AMR bacteria between healthy humans and their animals in addition to the presence of those AMR bacteria in the surrounding environment. A One Health (OH) approach is necessary to address this multisectoral problem. METHODS AND ANALYSIS This cross-sectional, mixed-method OH study design will use both quantitative and qualitative methods of data collection. Quantitative methods will be carried out to assess the prevalence and risk factors associated with multidrug resistant Gram-negative bacteria and vancomycin-resistant enterococci in humans, animals (cattle) and the environment. The focus will be on cattle rearing as an exposure risk for AMR among humans. The assessment of AMR in the population of Jimma, Ethiopia with or without exposure to cattle will reinforce the importance of OH research to identify the impending exchange of resistance profile between humans and animals as well as its ultimate dissemination in the surrounding environment.The targeted semistructured key stakeholder interviews will aid to strengthen the OH-AMR surveillance in Ethiopia by understanding the acceptability of an integrated AMR surveillance platform based on the District Health Information Software-2 and the feasibility of its context-specific establishment. ETHICS AND DISSEMINATION The study has been approved by the Regional Ethics Committee, Norway, and the Institutional Review Board of Jimma University, Ethiopia. The study's data will be stored on a secure server known as Services for Sensitive Data hosted by the University of Oslo. In addition, the new European Union Global Data Protection Guidelines for data sharing, storage and protection will be followed. We will publish the results in peer-reviewed journals and present the findings at national and international conferences.
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Affiliation(s)
- Muhammad Asaduzzaman
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ernst Kristian Rodland
- Department of Antibiotic Resistance and Infection Prevention, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Zeleke Mekonnen
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Christoph Gradmann
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Andrea Sylvia Winkler
- Centre for Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway
- Centre for Global Health, Department of Neurology, Faculty of Medicine, Technical University of Munich, Munich, Germany
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Sadauki AH, Olorukooba AA, Balogun MS, Dalhat MM, Waziri H, Abdulaziz MM, Umeokonkwo CD, Hassan-Hanga F, Sabitu K. Nasal carriage of meticillin-resistant Staphylococcus aureus among children living with HIV attending Infectious Diseases Clinics in Kano, Nigeria. Infect Prev Pract 2022; 4:100213. [PMID: 35574215 PMCID: PMC9095741 DOI: 10.1016/j.infpip.2022.100213] [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: 10/12/2021] [Accepted: 04/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background Children living with HIV (CLWH) are at risk of colonisation and infection with meticillin-resistant Staphylococcus aureus (MRSA). All S. aureus isolates from CLWH with bloodstream infections in Kano were MRSA. Aim To estimate the prevalence of nasal colonisation with S. aureus and MRSA in CLWH in Kano State and to determine associated risk factors. Methods A cross-sectional study was performed in the infectious diseases clinics of two public hospitals in Kano involving 214 CLWH/caregiver pairs. Children were selected from clinic registers by simple random sampling and an interviewer-administered questionnaire used to elicit factors associated with MRSA carriage from the caregivers. Clinical records were reviewed for patients' medical histories. Standard laboratory techniques were used to isolate S. aureus from nasal swabs collected from CLWH. MRSA was detected using the cefoxitin disc diffusion method and PCR for mecA gene detection. We measured the prevalence of S. aureus and MRSA carriage in the CLWH and calculated adjusted odds ratios (AOR) for factors associated with MRSA. Results Nasal S. aureus carriage in CLWH was 18.7% (40/214). Cefoxitin disc diffusion identified 6/214 (2.8%) of CLWH were MRSA carriers, while PCR identified that 9/214 (4.2%) of CLWH were MRSA carriers. Recent hospitalisation (AOR: 61.04; 95% CI: 9.01-413.38) and recent antibiotic therapy (AOR: 7.52; 95% CI: 1.07-52.95) were independent risk factors for MRSA colonisation. Conclusions The rate of MRSA nasal colonisation among CLWH in Kano was similar to that reported in other studies in Africa. Infection prevention and control measures including MRSA screening and decolonisation, as well as education for CLWH and their carers should be introduced to reduce MRSA spread.
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Affiliation(s)
- Aisha Habib Sadauki
- Nigeria Field Epidemiology and Laboratory Training Program, Nigeria Centre for Disease Control, Federal Ministry of Health, Nigeria
| | | | | | | | | | | | - Chukwuma David Umeokonkwo
- African Field Epidemiology Network, Abuja, Nigeria
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
| | - Fatimah Hassan-Hanga
- Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Kabir Sabitu
- Department of Community Medicine, Ahmadu Bello University Zaria, Nigeria
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Kebede B, Yihunie W, Abebe D, Addis Tegegne B, Belayneh A. Gram-negative bacteria isolates and their antibiotic-resistance patterns among pediatrics patients in Ethiopia: A systematic review. SAGE Open Med 2022; 10:20503121221094191. [PMID: 35509958 PMCID: PMC9058367 DOI: 10.1177/20503121221094191] [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: 10/04/2021] [Accepted: 03/22/2022] [Indexed: 11/26/2022] Open
Abstract
Objective: Antimicrobial resistance is one of the serious threats in the world, including Ethiopia. Even though several studies were conducted to estimate common bacteria and their antibiotic-resistance profile in Ethiopia, it is difficult to estimate the overall resistant patterns due to the lack of a nationwide study. This systematic review aimed to determine the prevalence of gram-negative bacteria isolates and their antibiotic-resistance profile among pediatrics patients in Ethiopia. Methods: A web-based search using PubMed, EMBASE, Science Direct, the Cochrane Database for Systematic Reviews, Scopus, Hinari, Sci-Hub, African Journals Online Library, and free-text web searches using Google Scholar was conducted from August to September 16, 2021. Each of the original articles was searched by Boolean search technique using various keywords and was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The data were extracted using Microsoft Excel format and exported to STATA 14.0 for statistical analyses. Results: The database search delivered a total of 2,684 studies. After articles were removed by duplications, title, reading the abstract, and assessed for eligibility criteria, 19 articles were included in the systematic review. Of a total of 1372 (16.77%) culture-positive samples, 735 (53.57%) were gram-negative. Escherichia coli was the most frequently isolated bacteria followed by Klebsiella species, 139/1372 (10.13%), and 125/1372(9.11%), respectively. More than 66.67% of isolates were resistant to ampicillin except for Neisseria meningitidis which was 32.35% (11/34). Pseudomonas aeruginosa, Klebsiela species, and Citrobacter species were 100% resistance for cefepime. Haemophilus influenzae was 100% resistant to meropenem. Salmonella species were 93.30%, 78.26%, and 63.64% resistant to tetracycline, chloramphenicol, and cotrimoxazole, respectively. Conclusion: Gram-negative bacteria were identified as the common pathogen causing infection in pediatrics and the level of resistance to commonly prescribed antibiotics was significantly higher in Ethiopia. Culture and susceptibility tests and well-designed infection control programs are important measures.
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Affiliation(s)
- Bekalu Kebede
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Wubetu Yihunie
- Pharmacology Unit, Department of Pharmacy, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Dehnnet Abebe
- Pharmacognosy Unit, Department of Pharmacy, College of Health Science, Debre Markos University, Debre Markos, Ethiopia1
| | - Bantayehu Addis Tegegne
- Pharmacology Unit, Department of Pharmacy, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Anteneh Belayneh
- Pharmaceutics Unit, Department of Pharmacy, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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Ghenea AE, Zlatian OM, Cristea OM, Ungureanu A, Mititelu RR, Balasoiu AT, Vasile CM, Salan AI, Iliuta D, Popescu M, Udriștoiu AL, Balasoiu M. TEM,CTX-M,SHV Genes in ESBL-Producing Escherichia coli and Klebsiella pneumoniae Isolated from Clinical Samples in a County Clinical Emergency Hospital Romania-Predominance of CTX-M-15. Antibiotics (Basel) 2022; 11:antibiotics11040503. [PMID: 35453254 PMCID: PMC9028254 DOI: 10.3390/antibiotics11040503] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 02/01/2023] Open
Abstract
Background: CTX-M betalactamases have shown a rapid spread in the recent years among Enterobacteriaceae and have become the most prevalent Extended Spectrum Beta-Lactamases (ESBLs) in many parts of the world. The introduction and dissemination of antibiotic-resistant genes limits options for treatment, increases mortality and morbidity in patients, and leads to longer hospitalization and expensive costs. We aimed to identify the beta-lactamases circulating encoded by the genes blaCTX-M-15, blaSHV-1 and blaTEM-1 in Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) strains. Furthermore, we established the associated resistance phenotypes among patients hospitalized in the Intensive Care Unit (ICU) from County Clinical Emergency Hospital of Craiova, Romania. Methods: A total of 46 non-duplicated bacterial strains (14 strains of E. coli and 32 strains of K. pneumoniae), which were resistant to ceftazidime (CAZ) and cefotaxime (CTX) by Kirby–Bauer disk diffusion method, were identified using the automated VITEK2 system. Detection of ESBL-encoding genes and other resistance genes was carried out by PCR. Results. E. coli strains were resistant to 3rd generation cephalosporins and moderately resistant to quinolones, whereas K. pneumoniae strains were resistant to penicillins, cephalosporins, and sulfamides, and moderately resistant to quinolones and carbapenems. Most E. coli strains harbored blaCTX-M-15 gene (13/14 strains), a single strain had the blaSHV-1 gene, but 11 strains harbored blaTEM-1 gene. The mcr-1 gene was not detected. We detected tet(A) gene in six strains and tet(B) in one strain. In K. pneumoniae strains we detected blaCTX-M-15 in 23 strains, blaSHV-1 in all strains and blaTEM-1 in 14 strains. The colistin resistance gene mcr-1 was not detected. The tetracycline gene tet(A) was detected in 11 strains, but the gene tet(B) was not detected in any strains. Conclusions. The development in antibiotic resistance highlights the importance of establishing policies to reduce antibiotic use and improving the national resistance surveillance system in order to create local antibiotic therapy guidelines.
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Affiliation(s)
- Alice Elena Ghenea
- Department of Bacteriology-Virology-Parasitology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.E.G.); (O.M.Z.); (A.U.); (R.R.M.); (M.B.)
| | - Ovidiu Mircea Zlatian
- Department of Bacteriology-Virology-Parasitology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.E.G.); (O.M.Z.); (A.U.); (R.R.M.); (M.B.)
| | - Oana Mariana Cristea
- Department of Bacteriology-Virology-Parasitology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.E.G.); (O.M.Z.); (A.U.); (R.R.M.); (M.B.)
- Correspondence: (O.M.C.); (C.M.V.)
| | - Anca Ungureanu
- Department of Bacteriology-Virology-Parasitology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.E.G.); (O.M.Z.); (A.U.); (R.R.M.); (M.B.)
| | - Radu Razvan Mititelu
- Department of Bacteriology-Virology-Parasitology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.E.G.); (O.M.Z.); (A.U.); (R.R.M.); (M.B.)
| | - Andrei Theodor Balasoiu
- Department of Ophthalmology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Corina Maria Vasile
- Department of Paediatrics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence: (O.M.C.); (C.M.V.)
| | - Alex-Ioan Salan
- Department of Oral and Maxillofacial Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Daniel Iliuta
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Mihaela Popescu
- Department of Endocrinology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Anca-Loredana Udriștoiu
- Faculty of Automation, Computers and Electronics, University of Craiova, 200776 Craiova, Romania;
| | - Maria Balasoiu
- Department of Bacteriology-Virology-Parasitology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.E.G.); (O.M.Z.); (A.U.); (R.R.M.); (M.B.)
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Choonara FE, Haldorsen BC, Ndhlovu I, Saulosi O, Maida T, Lampiao F, Simonsen GS, Essack SY, Sundsfjord A. Antimicrobial susceptibility profiles of clinically important bacterial pathogens at the Kamuzu Central Hospital in Lilongwe, Malawi. Malawi Med J 2022; 34:9-16. [PMID: 37265833 PMCID: PMC10230581 DOI: 10.4314/mmj.v34i1.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND The aim of this prospective study was to ascertain antimicrobial resistance (AMR) in clinical bacterial pathogens from in-hospital adult patients at a tertiary hospital in Lilongwe, Malawi. METHODS Clinical specimens (blood culture, pus, urine and cerebrospinal fluid) collected during June to December 2017 were examined for bacterial growth in standard aerobic conditions. One specimen per patient was included. Antimicrobial susceptibility testing (AST) was performed using the disk diffusion method and interpreted according to EUCAST guidelines. RESULTS A total of 694 specimens were collected during the study period, of which 336 (48%) specimen yielded visible bacterial growth. Of the 336 specimens, a total of 411 phenotypically different isolates were recovered. Of the 411 isolates, 84 isolates (20%) were excluded and the remaining 327 (80%) were further characterised. The characterised isolates were identified as ESKAPE pathogens (n=195/327; 60%), Escherichia coli (n=92/327; 28%), Proteus mirabilis (n=33/327; 10) or Salmonella spp. (n=7/327; 2%) and were included for further analysis. The excluded isolates (n=84) comprised of coagulase-negative staphylococci (n=25), streptococci (n=33), and low-prevalence Gram-negative bacilli (n=26). E. coli (n=92; 28%) and S. aureus (n=86; 26%) were the most dominant species. A multidrug resistant (MDR) extended spectrum β- lactamase (ESBL)-positive phenotype was detected in Klebsiella pneumoniae (n=20/29; 69%) and E. coli (n=49/92; 53%). One third of the Pseudomonas aeruginosa isolates were resistant to meropenem (MEM), but did not appear to be carbapenemase-producers. Methicillin resistant Staphylococcus aureus (MRSA) was molecularly confirmed in 10.5% of S. aureus (n=9/86). CONCLUSION The high proportion of the MDR ESBL-phenotype in clinical isolates of Enterobacterales, strongly limits antimicrobial treatment options and has consequences for empirical and targeted antimicrobial treatment as well as clinical microbiology services and hospital infection control. There is need for a continuous surveillance and an antimicrobial stewardship (AMS) program to contain and prevent the spread of AMR.
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Affiliation(s)
- Faheema E Choonara
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Microbiology Laboratory, Kamuzu Central Hospital, Lilongwe, Malawi
- Africa Centre of Excellence in Public Health and Herbal Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Bjørg C Haldorsen
- Department of Microbiology and Infection Control, Norwegian National Advisory Unit on Detection of Antimicrobial Resistance (K-res), University Hospital of North Norway, Tromsø, Norway
| | - Isaac Ndhlovu
- Microbiology Laboratory, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Osborne Saulosi
- Microbiology Laboratory, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Tarsizio Maida
- Microbiology Laboratory, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Fanuel Lampiao
- Africa Centre of Excellence in Public Health and Herbal Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Gunnar S Simonsen
- Department of Microbiology and Infection Control, Norwegian National Advisory Unit on Detection of Antimicrobial Resistance (K-res), University Hospital of North Norway, Tromsø, Norway
- Research Group for Host-Microbe Interactions, Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Sabiha Y Essack
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Arnfinn Sundsfjord
- Department of Microbiology and Infection Control, Norwegian National Advisory Unit on Detection of Antimicrobial Resistance (K-res), University Hospital of North Norway, Tromsø, Norway
- Research Group for Host-Microbe Interactions, Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Ombelet S, Kpossou G, Kotchare C, Agbobli E, Sogbo F, Massou F, Lagrou K, Barbé B, Affolabi D, Jacobs J. Blood culture surveillance in a secondary care hospital in Benin: epidemiology of bloodstream infection pathogens and antimicrobial resistance. BMC Infect Dis 2022; 22:119. [PMID: 35114948 PMCID: PMC8812239 DOI: 10.1186/s12879-022-07077-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although global surveillance of antimicrobial resistance (AMR) is considered key in the containment of AMR, data from low- and middle-income countries, especially from sub-Saharan Africa, are scarce. This study describes epidemiology of bloodstream infections and antimicrobial resistance rates in a secondary care hospital in Benin. METHODS Blood cultures were sampled, according to predefined indications, in BacT/ALERT FA Plus and PF Plus (bioMérieux, Marcy-l'Etoile, France) blood culture bottles (BCB) in a district hospital (Boko hospital) and to a lesser extent in the University hospital of Parakou. These BCB were incubated for 7 days in a standard incubator and twice daily inspected for visual signs of growth. Isolates retrieved from the BCB were processed locally and later shipped to Belgium for reference identification [matrix-assisted laser desorption/ionization time-of-flight spectrometry (MALDI-TOF)] and antibiotic susceptibility testing (disk diffusion and E-tests). RESULTS From October 2017 to February 2020, 3353 BCB were sampled, corresponding to 3140 blood cultures (212 cultures consisting of > 1 BCB) and 3082 suspected bloodstream infection (BSI) episodes. Most of these cultures (n = 2471; 78.7%) were sampled in children < 15 years of age. Pathogens were recovered from 383 (12.4%) cultures, corresponding to 381 confirmed BSI. 340 of these pathogens were available and confirmed by reference identification. The most common pathogens were Klebsiella pneumoniae (n = 53; 15.6%), Salmonella Typhi (n = 52; 15.3%) and Staphylococcus aureus (n = 46; 13.5%). AMR rates were high among Enterobacterales, with resistance to third-generation cephalosporins in 77.6% of K. pneumoniae isolates (n = 58), 12.8% of Escherichia coli isolates (n = 49) and 70.5% of Enterobacter cloacae isolates (n = 44). Carbapenemase production was detected in 2 Escherichia coli and 2 Enterobacter cloacae isolates, all of which were of the New Delhi metallo-beta lactamase type. Methicillin resistance was present in 22.4% of S. aureus isolates (n = 49). CONCLUSION Blood cultures were successfully implemented in a district hospital in Benin, especially among the pediatric patient population. Unexpectedly high rates of AMR among Gram-negative bacteria against commonly used antibiotics were found, demonstrating the clinical and scientific importance of clinical bacteriology laboratories at this level of care.
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Affiliation(s)
- Sien Ombelet
- Institute of Tropical Medicine, Antwerp, Belgium.
- Department of Microbiology, Immunology & Transplantation, KU Leuven, Leuven, Belgium.
| | | | | | - Esenam Agbobli
- Centre National Hospitalier Universitaire Hubert Koutougou MAGA de Cotonou (CNHU-HKM), Cotonou, Benin
- National Reference Laboratory for Mycobacteria, Cotonou, Benin
| | - Frédéric Sogbo
- Centre National Hospitalier Universitaire Hubert Koutougou MAGA de Cotonou (CNHU-HKM), Cotonou, Benin
- National Reference Laboratory for Mycobacteria, Cotonou, Benin
| | - Faridath Massou
- Centre National Hospitalier Universitaire Hubert Koutougou MAGA de Cotonou (CNHU-HKM), Cotonou, Benin
- National Reference Laboratory for Mycobacteria, Cotonou, Benin
| | - Katrien Lagrou
- Department of Microbiology, Immunology & Transplantation, KU Leuven, Leuven, Belgium
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Dissou Affolabi
- Centre National Hospitalier Universitaire Hubert Koutougou MAGA de Cotonou (CNHU-HKM), Cotonou, Benin
- National Reference Laboratory for Mycobacteria, Cotonou, Benin
| | - Jan Jacobs
- Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology & Transplantation, KU Leuven, Leuven, Belgium
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Mwansa TN, Kamvuma K, Mulemena JA, Phiri CN, Chanda W. Antibiotic susceptibility patterns of pathogens isolated from laboratory specimens at Livingstone Central Hospital in Zambia. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000623. [PMID: 36962542 PMCID: PMC10022373 DOI: 10.1371/journal.pgph.0000623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multidrug resistance (MDR) is a global problem that require multifaceted effort to curb it. This study aimed to evaluate the antibiotic susceptibility patterns of routinely isolated bacteria at Livingstone Central Hospital (LCH). METHODS A retrospective study was performed on all isolated organisms from patient specimens that were processed from January 2019 to December 2021. Specimens were cultured on standard media and Kirby-Bauer disc diffusion method was employed for susceptibility testing following the Clinical and Laboratory Standard Institute's recommendations. RESULTS A total of 765 specimens were processed and only 500 (65.4%) met the inclusion criteria. Of the 500, 291(58.2%) specimens were received from female and from the age-group 17-39 years (253, 50.6%) and 40-80 years (145, 29%) in form of blood (331, 66.2%), urine (165, 33%) and sputum (4, 0.8%). Amongst the bacterial isolates, Staphylococcus aureus (142, 28.4%) was the commonest followed by Escherichia coli (91, 18.2%), and Enterobacter agglomerans (76, 15.2%), and Klebsiella pneumoniae (43, 8.6%). The resistance pattern revealed ampicillin (93%) as the least effective drug followed by oxacillin (88%), penicillin (85.6%), co-trimoxazole (81.5%), erythromycin (71.9%), nalidixic acid (68%), and ceftazidime (60%) whereas the most effective antibiotics were imipenem (14.5%), and piperacillin/tazobactam (16.7%). The screening of methicillin resistant Staphylococcus aureus (MRSA) with cefoxitin showed 23.7% (9/38) resistance. CONCLUSION Increased levels of MDR strains and rising numbers of MRSA strains were detected. Therefore, re-establishing of the empiric therapy is needed for proper patient management, studies to determine the levels of extended spectrum beta lactamase- and carbapenemase-producing bacteria are warranted.
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Affiliation(s)
- Thresa N Mwansa
- Department of Pathology and Microbiology, Mulungushi University School of Medicine and Health Sciences, Livingstone, Zambia
| | - Kingsley Kamvuma
- Department of Pathology and Microbiology, Mulungushi University School of Medicine and Health Sciences, Livingstone, Zambia
| | - John Amos Mulemena
- Department of Pathology and Microbiology, Mulungushi University School of Medicine and Health Sciences, Livingstone, Zambia
| | - Christopher Newton Phiri
- Department of Pathology and Microbiology, Mulungushi University School of Medicine and Health Sciences, Livingstone, Zambia
| | - Warren Chanda
- Department of Pathology and Microbiology, Mulungushi University School of Medicine and Health Sciences, Livingstone, Zambia
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Otieno PA, Campbell S, Maley S, Obinju Arunga T, Otieno Okumu M. A Systematic Review of Pharmacist-Led Antimicrobial Stewardship Programs in Sub-Saharan Africa. Int J Clin Pract 2022; 2022:3639943. [PMID: 36311485 PMCID: PMC9584722 DOI: 10.1155/2022/3639943] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/27/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The misuse of antibiotics contributes significantly to antimicrobial resistance (AMR). Higher treatment costs, longer hospital stays, and clinical failure can all result from AMR. According to projections, Africa and Asia will bear the heaviest burden of AMR-related mortalities in the coming years. Antimicrobial stewardship (AMS) programmes are therefore critical in mitigating the effects of AMR. Pharmacists may play an important role in such programmes, as seen in Europe and North America, but the impact, challenges, and opportunities of pharmacist-led antimicrobial stewardship interventions in Sub-Saharan African hospitals are unknown. The purpose of this systematic review was to assess the impact, challenges, and opportunities of pharmacist-led antimicrobial stewardship interventions in Sub-Saharan African hospitals. METHODS The Joanna Briggs Institute (JBI) guidelines were used to search for peer-reviewed pharmacist-led studies based in hospitals in Sub-Saharan Africa that were published in English between January 2015 and January 2021. The PubMed, Embase, and Ovid databases were used. RESULTS Education and training, audits and feedback, protocol development, and ward rounds were identified as primary components of pharmacist-led antimicrobial stewardship interventions in Sub-Saharan Africa. The pharmacist-led antimicrobial interventions improved adherence to guidelines and reduced inappropriate prescribing, but were hampered by a lack of laboratory and technological support, limited stewardship time, poor documentation, and a lack of guidelines and policies. Funding, mentorship, guidelines, accountability, continuous monitoring, feedback, multidisciplinary engagements, and collaborations were identified as critical in the implementation of pharmacist-led antimicrobial stewardship programmes. CONCLUSIONS These findings suggest that pharmacists in Sub-Saharan African hospitals can successfully lead antimicrobial stewardship programmes but their implementation is limited by lack of mentorship, accountability, continuous monitoring, feedback, collaborations, and poor funding.
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Affiliation(s)
- Phanice Ajore Otieno
- College of Medical, Veterinary and Life Sciences, School of Life Sciences, University of Glasgow, Glasgow, UK
- Department of Health, County Government of Kisumu, PO Box 2738-40100, Kisumu, Kenya
| | - Sue Campbell
- College of Medical, Veterinary and Life Sciences, School of Life Sciences, University of Glasgow, Glasgow, UK
| | - Sonny Maley
- College of Medical, Veterinary and Life Sciences, School of Life Sciences, University of Glasgow, Glasgow, UK
| | - Tom Obinju Arunga
- Department of Health Informatics, Maseno University, Private Bag, Kisumu, Kenya
| | - Mitchel Otieno Okumu
- Department of Health, County Government of Kisumu, PO Box 2738-40100, Kisumu, Kenya
- Department of Public Health Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Nairobi, PO Box 29053-00625, Nairobi, Kenya
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Ankrah D, Owusu H, Aggor A, Osei A, Ampomah A, Harrison M, Nelson F, Aboagye GO, Ekpale P, Laryea J, Selby J, Amoah S, Lartey L, Addison O, Bruce E, Mahungu J, Mirfenderesky M. Point Prevalence Survey of Antimicrobial Utilization in Ghana's Premier Hospital: Implications for Antimicrobial Stewardship. Antibiotics (Basel) 2021; 10:antibiotics10121528. [PMID: 34943740 PMCID: PMC8698913 DOI: 10.3390/antibiotics10121528] [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: 10/27/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 12/19/2022] Open
Abstract
The first comprehensive point prevalence survey at the Korle Bu Teaching Hospital (KBTH) was performed as part of the 2019 Global Point Prevalence Survey (Global-PPS) on antimicrobials. The aim was to establish a PPS baseline for the whole hospital and to identify required stewardship interventions. The PPS was conducted over three days in June 2019 using the GLOBAL-PPS standardized method for surveillance of antimicrobial utilization in hospitals to evaluate antimicrobial prescribing. In all, 988 patients were admitted to 69 wards. Overall antimicrobial prevalence was 53.3%. More community-acquired infections (CAI) were treated empirically compared to health-care associated infections (94.0% vs. 86.1% respectively, p = 0.002). Main indications for prescribing antimicrobials were pneumonia (18.4%), skin and soft tissue infections (11.4%) and sepsis (11.1%). Among antimicrobials, systemic antibiotics accounted for 83.5%, of which amoxicillin with beta-lactam inhibitor (17.5%), metronidazole (11.8%) and ceftriaxone (11.5%) dominated. Guideline compliance was 89.0%. Stop/review dates were completed in 33.4% and documented reason was recorded in 53.0% of all prescriptions. If the findings in this PPS can be addressed antimicrobial stewardship at the KBTH stands to improve significantly.
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Affiliation(s)
- Daniel Ankrah
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
- Correspondence:
| | - Helena Owusu
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Asiwome Aggor
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Anthony Osei
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Agneta Ampomah
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Mark Harrison
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Frempomaa Nelson
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Grace Owusu Aboagye
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Priscilla Ekpale
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Jennifer Laryea
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Julia Selby
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Serwaa Amoah
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Linda Lartey
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Okaikor Addison
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Elizabeth Bruce
- Korle-Bu Teaching Hospital, Accra GA-221-1570, Ghana; (H.O.); (A.A.); (A.O.); (A.A.); (M.H.); (F.N.); (G.O.A.); (P.E.); (J.L.); (J.S.); (S.A.); (L.L.); (O.A.); (E.B.)
| | - Joyce Mahungu
- North Middlesex University Hospital NHS Trust, London N18 1QX, UK; (J.M.); (M.M.)
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Bloodstream Infections at Two Neonatal Intensive Care Units in Ghana: Multidrug Resistant Enterobacterales Undermine the Usefulness of Standard Antibiotic Regimes. Pediatr Infect Dis J 2021; 40:1115-1121. [PMID: 34561387 DOI: 10.1097/inf.0000000000003284] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bloodstream infections (BSIs) are a major cause of morbidity and mortality in hospitalized neonates. Data on antibiotic resistance in neonatal BSIs and their impact on clinical outcomes in Africa are limited. METHODS We conducted a prospective cohort study at 2 tertiary level neonatal intensive care units (NICUs) in Ghana. All neonates admitted to the NICUs were included from October 2017 to September 2019. We monitored BSI rates and analyzed the effect of BSI and antibiotic resistance on mortality and duration of hospitalization. RESULTS Of 5433 neonates included, 3514 had at least one blood culture performed and 355 had growth of a total of 368 pathogenic microorganisms. Overall incidence of BSI was 1.0 (0.9-1.1) per 100 person days. The predominant organisms were Klebsiella pneumoniae 49.7% (183/368) and Streptococcus spp. 10.6% (39/368). In addition, 512 coagulase negative Staphylococci were isolated but considered probable contaminants. Among K. pneumoniae, resistance to gentamicin and amikacin was 91.8% and 16.4%, respectively, while carbapenem resistance was 4.4%. All-cause mortality among enrolled neonates was 19.7% (1066/5416). The mortality rate was significantly higher in neonates with BSI compared with culture-negative neonates in univariate analysis (27.9%, n = 99/355 vs. 16.5%, n = 520/3148; hazard ratio 1.4, 95% confidence interval 1.07-1.70) but not in multivariate analysis. CONCLUSION The diversity of etiologic agents and the high-risk of antibiotic resistance suggest that standard empirical treatment is unlikely to improve the outcome of BSIs in low and middle income. Such improvements will depend on access to reliable clinical microbiologic services.
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Phenotypic and molecular characterization of antimicrobial resistance in clinical species of Enterobacter, Serratia, and Hafnia in Northeast Iran. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2021.101352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abongomera G, Koller M, Musaazi J, Lamorde M, Kaelin M, Tasimwa HB, Eberhard N, Hongler J, Haller S, Kambugu A, Castelnuovo B, Fehr J. Spectrum of antibiotic resistance in UTI caused by Escherichia coli among HIV-infected patients in Uganda: a cross-sectional study. BMC Infect Dis 2021; 21:1179. [PMID: 34814849 PMCID: PMC8609806 DOI: 10.1186/s12879-021-06865-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022] Open
Abstract
Background Antimicrobial drug resistance is one of the top ten threats to global health according to the World Health Organization. Urinary tract infections (UTIs) are among the most common bacterial infections and main reason for antibiotic prescription. The incidence of UTIs appears to be high among people living with HIV. We sought to determine the most common UTI pathogens among HIV infected patients and evaluate their susceptibility towards antibiotics. Methods We performed a cross-sectional study among HIV-infected patients aged ≥ 18 years presenting at an HIV care specialized clinic with symptoms suggestive of a urethritis. Urine cultures were subjected to antibiotic susceptibility testing according to Clinical Laboratory Standards Institute. The data was analyzed using STATA, we performed Pearson’s Chi-square and Fisher’s exact tests to compare differences between proportions. Results Out of the 200 patients, 123 (62%) were female. The median age was 41.9 years (IQR 34.7–49.3). Only 32 (16%) urine cultures showed bacterial growth. Escherichia coli was the most commonly isolated uropathogen (72%), followed by Klebsiella pneumoniae (9%). E. coli was completely resistant to cotrimoxazole and ampicillin; resistance to ciprofloxacin and ceftriaxone was 44% and 35% respectively; 9% to gentamicin; no resistance detected to nitrofurantoin and imipenem. Conclusions Our findings are congruent with the Uganda national clinical guidelines which recommends nitrofurantoin as the first line antibiotic for uncomplicated UTI. Significant ciprofloxacin and ceftriaxone resistance was detected. In the era of emerging antibiotic resistance, understanding the local susceptibilities among sub-populations such as HIV infected patients is crucial. Further investigation is needed to address reasons for the low bacterial growth rate observed in the urine cultures. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06865-3.
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Affiliation(s)
- George Abongomera
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH 8001, Zurich, Switzerland.
| | - Maurice Koller
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH 8001, Zurich, Switzerland
| | - Joseph Musaazi
- Makerere University Infectious Diseases Institute, Kampala, Uganda
| | - Mohammed Lamorde
- Makerere University Infectious Diseases Institute, Kampala, Uganda
| | - Marisa Kaelin
- University Hospital Zurich, Infectious Diseases and Hospital Epidemiology, Zürich, Switzerland
| | | | - Nadia Eberhard
- University Hospital Zurich, Infectious Diseases and Hospital Epidemiology, Zürich, Switzerland
| | - Jan Hongler
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH 8001, Zurich, Switzerland
| | - Sabine Haller
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH 8001, Zurich, Switzerland
| | - Andrew Kambugu
- Makerere University Infectious Diseases Institute, Kampala, Uganda
| | | | - Jan Fehr
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich and University Hospital Zurich, Infectious Diseases and Hospital Epidemiology, Zürich, Switzerland
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Geta K, Kibret M. Knowledge, attitudes and practices of animal farm owners/workers on antibiotic use and resistance in Amhara region, north western Ethiopia. Sci Rep 2021; 11:21211. [PMID: 34707158 PMCID: PMC8551280 DOI: 10.1038/s41598-021-00617-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/14/2021] [Indexed: 11/25/2022] Open
Abstract
Inappropriate use of antibiotics in animal and human plays a role in the emergence and spread of bacteria resistant to antibiotics which threatens human health significantly. Although extensive use of these antibiotics could contribute to the development of drug resistance, information on the knowledge, attitude and practice of antimicrobial resistance and use among animal farm owners/workers in north western Ethiopia is rare. The objective of the present study was to assess knowledge, attitude and practice of animal farm owner/workers towards antibiotic resistance and use in Amhara regional state north western Ethiopia. A cross sectional study was conducted in selected cities of Amhara regional state from January to February, 2020. Data was collected from 91 participants using structured questionnaire and analyzed using SPSSS version 23. The results showed that 96.7% of respondents gave antibiotics to treat their livestock from different sources. Most of the respondents bought their antibiotics from private pharmacies without prescription and the most frequently mentioned antibiotics used to treat animal diseases was tetracycline (76.9%), followed by ampicillin (72.5%). Although, 90.1% of the animal farm owners heard about antibiotics and antibiotic resistance from different sources, they did not know the factors contributing to the transmission of resistant bacteria to humans and the impact of antibiotic resistance on human and animals' health. Using the mean score 4.44 ± 0.15 as the cut-off, half of the animal farm owners/workers had good knowledge about antimicrobial resistance and use. 52.5% of animal farm owners/workers had positive attitudes towards wise antibiotic use and resistance with a mean score of 28.4 ± 0.5. However, 52.75% participants had poor practice with the mean score of practice 4.95 ± 0.17. Better knowledge, positive attitudes and better practices on antibiotic use and resistance were associated with farm owners/workers who engaged in higher education. Although poor awareness on antimicrobial resistance was perceived by 76.9% of respondents as very important factors that contribute to increasing antibiotic resistance, increasing the use of complementary treatments was perceived by the majority of respondents as very important strategies that contribute to reduce antibiotic use and resistance. The current study disclosed that there is low level of awareness among animal farm owners about the correct use of antibiotics and resistance. It is necessary to raise awareness, develop and implement interventions to reduce antimicrobial use and antibiotic resistance in the study area.
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Affiliation(s)
- Kindu Geta
- Department of Biology, Faculty of Natural and Computational Sciences, Debre Tabor University, Debre Tabor, Ethiopia, P.O.Box 272.
| | - Mulugeta Kibret
- Department of Biology, Science College, Bahir Dar University, Bahir Dar, Ethiopia
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Nabadda S, Kakooza F, Kiggundu R, Walwema R, Bazira J, Mayito J, Mugerwa I, Sekamatte M, Kambugu A, Lamorde M, Kajumbula H, Mwebasa H. Implementation of the World Health Organization Global Antimicrobial Resistance Surveillance System in Uganda, 2015-2020: Mixed-Methods Study Using National Surveillance Data. JMIR Public Health Surveill 2021; 7:e29954. [PMID: 34673531 PMCID: PMC8569544 DOI: 10.2196/29954] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 12/17/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is an emerging public health crisis in Uganda. The World Health Organization (WHO) Global Action Plan recommends that countries should develop and implement National Action Plans for AMR. We describe the establishment of the national AMR program in Uganda and present the early microbial sensitivity results from the program. Objective The aim of this study is to describe a national surveillance program that was developed to perform the systematic and continuous collection, analysis, and interpretation of AMR data. Methods A systematic qualitative description of the process and progress made in the establishment of the national AMR program is provided, detailing the progress made from 2015 to 2020. This is followed by a report of the findings of the isolates that were collected from AMR surveillance sites. Identification and antimicrobial susceptibility testing (AST) of the bacterial isolates were performed using standard methods at both the surveillance sites and the reference laboratory. Results Remarkable progress has been achieved in the establishment of the national AMR program, which is guided by the WHO Global Laboratory AMR Surveillance System (GLASS) in Uganda. A functional national coordinating center for AMR has been established with a supporting designated reference laboratory. WHONET software for AMR data management has been installed in the surveillance sites and laboratory staff trained on data quality assurance. Uganda has progressively submitted data to the WHO GLASS reporting system. Of the 19,216 isolates from WHO GLASS priority specimens collected from October 2015 to June 2020, 22.95% (n=4411) had community-acquired infections, 9.46% (n=1818) had hospital-acquired infections, and 68.57% (n=12,987) had infections of unknown origin. The highest proportion of the specimens was blood (12,398/19,216, 64.52%), followed by urine (5278/19,216, 27.47%) and stool (1266/19,216, 6.59%), whereas the lowest proportion was urogenital swabs (274/19,216, 1.4%). The mean age was 19.1 (SD 19.8 years), whereas the median age was 13 years (IQR 28). Approximately 49.13% (9440/19,216) of the participants were female and 50.51% (9706/19,216) were male. Participants with community-acquired infections were older (mean age 28, SD 18.6 years; median age 26, IQR 20.5 years) than those with hospital-acquired infections (mean age 17.3, SD 20.9 years; median age 8, IQR 26 years). All gram-negative (Escherichia coli, Klebsiella pneumoniae, and Neisseria gonorrhoeae) and gram-positive (Staphylococcus aureus and Enterococcus sp) bacteria with AST showed resistance to each of the tested antibiotics. Conclusions Uganda is the first African country to implement a structured national AMR surveillance program in alignment with the WHO GLASS. The reported AST data indicate very high resistance to the recommended and prescribed antibiotics for treatment of infections. More effort is required regarding quality assurance of laboratory testing methodologies to ensure optimal adherence to WHO GLASS–recommended pathogen-antimicrobial combinations. The current AMR data will inform the development of treatment algorithms and clinical guidelines.
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Affiliation(s)
- Susan Nabadda
- Laboratory and Diagnostics Services Department, Ministry of Health, Kampala, Uganda
| | - Francis Kakooza
- Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda.,Department of Immunology and Molecular Biology, Makerere University, Kampala, Uganda
| | - Reuben Kiggundu
- Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda.,United States Agency for International Development Medicines, Technologies, and Pharmaceutical Services Program, Management Sciences for Health, Kampala, Uganda
| | - Richard Walwema
- Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda
| | - Joel Bazira
- Department of Medical Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jonathan Mayito
- Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda
| | - Ibrahimm Mugerwa
- Laboratory and Diagnostics Services Department, Ministry of Health, Kampala, Uganda.,Antimicrobial Resistance Sub-Committee, National One Health Platform, Kampala, Uganda
| | - Musa Sekamatte
- Antimicrobial Resistance Sub-Committee, National One Health Platform, Kampala, Uganda
| | - Andrew Kambugu
- Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda
| | - Mohammed Lamorde
- Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda
| | - Henry Kajumbula
- Antimicrobial Resistance Sub-Committee, National One Health Platform, Kampala, Uganda.,Department of Medical Microbiology, Makerere University, Kampala, Uganda
| | - Henry Mwebasa
- Laboratory and Diagnostics Services Department, Ministry of Health, Kampala, Uganda.,Antimicrobial Resistance Sub-Committee, National One Health Platform, Kampala, Uganda
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Lord J, Gikonyo A, Miwa A, Odoi A. Antimicrobial resistance among Enterobacteriaceae, Staphylococcus aureus, and Pseudomonas spp. isolates from clinical specimens from a hospital in Nairobi, Kenya. PeerJ 2021; 9:e11958. [PMID: 34557345 PMCID: PMC8418212 DOI: 10.7717/peerj.11958] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/21/2021] [Indexed: 12/30/2022] Open
Abstract
Background Antimicrobial resistance among pathogens of public health importance is an emerging problem in sub-Saharan Africa. Unfortunately, published information on the burden and patterns of antimicrobial resistance (AMR) in this region is sparse. There is evidence that the burden and patterns of AMR vary by geography and facility. Knowledge of local epidemiology of AMR is thus important for guiding clinical decisions and mitigation strategies. Therefore, the objective of this study was to determine the burden and predictors of AMR and multidrug resistance (MDR) among bacterial pathogens isolated from specimens submitted to the diagnostic laboratory of a hospital in Nairobi, Kenya. Methods This retrospective study used laboratory records of 1,217 clinical specimens submitted for bacterial culture and sensitivity testing at the diagnostic laboratory of The Karen Hospital in Nairobi, Kenya between 2012 and 2016. Records from specimens positive for Enterobacteriaceae, Staphylococcus aureus, or Pseudomonas spp. isolates were included for analysis. Firth logistic models, which minimize small sample bias, were used to investigate determinants of AMR and MDR of the isolates. Results A total of 222 specimens had bacterial growth. Most Enterobacteriaceae isolates were resistant to commonly used drugs such as penicillin/β-lactamase inhibitor combinations (91.2%) and folate pathway inhibitors (83.7%). Resistance to extended-spectrum cephalosporins was also high (52.9%). Levels of AMR and MDR for Enterobacteriaceae were 88.5% and 51%, respectively. Among S. aureus isolates, 57.1% were AMR, while 16.7% were MDR. As many as 42.1% of the Pseudomonas spp. isolates were aminoglycoside-resistant and 15% were fluoroquinolone-resistant, but none exhibited resistance to antipseudomonal carbapenems. Half of Pseudomonas spp. isolates were AMR but none were MDR. Significant predictors of MDR among Enterobacteriaceae were organism species (p = 0.002) and patient gender (p = 0.024). Conclusions The high levels of extended-spectrum cephalosporin resistance and MDR among Enterobacteriaceae isolates are concerning. However, the relatively low levels of MDR S. aureus, and an absence of carbapenem resistance among Pseudomonas isolates, suggests that last-line drugs are still effective against S. aureus and Pseudomonas infections. These findings are relevant for guiding evidence-based treatment decisions as well as surveillance efforts and directions for future research, and contribute to the sparse literature on AMR in sub-Saharan Africa.
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Affiliation(s)
- Jennifer Lord
- Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, TN, United States of America
| | | | | | - Agricola Odoi
- Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, TN, United States of America
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Simeon P, Godman B, Kalemeera F. Antibiotics' susceptibility patterns of bacterial isolates causing lower respiratory tract infections in ICU patients at referral hospitals in Namibia. Hosp Pract (1995) 2021; 49:356-363. [PMID: 34436942 DOI: 10.1080/21548331.2021.1973825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lower respiratory tract infections (LRTIs) are a particular public health concern especially among sub-Saharan African countries. This is especially the case in Namibia, where LRTIs are currently the third leading cause of death, 300 deaths in children under 5 years of age. To reduce the burden of LRTIs on health systems and ensure appropriate patient management, it is critical to know the most prevalent pathogens leading to LRTIs and their susceptibility patterns in the local setting. Consequently, the objective of this study was to formulate cumulative antibiograms for Intensive Care Units (ICUs) of referral hospitals in Namibia to guide future antibiotic use. METHODS A retrospective analytical cross-sectional study was conducted over 2 years. The cumulative antibiograms were constructed in accordance with current guidelines. RESULTS A total of 976 first isolate cultures were obtained from ICUs of the different referral hospitals. K. pneumoniae (8.8%, 8.1%) was a predominant pathogen in Windhoek Central hospital ICU in 2017 and 2018. In Oshakati intermediate hospital ICU, Enterobacter sp. (22.2%) and P. aeruginosa (37.5%) were the common pathogens in 2017 and 2018, respectively. A. baumannii isolates were >90% susceptibility to colistin, carbapenems, and tigecycline in 2017. In 2017, K. pneumoniae isolates were more susceptible to carbapenems (94% and 93.8% among isolates), amikacin (89.3%), and tigecycline (88.7%). In 2018, K. pneumoniae isolates were 100% susceptible amikacin, colistin, and carbapenems. S. maltophilia isolates were more than 80% susceptible to all the tested antibiotics. S. aureus isolates were 100% susceptible to linezolid, rifampicin, teicoplanin, and vancomycin in 2017 and in 2018. Its susceptibility to these antibiotics did not change. CONCLUSION The susceptibility patterns of the common isolated gram-negative pathogens were highly variable. Meropenem in combination with gentamicin is now the recommended antibiotic combination for empiric therapy for patients with LRTIs in Windhoek Central Hospital ICU.
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Affiliation(s)
- Pia Simeon
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Francis Kalemeera
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
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Porter GJ, Owens S, Breckons M. A systematic review of qualitative literature on antimicrobial stewardship in Sub-Saharan Africa. Glob Health Res Policy 2021; 6:31. [PMID: 34412692 PMCID: PMC8377884 DOI: 10.1186/s41256-021-00216-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 06/28/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Antibiotic resistance is a major problem in every region of the globe and Sub-Saharan Africa (SSA) is no exception. Several systematic reviews have addressed the prevalence of resistant organisms but few have examined the underlying causes in this region. This systematic review of qualitative literature aims to highlight barriers and facilitators to antimicrobial stewardship in SSA. METHODS A literature search of Embase and MEDLINE(R) was carried out. Studies were included if they were in English, conducted in SSA, and reported qualitative data on the barriers and facilitators of antimicrobial stewardship or on attitudes towards resistance promoting behaviours. Studies were screened with a simple critical appraisal tool. Secondary constructs were extracted and coded into concepts, which were then reviewed and grouped into themes in light of the complete dataset. RESULTS The literature search yielded 169 results, of which 14 studies from 11 countries were included in the final analysis. No studies were excluded as a result of the critical appraisal. Eight concepts emerged from initial coding, which were consolidated into five major themes: ineffective regulation, health system factors, clinical governance, patient factors and lack of resources. The ineffective regulation theme highlighted the balance between tightening drugstore regulation, reducing over-the-counter sale of antibiotics, and maintaining access to medicines for rural communities. Meanwhile, health system factors explored the tension between antimicrobial stewardship and the need of pharmacy workers to maintain profitable businesses. Additionally, a lack of resources, actions by patients and the day-to-day challenges of providing healthcare were shown to directly impede antimicrobial stewardship and exacerbate other factors which promote resistance. CONCLUSION Antibiotic resistance in SSA is a multi-faceted issue and while limited resources contribute to the problem they should be viewed in the context of other factors. We identify several contextual factors that affect resistance and stewardship that should be considered by policy makers when planning interventions. This literature base is also incomplete, with only 11 nations accounted for and many studies being confined to regions within countries, so more research is needed. Specifically, further studies on implementing stewardship interventions, successful or not, would be beneficial to inform future efforts.
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Affiliation(s)
- George James Porter
- Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle Upon Tyne, UK.
| | - Stephen Owens
- Department of Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Framlington Place, Newcastle Upon Tyne, UK
| | - Matthew Breckons
- Population Health Sciences Institute, Newcastle University, Framlington Place, Newcastle Upon Tyne, UK
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Mzumara GW, Mambiya M, Iroh Tam PY. Antimicrobial stewardship interventions in least developed and low-income countries: a systematic review protocol. BMJ Open 2021; 11:e047312. [PMID: 34385248 PMCID: PMC8362704 DOI: 10.1136/bmjopen-2020-047312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is increasing in low resource settings. It complicates the management of infectious diseases and is an increasing cause of death. This is due to, among other things, lack of health resources for appropriate diagnosis and unregulated access to antimicrobials in the public sphere. Developing context-specific interventions that enable judicious use of antimicrobials is important to curb this problem. METHODS We will conduct a systematic review of antimicrobial stewardship (AMS) approaches in Development Assistance Committee in least developed and low-income countries. The inclusion criteria are antimicrobial stewardship interventions in hospitalised patients of all age groups and exclusion criteria are community-based trials and studies that solely focus on viral, fungal or parasite infections. Antimicrobial stewardship interventions will be classified as structural, enabling, persuasive, restrictive or combined. Outcomes of included studies will be classified as clinical, microbiological or behavioural outcomes. The studies to be included will be randomised controlled trials, controlled before-after studies, interrupted time series trials, cohort and qualitative studies. Data will be extracted using forms adapted from the Cochrane collaboration data collection form. This systematic review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and risk of bias will be done according to the Integrated quality Criteria for Review of Multiple Study Designs. ETHICS AND DISSEMINATION Our findings will be presented to clinicians and policymakers, to support developing AMS protocols for low resource settings. We will publish our results in peer-reviewed journals. TRIAL REGISTRATION NUMBER CRD42020210634.
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Affiliation(s)
- Grace Wezi Mzumara
- Child Health, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Chichiri, Blantyre 3 Malawi, Malawi
- Peadiatrics and Child Health, University of Malawi College of Medicine, Chichiri, Blantyre 3 Malawi, Malawi
| | - Michael Mambiya
- Child Health, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Chichiri, Blantyre 3 Malawi, Malawi
| | - Pui-Ying Iroh Tam
- Child Health, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Chichiri, Blantyre 3 Malawi, Malawi
- Peadiatrics and Child Health, University of Malawi College of Medicine, Chichiri, Blantyre 3 Malawi, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
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Umutesi G, Velin L, Muwanguzi M, Faktor K, Mugabo C, Rukundo G, Rucogoza A, Yankurije M, Mazimpaka C, de Dieu Gatete J, Shyirambere C, Hedt-Gauthier B, Riviello R, Mpunga T, Mwikarago EI, Kateera F. Strengthening Antimicrobial Resistance Diagnostic Capacity in Rural Rwanda: A Feasibility Assessment. Ann Glob Health 2021; 87:78. [PMID: 34430228 PMCID: PMC8344959 DOI: 10.5334/aogh.3416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction Antimicrobial resistance (AMR) is a global public health threat. Worse still, there is a paucity of data from low- and middle-income countries to inform rational antibiotic use. Objective Assess the feasibility of setting up microbiology capacity for AMR testing and estimate the cost of setting up microbiology testing capacity at rural district hospitals in Rwanda. Methods Laboratory needs assessments were conducted, and based on identified equipment gaps, appropriate requisitions were processed. Laboratory technicians were trained on microbiology testing processes and open wound samples were collected and cultured at the district hospital (DH) laboratories before being transported to the National Reference Laboratory (NRL) for bacterial identification and antibiotic susceptibility testing. Quality control (QC) assessments were performed at the DHs and NRL. We then estimated the cost of three scenarios for implementing a decentralized microbiology diagnostic testing system. Results There was an eight-month delay from the completion of the laboratory needs assessments to the initiation of sample collection due to the regional unavailability of appropriate supplies and equipment. When comparing study samples processed by study laboratory technicians and QC samples processed by other laboratory staff, there was 85.0% test result concordance for samples testing at the DHs and 90.0% concordance at the NRL. The cost for essential equipment and supplies for the three DHs was $245,871. The estimated costs for processing 600 samples ranged from $29,500 to $92,590. Conclusion There are major gaps in equipment and supply availability needed to conduct basic microbiology assays at rural DHs. Despite these challenges, we demonstrated that it is feasible to establish microbiological testing capacity in Rwandan DHs. Building microbiological testing capacity is essential for improving clinical care, informing rational antibiotics use, and ultimately, contributing to the establishment of robust national antimicrobial stewardship programs in rural Rwanda and comparable settings.
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Affiliation(s)
- Grace Umutesi
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Lotta Velin
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Surgery and Public Health, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Sweden
| | | | - Kara Faktor
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Carol Mugabo
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | | | - Aniceth Rucogoza
- National Reference Laboratory, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | | | | | | | | | - Bethany Hedt-Gauthier
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Robert Riviello
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Emil Ivan Mwikarago
- National Reference Laboratory, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
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Wysocka M, Monteiro T, de Pina C, Gonçalves D, de Pina S, Ludgero-Correia A, Moreno J, Zamudio R, Almebairik N, Gray LJ, Pareek M, Jenkins DR, De Sousa MA, De Lencastre H, Beleza S, Araujo II, Conceição T, Oggioni MR. Whole-genome analysis uncovers loss of blaZ associated with carriage isolates belonging to methicillin-resistant Staphylococcus aureus (MRSA) clone ST5-VI in Cape Verde. J Glob Antimicrob Resist 2021; 26:77-83. [PMID: 34052522 PMCID: PMC8440226 DOI: 10.1016/j.jgar.2021.04.018] [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: 12/04/2020] [Revised: 04/01/2021] [Accepted: 04/14/2021] [Indexed: 12/01/2022] Open
Abstract
One of the first whole genome analyses of Staphylococcus aureus carriage isolates in an African country. Genome data allowed to place S. aureus isolates from Cape Verde in a phylogenetic context. Loss of blaZ-carrying plasmids and transposons is not rare, which is also evident in other international MRSA isolates. Steady increase in antimicrobial drug resistance in Cape Verde. Data provide genomic information for the design of intervention measures to decrease antimicrobial resistance.
Objectives Surveillance studies for Staphylococcus aureus carriage are a primary tool to survey the prevalence of methicillin-resistant S. aureus (MRSA) in the general population, patients and healthcare workers. We have previously reported S. aureus carriage in various African countries, including Cape Verde. Methods Whole-genome sequences of 106 S. aureus isolates from Cape Verde were determined. Results Staphylococcus aureus carriage isolates in Cape Verde show high genetic variability, with the detection of 27 sequence types (STs) and three primary genetic clusters associated with ST152, ST15 and ST5. One transmission event with less than eight core-genome single nucleotide polymorphisms (cgSNP) differences was detected among the ST5-VI MRSA lineage. Genetic analysis confirmed the phenotypic resistance and allowed the identification of six independent events of plasmid or transposon loss associated with the deletion of blaZ in nine isolates. In the four ST5 MRSA isolates, loss of the blaZ plasmid coincided with the acquisition of SCCmec type VI and an unusual penicillin phenotype with a minimum inhibitory concentration (MIC) at the breakpoint, indicating an adaptation trend in this endemic lineage. Similar events of blaZ plasmid loss, with concomitant acquisition SCCmec elements, were detected among ST5 isolates from different geographical origins. Conclusion Overall, the genome data allowed to place isolates in a phylogenetic context and to identify different blaZ gene deletions associated with plasmid or transposon loss. Genomic analysis unveiled adaptation and evolution trends, namely among emerging MRSA lineages in the country, which deserve additional consideration in the design of future infection control protocols.
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Affiliation(s)
- Magdalena Wysocka
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK; Department of Molecular Biotechnology and Microbiology, Gdansk University of Technology, Gdańsk, Poland
| | | | | | | | | | | | - Joao Moreno
- Universidade de Cabo Verde, Praia, Santiago, Cape Verde
| | - Roxana Zamudio
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK
| | - Nada Almebairik
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - David R Jenkins
- Department of Clinical Microbiology, Leicester University Hospitals, NHS Trust, Leicester, UK
| | - Marta Aires De Sousa
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica António Xavier (ITQB-NOVA), Universidade Nova de Lisboa, Oeiras, Portugal; Escola Superior de Saúde da Cruz Vermelha Portuguesa, Lisbon, Portugal
| | - Herminia De Lencastre
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica António Xavier (ITQB-NOVA), Universidade Nova de Lisboa, Oeiras, Portugal; Laboratory of Microbiology & Infectious Diseases, The Rockefeller University, New York, NY, USA
| | - Sandra Beleza
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK
| | | | - Teresa Conceição
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica António Xavier (ITQB-NOVA), Universidade Nova de Lisboa, Oeiras, Portugal.
| | - Marco R Oggioni
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK; Dipartimento di Farmacia e Biotecnologie, Universita' di Bologna, Bologna, Italy.
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Abstract
Surveillance is critical in containing globally increasing antimicrobial resistance (AMR). Affordable methodologies to prioritize AMR surveillance efforts are urgently needed, especially in low- and middle-income countries (LMICs), where resources are limited. While socioeconomic characteristics correlate with clinical AMR prevalence, this correlation has not yet been used to estimate AMR prevalence in countries lacking surveillance. We captured the statistical relationship between AMR prevalence and socioeconomic characteristics in a suite of beta-binomial principal component regression models for nine pathogens resistant to 19 (classes of) antibiotics. Prevalence data from ResistanceMap were combined with socioeconomic profiles constructed from 5,595 World Bank indicators. Cross-validated models were used to estimate clinical AMR prevalence and temporal trends for countries lacking data. Our approach provides robust estimates of clinical AMR prevalence in LMICs for most priority pathogens (cross-validated q 2 > 0.78 for six out of nine pathogens). By supplementing surveillance data, 87% of all countries worldwide, which represent 99% of the global population, are now informed. Depending on priority pathogen, our estimates benefit 2.1 to 4.9 billion people living in countries with currently insufficient diagnostic capacity. By estimating AMR prevalence worldwide, our approach allows for a data-driven prioritization of surveillance efforts. For carbapenem-resistant Acinetobacter baumannii and third-generation cephalosporin-resistant Escherichia coli, specific countries of interest are located in the Middle East, based on the magnitude of estimates; sub-Saharan Africa, based on the relative prevalence increase over 1998 to 2017; and the Pacific Islands, based on improving overall model coverage and performance.
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Moges F, Gizachew M, Dagnew M, Amare A, Sharew B, Eshetie S, Abebe W, Million Y, Feleke T, Tiruneh M. Multidrug resistance and extended-spectrum beta-lactamase producing Gram-negative bacteria from three Referral Hospitals of Amhara region, Ethiopia. Ann Clin Microbiol Antimicrob 2021; 20:16. [PMID: 33706775 PMCID: PMC7953565 DOI: 10.1186/s12941-021-00422-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/05/2021] [Indexed: 12/20/2022] Open
Abstract
Background Multidrug resistance (MDR), extended-spectrum beta-lactamase (ESBL) and carbapenemase-producing Gram-negative bacteria (GNB) has become a public health threat worldwide. This threat is worse in developing countries where there is high infectious disease burden and spread of antimicrobial resistance co-exist. The aim of the present study was, therefore, to assess MDR, ESBL and carbapenemase producing GNB from patients attending three selected referral hospitals in Amhara region. Methods A cross-sectional study was conducted from December 2017- April 2018 at the University of Gondar Comprehensive Specialized Hospital, Dessie Referral Hospital and Debre Markos Referral Hospital of Amhara national regional state. A total of 833 study subjects were recruited using a convenient sampling technique. Clinical samples such as blood, urine, stool, wound, abscess, ear discharge, nasal discharge, cervical discharge and body fluid specimens were aseptically collected. Culturing for identification of bacteria and determination of drug susceptibility testing were done following standard microbiological techniques. Selected MDR isolates were phenotypically assessed for ESBL and carbapenemase production. Results Of the 833 clinical samples cultured for bacterial growth, 141 (16.9%) were positive for GNB. The most common GNB identified were E. coli 46 (32.6%), Klebsiella spp. 38 (26.5%) and Proteus spp. 13 (9.2%). The overall MDR prevalence was 121 (85.8%). Among the total isolates, 137 (97.2%) were resistant to ampicillin followed by cotrimoxazole 115 (81.6%), amoxicillin-clavulanic acid 109 (77.3%), cefixime 99 (70.2%), cefepime 93 (66.0%) and tetracycline 91 (64.5%). The extended-spectrum beta-lactamase producing GNB were 69/124 (55.6%). Of which Klebsiella spp. 19 (15.3%) and E. coli 17 (13.7%) were common ESBL producers. Carbapenemase-producing isolates were 8/51(15.7%). Of which Enterobacter, Klebsiella and E. coli were common carbapenemase producers. Conclusion and recommendation Multi-drug resistance and ESBL producing isolates in the present study were high. E. coli and Klebsiella spp. were the most common ESBL producing GNB. Klebsiella spp., Enterobacter spp., E. coli and Citrobacter spp. were typical carbapenemase-producing isolates. Continuous monitoring, antibiotic stewardship and molecular detection of the gene responsible for drug resistance are important means to reduce the spread of drug-resistant pathogens.
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Affiliation(s)
- Feleke Moges
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Mucheye Gizachew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulat Dagnew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Azanaw Amare
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bekele Sharew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Setegn Eshetie
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wondwossen Abebe
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yihenew Million
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tigist Feleke
- Department of Hospital Laboratory, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Moges Tiruneh
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Abera K, Anticho TL, Ali MM. Salmonella and Shigella and antimicrobial susceptibility profiles among adult patients with complaints of diarrhea at Hawassa comprehensive specialized hospital, Hawassa, Ethiopia. SAGE Open Med 2021; 9:20503121211000911. [PMID: 33786180 PMCID: PMC7958172 DOI: 10.1177/20503121211000911] [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: 01/11/2021] [Accepted: 02/12/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Diarrhea is one of the public health important diseases in developing
countries. Among the causative agents of diarrhea,
Salmonella serovars and Shigella
species continue to play a major role in resource-limited countries. The aim
of this study was to assess the prevalence of Salmonella
and Shigella, risk factors, and antimicrobial
susceptibility profiles among adult patients with complaints of
diarrhea. Methods: A hospital-based cross-sectional study was conducted among adult patients
with complaints of diarrhea at Hawassa University Comprehensive Specialized
Hospital from March 2019 to November 2019. A structured questionnaire was
used to collect sociodemographic, behavioral, and environmental
characteristics of participants. Fecal samples were inoculated onto Selenite
F broth and Xylose Lysine Dextrose media to isolate
Salmonella serovars and Shigella
species. Antibiotic susceptibility testing was performed by the Kirby-Bauer
method. Data were analyzed by SPSS computer software version 20. Bivariate
and multivariable analysis was used to determine the association between
dependent and independent variables. Results: The overall prevalence of Salmonella serovars and
Shigella species was 8.6% with 95% confidence interval
(3.2–13.8). Participant those who do not wash their hands were three times
more likely to be infected with Salmonella and
Shigella (p < 0.001) than their
counterparts. Participants who consume uncooked food had about two times the
chance to be infected with Salmonella and
Shigella (p < 0.001) than their
counterparts. All serovars of Salmonella and serotypes of
Shigella were resistant to ampicillin. Conclusion: In this study, relatively a high prevalence of Salmonella
serovars and Shigella species was found among adult
patients with complaints of diarrhea at Hawassa University Comprehensive
Specialized Hospital. Consuming uncooked food and not washing hands were
significantly associated with the prevalence of Salmonella
and Shigella.
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Affiliation(s)
| | - Tariku Lambiyo Anticho
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Musa Mohammed Ali
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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