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Kakumba JM, Kindenge JM, Kapepula PM, Iyamba JML, Mashi ML, Mulwahali JW, Kialengila DM. Evaluation of Antibiotic Prescribing Pattern Using WHO Access, Watch and Reserve Classification in Kinshasa, Democratic Republic of Congo. Antibiotics (Basel) 2023; 12:1239. [PMID: 37627659 PMCID: PMC10451486 DOI: 10.3390/antibiotics12081239] [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: 04/16/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The AWaRe tool was set up by the World Health Organization (WHO) to promote the rational use of antimicrobials. Indeed, this tool classifies antibiotics into four groups: access, watch, reserve and not-recommended antibiotics. In The Democratic Republic of Congo, data on antibiotic dispensing (prescribing) by health professionals according to the AWaRe classification are scarce. In this research work, we aimed to explore antibiotic dispensing pattern from health professionals according to the WHO AWaRe classification to strengthen the national antimicrobial resistance plan. METHODS For this purpose, a survey was conducted from July to December 2022 in the district of Tshangu in Kinshasa. From randomly selected drugstores, drug-sellers were interviewed and randomly selected customers attending those drugstores were included in the study for medical prescriptions collection. The prescribed antibiotics were classified into the access, watch, reserve and not-recommended antibiotics group and by antibiotics number by prescription among pharmacies surveyed. RESULTS 400 medical prescriptions were collected from 80 drugstores and among which, 301 (75.25%) contained antibiotics. Out of 301 prescriptions, we noticed 164 (54.5%) containing one antibiotic, 117 (38.9%) containing two antibiotics, 15 (5%) containing three antibiotics and 5 (1.6%) containing four antibiotics. A total of 463 antibiotics were prescribed and distributed as 169 (36.5%) were from the access group, 200 (43.2%) from the watch group and 94 (20.3%) from not-recommended antibiotics group, respectively. This can explain the fact of emerging bacterial strains, as, according to the WHO recommendations, the access group should be prioritized because of its activity against a wide range of commonly encountered pathogens and its showing low resistance susceptibility compared to antibiotics from other groups. Based on the anatomical, therapeutic and chemical (ATC) classifications, we observed that third generation cephalosporins represented 34.33% of the prescribed antibiotics, followed by penicillins (17.17%), macrolides (7.63%), aminoglycosides (7.36%) and Imidazole (7.36%), thus accounting approximately for 74% of the classes of antibiotics prescribed. Additionally, among them, the most frequently prescribed antibiotics were Ceftriaxone (21.38%), Amoxicillin (11.01%), Gentamycin (5.61%), Amoxicillin-clavulanic acid (5.61%), Azithromycin (4.97%) and Metronidazole (4.75%), thus accounting for approximately 54% of all the prescribed antibiotics. CONCLUSION These results highlight the importance of strict implementation of the national plan to combat antimicrobial resistance and the need to train health workers in the correct application of the WHO AWaRe classification.
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Affiliation(s)
- Jocelyn Mankulu Kakumba
- Laboratory of Drug Analysis, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa XI 212, Democratic Republic of Congo; (J.M.K.); (D.M.K.)
| | - Jérémie Mbinze Kindenge
- Laboratory of Drug Analysis, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa XI 212, Democratic Republic of Congo; (J.M.K.); (D.M.K.)
| | - Paulin Mutwale Kapepula
- Centre d’Etudes des Substances Naturelles d’Origine Végétale (CESNOV), Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa XI 212, Democratic Republic of Congo;
| | - Jean-Marie Liesse Iyamba
- Laboratory of Experimental and Pharmaceutical Microbiology, University of Kinshasa, Kinshasa XI 212, Democratic Republic of Congo; (J.-M.L.I.); (J.W.M.)
| | - Murielle Longokolo Mashi
- Département de Médecine Interne, Service de Maladies Infectieuses et Tropicales, Kinshasa XI 212, Democratic Republic of Congo;
| | - Jose Wambale Mulwahali
- Laboratory of Experimental and Pharmaceutical Microbiology, University of Kinshasa, Kinshasa XI 212, Democratic Republic of Congo; (J.-M.L.I.); (J.W.M.)
| | - Didi Mana Kialengila
- Laboratory of Drug Analysis, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa XI 212, Democratic Republic of Congo; (J.M.K.); (D.M.K.)
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Roth BM, Laps A, Yamba K, Heil EL, Johnson JK, Stafford K, Hachaambwa LM, Kalumbi M, Mulenga L, Patel DM, Claassen CW. Antibiogram Development in the Setting of a High Frequency of Multi-Drug Resistant Organisms at University Teaching Hospital, Lusaka, Zambia. Antibiotics (Basel) 2021; 10:782. [PMID: 34203126 PMCID: PMC8300684 DOI: 10.3390/antibiotics10070782] [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: 04/13/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 11/24/2022] Open
Abstract
Antimicrobial resistance is a global challenge requiring reliable surveillance data collection and use. Prior studies on resistance in Zambia depended on laboratory methods with limited standardization. Since 2015, the University Teaching Hospital (UTH) microbiology laboratory has used the Vitek 2 Compact (bioMerieux, Inc., Marcy-l'Étoile, France) for standardized identification and susceptibility testing. We conducted a cross-sectional study of 2019 bacterial isolates collected from July 2015 to April 2017 to identify bacterial causes of infections, their susceptibility to commonly used antibiotics at UTH, and develop hospital antibiograms with a multidisciplinary team using World Health Organization guidance. We found high levels of antibiotic resistance among Gram negative bacteria. Escherichia coli and Klebsiella pneumoniae were highly resistant to all antibiotics except amikacin and carbapenems. E. coli had susceptibilities of 42.4% to amoxicillin/clavulanic acid, 41.4% to ceftriaxone, 40.2% to ciprofloxacin, and 10.4% to trimethoprim/sulfamethoxazole (TMP/SMX). K. pneumoniae had susceptibilities of 20.7% to amoxicillin/clavulanic acid, 15.6% to ceftriaxone, 48.5% to ciprofloxacin, and 12.3% to TMP/SMX. The high resistance to 3rd generation cephalosporins indicates high rates of beta-lactamase production. This is information that clinicians need to inform clinical decision making and choice of empiric antibiotics and that UTH requires to inform antimicrobial stewardship such as improvements in antibiotic use.
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Affiliation(s)
- Brenna M. Roth
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (K.S.); (L.M.H.); (C.W.C.)
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Alexandra Laps
- University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Kaunda Yamba
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka 10101, Zambia; (K.Y.); (M.K.)
| | - Emily L. Heil
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA;
| | - J. Kristie Johnson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Kristen Stafford
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (K.S.); (L.M.H.); (C.W.C.)
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Lottie M. Hachaambwa
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (K.S.); (L.M.H.); (C.W.C.)
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Department of Medicine, University of Zambia School of Medicine, Lusaka 10101, Zambia;
- Infectious Diseases Unit, Department of Internal Medicine, University Teaching Hospital, Lusaka 10101, Zambia
| | - Mox Kalumbi
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka 10101, Zambia; (K.Y.); (M.K.)
| | - Lloyd Mulenga
- Department of Medicine, University of Zambia School of Medicine, Lusaka 10101, Zambia;
- Infectious Diseases Unit, Department of Internal Medicine, University Teaching Hospital, Lusaka 10101, Zambia
- Ministry of Health, Government of the Republic of Zambia, Lusaka 10101, Zambia
| | - Devang M. Patel
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Cassidy W. Claassen
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (K.S.); (L.M.H.); (C.W.C.)
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Department of Medicine, University of Zambia School of Medicine, Lusaka 10101, Zambia;
- Infectious Diseases Unit, Department of Internal Medicine, University Teaching Hospital, Lusaka 10101, Zambia
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Torumkuney D, Hammami A, Mezghani Maalej S, Ayed NB, Revathi G, Zerouali K, Elmdaghri N, Gachii AK, Morrissey I. Results from the Survey of Antibiotic Resistance (SOAR) 2015-18 in Tunisia, Kenya and Morocco: data based on CLSI, EUCAST (dose-specific) and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. J Antimicrob Chemother 2021; 75:i2-i18. [PMID: 32337595 DOI: 10.1093/jac/dkaa081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine antibiotic susceptibility of community-acquired respiratory tract infection (CA-RTI) isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2015-18 from Tunisia, Kenya and Morocco. METHODS MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST (dose-specific) and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. RESULTS S. pneumoniae isolates from Tunisia (n = 79), Kenya (n = 44) and Morocco (n = 19) and H. influenzae isolates (n = 74) from Tunisia only were collected and analysed. Low antibiotic susceptibility was observed in S. pneumoniae from Tunisia, with >90% susceptible only to the fluoroquinolones (all breakpoints), penicillin (CLSI IV and EUCAST high-dose) and ceftriaxone (CLSI, EUCAST high-dose and PK/PD breakpoints). In addition, isolate susceptibility in Kenya was >90% to amoxicillin and amoxicillin/clavulanic acid (CLSI and PK/PD breakpoints). Antibiotic activity was highest in Morocco, where ≥89.5% of pneumococci were susceptible to most antibiotics, excluding trimethoprim/sulfamethoxazole (68.4% by CLSI or PK/PD and 79%-84.2% by EUCAST), macrolides (79%-84.2% by all breakpoints) and cefaclor (0% by EUCAST and 52.6% by PK/PD). The majority (≥86.5%) of H. influenzae isolates from Tunisia were susceptible to most antibiotics by all available breakpoints, except ampicillin and amoxicillin (almost one-third were β-lactamase positive), trimethoprim/sulfamethoxazole (51.4%-56.8%), cefaclor (1.4% by PK/PD), cefuroxime (4.1% by EUCAST), macrolides (1.4%-2.7% by PK/PD) and cefdinir (66.2% by PK/PD). The application of different EUCAST breakpoints for low and higher doses for some of the antibiotics (amoxicillin, amoxicillin/clavulanic acid, ampicillin, penicillin, ceftriaxone, clarithromycin, erythromycin, levofloxacin and trimethoprim/sulfamethoxazole) allowed, for the first time in a SOAR study, the effect of raising the dosage on susceptibility to be quantified. CONCLUSIONS Low antibiotic susceptibility was observed in S. pneumoniae from Tunisia, but susceptibility was higher in isolates from Kenya and highest in those from Morocco. H. influenzae from Tunisia were highly susceptible to most antibiotics. These factors are important in decision making for empirical therapy of CA-RTIs.
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Affiliation(s)
- D Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - A Hammami
- Department of Microbiology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - S Mezghani Maalej
- Department of Microbiology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - N Ben Ayed
- Department of Microbiology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - G Revathi
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - K Zerouali
- Laboratory of Bacteriology & Virology and Hygiene, CHU Ibn Rochd, Casablanca, Morocco.,Laboratory of Microbiology, Faculté de Médecine et de Pharmacie, Hassan II University, Casablanca, Morocco
| | - N Elmdaghri
- Laboratory of Bacteriology & Virology and Hygiene, CHU Ibn Rochd, Casablanca, Morocco.,Laboratory of Microbiology, Faculté de Médecine et de Pharmacie, Hassan II University, Casablanca, Morocco
| | - A K Gachii
- Department of Pathology, Kenyatta National Hospital, Nairobi, Kenya
| | - I Morrissey
- IHMA Europe Sàrl, Route de l'Ile-au-Bois 1A, 1870 Monthey/VS, Switzerland
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The Role of PK/PD Analysis in the Development and Evaluation of Antimicrobials. Pharmaceutics 2021; 13:pharmaceutics13060833. [PMID: 34205113 PMCID: PMC8230268 DOI: 10.3390/pharmaceutics13060833] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 12/13/2022] Open
Abstract
Pharmacokinetic/pharmacodynamic (PK/PD) analysis has proved to be very useful to establish rational dosage regimens of antimicrobial agents in human and veterinary medicine. Actually, PK/PD studies are included in the European Medicines Agency (EMA) guidelines for the evaluation of medicinal products. The PK/PD approach implies the use of in vitro, ex vivo, and in vivo models, as well as mathematical models to describe the relationship between the kinetics and the dynamic to determine the optimal dosing regimens of antimicrobials, but also to establish susceptibility breakpoints, and prevention of resistance. The final goal is to optimize therapy in order to maximize efficacy and minimize side effects and emergence of resistance. In this review, we revise the PK/PD principles and the models to investigate the relationship between the PK and the PD of antibiotics. Additionally, we highlight the outstanding role of the PK/PD analysis at different levels, from the development and evaluation of new antibiotics to the optimization of the dosage regimens of currently available drugs, both for human and animal use.
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Tsuzuki S, Akiyama T, Matsunaga N, Yahara K, Shibayama K, Sugai M, Ohmagari N. Improved penicillin susceptibility of Streptococcus pneumoniae and increased penicillin consumption in Japan, 2013-18. PLoS One 2020; 15:e0240655. [PMID: 33091045 PMCID: PMC7580930 DOI: 10.1371/journal.pone.0240655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To examine the association between penicillin susceptibility of Streptococcus pneumoniae and penicillin consumption in Japan. METHODS We used Japan Nosocomial Infection Surveillance data on the susceptibility of S. pneumoniae and sales data obtained from IQVIA Services Japan K.K. for penicillin consumption. We analysed both sets of data by decomposing them into seasonality and chronological trend components. The cross-correlation function was checked using Spearman's rank correlation coefficient to examine the correlation between susceptibility and consumption. RESULTS After adjusting for seasonality, the susceptibility of S. pneumoniae to penicillins gradually improved (55.7% in 2013 and 60.6% in 2018, respectively) and penicillin consumption increased during the same period (0.76 defined daily doses per 1,000 inhabitants per day [DID] in 2013, and 0.89 DID in 2018). The results showed positive cross-correlation (coefficient 0.801, p-value < 0.001). In contrast, cephalosporin consumption decreased (3.91 DID in 2013 and 3.19 DID in 2018) and showed negative cross-correlation with susceptibility of S. pneumoniae to penicillins (coefficient -0.981, p-value < 0.001). CONCLUSIONS The rates of penicillin-susceptible S. pneumoniae isolates did not negatively correlate with penicillin consumption at the population level. Increased penicillin consumption might not impair the penicillin susceptibility of S. pneumoniae.
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Affiliation(s)
- Shinya Tsuzuki
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Takayuki Akiyama
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nobuaki Matsunaga
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Koji Yahara
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Keigo Shibayama
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Motoyuki Sugai
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Norio Ohmagari
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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Tchatchouang S, Nzouankeu A, Hong E, Terrade A, Denizon M, Deghmane AE, Ndiang SMT, Pefura-Yone EW, Penlap Beng V, Njouom R, Fonkoua MC, Taha MK. Analysis of Haemophilus species in patients with respiratory tract infections in Yaoundé, Cameroon. Int J Infect Dis 2020; 100:12-20. [PMID: 32827751 DOI: 10.1016/j.ijid.2020.08.040] [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] [Received: 06/22/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES To identifyHaemophilus species and characterize antimicrobial susceptibility of isolates from patients with respiratory tract infections (RTIs) in Cameroon. METHODS Isolates (n = 95) were from patients with RTIs obtained from two Hospitals in Yaoundé, Cameroon. Isolates were identified by biochemical assay, PCR-based method, MALDI-TOF and whole genome sequencing. Antibiotic minimum inhibitory concentrations were determined by E-test. RESULTS H. influenzae was the most prevalent species varying from 76.8% to 84.2% according to different methods. The isolates were mainly nontypable (n = 70, 96%). Three isolates of H. influenzae were capsulated (b, e and f). The isolates were genetically diverse and 40 unique sequence types were identified including 11 new ones. Resistance to ampicillin was observed among 55.3% (52/94) and 9% (14/52) produced TEM-1 β-lactamase. PBP3 mutations occurred in 57.7% of ampicillin resistant isolates (30/52). Eleven isolates were chloramphenicol resistant with 80% producing chloramphenicol acetyltransferase (8/10). Four Haemophilus isolates were rifampicin resistant with two mutations in rpoB gene. Five isolates were ciprofloxacin resistant and harbored mutations in the quinolone resistance determining regions of gyrA and parC genes. CONCLUSION H. influenzae isolates are highly diverse and show high levels of antibiotic resistance. H. influenzae serotype b is still circulating in the post-vaccination era.
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Affiliation(s)
- Serges Tchatchouang
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon; Department of Bacteriology, Centre Pasteur of Cameroon, Yaoundé, Cameroon; Department of Biochemistry, University of Yaoundé, Yaoundé, Cameroon; Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Paris, France
| | - Ariane Nzouankeu
- Department of Bacteriology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Eva Hong
- Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Paris, France
| | - Aude Terrade
- Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Paris, France
| | - Mélanie Denizon
- Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Paris, France
| | - Ala-Eddine Deghmane
- Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Paris, France
| | | | | | | | - Richard Njouom
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | | | - Muhamed-Kheir Taha
- Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Paris, France.
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Lupande-Mwenebitu D, Baron SA, Nabti LZ, Lunguya-Metila O, Lavigne JP, Rolain JM, Diene SM. Current status of resistance to antibiotics in the Democratic Republic of the Congo: A review. J Glob Antimicrob Resist 2020; 22:818-825. [PMID: 32688007 DOI: 10.1016/j.jgar.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/23/2020] [Accepted: 07/04/2020] [Indexed: 11/29/2022] Open
Abstract
A review of literature was conducted to assess the prevalence and mechanisms of antibiotic resistance to date, mainly to β-lactam antibiotics, cephalosporins, carbapenems, colistin, and tigecycline in the Democratic Republic of the Congo (DRC). English and French publications were listed and analysed using PubMed/Medline, Google Scholar, and African Journals database between 1 January 1990 and 31 December 2019. For the 30 published articles found: (1) bacterial resistance to antibiotics concerned both Gram-negative and Gram-positive bacteria; (2) multidrug resistance prevalence was the same in half of Streptococcus pneumoniae isolates; (3) a worrying prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was noted, which is associated with co-resistance to several other antibiotics; and (4) resistance to third-generation cephalosporins was very high in Enterobacteriaceae, mainly because of blaCTX-M-1 group and blaSHV genes. Data on carbapenem and colistin resistance were not available in DRC until recently. Further work is required to set up a surveillance system for antibiotic resistance in DRC.
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Affiliation(s)
- David Lupande-Mwenebitu
- Faculté de Pharmacie, IRD, APHM, MEPHI, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385 Marseille, France; Université Catholique de Bukavu (UCB), Hôpital Provincial Général de Référence de Bukavu, Bukavu, Congo
| | - Sophie Alexandra Baron
- Faculté de Pharmacie, IRD, APHM, MEPHI, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385 Marseille, France
| | - Larbi Zakaria Nabti
- Faculté de Pharmacie, IRD, APHM, MEPHI, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385 Marseille, France
| | | | - Jean-Philippe Lavigne
- Service de Microbiologie et Hygiène hospitalière, VBMI, INSERM U1047, Université de Montpellier, CHU Nîmes, Nîmes, France
| | - Jean-Marc Rolain
- Faculté de Pharmacie, IRD, APHM, MEPHI, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385 Marseille, France; IHU Méditerranée Infection, 19-21 boulevard Jean Moulin, 13385 Marseille, France.
| | - Seydina Mouhamadou Diene
- Faculté de Pharmacie, IRD, APHM, MEPHI, Aix Marseille University, 19-21 Boulevard Jean Moulin, 13385 Marseille, France; IHU Méditerranée Infection, 19-21 boulevard Jean Moulin, 13385 Marseille, France.
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Ibar-Bariain M, Rodríguez-Gascón A, Isla A, Solinís MÁ, Canut-Blasco A. Evaluation of the adequacy of the antimicrobial therapy of invasive Haemophilus influenzae infections: A pharmacokinetic/pharmacodynamic perspective. Enferm Infecc Microbiol Clin 2020; 39:65-71. [PMID: 32636039 DOI: 10.1016/j.eimc.2020.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION In Europe, non-typeable H. influenzae (NTHi) is the leading cause of invasive H. influenzae disease in adults and is associated with high mortality. The goal of this study was to determine whether current antimicrobial treatments for H. influenzae infection in Spain are suitable based on their probability of achieving pharmacokinetic/pharmacodynamic (PK/PD) targets. METHODS Pharmacokinetic parameters for the antibiotics studied (amoxicillin, amoxicillin/clavulanic acid, ampicillin, cefotaxime, ceftriaxone, imipenem and ciprofloxacin) and susceptibility data for H. influenzae were obtained from literature. A Monte Carlo simulation was used to estimate the probability of target attainment (PTA), defined as the probability that at least a specific value of a PK/PD index is achieved at a certain MIC, and the cumulative fraction of response (CFR), defined as the expected population PTA for a specific drug dose and a specific microorganism population. RESULTS Regardless of dosing regimen, all antibiotics yielded CFR values of 100% or nearly 100% for all strains, including BL+, BL- and BLNAR, except amoxicillin and ampicillin for BL+. Thus, if an infection is caused by BL+ strains, treatment with amoxicillin and ampicillin has a high probability of failure (CFR≤8%). For standard doses of amoxicillin, amoxicillin/clavulanic acid and imipenem, PK/PD breakpoints were consistent with EUCAST clinical breakpoints. For the other antimicrobials, PK/PD breakpoints were higher than EUCAST clinical breakpoints. CONCLUSIONS Our study confirms by PK/PD analysis that, with the antimicrobials used as empirical treatment of invasive H. influenzae disease, a high probability of therapeutic success can be expected.
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Affiliation(s)
- Maitane Ibar-Bariain
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de Investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz, Spain
| | - Alicia Rodríguez-Gascón
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de Investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz, Spain
| | - Arantxa Isla
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de Investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz, Spain
| | - María Ángeles Solinís
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de Investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad 7, Vitoria-Gasteiz, Spain
| | - Andrés Canut-Blasco
- Microbiology Service, Hospital Universitario de Álava (HUA), Instituto de Investigación Sanitaria de Álava (BIOARABA), Servicio Vasco de Salud-Osakidetza, C/Francisco Leandro de Viana s/n, Vitoria-Gasteiz, Spain.
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Torumkuney D, Mayanskiy N, Edelstein M, Sidorenko S, Kozhevin R, Morrissey I. Results from the Survey of Antibiotic Resistance (SOAR) 2014-16 in Russia. J Antimicrob Chemother 2019; 73:v14-v21. [PMID: 29659881 DOI: 10.1093/jac/dky065] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives To determine antibiotic susceptibility in isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2014-16 from Russia. Methods MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. Results A total of 279 S. pneumoniae and 279 H. influenzae were collected. Overall, 67.0% of S. pneumoniae were penicillin susceptible by CLSI oral/EUCAST and 93.2% by CLSI intravenous (iv) breakpoints. All were fluoroquinolone susceptible, with amoxicillin, amoxicillin/clavulanic acid and ceftriaxone susceptibility ≥92.8% by CLSI and PK/PD breakpoints. Isolates showed lower susceptibility to cefuroxime, cefaclor, macrolides and trimethoprim/sulfamethoxazole by CLSI criteria: 85.0%, 76.7%, 68.8% and 67.7%, respectively. Generally, susceptibility was slightly lower by EUCAST criteria, except for cefaclor, for which the difference in susceptibility was much greater. Penicillin-resistant isolates had low susceptibility (≤60%) to all agents except fluoroquinolones. All 279 H. influenzae were ceftriaxone susceptible, 15.4% were β-lactamase positive and ≥97.5% were amoxicillin/clavulanic acid susceptible (CLSI, EUCAST and PK/PD breakpoints). Four isolates were fluoroquinolone non-susceptible by current EUCAST criteria. A major discrepancy was found with azithromycin susceptibility between CLSI (99.3%) and EUCAST and PK/PD (2.2%) breakpoints. Trimethoprim/sulfamethoxazole was poorly active (62.7% susceptible). Conclusions Susceptibility to penicillin (oral), macrolides and trimethoprim/sulfamethoxazole was low in S. pneumoniae from Russia. However, isolates were fully susceptible to fluoroquinolones and ≥92.8% were susceptible to amoxicillin, amoxicillin/clavulanic acid and ceftriaxone. Isolates of H. influenzae only showed reduced susceptibility to ampicillin, cefaclor, clarithromycin and trimethoprim/sulfamethoxazole. Some differences were detected between CLSI, EUCAST and PK/PD breakpoints, especially with cefaclor, cefuroxime and macrolides. These data suggest further efforts are required to harmonize international breakpoints.
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Affiliation(s)
- D Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - N Mayanskiy
- Federal State Autonomous Institution 'National Scientific and Practical Center of Children's Health' of the Ministry of Health of the Russian Federation, Lomonosovsky prospekt, 2, b.1, 119991, Moscow, Russia
| | - M Edelstein
- Institute of Antimicrobial Chemotherapy, Smolensk State Medical University, Kirova str. 46a, 214019, Smolensk, Russia
| | - S Sidorenko
- Scientific Research Institute of Children's Infections, Professor Popov, str. 9, 191014, St Petersburg, Russia
| | - R Kozhevin
- ZAO GlaxoSmithKline Trading, Krylatskaya st 17/3, 121614, Moscow, Russia
| | - I Morrissey
- IHMA Europe Sàrl, Route de l'Ile-au-Bois 1A, 1870 Monthey/VS, Switzerland
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Torumkuney D, Papaparaskevas J, Morrissey I. Results from the Survey of Antibiotic Resistance (SOAR) 2014-16 in Greece. J Antimicrob Chemother 2019; 73:v36-v42. [PMID: 29659884 DOI: 10.1093/jac/dky068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives To determine antimicrobial susceptibility in isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2014-16 from patients with community-acquired respiratory tract infections in Greece. Methods MICs were determined by CLSI broth microdilution and susceptibility assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. Results A total of 99 S. pneumoniae and 52 H. influenzae isolates were collected. Overall, 36.4% of S. pneumoniae were penicillin susceptible by CLSI oral/EUCAST and 88.9% by CLSI intravenous (iv) breakpoints. All were fluoroquinolone susceptible with ≥94% of isolates also susceptible to amoxicillin, amoxicillin/clavulanic acid and ceftriaxone by CLSI and PK/PD breakpoints. Trimethoprim/sulfamethoxazole, cefuroxime, cefaclor and macrolides were less active, with rates of susceptibility of 83.8%, 69.7%, 50.5% and 49.5%, respectively, by CLSI. Generally susceptibility was the same or slightly lower by EUCAST, but the cefaclor difference was much greater. Among H. influenzae, 15.4% of isolates were β-lactamase positive. Susceptibility to amoxicillin/clavulanic acid, ceftriaxone, cefuroxime and the fluoroquinolones was seen in >95% of isolates by CLSI criteria. Susceptibility to azithromycin was seen in 94.2% of isolates using CLSI breakpoints, but clarithromycin susceptibility was lower (61.5%). However, susceptibility to both macrolides was seen in <5% of isolates by PK/PD and EUCAST criteria. Susceptibility to trimethoprim/sulfamethoxazole was seen in 71.2% of isolates. Conclusions Owing to the high prevalence of macrolide resistance among S. pneumoniae and the reduced activity of clarithromycin against H. influenzae, it appears that these agents are not appropriate as monotherapy for community-acquired pneumonia in Greece. Amoxicillin/clavulanic acid, on the other hand, maintained excellent in vitro activity and, as opposed to the similarly effective fluoroquinolones, is safe to use in paediatric patients.
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Affiliation(s)
- D Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - J Papaparaskevas
- National and Kapodistrian University of Athens, Medical School, Department of Microbiology, Mikras Asias str. 75, 11527, Athens, Greece
| | - I Morrissey
- IHMA Europe Sàrl, Route de l'Ile-au-Bois 1A, 1870 Monthey/VS, Switzerland
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Torumkuney D, Pertseva T, Bratus E, Dziublik A, Yachnyk V, Liskova A, Sopko O, Malynovska K, Morrissey I. Results from the Survey of Antibiotic Resistance (SOAR) 2014-16 in Ukraine and the Slovak Republic. J Antimicrob Chemother 2019; 73:v28-v35. [PMID: 29659885 DOI: 10.1093/jac/dky069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives To determine antibiotic susceptibility in isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2014-16 from Ukraine and the Slovak Republic. Methods MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. Results S. pneumoniae isolates collected in Ukraine (n = 100) showed susceptibility rates ≥97% for amoxicillin, amoxicillin/clavulanic acid, penicillin [intravenous (iv) non-meningitis] and fluoroquinolones, between 83% and 86% for oral penicillin, macrolides and cefaclor, and 75% for trimethoprim/sulfamethoxazole. Susceptibility was substantially lower in the Slovak Republic (n = 95). All isolates were susceptible to the fluoroquinolones, but susceptibility to penicillin, amoxicillin, amoxicillin/clavulanic acid, cefuroxime and trimethoprim/sulfamethoxazole varied between 61% and 64%, with only 44% of isolates susceptible to the macrolides. Susceptibility of H. influenzae was more homogeneous, with susceptibility to amoxicillin/clavulanic acid, ceftriaxone, cefuroxime, azithromycin and the fluoroquinolones seen in >90% of isolates by CLSI criteria in both countries. Much greater variability was seen across breakpoints, especially for azithromycin, cefaclor and cefuroxime. The β-lactamase rate was 5.1% (5/98) in the Slovak Republic and 7.3% (7/96) in Ukraine, but the Slovak Republic also had a relatively high rate of β-lactamase-negative-ampicillin-resistant (BLNAR) isolates (7.1%; 7/98). Conclusions The variability found across these two neighbouring countries illustrates the need to monitor and publish national and local resistance patterns. This information is not only critical for effective empirical therapy but can also be used to help shape and support antimicrobial stewardship efforts in order to limit antibiotic resistance.
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Affiliation(s)
- D Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - T Pertseva
- Dnipropetrovsk State Medical Academy, Soborna Square 4, 49027, Dnipro, Ukraine
| | - E Bratus
- Dnipropetrovsk State Medical Academy, Diagnostic Center, Soborna Square 4, 49027, Dnipropetrovsk, Kyiv, Ukraine
| | - A Dziublik
- State Organization National Institute of Phthisiology and Pulmonology named after F. G. Yanovsky, National Academy of Medical Sciences of Ukraine, Amosova Str. 10, 03680, Kiev, Ukraine
| | - V Yachnyk
- State Organization National Institute of Phthisiology and Pulmonology named after F. G. Yanovsky, National Academy of Medical Sciences of Ukraine, Amosova Str. 10, 03680, Kiev, Ukraine
| | - A Liskova
- Nitra Teaching Hospital, Department of Clinical Microbiology, Spitalska 6, 950 01 Nitra, Slovak Republic
| | - O Sopko
- GlaxoSmithKline, Pavla Tychyny avenue, 1-V, Kyiv, 02152, Ukraine
| | - K Malynovska
- GlaxoSmithKline, Pavla Tychyny avenue, 1-V, Kyiv, 02152, Ukraine
| | - I Morrissey
- IHMA Europe Sàrl, Route de l'Ile-au-Bois 1A, 1870 Monthey/VS, Switzerland
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Torumkuney D, Nica M, Nistor I, Vatcheva-Dobrevska R, Petrovic V, Stoica A, Hanicar B, Antic D, Morrissey I. Results from the Survey of Antibiotic Resistance (SOAR) 2014-16 in Bulgaria, Romania, Serbia and Croatia. J Antimicrob Chemother 2019; 73:v2-v13. [PMID: 29659882 DOI: 10.1093/jac/dky066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives To determine antibiotic susceptibility of isolates of Streptococcus pneumoniae (n = 573) and Haemophilus influenzae (n = 345) collected in 2014-16 from Bulgaria, Romania, Serbia and Croatia. Methods MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. Results Among S. pneumoniae, susceptibility was generally lowest in Romania and Serbia and highest in Bulgaria. Rates of susceptibility to penicillin (CLSI oral or EUCAST) were 22.3% and 21.8% in Romania and Serbia respectively, 57% in Croatia and 86.6% in Bulgaria. Similarly, macrolide susceptibility using CLSI/EUCAST breakpoints was low in Romania and Serbia (∼28% and 34.5%, respectively), higher in Croatia (55.9%) and highest in Bulgaria (∼75%). Only fluoroquinolones were active against all isolates in all four countries. Susceptibility was higher and variability across countries less pronounced for H. influenzae. Susceptibility by CLSI criteria to amoxicillin/clavulanic acid, azithromycin, cefuroxime, ceftriaxone and fluoroquinolones was ≥98% in all countries. Ampicillin susceptibility ranged from 85.3% in Romania to 100% in Bulgaria. Much greater variability was seen across breakpoints. Susceptibility to azithromycin and cefuroxime using CLSI criteria was ≥98% in all four countries, but was 0%-1% by EUCAST criteria. Conclusions The variability in antimicrobial susceptibility using different breakpoints makes it difficult for clinicians to interpret antimicrobial resistance data, and efforts should be made to harmonize breakpoints. The variability found across the four neighbouring countries demonstrates the need to monitor and publish national and local resistance patterns. These findings provide information critical for the selection of appropriate antimicrobial agents for the treatment of S. pneumoniae and H. influenzae.
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Affiliation(s)
- D Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - M Nica
- Infectious and Tropical Diseases Hospital 'Dr. Victor Babes', Mihai Bravu str. 281, 030303, Bucharest, Romania
| | - I Nistor
- Grigore Alexandrescu Children's Emergency Hospital, Iancu de Hunedoara str, 30-32, 011743, Bucharest, Romania
| | - R Vatcheva-Dobrevska
- University Hospital 'Tsaritsa Yoanna' ISUL Dept Microbiology and Virology, Byalo more str. 8, 1527, Sofia, Bulgaria
| | - V Petrovic
- Institute of Public Health of Vojvodina, Futoska 121, 21000, Novi Sad, Serbia
| | - A Stoica
- GlaxoSmithKline, Opera Center 1, Costache Negri str. 1-5, 050552, Bucharest, Romania
| | - B Hanicar
- GlaxoSmithKline, Ulica Damira Tomljanovica Gavrana 15, 10020, Zagreb, Croatia
| | - Dj Antic
- GlaxoSmithKline, Omladinskih brigada 88, 11070, Belgrade, Serbia
| | - I Morrissey
- IHMA Europe Sàrl, Route de l'Ile-au-Bois 1A, 1870 Monthey/VS, Switzerland
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Torumkuney D, Zemlickova H, Maruscak M, Morrissey I. Results from the Survey of Antibiotic Resistance (SOAR) 2014-16 in the Czech Republic. J Antimicrob Chemother 2019; 73:v22-v27. [PMID: 29659883 DOI: 10.1093/jac/dky067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objectives To determine the antibiotic susceptibility of isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2014-16 from patients with community-acquired respiratory infections in the Czech Republic. Methods MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. Results S. pneumoniae isolates (n = 200) showed high rates of susceptibility (>95%) to amoxicillin, amoxicillin/clavulanic acid, penicillin [intravenous (iv) non-meningitis], ceftriaxone, cefuroxime and the fluoroquinolones using CLSI breakpoints. Susceptibility to cefaclor and trimethoprim/sulfamethoxazole was 94%-94.5%, to penicillin (oral) 91.5% and to the macrolides 89.5%. Susceptibility of H. influenzae (n = 197) to amoxicillin/clavulanic acid, ceftriaxone, cefuroxime, azithromycin and the fluoroquinolones was ≥98% by CLSI criteria. Rates of susceptibility to the remaining agents were ≥75% except for clarithromycin at 37.1%. Great variability was seen across breakpoints, especially for the macrolides, cefaclor and cefuroxime (oral), 98.0% of H. influenzae showing susceptibility to the latter by CLSI criteria, 69.5% by PK/PD and 1.5% by EUCAST standards. The β-lactamase rate was 13.7% with no β-lactamase-negative-ampicillin-resistant (BLNAR) isolates by CLSI criteria. Conclusions Antibiotic resistance among the two major respiratory pathogens remained low in the Czech Republic. These findings support local clinicians in continuing the historically restrictive use of antibiotics in the Czech Republic, with selection of narrower-spectrum agents for the empirical therapy of community-acquired respiratory tract infections. This highlights one of the great benefits of continuous surveillance of antimicrobial resistance: knowledge of current local resistance patterns reduces the need to choose broad-spectrum agents that contribute to increasing resistance worldwide.
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Affiliation(s)
- D Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - H Zemlickova
- National Institute of Public Health, Centre for Epidemiology and Microbiology, National Reference Laboratory for Antibiotics, Šrobárova 48, 100 42 Prague 10, Czech Republic
| | - M Maruscak
- GlaxoSmithKline, s.r.o., Hvezdova 1734/2c, 140 00, Prague 4, Czech Republic
| | - I Morrissey
- IHMA Europe Sàrl, Route de l'Ile-au-Bois 1A, 1870 Monthey/VS, Switzerland
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Iroh Tam PY, Sadoh AE, Obaro SK. A meta-analysis of antimicrobial susceptibility profiles for pneumococcal pneumonia in sub-Saharan Africa. Paediatr Int Child Health 2018; 38:7-15. [PMID: 28453405 DOI: 10.1080/20469047.2017.1298700] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pneumonia causes an enormous burden of childhood disease globally, particularly in low- and middle-income countries. Pneumococcus is the most common bacterial aetiology of pneumonia; however, antimicrobials are limited and may not adequately address the local epidemiology of the region. AIM To undertake a review and meta-analysis of pneumonia studies in sub-Saharan Africa to evaluate antimicrobial susceptibility patterns in childhood pneumonia. METHODS Articles published in PubMed and Google between 2006 and 2016 which evaluated antimicrobial susceptibility profiles of pneumococcal pneumonia in children in sub-Saharan Africa were identified. The source of specimens, pathogens and antimicrobial susceptibility data were extracted. Pooled analysis of susceptible isolates was conducted using random effects models. RESULTS Children from 15 studies and 1634 isolates were included in the meta-analysis. In cases of childhood pneumonia, the mean overall proportion of penicillin susceptibility from invasive specimens of Streptococcus pneumoniae was 85.7% (95% CI 80.1-91.3), and of trimethoprim-sulfamethoxazole was 21.0% (95% CI 5.1-36.9). Compared with all S. pneumoniae specimens, penicillin susceptibility was 68.6% (95% CI 59.6-77.5) and that of trimethoprim-sulfamethoxazole was 26.3% (95% CI 14.1-38.6). CONCLUSIONS A high level of heterogeneity was detected, reflecting the paucity of data available. The establishment of national and regional diagnostic platforms to monitor antimicrobial susceptibility profiles for pneumonia as well as other invasive diseases will provide data with which to assess the relevance and adaptation of antimicrobial prescribing recommendations.
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Affiliation(s)
- Pui-Ying Iroh Tam
- a Department of Pediatrics , University of Minnesota , Minneapolis , MN , USA
| | - Ayebo E Sadoh
- b Department of Pediatrics , University of Nebraska , Omaha , NE , USA
| | - Stephen K Obaro
- b Department of Pediatrics , University of Nebraska , Omaha , NE , USA
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Musicha P, Cornick JE, Bar-Zeev N, French N, Masesa C, Denis B, Kennedy N, Mallewa J, Gordon MA, Msefula CL, Heyderman RS, Everett DB, Feasey NA. Trends in antimicrobial resistance in bloodstream infection isolates at a large urban hospital in Malawi (1998-2016): a surveillance study. THE LANCET. INFECTIOUS DISEASES 2017; 17:1042-1052. [PMID: 28818544 PMCID: PMC5610140 DOI: 10.1016/s1473-3099(17)30394-8] [Citation(s) in RCA: 188] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 05/31/2017] [Accepted: 06/15/2017] [Indexed: 01/22/2023]
Abstract
Background Bacterial bloodstream infection is a common cause of morbidity and mortality in sub-Saharan Africa, yet few facilities are able to maintain long-term surveillance. The Malawi-Liverpool-Wellcome Trust Clinical Research Programme has done sentinel surveillance of bacteraemia since 1998. We report long-term trends in bloodstream infection and antimicrobial resistance from this surveillance. Methods In this surveillance study, we analysed blood cultures that were routinely taken from adult and paediatric patients with fever or suspicion of sepsis admitted to Queen Elizabeth Central Hospital, Blantyre, Malawi from 1998 to 2016. The hospital served an urban population of 920 000 in 2016, with 1000 beds, although occupancy often exceeds capacity. The hospital admits about 10 000 adults and 30 000 children each year. Antimicrobial susceptibility tests were done by the disc diffusion method according to British Society of Antimicrobial Chemotherapy guidelines. We used the Cochran-Armitage test for trend to examine trends in rates of antimicrobial resistance, and negative binomial regression to examine trends in icidence of bloodstream infection over time. Findings Between Jan 1, 1998, and Dec 31, 2016, we isolated 29 183 pathogens from 194 539 blood cultures. Pathogen detection decreased significantly from 327·1/100 000 in 1998 to 120·2/100 000 in 2016 (p<0·0001). 13 366 (51·1%) of 26 174 bacterial isolates were resistant to the Malawian first-line antibiotics amoxicillin or penicillin, chloramphenicol, and co-trimoxazole; 68·3% of Gram-negative and 6·6% of Gram-positive pathogens. The proportions of non-Salmonella Enterobacteriaceae with extended spectrum beta-lactamase (ESBL) or fluoroquinolone resistance rose significantly after 2003 to 61·9% in 2016 (p<0·0001). Between 2003 and 2016, ESBL resistance rose from 0·7% to 30·3% in Escherichia coli, from 11·8% to 90·5% in Klebsiella spp and from 30·4% to 71·9% in other Enterobacteriaceae. Similarly, resistance to ciprofloxacin rose from 2·5% to 31·1% in E coli, from 1·7% to 70·2% in Klebsiella spp and from 5·9% to 68·8% in other Enterobacteriaceae. By contrast, more than 92·0% of common Gram-positive pathogens remain susceptible to either penicillin or chloramphenicol. Meticillin-resistant Staphylococcus aureus (MRSA) was first reported in 1998 at 7·7% and represented 18·4% of S aureus isolates in 2016. Interpretation The rapid expansion of ESBL and fluoroquinolone resistance among common Gram-negative pathogens, and the emergence of MRSA, highlight the growing challenge of bloodstream infections that are effectively impossible to treat in this resource-limited setting. Funding Wellcome Trust, H3ABionet, Southern Africa Consortium for Research Excellence (SACORE).
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Affiliation(s)
- Patrick Musicha
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; College of Medicine, University of Malawi, Blantyre, Malawi; Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Jennifer E Cornick
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Naor Bar-Zeev
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Neil French
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Clemens Masesa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Brigitte Denis
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Neil Kennedy
- College of Medicine, University of Malawi, Blantyre, Malawi; Queen's University, Belfast, UK
| | - Jane Mallewa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; College of Medicine, University of Malawi, Blantyre, Malawi
| | - Melita A Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Chisomo L Msefula
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; College of Medicine, University of Malawi, Blantyre, Malawi
| | - Robert S Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Division of Infection and Immunity, University College London, London, UK
| | - Dean B Everett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Nicholas A Feasey
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Liverpool School of Tropical Medicine, Liverpool, UK.
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Appendectomy as a Risk Factor for Bacteremic Biliary Tract Infection Caused by Antibiotic-Resistant Pathogens. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3276120. [PMID: 28589138 PMCID: PMC5447260 DOI: 10.1155/2017/3276120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/20/2017] [Indexed: 12/13/2022]
Abstract
Background/Aims Recent evidence has suggested that appendix plays a pivotal role in the development and preservation of intestinal immune system. The aim of this study is to examine whether prior appendectomy is associated with an increased risk for the development of antibiotic-resistant bacteria in bacteremia from biliary tract infection (BTI). Methods Charts from 174 consecutive cases of bacteremia derived from BTI were retrospectively reviewed. Using multivariate analysis, independent risk factors for development of antibiotic-resistant bacteria were identified among the clinical parameters, including a history of appendectomy. Results In total, 221 bacteria strains were identified from 174 BTI events. Of those, 42 antibiotic-resistant bacteria were identified in 34 patients. Multivariate analysis revealed that prior appendectomy (Odds ratio (OR), 3.02; 95% confidence interval (CI), 1.15–7.87; p = 0.026), antibiotic use within the preceding three months (OR, 3.06; 95% CI, 1.26–7.64; p = 0.013), and bilioenteric anastomosis or sphincterotomy (OR, 3.77; 95% CI, 1.51–9.66; p = 0.0046) were independent risk factors for antibiotic-resistant bacteria. Conclusions Prior appendectomy was an independent risk factor for the development of antibiotic-resistant bacteria in bacteremia from BTI.
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