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Hasegawa K, Matsumura Y, Mori T, Asakura T, Nakaminami H. Surveillance of antimicrobial awareness among patients visiting community pharmacies. J Infect Chemother 2024; 30:887-891. [PMID: 38432558 DOI: 10.1016/j.jiac.2024.02.034] [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: 11/15/2023] [Revised: 02/17/2024] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Although antimicrobial resistance (AMR) measures have been progressing, cases of patients requesting their doctors to prescribe antimicrobial agents and patients mistakenly believing that these agents are effective against viruses occasionally occur. In the AMR action plan (2023-2027) in Japan, one of the primary goals are public awareness and education. However, public understanding of AMR and antimicrobial agents has been reported to be at an unsatisfactory level. Here, we conducted a surveillance of antimicrobial awareness among patients visiting community pharmacies. MATERIAL AND METHODS A questionnaire survey was conducted among patients visiting nine pharmacies in Hachioji, Tokyo, Japan. A total of 1887 active questionnaires were collected. The relationship between answers was analyzed using logistic regression analysis. RESULTS Of the patients, 72% were unaware of AMR, and 68% believed that antimicrobials are effective against viruses. In addition, 28% of the patients answered that they did not take antimicrobial agents as prescribed by their physicians. Seventeen percent of the patients had never received appropriate instruction of antimicrobial use from pharmacists. Analysis of the relationship between answers showed that patients with correct knowledge were 1.65 times more likely to take antimicrobial agents as prescribed by their physicians (P < 0.01). Furthermore, the factors that led to the inappropriate behaviors of patients were associated with preliminary antimicrobial prescriptions from physicians (odds ratio, 3.18; 95% CI, 2.12-4.76) (P < 0.01). CONCLUSION This study strongly suggests that physician and pharmacist interventions regarding the appropriate use of antimicrobial agents are important to improve awareness of antimicrobial agents.
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Affiliation(s)
- Kosuke Hasegawa
- Department of Clinical Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo, 192-0392, Japan; MEDIX, Inc, 1-2-3 Motoyokoyamacho, Hachioji, Tokyo, 192-0063, Japan; Shinwa Pharmacy Shincho Store, 101 Iwasaki Building 7-12 Shincho, Hachioji, Tokyo, 192-0065, Japan
| | - Yuriko Matsumura
- MEDIX, Inc, 1-2-3 Motoyokoyamacho, Hachioji, Tokyo, 192-0063, Japan
| | - Tomoko Mori
- MEDIX, Inc, 1-2-3 Motoyokoyamacho, Hachioji, Tokyo, 192-0063, Japan
| | - Toshio Asakura
- MEDIX, Inc, 1-2-3 Motoyokoyamacho, Hachioji, Tokyo, 192-0063, Japan
| | - Hidemasa Nakaminami
- Department of Clinical Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo, 192-0392, Japan.
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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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Nofal MR, Tesfaye A, Gebeyehu N, Masersha MN, Hayredin I, Belayneh K, Getahun B, Starr N, Abebe K, Sebsebe Y, Alemu SB, Mammo TN, Weiser TG. A Prospective Quality Improvement Program to Reduce Prolonged Postoperative Antibiotic Prophylaxis in Ethiopia. Surg Infect (Larchmt) 2024. [PMID: 38990697 DOI: 10.1089/sur.2024.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Introduction: Although postoperative antibiotic prophylaxis has not been shown to prevent surgical site infections, prolonged antibiotic administration is common in low- and middle-income countries. We developed a quality improvement program to reduce unnecessary postoperative antibiotics through hospital-specific guideline development and the use of a brief, multidisciplinary discussion of antibiotic indication, choice, and duration during clinical rounds. We assessed reduction in the number of patients receiving ≥24 h of antibiotic prophylaxis after clean and clean-contaminated surgery. Methods: We piloted the program at a referral hospital in Ethiopia from February to September 2023. After a 6-week baseline assessment, multidisciplinary teams adapted international guidelines for surgical prophylaxis to local disease burden, medication availability, and cost restrictions; stakeholders from surgical departments provided feedback. Surgical teams implemented a "timeout" during rounds to apply these guidelines to patient care; compliance with the timeout and antibiotic administration was assessed throughout the study period. Results: We collected data from 636 patients; 159 (25%) in the baseline period and 477 (75%) in the intervention period. The percentage of patients receiving ≥24 h of antibiotic prophylaxis after surgery decreased from 50.9% in the baseline period to 40.9% in the intervention period (p = 0.027) and was associated with a 0.5 day reduction in postoperative length of stay (p = 0.047). Discussion: This antibiotic stewardship pilot program reduced postoperative antibiotic prophylaxis in a resource-constrained setting in Sub-Saharan Africa and was associated with shorter length of stay. This program has the potential to reduce unnecessary antibiotic use in this population.
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Affiliation(s)
- Maia R Nofal
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Department of Surgery, Stanford University, Palo Alto, California, USA
- Lifebox, Addis Ababa, Ethiopia
- Global Health Equity Scholars Program (D43TW010540), Fogarty International Center, Washington, District of Columbia, USA
| | - Assefa Tesfaye
- Lifebox, Addis Ababa, Ethiopia
- St. Peter's Specialized Hospital, Addis Ababa, Ethiopia
| | - Natnael Gebeyehu
- Lifebox, Addis Ababa, Ethiopia
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | - Benti Getahun
- St. Peter's Specialized Hospital, Addis Ababa, Ethiopia
| | - Nichole Starr
- Lifebox, Addis Ababa, Ethiopia
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Kaleb Abebe
- St. Peter's Specialized Hospital, Addis Ababa, Ethiopia
| | | | - Senait Bitew Alemu
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Tihitena Negussie Mammo
- Lifebox, Addis Ababa, Ethiopia
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Thomas G Weiser
- Department of Surgery, Stanford University, Palo Alto, California, USA
- Lifebox, Addis Ababa, Ethiopia
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Aboushady AT, Manigart O, Sow A, Fuller W, Ouedraogo AS, Ebruke C, Babin FX, Gahimbare L, Sombié I, Stelling J. Surveillance of Antimicrobial Resistance in the ECOWAS Region: Setting the Scene for Critical Interventions Needed. Antibiotics (Basel) 2024; 13:627. [PMID: 39061309 PMCID: PMC11273779 DOI: 10.3390/antibiotics13070627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Antimicrobial resistance poses a significant challenge to public health globally, leading to increased morbidity and mortality. AMR surveillance involves the systematic collection, analysis, and interpretation of data on the occurrence and distribution of AMR in humans, animals, and the environment for action. The West African Health Organization, part of the Economic Community of West African States (ECOWAS), is committed to addressing AMR in the region. This paper examines the status of AMR surveillance in ECOWAS countries using available WHO data from the TrACSS survey and GLASS enrollments. The analysis reveals that while progress has been made, significant challenges remain. Twelve of the fifteen ECOWAS countries are enrolled in GLASS, and ten have developed national action plans (NAPs) for AMR. However, there is a need to ensure all countries fully implement their NAPs, continue reporting to GLASS, and use the data for evidence-based actions and decision making. Surveillance systems for AMR and antimicrobial consumption/use vary across countries with some demonstrating limited capacity. All countries, except Cabo Verde, reported having a reference laboratory for AMR testing. Strengthening laboratory capabilities, data management and use, and multisectoral coordination are crucial for effective AMR surveillance and response. Based on the findings and the regional context, it is essential to prioritize capacity building, data utilization, and the adoption of standardized guidelines for AMR surveillance. Collaboration among ECOWAS countries, the WAHO, and international partners is essential to address AMR comprehensively. Ensuring a consistent supply of essential antimicrobial medications and reagents is vital.
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Affiliation(s)
| | - Olivier Manigart
- West African Health Organization, Bobo-Dioulasso 01 BP 153, Burkina Faso (A.S.); (C.E.); (I.S.)
- GFA Consulting Group, 22359 Hamburg, Germany
- Ecole de Santé Publique, Université Libre de Bruxelles, 1050 Brussels, Belgium
| | - Abdourahmane Sow
- West African Health Organization, Bobo-Dioulasso 01 BP 153, Burkina Faso (A.S.); (C.E.); (I.S.)
- Institut Pasteur de Dakar, Dakar 220, Senegal
- Department de Santé Public, Faculté de Médecine, de Pharmacie et D’Odontostomatologie, Université Cheikh Anta Diop, Dakar 5005, Senegal
| | - Walter Fuller
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo; (W.F.); (L.G.)
| | - Abdoul-Salam Ouedraogo
- Centre Muraz, Institut National de Santé Publique, Bobo-Dioulasso 01 BP 390, Burkina Faso;
| | - Chinelo Ebruke
- West African Health Organization, Bobo-Dioulasso 01 BP 153, Burkina Faso (A.S.); (C.E.); (I.S.)
- GFA Consulting Group, 22359 Hamburg, Germany
| | | | - Laetitia Gahimbare
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo; (W.F.); (L.G.)
| | - Issiaka Sombié
- West African Health Organization, Bobo-Dioulasso 01 BP 153, Burkina Faso (A.S.); (C.E.); (I.S.)
| | - John Stelling
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
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Abejew AA, Wubetu GY, Fenta TG. Assessment of challenges and opportunities in antibiotic stewardship program implementation in Northwest Ethiopia. Heliyon 2024; 10:e32663. [PMID: 38912506 PMCID: PMC11193037 DOI: 10.1016/j.heliyon.2024.e32663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 06/06/2024] [Accepted: 06/06/2024] [Indexed: 06/25/2024] Open
Abstract
Background Indiscriminate use of antibiotics leads to antibiotic resistance (AMR) and results in mortality, morbidity, and financial burden. Antibiotic stewardship programs (ASPs) with education can resolve a number of barriers recognized in the implementation of successful ASPs. The aim of this study was to assess health professionals' perceptions and status of ASPs in hospitals in 2022. Methods A cross-sectional study was conducted from September 1, 2022 to October 30, 2022. A total of 181 health professionals were included, and a self-administered questionnaire was used to collect data. The status of hospitals was assessed using a checklist. The data were analyzed using SPSS version 23, and descriptive statistics and Chi-square tests (X2) at a P-value of <0.05 were used. Results Of the 181 respondents, 163 (90.1 %), and 161 (89.0 %) believed that AMR is a significant problem in Ethiopia and globally, respectively. Easy access to antibiotics 155 (85.6 %), and inappropriate use 137 (75.7 %) were perceived as key contributors to AMR. Antibiotics were believed to be prescribed/dispensed without laboratory results 86 (47.5 %), and antibiotic susceptibility patterns were not considered to guide empiric therapy 81 (44.8 %). ASP was believed to reduce the duration of hospital stays and associated costs 137 (75.7 %), and improve the quality of patient care 133 (73.5 %), whereas 151 (83.4 %), 143 (79 %), and 142 (78.5 %) suggested education, institutional guidelines, and prospective audits with feedback interventions to combat AMR in their hospitals, respectively. There were significant differences in perception among professionals based on professional category and attempts by hospitals to implement ASPs. Although ASPs were not functioning according to standard, there have been attempts to implement it in three hospitals. The issue of ASP had never been heard in general hospitals. Currently, it is feasible to implement ASPs in four hospitals. Conclusion The status of ASP in hospitals was very poor. Despite a lack of prior knowledge on ASPs, most respondents do have a positive perception of AMR and the implementation of ASPs. Pharmacist-led prospective audits and feedback with education and institutional guidelines for empiric antibiotic use can be better implemented in hospitals. Involvement of representatives from infection prevention and control, and collaboration among hospitals in ASP implementation will help establish a strong ASP in the area.
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Affiliation(s)
- Asrat Agalu Abejew
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Teferi Gedif Fenta
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Mendelson M, Lewnard JA, Sharland M, Cook A, Pouwels KB, Alimi Y, Mpundu M, Wesangula E, Weese JS, Røttingen JA, Laxminarayan R. Ensuring progress on sustainable access to effective antibiotics at the 2024 UN General Assembly: a target-based approach. Lancet 2024; 403:2551-2564. [PMID: 38797179 DOI: 10.1016/s0140-6736(24)01019-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/19/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
Rising antimicrobial resistance (AMR) is a global health crisis for countries of all economic levels, alongside the broader challenge of access to antibiotics. As a result, development goals for child survival, healthy ageing, poverty reduction, and food security are at risk. Preserving antimicrobial effectiveness, a global public good, requires political will, targets, accountability frameworks, and funding. The upcoming second high-level meeting on AMR at the UN General Assembly (UNGA) in September, 2024, is evidence of political interest in addressing the problem of AMR, but action on targets, accountability, and funding, absent from the 2016 UNGA resolution, is needed. We propose ambitious yet achievable global targets for 2030 (relative to a prepandemic 2019 baseline): a 10% reduction in mortality from AMR; a 20% reduction in inappropriate human antibiotic use; and a 30% reduction in inappropriate animal antibiotic use. Given national variation in current levels of antibiotic use, these goals (termed the 10-20-30 by 2030) should be met within a framework of universal access to effective antibiotics. The WHO Access, Watch, Reserve (AWARE) system can be used to define, monitor, and evaluate appropriate levels of antibiotic use and access. Some countries should increase access to narrow-spectrum, safe, and affordable (Access) antibiotics, whereas others should discourage the inappropriate use of broader-spectrum (Watch) and last-resort (Reserve) antibiotics; AWARE targets should use a risk-based, burden-adjusted approach. Improved infection prevention and control, access to clean water and sanitation, and vaccination coverage can offset the selection effects of increased antibiotic use in low-income settings. To ensure accountability and global scientific guidance and consensus, we call for the establishment of the Independent Panel on Antimicrobial Access and Resistance and the support of leaders from low-income and middle-income countries.
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Affiliation(s)
- Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
| | - Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Mike Sharland
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St Georges University of London, London, UK
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St Georges University of London, London, UK; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Koen B Pouwels
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yewande Alimi
- Africa Centres for Disease Prevention and Control, Addis Ababa, Ethiopia
| | | | - Evelyn Wesangula
- East Central and Southern Africa Health Community, Arusha, Tanzania
| | - Jeffrey Scott Weese
- Centre for Public Health and Zoonoses, University of Guelph, Guelph, ON, Canada
| | | | - Ramanan Laxminarayan
- One Health Trust, Bengaluru, India; High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA.
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Evendi A, Karuniawati A, Ibrahim F, Asmarinah. Genetic and phenotypic of Pseudomonas aeruginosa sensitive to meropenem antibiotics after exposure to meropenem. IRANIAN JOURNAL OF MICROBIOLOGY 2024; 16:299-305. [PMID: 39005611 PMCID: PMC11245351 DOI: 10.18502/ijm.v16i3.15760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Background and Objectives Pseudomonas aeruginosa, drug-resistant, causes health infections. Resistance to the preferred therapy meropenem is a serious threat. This study aimed to analyze changes in meropenem minimum inhibitory concentration (MIC), changes in ampC, mexA, and oprD gene expression, and the correlation between MIC and ampC, mexA, and oprD gene expression after meropenem exposure. Materials and Methods Ten isolates of P. aeruginosa from the Clinical Microbiology Department, Faculty of Medicine, Universitas Indonesia were used. After the bacteria were shown to be sensitive to meropenem phenotypically, intrinsic resistance genes were detected using PCR. After meropenem exposure on Days 5 and 12, sensitivity testing was carried out with the concentration gradient method and RNA was detected using real-time RT-PCR. Results All P. aeruginosa isolates that were phenotypically sensitive to meropenem had the ampC, mexA, and oprD genes. An increase in MIC, an increase in ampC and mexA gene expression, and a decrease in oprD gene expression were observed after meropenem exposure. There was a very strong and significant correlation (p ≤ 0.05) between MIC and oprD gene expression after Day 12 of meropenem exposure. Conclusion Although there were no significant differences in MIC and ampC, mexA, and oprD gene expression between Day 5 and Day 12, there was a very strong and significant correlation between MIC and oprD gene expression on Day 12 (p ≤ 0.05). This indicates that decreasing oprD gene expression has the potential to increase meropenem resistance in Pseudomonas aeruginosa.
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Affiliation(s)
- Agus Evendi
- Doctoral Program in Biomedical Science, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Medical Laboratory Technology, Health Polytechnic, Ministry of Health, East Kalimantan, Indonesia
| | - Anis Karuniawati
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Fera Ibrahim
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Asmarinah
- Department of Medical Biology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Yakobi SH, Magibile YB, Pooe OJ. A systematic review of Neisseria gonorrhoeae drug resistance development in South Africa. Braz J Microbiol 2024; 55:1053-1063. [PMID: 38662152 PMCID: PMC11153458 DOI: 10.1007/s42770-024-01281-6] [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: 03/29/2023] [Accepted: 02/07/2024] [Indexed: 04/26/2024] Open
Abstract
In South Africa, basic healthcare centres treat sexually transmitted infections (STIs) using a syndromic approach. In line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, a complete study of all randomised controlled trials and surveillance data relevant to N. gonorrhoeae antibiotic resistance was conducted. To discover papers published between 2002 and 2022, searches were undertaken using PubMed, EMBASE and any other relevant databases. This systematic review extracted a total of 463 articles published between 2002 and 2022 from a variety of online research sources. Seven South African provinces were represented in the studies that were assessed. Mpumalanga and the North West Province did not have any studies that described the identification and monitoring of antimicrobial resistance (AMR). This study presents data obtained from a comprehensive analysis of 2140 isolates, in which we examined the presence of one or more antibiotic resistance. Our findings revealed that out of these samples, 1891 isolates exhibited antimicrobial properties; tetracycline was the antimicrobial resistance that was found the most often (30%), followed by ciprofloxacin (19%) and penicillin (17%). The mean of the isolates was 143, the upper 95% mean was 243, and the standard deviation (SD) was 181.6. All microbiological identification and susceptibility testing processes must be standardised and improved so national organisations can monitor AMR. The nation's health community must address all identified areas of concern to avoid AMR.
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Affiliation(s)
- Sinethemba H Yakobi
- School of Life Sciences, Biochemistry, University of KwaZulu-Natal, Durban, 4041, South Africa.
| | - Yolisa B Magibile
- School of Life Sciences, Biochemistry, University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Ofentse J Pooe
- School of Life Sciences, Biochemistry, University of KwaZulu-Natal, Durban, 4041, South Africa
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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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Gobezie MY, Tesfaye NA, Solomon T, Demessie MB, Kassa TD, Wendie TF, Alemayehu E, Hassen M. Neisseria gonorrhea in Ethiopia, prevalence among STI suspected patients and its antimicrobial susceptibility: a systematic review and meta-analysis. Front Microbiol 2024; 15:1390001. [PMID: 38694795 PMCID: PMC11062254 DOI: 10.3389/fmicb.2024.1390001] [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: 02/22/2024] [Accepted: 04/04/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction Neisseria gonorrhea (N. gonorrhea) represents a significant causative agent of sexually transmitted infections (STIs), posing considerable global health challenges. Despite the presence of diagnostic tools and empirically guided therapies, the escalating AMR of N. gonorrhea continues to pose a threat. This study aims to assess the prevalence of N. gonorrhea among STI suspected patients in Ethiopia and explore the patterns of AMR to common antimicrobials. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review and meta-analysis. A thorough search of electronic databases from July 11 to July 24, 2023, identified 10 eligible studies. Data were extracted and analyzed using a random-effects model. Heterogeneity was assessed using the I2 statistic, and publication bias was evaluated through Egger's regression test and funnel plots. Results The overall pooled prevalence of N. gonorrhea among STI suspected patients in Ethiopia was 20% (95% confidence interval (CI): 8-30, I2 = 99.0%; p-value <0.001). Substantial regional variations were observed, with the highest prevalence in Addis Ababa (55, 95% CI: 45-65) and the lowest in the Southern Nations, Nationalities, and Peoples' Region (SNNPR) (4, 95% CI: 2-8). The pooled prevalence of AMR to ciprofloxacin, ceftriaxone, azithromycin, benzylpenicillin, tetracycline, and spectinomycin was 37, 9, 10, 79, 93, and 2%, respectively. Significant heterogeneity existed between studies (I2 = 99.0%; p value <0.001). Publication bias, identified through funnel plot examination and Egger's regression test (p < 0.001), execution of trim and fill analysis resulted in an adjusted pooled prevalence of (6.2, 95% CI: -6.8 to 19.3). Conclusion The prevalence of N. gonorrhea among STI suspected patients in Ethiopia is alarming, particularly in specific regions. The elevated AMR to ciprofloxacin underscores the immediate need for alternative treatment options and enhanced surveillance systems. Future initiatives should prioritize strengthening laboratory capacities and implementing targeted interventions to curtail N. gonorrhea transmission and prevent the emergence of AMR. Systematic Review Registration https://www.crd.york.ac.uk/prospero, identifier CRD42023459698.
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Affiliation(s)
- Mengistie Yirsaw Gobezie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Nuhamin Alemayehu Tesfaye
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tewodros Solomon
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mulat Belete Demessie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tesfaye Dessale Kassa
- Department of Clinical Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Teklehaimanot Fentie Wendie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ermiyas Alemayehu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Minimize Hassen
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Olorunleke SO, Kirchner M, Duggett N, Stevens K, Chah KF, Nwanta JA, Brunton LA, Anjum MF. Rapid detection and molecular epidemiology of β-lactamase producing Enterobacteriaceae isolated from food animals and in-contact humans in Nigeria. PLoS One 2024; 19:e0289190. [PMID: 38603727 PMCID: PMC11008865 DOI: 10.1371/journal.pone.0289190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/02/2024] [Indexed: 04/13/2024] Open
Abstract
The emergence and spread of β-lactamase-producing Enterobacteriaceae poses a significant threat to public health, necessitating the rapid detection and investigation of the molecular epidemiology of these pathogens. We modified a multiplex real-time (RT)-PCR to concurrently detect β-lactamase genes (blaCTX-M, blaTEM, and blaSHV) and Enterobacteriaceae 16S ribosomal RNA. qPCR probes and primers were validated using control isolates, and the sensitivity and specificity assessed. The optimised multiplex qPCR was used to screen 220 non-clinical Enterobacteriaceae from food animals and in-contact humans in Southeast Nigeria selected on cefotaxime-supplemented agar plates. Binary logistic regression was used to explore factors associated with the presence of the blaTEM and blaSHV genes in these isolates, and a subset of isolates from matched sampling sites and host species were whole genome sequenced, and their antimicrobial resistance (AMR) and plasmid profiles determined. The sensitivity and specificity of the qPCR assay was 100%. All isolates (220/220) were positive for Enterobacteriaceae ribosomal 16S rRNA and blaCTX-M, while 66.4% (146/220) and 9% (20/220) were positive for blaTEM and blaSHV, respectively. The prevalence of blaTEM and blaSHV varied across different sampling sites (farm, animal market and abattoirs). Isolates from Abia state were more likely to harbour blaTEM (OR = 2.3, p = 0.04) and blaSHV (OR = 5.12,p = 0.01) than isolates from Ebonyi state; blaTEM was more likely to be detected in isolates from food animals than humans (OR = 2.34, p = 0.03), whereas the reverse was seen for blaSHV (OR = 7.23, p = 0.02). Furthermore, Klebsiella and Enterobacter isolates harboured more AMR genes than Escherichia coli, even though they were isolated from the same sample. We also identified pan resistant Klebsiella harbouring resistance to ten classes of antimicrobials and disinfectant. Therefore, we recommend ESKAPE pathogens are included in AMR surveillance in future and suggest qPCRs be utilised for rapid screening of Enterobacteriaceae from human and animal sources.
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Affiliation(s)
- Solomon Olabiyi Olorunleke
- Department of Bacteriology, Animal and Plant Health Agency, Weybridge, Surrey, United Kingdom
- Veterinary Epidemiology, Economics and Public Health Group, Department of Pathobiology and Population Sciences, Royal Veterinary College, London, United Kingdom
- Department of Veterinary Public Health and Preventive Medicine, University of Nigeria Nsukka, Enugu, Nigeria
| | - Miranda Kirchner
- Department of Bacteriology, Animal and Plant Health Agency, Weybridge, Surrey, United Kingdom
| | - Nicholas Duggett
- Department of Bacteriology, Animal and Plant Health Agency, Weybridge, Surrey, United Kingdom
| | - Kim Stevens
- Veterinary Epidemiology, Economics and Public Health Group, Department of Pathobiology and Population Sciences, Royal Veterinary College, London, United Kingdom
| | - Kennedy F. Chah
- Department of Veterinary Pathology and Microbiology, University of Nigeria Nsukka, Enugu, Nigeria
| | - John A. Nwanta
- Department of Veterinary Public Health and Preventive Medicine, University of Nigeria Nsukka, Enugu, Nigeria
| | - Lucy A. Brunton
- Veterinary Epidemiology, Economics and Public Health Group, Department of Pathobiology and Population Sciences, Royal Veterinary College, London, United Kingdom
| | - Muna F. Anjum
- Department of Bacteriology, Animal and Plant Health Agency, Weybridge, Surrey, United Kingdom
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13
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Gobezie MY, Hassen M, Tesfaye NA, Solomon T, Demessie MB, Kassa TD, Wendie TF, Andualem A, Alemayehu E, Belayneh YM. Prevalence of meropenem-resistant Pseudomonas Aeruginosa in Ethiopia: a systematic review and meta‑analysis. Antimicrob Resist Infect Control 2024; 13:37. [PMID: 38600535 PMCID: PMC11005134 DOI: 10.1186/s13756-024-01389-2] [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: 01/04/2024] [Accepted: 03/23/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a pressing global health concern, particularly pronounced in low-resource settings. In Ethiopia, the escalating prevalence of carbapenem-resistant Pseudomonas aeruginosa (P. aeruginosa) poses a substantial threat to public health. METHODS A comprehensive search of databases, including PubMed, Scopus, Embase, Hinari, and Google Scholar, identified relevant studies. Inclusion criteria encompassed observational studies reporting the prevalence of meropenem-resistant P. aeruginosa in Ethiopia. Quality assessment utilized JBI checklists. A random-effects meta-analysis pooled data on study characteristics and prevalence estimates, with subsequent subgroup and sensitivity analyses. Publication bias was assessed graphically and statistically. RESULTS Out of 433 studies, nineteen, comprising a total sample of 11,131, met inclusion criteria. The pooled prevalence of meropenem-resistant P. aeruginosa was 15% (95% CI: 10-21%). Significant heterogeneity (I2 = 83.6%) was observed, with the number of P. aeruginosa isolates identified as the primary source of heterogeneity (p = 0.127). Subgroup analysis by infection source revealed a higher prevalence in hospital-acquired infections (28%, 95% CI: 10, 46) compared to community settings (6%, 95% CI: 2, 11). Geographic based subgroup analysis indicated the highest prevalence in the Amhara region (23%, 95% CI: 8, 38), followed by Addis Ababa (21%, 95% CI: 11, 32), and lower prevalence in the Oromia region (7%, 95% CI: 4, 19). Wound samples exhibited the highest resistance (25%, 95% CI: 25, 78), while sputum samples showed the lowest prevalence. Publication bias, identified through funnel plot examination and Egger's regression test (p < 0.001), execution of trim and fill analysis resulted in an adjusted pooled prevalence of (3.7%, 95% CI: 2.3, 9.6). CONCLUSION The noteworthy prevalence of meropenem resistance among P. aeruginosa isolates in Ethiopia, particularly in healthcare settings, underscores the urgency of implementing strict infection control practices and antibiotic stewardship. Further research is imperative to address and mitigate the challenges posed by antimicrobial resistance in the country.
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Affiliation(s)
- Mengistie Yirsaw Gobezie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Minimize Hassen
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Nuhamin Alemayehu Tesfaye
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tewodros Solomon
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mulat Belete Demessie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tesfaye Dessale Kassa
- Department of Clinical Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Teklehaimanot Fentie Wendie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abel Andualem
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ermiyas Alemayehu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yaschilal Muche Belayneh
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Osman EA, Omer SA, Elmubarak RMA, Abdelnabi M, Abdelgadir S, Ahmed DG, Arbab Nasr MH, Yousif M, Mukhtar M, Al-Hassan L. Antibiotic resistance in Sudan: assessing the knowledge and practices of healthcare workers in Khartoum. JAC Antimicrob Resist 2024; 6:dlae049. [PMID: 38660369 PMCID: PMC11040271 DOI: 10.1093/jacamr/dlae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/19/2024] [Indexed: 04/26/2024] Open
Abstract
Background Antibiotic resistance (ABR) is a major public health issue, associated with increased patient morbidity and mortality globally, with significantly higher rates in low- and middle-income countries (LMICs). Assessment of contextual factors, such as information, education, infrastructure and regulations are important for developing local solutions against ABR. Objectives To determine the knowledge and practices of healthcare workers (HCWs) towards ABR in hospitals in Sudan. Materials and methods A survey was conducted in three different hospitals in Khartoum, Sudan from February to December 2020. HCWs of different specialties and expertise were invited to participate. Data were descriptively analysed using Statistical Package for Social Sciences (SPSS). Results ABR was identified as a big challenge by 89% of 345 HCWs who participated. The results show that 79% of doctors don't rely on the clinical microbiology laboratory (CML) results for antibiotic prescription or clinical decision-making. Sixty percent of HCWs agreed there are infection prevention and control (IPC) guidelines in their hospital, but 74% of them don't have access to them, and infrequently receive relevant IPC training. Furthermore, HCWs obtain ABR information from other colleagues informally, not through local data or reports. Conclusions Despite adequate knowledge of ABR locally, there are significant contextual technical challenges facing HCWs in Sudan, such as availability of policies and accurate data from CMLs. The results indicate a poor link between HCWs and the CMLs for infection management and it is essential to improve communication between the different hospital departments with regard to ABR transmission, and ensure the effectiveness of local IPC policies based on locally available data.
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Affiliation(s)
- Einas A Osman
- College of Applied and Health Sciences, A’Sharqiyah University, Ibra, Oman
| | - Sara A Omer
- Department of Clinical Chemistry, International University of Africa, Khartoum, Sudan
| | - Rashida M A Elmubarak
- Department of Clinical Microbiology and Infectious Diseases, Soba University Hospital, Khartoum, Sudan
| | - Manal Abdelnabi
- Department of Infection Control, Fedail Hospital, Khartoum, Sudan
| | - Safaa Abdelgadir
- Department of Neonatal Intensive Care Unit (NICU), Al-Ribat University Hospital, Khartoum, Sudan
| | - Dalal G Ahmed
- Department of Neonatal Intensive Care Unit (NICU), Al-Ribat University Hospital, Khartoum, Sudan
- Paediatric Department, Tathleeth General Hospital, Bisha, Kingdom of Saudi Arabia
| | | | - Muna Yousif
- Department of Microbiology, Countess of Chester Hospital NHS Foundation Trust, Chester CH2 1UL, UK
| | | | - Leena Al-Hassan
- Department of Global Health and Infection, Brighton and Sussex Medical School, 3.11 Medical Teaching Building, Falmer, Brighton BN1 9PX, UK
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Boutefnouchet C, Aouras H, Khennouchi NCEH, Berredjem H, Rolain JM, Hadjadj L. Algerian postcaesarean surgical site infections: A cross-sectional investigation of the epidemiology, bacteriology, and antibiotic resistance profile. Am J Infect Control 2024; 52:456-462. [PMID: 37805027 DOI: 10.1016/j.ajic.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) are one of the most common health care-associated infections in low and middle-income countries. The aims of this cross-sectional descriptive study were to estimate the frequency of postcaesarean infection with associated clinical characteristics and the antibiotic resistance profile of bacterial isolates. METHODS Patients who underwent a cesarean section at the obstetrics and gynecology department of the hospital in Annaba, Algeria were included. Each woman was followed postoperatively for 30 days and sociodemographic data were collected. Culture-based microbiological methods were used to identify the causative bacteria and determine their antibiotic resistance phenotype and molecular characterization. RESULTS Among 1,810 patients, we recorded 36 (1.9%) SSIs. Most patients had undergone an emergency delivery (75%) and low educational level (72.2%). The most frequent maternal pathologies were Body Mass Index ≥ 30 (63.9%), scarred uteri (58.3%), anemia (55.6%), and an American Society of Anaesthesiologists score between II and III (33.3%). Of the 43 bacteria isolated, Enterobacteriaceae were the most frequent (62.8%), predominated by Escherichia coli strains (43.5%), a majority of which were extended-spectrum β-lactamases carriers (62.9%). Although gram-positive cocci were less frequent (37.2%), a majority of Enterococcus faecalis (56.2%) were observed and 2 strains of vancomycin-resistant Enterococcus faecium harboring the vanA gene were identified. CONCLUSIONS Extensive surveillance of at-risk populations should be integrated to prevent the occurrence of SSIs.
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Affiliation(s)
- Chahinez Boutefnouchet
- Laboratoire de Biochimie et Microbiologie Appliquée, Département de Biochimie, Faculté des Sciences, Université Badji Mokhtar-Annaba, Algeria; Aix Marseille University, IRD, APHM, MEPHI, Faculté de Médecine et de Pharmacie, Marseille Cedex 05, France; IHU Méditerranée Infection, France
| | - Hayet Aouras
- Etablissement Hospitalier de Santé Abdallah Nouaouria "'El Bouni"' Annaba, Algeria
| | - Nour Chems El Houda Khennouchi
- Laboratoire de Biotechnologie des substances naturelles et applications, Université L'arbi Ben M'hidi, Oum El Bouaghi, Algeria
| | - Hajira Berredjem
- Laboratoire de Biochimie et Microbiologie Appliquée, Département de Biochimie, Faculté des Sciences, Université Badji Mokhtar-Annaba, Algeria
| | - Jean-Marc Rolain
- Aix Marseille University, IRD, APHM, MEPHI, Faculté de Médecine et de Pharmacie, Marseille Cedex 05, France; IHU Méditerranée Infection, France
| | - Linda Hadjadj
- Aix Marseille University, IRD, APHM, MEPHI, Faculté de Médecine et de Pharmacie, Marseille Cedex 05, France; IHU Méditerranée Infection, France.
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Ngoma MT, Sitali D, Mudenda S, Mukuma M, Bumbangi FN, Bunuma E, Skjerve E, Muma JB. Community antibiotic consumption and associated factors in Lusaka district of Zambia: findings and implications for antimicrobial resistance and stewardship. JAC Antimicrob Resist 2024; 6:dlae034. [PMID: 38449513 PMCID: PMC10914457 DOI: 10.1093/jacamr/dlae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/10/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Antimicrobial resistance (AMR) is a global public health crisis. This study assessed the general public's consumption of antibiotics and associated factors in the Lusaka district of Zambia. Methods This cross-sectional study was conducted among 2038 participants between December 2022 and January 2023. Data were analysed using Stata 13.0. Multivariable regression techniques were used to determine the factors that influenced antibiotic consumption. Results Of the 2038 participants, 53.4% were female, and 51.5% had attended at least secondary school. Antibiotic use was 99.2%, of which 40.9% were appropriately used. Overall, 79.1% of antibiotics were prescribed in hospitals, while 20.9% were used from leftovers and accessed without prescriptions. This study found that the appropriate use of antibiotics was associated with being female, being aged 35 years and above, attaining secondary school or tertiary education, having a monthly expenditure of 195 USD and above, being aware that antibiotics were not the same as painkillers, and being confident that when someone was hospitalized, they would get well. Conclusions This study found that the appropriate use of antibiotics was low, and this is an urgent public health issue requiring community engagement in tackling AMR and adherence to treatment guidelines in healthcare facilities. Additionally, there is a need to implement and strengthen antimicrobial stewardship programmes in healthcare facilities to promote the rational use of antibiotics in Zambia. There is also a need to heighten community awareness campaigns and educational activities on the appropriate use of antibiotics.
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Affiliation(s)
- Maty Tsumbu Ngoma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Doreen Sitali
- Department of Health Promotion, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Mercy Mukuma
- Department of Food Science, School of Agricultural Sciences and Nutrition, University of Zambia, Lusaka, Zambia
| | - Flavien Nsoni Bumbangi
- Department of Medicine and Clinical Sciences, School of Medicine, Eden University, Lusaka, Zambia
| | - Emmanuel Bunuma
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Eystein Skjerve
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Ås, Norway
| | - John Bwalya Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
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Kowalski M, Minka Obama B, Catho G, Dewez JE, Merglen A, Ruef M, Andrey DO, Hassoun-Kheir N, de Kraker ME, Combescure C, Emonet S, Galetto-Lacour A, Wagner N. Antimicrobial resistance in Enterobacterales infections among children in sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine 2024; 70:102512. [PMID: 38495519 PMCID: PMC10940950 DOI: 10.1016/j.eclinm.2024.102512] [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: 12/22/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Abstract
Background The burden of antimicrobial resistance (AMR) has been estimated to be the highest in sub-Saharan Africa (SSA). The current study estimated the proportion of drug-resistant Enterobacterales causing infections in SSA children. Methods We searched MEDLINE/PubMed, Embase and the Cochrane Library to identify retrospective and prospective studies published from 01/01/2005 to 01/06/2022 reporting AMR of Enterobacterales causing infections in sub-Saharan children (0-18 years old). Studies were excluded if they had unclear documentation of antimicrobial susceptibility testing methods or fewer than ten observations per bacteria. Data extraction and quality appraisal were conducted by two authors independently. The primary outcome was the proportion of Enterobacterales resistant to antibiotics commonly used in paediatrics. Proportions were combined across studies using mixed-effects logistic regression models per bacteria and per antibiotic. Between-study heterogeneity was assessed using the I2 statistic. The protocol was registered with PROSPERO (CRD42021260157). Findings After screening 1111 records, 122 relevant studies were included, providing data on more than 30,000 blood, urine and stool isolates. Escherichia coli and Klebsiella spp. were the predominant species, both presenting high proportions of resistance to third-generation cephalosporins, especially in blood cultures: 40.6% (95% CI: 27.7%-55%; I2: 85.7%, number of isolates (n): 1032) and 84.9% (72.8%-92.2%; I2: 94.1%, n: 2067), respectively. High proportions of resistance to other commonly used antibiotics were also observed. E. coli had high proportions of resistance, especially for ampicillin (92.5%; 95% CI: 76.4%-97.9%; I2: 89.8%, n: 888) and gentamicin (42.7%; 95% CI: 30%-56.5%; I2: 71.9%, n: 968). Gentamicin-resistant Klebsiella spp. were also frequently reported (77.6%; 95% CI: 65.5%-86.3%; I2: 91.6%, n: 1886). Interpretation High proportions of resistance to antibiotics commonly used for empirical treatment of infectious syndromes were found for Enterobacterales in sub-Saharan children. There is a critical need to better identify local patterns of AMR to inform and update clinical guidelines for better treatment outcomes. Funding No funding was received.
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Affiliation(s)
- Morgane Kowalski
- Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Basilice Minka Obama
- Paediatric Infectious Diseases Unit, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Regional Hospital Centre for Ebolowa, Ebolowa, Cameroon
| | - Gaud Catho
- Division of Infectious Diseases, Central Institute, Hospital of Valais, Switzerland
- Infection Control Division, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Juan Emmanuel Dewez
- Medical Department, Médecins Sans Frontières, Operational Centre Geneva, Geneva, Switzerland
| | - Arnaud Merglen
- Division of General Paediatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Micaela Ruef
- Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Diego O. Andrey
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Nasreen Hassoun-Kheir
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Centre, Geneva, Switzerland
| | - Marlieke E.A. de Kraker
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Centre, Geneva, Switzerland
| | - Christophe Combescure
- Centre for Clinical Research, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephane Emonet
- Division of Infectious Diseases, Central Institute, Hospital of Valais, Switzerland
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Annick Galetto-Lacour
- Division of Paediatric Emergency Medicine, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Noémie Wagner
- Paediatric Infectious Diseases Unit, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Medical Department, Médecins Sans Frontières, Operational Centre Geneva, Geneva, Switzerland
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Hamill MM, Onzia A, Parkes-Ratanshi RM, Kyambadde P, Mande E, Nakate V, Melendez JH, Gough E, Manabe YC. Antibiotic overuse, poor antimicrobial stewardship, and low specificity of syndromic case management in a cross section of men with urethral discharge syndrome in Kampala, Uganda. PLoS One 2024; 19:e0290574. [PMID: 38489281 PMCID: PMC10942085 DOI: 10.1371/journal.pone.0290574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/11/2023] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE High prevalence of sexually transmitted infections (STIs) combined with poor antimicrobial stewardship are drivers of STI antimicrobial resistance (AMR) especially in resource-limited settings where syndromic case management (SCM) is the norm. We characterized patterns of antibiotic use prior to clinic attendance and study enrollment in Ugandan men with urethral discharge syndrome (UDS), evaluated in-clinic prescribing, and the performance characteristics of SCM. METHODS Participants were recruited from government clinics participating in an existing gonococcal surveillance program in Kampala, Uganda. Questionnaires including antimicrobial use prior to attendance, prior episodes of UDS, penile swabs, and blood samples were collected. Bivariable and multivariable logistic regression models were used to estimate odds ratios (OR) for preselected factors likely to be associated with antibiotic use. In-clinic antibiotic treatment data were extracted from clinical notes, and the performance of SCM against laboratory-based STI diagnoses was evaluated. FINDINGS Between October 2019 and November 2020, 100(40%) of 250 men with UDS reported taking antibiotics in the 14days prior to attending the clinic. Of these 210(84%) had at least one curable STI and 20% had a reactive point-of-care HIV test. Multivariable analysis demonstrated significant associations between recent antimicrobial use and duration of UDS symptoms <6 days (OR 2.98(95%CI 1.07,8.36), p = 0.038), and sex with women only (OR 0.08(95%CI 0.01,0.82),p = 0.038). The sensitivity of SCM ranged from 80.0% to 94.4%; specificity was low between 5.6% and 33.1%. The positive predictive value of SCM ranged from 2.4(95%CI 0.7,6.0) for trichomoniasis to 63.4(95%CI 56.5,69.9) for gonorrhea. CONCLUSION Pre-enrollment antibiotic use was common in this population at high risk of STI and HIV. Combined with the poor specificity of SCM for male UDS, extensive antibiotic use is a likely driver of STI-AMR in Ugandan men. Interventions to improve antimicrobial stewardship and deliver affordable diagnostics to augment SCM and decrease overtreatment of STI syndromes are required.
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Affiliation(s)
- Matthew M. Hamill
- Division of infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Annet Onzia
- Infectious Disease Institute, Kampala, Uganda
| | | | - Peter Kyambadde
- Ministry of Health, National Sexually Transmitted Infections Control Program, Kampala, Uganda
| | | | | | - Johan H. Melendez
- Division of infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Ethan Gough
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Yukari C. Manabe
- Division of infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
- Infectious Disease Institute, Kampala, Uganda
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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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Behera LM, Ghosh M, Gupta PK, Rana S. A rationally engineered small antimicrobial peptide with potent antibacterial activity. J Cell Biochem 2024; 125:e30503. [PMID: 37992185 DOI: 10.1002/jcb.30503] [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: 09/06/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 11/24/2023]
Abstract
Antimicrobial resistance (AMR) is a silent pandemic declared by the WHO that requires urgent attention in the post-COVID world. AMR is a critical public health concern worldwide, potentially affecting people at different stages of life, including the veterinary and agriculture industries. Notably, very few new-age antimicrobial agents are in the current developmental pipeline. Thus, the design, discovery, and development of new antimicrobial agents are required to address the menace of AMR. Antimicrobial peptides (AMPs) are an important class of antimicrobial agents for combating AMR due to their broad-spectrum activity and ability to evade AMR through a multimodal mechanism of action. However, molecular size, aggregability, proteolytic degradation, cytotoxicity, and hemolysis activity significantly limit the clinical application of natural AMPs. The de novo design and engineering of a short synthetic amphipathic AMP (≤16 aa, Mol. Wt. ≤ 2 kDa) with an unusual architecture comprised of coded and noncoded amino acids (NCAAs) is presented here, which demonstrates potent antibacterial activity against a few selected bacterial strains mentioned in the WHO priority list. The designer AMP is conformationally ordered in solution and effectively permeabilizes the outer and inner membranes, leading to bacterial growth inhibition and death. Additionally, the peptide is resistant to proteolysis and has negligible cytotoxicity and hemolysis activity up to 150 μM toward cultured human cell lines and erythrocytes. The designer AMP is unique and appears to be a potent therapeutic candidate, which can be subsequently subjected to preclinical studies to explicitly understand and address the menace of AMR.
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Affiliation(s)
- Lalita Mohan Behera
- Chemical Biology Laboratory, School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Odisha, India
| | - Manaswini Ghosh
- Chemical Biology Laboratory, School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Odisha, India
| | - Pulkit Kr Gupta
- Chemical Biology Laboratory, School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Odisha, India
| | - Soumendra Rana
- Chemical Biology Laboratory, School of Basic Sciences, Indian Institute of Technology Bhubaneswar, Odisha, India
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Sartorius B, Gray AP, Davis Weaver N, Robles Aguilar G, Swetschinski LR, Ikuta KS, Mestrovic T, Chung E, Wool EE, Han C, Gershberg Hayoon A, Araki DT, Abd-Elsalam S, Aboagye RG, Adamu LH, Adepoju AV, Ahmed A, Akalu GT, Akande-Sholabi W, Amuasi JH, Amusa GA, Argaw AM, Aruleba RT, Awoke T, Ayalew MK, Azzam AY, Babin FX, Banerjee I, Basiru A, Bayileyegn NS, Belete MA, Berkley JA, Bielicki JA, Dekker D, Demeke D, Demsie DG, Dessie AM, Dunachie SJ, Ed-Dra A, Ekholuenetale M, Ekundayo TC, El Sayed I, Elhadi M, Elsohaby I, Eyre D, Fagbamigbe AF, Feasey NA, Fekadu G, Fell F, Forrest KM, Gebrehiwot M, Gezae KE, Ghazy RM, Hailegiyorgis TT, Haines-Woodhouse G, Hasaballah AI, Haselbeck AH, Hsia Y, Iradukunda A, Iregbu KC, Iwu CCD, Iwu-Jaja CJ, Iyasu AN, Jaiteh F, Jeon H, Joshua CE, Kassa GG, Katoto PDMC, Krumkamp R, Kumaran EAP, Kyu HH, Manilal A, Marks F, May J, McLaughlin SA, McManigal B, Melese A, Misgina KH, Mohamed NS, Mohammed M, Mohammed S, Mohammed S, Mokdad AH, Moore CE, Mougin V, Mturi N, Mulugeta T, Musaigwa F, Musicha P, Musila LA, Muthupandian S, Naghavi P, Negash H, Nuckchady DC, Obiero CW, Odetokun IA, Ogundijo OA, Okidi L, Okonji OC, Olagunju AT, Olufadewa II, Pak GD, Perovic O, Pollard A, Raad M, Rafaï C, Ramadan H, Redwan EMM, Roca A, Rosenthal VD, Saleh MA, Samy AM, Sharland M, Shittu A, Siddig EE, Sisay EA, Stergachis A, Tesfamariam WB, Tigoi C, Tincho MB, Tiruye TY, Umeokonkwo CD, Walsh T, Walson JL, Yusuf H, Zeru NG, Hay SI, Dolecek C, Murray CJL, Naghavi M. The burden of bacterial antimicrobial resistance in the WHO African region in 2019: a cross-country systematic analysis. Lancet Glob Health 2024; 12:e201-e216. [PMID: 38134946 PMCID: PMC10805005 DOI: 10.1016/s2214-109x(23)00539-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/18/2023] [Accepted: 11/07/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND A critical and persistent challenge to global health and modern health care is the threat of antimicrobial resistance (AMR). Previous studies have reported a disproportionate burden of AMR in low-income and middle-income countries, but there remains an urgent need for more in-depth analyses across Africa. This study presents one of the most comprehensive sets of regional and country-level estimates of bacterial AMR burden in the WHO African region to date. METHODS We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR for 23 bacterial pathogens and 88 pathogen-drug combinations for countries in the WHO African region in 2019. Our methodological approach consisted of five broad components: the number of deaths in which infection had a role, the proportion of infectious deaths attributable to a given infectious syndrome, the proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antimicrobial drug of interest, and the excess risk of mortality (or duration of an infection) associated with this resistance. These components were then used to estimate the disease burden by using two counterfactual scenarios: deaths attributable to AMR (considering an alternative scenario where infections with resistant pathogens are replaced with susceptible ones) and deaths associated with AMR (considering an alternative scenario where drug-resistant infections would not occur at all). We obtained data from research hospitals, surveillance networks, and infection databases maintained by private laboratories and medical technology companies. We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. FINDINGS In the WHO African region in 2019, there were an estimated 1·05 million deaths (95% UI 829 000-1 316 000) associated with bacterial AMR and 250 000 deaths (192 000-325 000) attributable to bacterial AMR. The largest fatal AMR burden was attributed to lower respiratory and thorax infections (119 000 deaths [92 000-151 000], or 48% of all estimated bacterial pathogen AMR deaths), bloodstream infections (56 000 deaths [37 000-82 000], or 22%), intra-abdominal infections (26 000 deaths [17 000-39 000], or 10%), and tuberculosis (18 000 deaths [3850-39 000], or 7%). Seven leading pathogens were collectively responsible for 821 000 deaths (636 000-1 051 000) associated with resistance in this region, with four pathogens exceeding 100 000 deaths each: Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus. Third-generation cephalosporin-resistant K pneumoniae and meticillin-resistant S aureus were shown to be the leading pathogen-drug combinations in 25 and 16 countries, respectively (53% and 34% of the whole region, comprising 47 countries) for deaths attributable to AMR. INTERPRETATION This study reveals a high level of AMR burden for several bacterial pathogens and pathogen-drug combinations in the WHO African region. The high mortality rates associated with these pathogens demonstrate an urgent need to address the burden of AMR in Africa. These estimates also show that quality and access to health care and safe water and sanitation are correlated with AMR mortality, with a higher fatal burden found in lower resource settings. Our cross-country analyses within this region can help local governments to leverage domestic and global funding to create stewardship policies that target the leading pathogen-drug combinations. FUNDING Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.
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Mathur S, Smuk M, Evans C, Wedderburn CJ, Gibb DM, Penazzato M, Prendergast AJ. Estimating the impact of alternative programmatic cotrimoxazole strategies on mortality among children born to mothers with HIV: A modelling study. PLoS Med 2024; 21:e1004334. [PMID: 38377150 PMCID: PMC10914273 DOI: 10.1371/journal.pmed.1004334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 03/05/2024] [Accepted: 01/10/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND World Health Organization (WHO) guidelines recommend cotrimoxazole prophylaxis for children who are HIV-exposed until infection is excluded and vertical transmission risk has ended. While cotrimoxazole has benefits for children with HIV, there is no mortality benefit for children who are HIV-exposed but uninfected, prompting a review of global guidelines. Here, we model the potential impact of alternative cotrimoxazole strategies on mortality in children who are HIV-exposed. METHODS AND FINDINGS Using a deterministic compartmental model, we estimated mortality in children who are HIV-exposed from 6 weeks to 2 years of age in 4 high-burden countries: Côte d'Ivoire, Mozambique, Uganda, and Zimbabwe. Vertical transmission rates, testing rates, and antiretroviral therapy (ART) uptake were derived from UNAIDS data, trial evidence, and meta-analyses. We explored 6 programmatic strategies: maintaining current recommendations; shorter cotrimoxazole provision for 3, 6, 9, or 12 months; and starting cotrimoxazole only for children diagnosed with HIV. Modelled alternatives to the current strategy increased mortality to varying degrees; countries with high vertical transmission had the greatest mortality. Compared to current recommendations, starting cotrimoxazole only after a positive HIV test had the greatest predicted increase in mortality: Mozambique (961 excess annual deaths; excess mortality 339 per 100,000 HIV-exposed children; risk ratio (RR) 1.06), Uganda (491; 221; RR 1.04), Zimbabwe (352; 260; RR 1.05), and Côte d'Ivoire (125; 322; RR 1.06). Similar effects were observed for 3-, 6-, 9-, and 12-month strategies. Increased mortality persisted but was attenuated when modelling lower cotrimoxazole uptake, smaller mortality benefits, higher testing coverage, and lower vertical transmission rates. The study is limited by uncertain estimates of cotrimoxazole coverage in programmatic settings; an inability to model increases in mortality arising from antimicrobial resistance due to limited surveillance data in sub-Saharan Africa; and lack of a formal health economic analysis. CONCLUSIONS Changing current guidelines from universal cotrimoxazole provision for children who are HIV-exposed increased predicted mortality across the 4 modelled high-burden countries, depending on test-to-treat cascade coverage and vertical transmission rates. These findings can help inform policymaker deliberations on cotrimoxazole strategies, recognising that the risks and benefits differ across settings.
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Affiliation(s)
- Shrey Mathur
- Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Melanie Smuk
- Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Ceri Evans
- Blizard Institute, Queen Mary University of London, London, United Kingdom
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Catherine J. Wedderburn
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
- Department of Paediatrics and Child Health and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Diana M. Gibb
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Martina Penazzato
- Department of Research for Health, Science Division, World Health Organization, Geneva, Switzerland
| | - Andrew J. Prendergast
- Blizard Institute, Queen Mary University of London, London, United Kingdom
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
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Yenyetou D, Zongo E, Dama E, Muhigwa M, Sanou I, Sawadogo C, Ouangraoua S, Sangare I, Nikiema A, Dahourou AG, Ouedraogo AS. Sentinel laboratory compliance with best practices in Burkina Faso's antimicrobial resistance surveillance network. Afr J Lab Med 2024; 13:2259. [PMID: 38322503 PMCID: PMC10839167 DOI: 10.4102/ajlm.v13i1.2259] [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: 07/14/2023] [Accepted: 11/20/2023] [Indexed: 02/08/2024] Open
Abstract
Background Standardising procedures is the best way to harmonise and strengthen the quality of laboratory-based antimicrobial resistance surveillance. Since 2018, Burkina Faso has developed and disseminated the national manual of procedures for performing antibiotic susceptibility tests in sentinel laboratories within its national antimicrobial resistance surveillance network. Objective Our study aimed to assess these sentinel laboratories' compliance with good practices for antibiotics susceptibility tests. Methods Four teams evaluated the antimicrobial resistance sentinel sites laboratories throughout Burkina Faso from 19 to 28 September 2022. Eighteen out of 19 sentinel laboratories were evaluated. A four-member technical committee designed and validated the evaluation tool composed of three Microsoft Excel sheets. The evaluation emphasised quality controls for culture media, antibiotic discs and compliance with antimicrobial susceptibility testing procedures by the laboratories. Excel software was used for data recording and graphs and table design. The free R software version 4.2.0 was used for descriptive statistics. An overall score below 80% was considered noncompliance. Results Most (83.33%) of the sentinel laboratories conducted at least one quality control activity for culture media, and 66.67% conducted at least one quality control activity for antibiotic discs. Over three-quarters (76.47%) of the laboratories were more than 80% compliant with the modified Kirby Bauer antimicrobial susceptibility testing method. Conclusion The evaluation revealed the noncompliance of sentinel laboratories with the national procedure manual, particularly in the quality control component. What this study adds This study has provided baseline data on the sentinel laboratories' compliance with the national antimicrobial susceptibility testing procedures manual, particularly in areas performing quality control checks or meeting quality indicators for culture media and antibiotic discs.
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Affiliation(s)
- Dame Yenyetou
- Laboratoire National de Référence des Résistances aux Antimicrobiens, Centre Hospitalier Universitaire Souro SANOU, Bobo-Dioulasso, Burkina Faso
- Laboratoire des Pathogènes Emergents et Reémergents (LaPathER), École Doctorale Sciences de la Santé, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso
| | - Emmanuel Zongo
- Laboratoire National de Référence des Résistances aux Antimicrobiens, Centre Hospitalier Universitaire Souro SANOU, Bobo-Dioulasso, Burkina Faso
- Laboratoire des Pathogènes Emergents et Reémergents (LaPathER), École Doctorale Sciences de la Santé, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Emilie Dama
- US Centers for Disease Control and Prevention, Ouagadougou, Burkina Faso
| | - Merci Muhigwa
- Laboratoire National de Référence des Résistances aux Antimicrobiens, Centre Hospitalier Universitaire Souro SANOU, Bobo-Dioulasso, Burkina Faso
- Laboratoire des Pathogènes Emergents et Reémergents (LaPathER), École Doctorale Sciences de la Santé, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso
| | - Issouf Sanou
- Laboratoire des Pathogènes Emergents et Reémergents (LaPathER), École Doctorale Sciences de la Santé, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso
- Service des Systèmes d’Information, et de l’Évaluation de la Qualité, Centre Muraz, Ouagadougou, Burkina Faso
| | - Charles Sawadogo
- Direction des Laboratoires de Biologie Médicale, Ministère de la Santé, Ouagadougou, Burkina Faso
| | | | - Ibrahim Sangare
- Laboratoire des Pathogènes Emergents et Reémergents (LaPathER), École Doctorale Sciences de la Santé, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso
| | | | - Anicet G. Dahourou
- US Centers for Disease Control and Prevention, Ouagadougou, Burkina Faso
| | - Abdoul S. Ouedraogo
- Laboratoire National de Référence des Résistances aux Antimicrobiens, Centre Hospitalier Universitaire Souro SANOU, Bobo-Dioulasso, Burkina Faso
- Laboratoire des Pathogènes Emergents et Reémergents (LaPathER), École Doctorale Sciences de la Santé, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso
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Nofal MR, Zhuang AY, Gebeyehu N, Starr N, Haile ST, Woldeamanuel H, Tesfaye A, Alemu SB, Bekele A, Mammo TN, Weiser TG, Abdukadir AA, Abebe BM, Admasu AK, Alito TA, Ambulkar R, Arimino S, Arusi M, Aynalem N, Bajaj V, Delelo TS, Gutu M, Habte F, Hurrisa GA, Kunte A, Rocabado K, Shiferaw MA, Harrell-Shreckengost C, Tiruneh A, Zamorano R, Abreha M, Aguilera C, Lima B, Kebede H. An observational cohort study on the effects of extended postoperative antibiotic prophylaxis on surgical-site infections in low- and middle-income countries. Br J Surg 2024; 111:znad438. [PMID: 38198157 PMCID: PMC10782210 DOI: 10.1093/bjs/znad438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Worldwide, approximately one in six inpatient antibiotic prescriptions are for surgical-infection prophylaxis, including postoperative prophylaxis. The WHO recommends against prolonged postoperative antibiotics to prevent surgical-site infection. However, in many low- and middle-income countries, postoperative antibiotic prophylaxis is common due to perceptions that it protects against surgical-site infection and data informing recommendations against antibiotic administration are largely derived from high-income countries. The aim of this study was to describe postoperative antibiotic-prescribing patterns and related surgical-site infection rates in hospitals in low- and middle-income countries. METHODS Patients from 19 hospitals in Ethiopia, Madagascar, India, and Bolivia with wound class I and II operations were included. Data on antibiotic administration, indication, surgical-site infection, length of hospital stay, and adherence to perioperative infection-prevention standards were collected by trained personnel. The association between postoperative antibiotic prophylaxis for greater than or equal to 24 h and surgical-site infection was analysed via modified robust Poisson regression, controlling for patient and procedural factors and degree of adherence to perioperative infection-prevention practices. RESULTS Of 8714 patients, 92.9% received antibiotics for prophylaxis after surgery and 27.7% received antibiotics for greater than or equal to 24 h. Patients receiving postoperative prophylaxis for greater than or equal to 24 h did not have lower surgical-site infection rates (Relative risk 1.09 (95% c.i. 0.89 to 1.33); P = 0.399), but the length of hospital stay was 1.4 days longer (P < 0.001). CONCLUSION Prolonged postoperative antibiotics did not reduce surgical-site infection, but pervasive use was associated with a longer length of hospital stay, in resource-limited healthcare systems. With the growing threat of antimicrobial resistance, surgical initiatives to implement antimicrobial stewardship programmes in low- and middle-income countries are critical.
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Niriayo YL, Ayalneh M, Demoz GT, Tesfay N, Gidey K. Antimicrobial use related problems and determinants in surgical ward of Ethiopian tertiary hospital. PLoS One 2023; 18:e0296284. [PMID: 38134131 PMCID: PMC10745209 DOI: 10.1371/journal.pone.0296284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Antibiotic use related problems lead to the emergence of resistance, failure of therapy, morbidity, mortality, and unnecessary healthcare expenditure. However, little is known about antimicrobial use related problems in our setting particularly in hospitalized surgical patients. OBJECTIVE The purpose of this study was to investigate antibiotic use related problems and their determinants among hospitalized surgical patients. METHODOLOGY A prospective observational study was conducted from December 2018 to April 2019 at the surgical ward of the Ayder comprehensive specialized hospital, located in Northern Ethiopia. We included patients admitted to the surgical ward who were on antibiotic therapy or were candidates for antibiotic therapy/prophylaxis. The patients were recruited during admission and were followed daily until discharge. Data were collected through patient interviews and expert reviews of medical and medication records. The appropriateness of antibiotic use was evaluated according to the Infectious Disease Society of America, American Society of Health System Pharmacists, and World Health Organization guidelines. Subsequently, antibiotic use related problems were identified and classified based on Cipolle's method followed by consensus review with experts. Binary logistic regression was performed to identify the determinants of antibiotic use related problems. Statistical significance was set at p <0.05. RESULTS Among 272 patients, 167(61.4%) experienced antibiotics use related problems. A total of 235 antibiotics use related problems were identified equating 0.86±0.82 problems per patient. The commonly identified antibiotic use related problems were the need for additional drug therapy (29.4%), unnecessary drug therapy (15%), and dosage too high (12.1%). Cephalosporin (47.02%) was the most commonly implicated class of antibiotics in these drug related problems, followed by penicillin (18.45%) and metronidazole (16.02%). Prolonged hospitalization (AOR: 3.57, 95% CI: 1.91-6.70), number of medications≥5 (AOR: 2.08, 95%CI: 1.10-3.94), and lower qualifications of practitioners [general practitioners (AOR: 10.27, 95%CI: 4.13-25.58) and surgical residents (AOR: 2.28, 95%CI: 1.12-4.63)] were predictors of antibiotic use related problems. CONCLUSION Antibiotic use related problems were common among the hospitalized surgical patients. Prolonged hospitalizations, number of medications, and lower qualifications of practitioners were predictors of antibiotic use related problems. Therefore, more emphasis should be given for patients with prolonged hospitalization and multiple medications. Moreover, practitioners with higher qualifications including surgical specialists need to be involved in patient evaluations.
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Affiliation(s)
- Yirga Legesse Niriayo
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Melisew Ayalneh
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Gebre Teklemariam Demoz
- Clinical Pharmacy and Pharmacy Practice Unit, Departments of Pharmacy, College of Health Sciences, Aksum University, Axum, Tigray, Ethiopia
| | - Nigusse Tesfay
- School of dental medicine, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kidu Gidey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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Nyarko JA, Akuoko KO, Dapaah JM, Gyapong M. Exploring the operations of itinerant medicine sellers within urban bus terminals in Kumasi, Ghana. HEALTH POLICY OPEN 2023; 5:100108. [PMID: 38059004 PMCID: PMC10696389 DOI: 10.1016/j.hpopen.2023.100108] [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: 04/21/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023] Open
Abstract
This paper explores Itinerant Medicine Sellers' (IMSs) operations at loading bays within bus terminals in the Kumasi metropolis. The paper examines how the sellers negotiated access into the loading bays, how they marketed their medicines, where they sourced their medicines from, and the challenges they faced. An exploratory qualitative survey design was adopted for the study. Through convenience sampling, 18 IMSs operating within the bus terminals in the Kumasi metropolis participated in this study. In-depth interviews were conducted, audio-recorded and transcribed. The transcripts were thematically analysed. The study found that these hawkers negotiated access to the loading bays through multiple informal gatekeepers and employed direct customer engagement in marketing their medicines. It was further revealed that the IMSs sourced their medicines from both formal and informal sources for different reasons, such as affordability and informality of medicines acquisition. The participants operated outside government-prescribed regulations and faced challenges of low capital and sales revenue, poor reception by prospective clients, and government clampdown. The study concludes that medicine hawking is an illegal livelihood strategy and a public health concern. As a phenomenon outside government's policy guidelines, it is recommended that government intensifies its clampdown activities on these hawkers and engage in public health education on the negative implications of accessing medicines from these IMSs.
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Affiliation(s)
- Joy Ato Nyarko
- Department of General and Liberal Studies, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Ghana
- Department of Sociology and Social Work, Faculty of Social Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kofi Osei Akuoko
- Department of Sociology and Social Work, Faculty of Social Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jonathan Mensah Dapaah
- Department of Sociology and Social Work, Faculty of Social Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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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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Liu Y, Chen X, Sun J, Xu N, Tang Q, Ren J, Chen C, Lei W, Zhang C, Liu D. Large-scale production of MXenes as nanoknives for antibacterial application. NANOSCALE ADVANCES 2023; 5:6572-6581. [PMID: 38024301 PMCID: PMC10662114 DOI: 10.1039/d3na00744h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023]
Abstract
Antimicrobial resistance of existing antibacterial agents has become a pressing issue for human health and demands effective antimicrobials beyond conventional antibacterial mechanisms. Two-dimensional (2D) nanomaterials have attracted considerable interest for this purpose. However, obtaining a high yield of 2D nanomaterials with a designed morphology for effective antibacterial activity remains exceptionally challenging. In this study, an efficient one-step mechanical exfoliation (ECO-ME) method has been developed for rapidly preparing Ti3C2 MXenes with a concentration of up to 30 mg mL-1. This synthetic pathway involving mechanical force endows E-Ti3C2 MXene prepared by the ECO-ME method with numerous irregular sharp edges, resulting in a unique nanoknife effect that can successfully disrupt the bacterial cell wall, demonstrating better antibacterial activity than the MXenes prepared by conventional wet chemical etching methods. Overall, this study provides a simple and effective method for preparing MXenes on a large scale, and its antibacterial effects demonstrate great potential for E-Ti3C2 in environmental and biomedical applications.
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Affiliation(s)
- Yuchen Liu
- School of Resources and Environment, Anhui Agricultural University 130 Changjiang West Road Hefei 230036 Anhui China
- Institute for Frontier Materials, Deakin University Locked Bag 2000 Geelong Victoria 3220 Australia
| | - Xing Chen
- Key Laboratory of Integrated Crop Pest Management of Anhui Province, School of Plant Protection, Anhui Agricultural University Hefei 230036 China
| | - Jiazhi Sun
- Key Laboratory of Integrated Crop Pest Management of Anhui Province, School of Plant Protection, Anhui Agricultural University Hefei 230036 China
| | - Nuo Xu
- School of Resources and Environment, Anhui Agricultural University 130 Changjiang West Road Hefei 230036 Anhui China
| | - Qi Tang
- School of Resources and Environment, Anhui Agricultural University 130 Changjiang West Road Hefei 230036 Anhui China
| | - Jie Ren
- School of Resources and Environment, Anhui Agricultural University 130 Changjiang West Road Hefei 230036 Anhui China
| | - Cheng Chen
- School of Resources and Environment, Anhui Agricultural University 130 Changjiang West Road Hefei 230036 Anhui China
| | - Weiwei Lei
- Institute for Frontier Materials, Deakin University Locked Bag 2000 Geelong Victoria 3220 Australia
| | - Chao Zhang
- School of Resources and Environment, Anhui Agricultural University 130 Changjiang West Road Hefei 230036 Anhui China
| | - Dan Liu
- Institute for Frontier Materials, Deakin University Locked Bag 2000 Geelong Victoria 3220 Australia
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Ekuma A, Onukak A, Udoette S, Versporten A, Pauwels I, Oduyebo O, Goossens H. AWaRe classification of antibiotics prescribed within 2018-2021 for hospitalised medical and surgical patients in Uyo, Nigeria. Pan Afr Med J 2023; 46:80. [PMID: 38282765 PMCID: PMC10819836 DOI: 10.11604/pamj.2023.46.80.33027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 08/13/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction point prevalence surveys have been used as a standardized tool to monitor antibiotic consumption to inform antimicrobial stewardship interventions in many countries. The 2021 WHO model list of Essential Medicines has classified antibiotics into three groups: access, watch and reserve. The aim of this paper is to describe the antibiotics used within a space of three years between 2018 and 2021 at the University of Uyo Teaching Hospital based on WHO AWaRe classification. Methods three point-prevalence surveys were conducted in the wards in our 500-bed tertiary hospital in 2018, 2019 and 2021. Each ward was surveyed on a particular day within a four-week period. The wards were grouped into medical and surgical for comparison. Antibiotics were classified as access, watch, and reserve. Validated data were analyzed with IBM SPSS Statistics for Windows, Version 20.0 (Armonk, NY: IBM Corp.). Results a total of 526 patients were surveyed out of which 344 were on antimicrobial therapy with a total of 687 antibiotic prescriptions. The overall prevalence of patients who received at least one antimicrobial was 65.4% (62.4 -72.8%). The Access group of antibiotics made up 48.2% of prescriptions while the watch group made up 50.5% of prescriptions. More watch Antibiotics were prescribed by surgical wards (49.7%) than by medical wards (43.7%). Conclusion the use of Access group antibiotics in our hospital falls below the WHO target level in both medical and surgical wards. There is a need for strengthening antibiotic stewardship activities to reduce the use of watch group antibiotics and limit antimicrobial resistance.
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Affiliation(s)
- Agantem Ekuma
- Department of Medical Microbiology and Parasitology, University of Uyo, Uyo, Nigeria
| | - Asukwo Onukak
- Department of Internal Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Sylvanus Udoette
- Department of Internal Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ines Pauwels
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Oyinlola Oduyebo
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Kihwili L, Silago V, Francis EN, Idahya VA, Saguda ZC, Mapunjo S, Mushi MF, Mshana SE. A Point Prevalence Survey of Antimicrobial Use at Geita Regional Referral Hospital in North-Western Tanzania. PHARMACY 2023; 11:159. [PMID: 37888504 PMCID: PMC10609811 DOI: 10.3390/pharmacy11050159] [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: 07/13/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
We conducted a point prevalence survey (PPS) to determine the prevalence of antibiotic use at Geita Regional Referral Hospital (GRRH) located along the shores of Lake Victoria in north-western Tanzania. This has led to the identification of gaps for improvement. This PPS study was conducted on 9-10 March 2023. Patient-related information, including sociodemographic and clinical data, was collected from medical records. STATA software version 15.0 was used to perform descriptive data analysis. About 94.8% (55/58) patients were on antibiotics with a mean (±SD) prescription of 2 (±0.5) antibiotic agents ranging from 1 to 4 different agents. The commonest indications of the antibiotic prescription were medical prophylaxis 47.3% (26/55) followed by empiric treatment 41.8% (23/55). In total, 110 prescriptions were made, of which metronidazole (25.5%; n = 28), ceftriaxone (23.6%; n = 26), and ampicillin-cloxacillin (23.6%; n = 26) were frequently observed. Only 67.3% (n = 74) of prescriptions complied with Tanzania Standard Treatment Guidelines. Moreover, according to the WHO-AWaRe classification, 50.9%, 23.6%, and 25.5% were under the Access category, Watch category, and Not Recommended category, respectively. The prevalence of antibiotic use among patients admitted to GRRH was high, whereby medical prophylaxis and empiric treatment were the commonest indications for antibiotic prescription. To support rational therapy and antimicrobial stewardship initiatives, we recommend that laboratories in regional hospitals be equipped to conduct sustained routine culture and antimicrobial susceptibility testing.
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Affiliation(s)
- Lutugera Kihwili
- Department of Pharmaceutical Sciences, School of Pharmacy, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania;
| | - Vitus Silago
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (M.F.M.); (S.E.M.)
| | | | - Vicent A. Idahya
- Geita Regional Referral Hospital, Geita P.O. Box 40, Tanzania; (V.A.I.); (Z.C.S.)
| | - Zabron C. Saguda
- Geita Regional Referral Hospital, Geita P.O. Box 40, Tanzania; (V.A.I.); (Z.C.S.)
| | - Siana Mapunjo
- National Multi-Sectoral Coordinating Committee, Ministry of Health, Dodoma P.O. Box 573, Tanzania;
| | - Martha F. Mushi
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (M.F.M.); (S.E.M.)
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania; (M.F.M.); (S.E.M.)
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Mlugu EM, Mohamedi JA, Sangeda RZ, Mwambete KD. Prevalence of urinary tract infection and antimicrobial resistance patterns of uropathogens with biofilm forming capacity among outpatients in morogoro, Tanzania: a cross-sectional study. BMC Infect Dis 2023; 23:660. [PMID: 37798713 PMCID: PMC10557311 DOI: 10.1186/s12879-023-08641-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Urinary tract infection (UTI) is the second most common infectious disease affecting more than 150 million people globally annually. Uropathogenic E. coli (UPEC), the predominant cause of UTI, can occur as a biofilm associated with antimicrobial resistance (AMR). There is a data gap on global AMR patterns from low-income settings, including Tanzania. Data on antimicrobial susceptibility patterns in relation to biofilm formation will help in the proper selection of antibiotics and the fight against AMR. METHODS This analytical cross-sectional study was conducted among consecutively selected outpatients (n = 344) from January to May 2022 at Morogoro Regional Referal Hospital. Mid-stream urine samples were collected aseptically from symptomatic patients. A significant UTI was defined when more than 105 colonies/ml of urine were recorded. Kirby Bauer's disc diffusion method was used for antibiotics susceptibility patterns and a Congo Red Agar method was used to determine biofilm formation. Two-sided χ2 test or Fisher's exact test, Cohen's kappa coefficient and logistic regression were used for data analysis. A p-value < 0.05 was considered statistically significant. RESULTS The prevalence of UTIs was 41% (141/344) and elders (>=60 years) had five times higher odds of having UTI as compared to adolescents (p < 0.001). E. coli was the most predominant bacteria (47%; 66/141), which displayed moderate susceptibility against ciprofloxacin (59.1%) and nitrofurantoin (57.6%). A total of 72 (51%) of all isolated bacteria were multi-drug resistant. All isolated bacteria demonstrated high resistance (> 85%) against ampicillin and co-trimoxazole. In this study, 51.5% (34/66) were biofilm-forming E. coli and demonstrated relatively higher antibiotic resistance as compared to non-biofilm forming bacteria (p < 0.05). CONCLUSION We report high antibiotic resistance against commonly used antibiotics. Slightly more than half of the isolated bacteria were biofilm forming E. coli. A need to strengthen stewardship programs is urgently advocated.
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Affiliation(s)
- Eulambius M Mlugu
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Juma A Mohamedi
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Raphael Z Sangeda
- Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kennedy D Mwambete
- Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Ousmane S, Kollo IA, Jambou R, Boubacar R, Arzika AM, Maliki R, Amza A, Liu Z, Lebas E, Colby E, Zhong L, Chen C, Hinterwirth A, Doan T, Lietman TM, O’Brien KS. Wastewater-Based Surveillance of Antimicrobial Resistance in Niger: An Exploratory Study. Am J Trop Med Hyg 2023; 109:725-729. [PMID: 37640288 PMCID: PMC10551091 DOI: 10.4269/ajtmh.23-0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/31/2023] [Indexed: 08/31/2023] Open
Abstract
Wastewater-based surveillance is increasingly recognized as an important approach to monitoring population-level antimicrobial resistance (AMR). In this exploratory study, we examined the use of metagenomics to evaluate AMR using untreated wastewater samples routinely collected by the Niger national polio surveillance program. Forty-eight stored samples from two seasons each year over 4 years (2016-2019) in three regions were selected for inclusion in this study and processed using unbiased DNA deep sequencing. Normalized number of reads of genetic determinants for different antibiotic classes were compared over time, by season, and by location. Correlations in resistance were examined among classes. Changes in reads per million per year were demonstrated for several classes, including decreases over time in resistance determinants for phenicols (-3.3, 95% CI: -8.7 to -0.1, P = 0.029) and increases over time for aminocoumarins (3.8, 95% CI: 0.0 to 11.4, P = 0.043), fluoroquinolones (6.8, 95% CI: 0.0 to 20.5, P = 0.048), and beta-lactams (0.85, 95% CI: 0.1 to 1.7, P = 0.006). Sulfonamide resistance was higher in the post-rainy season compared with the dry season (5.2-fold change, 95% CI: 3.4 to 7.9, P < 0.001). No differences were detected when comparing other classes by season or by site for any antibiotic class. Positive correlations were identified in genetic determinants of resistance among several antibiotic classes. These results demonstrate the potential utility of leveraging existing wastewater sample collection in this setting for AMR surveillance.
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Affiliation(s)
- Sani Ousmane
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | | | - Ronan Jambou
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | - Rakia Boubacar
- Centre de Recherche Médicale et Sanitaire, Niamey, Niger
| | - Ahmed M. Arzika
- Centre de Recherche et Interventions en Santé Publique, Birni N’Gaoure, Niger
| | - Ramatou Maliki
- Centre de Recherche et Interventions en Santé Publique, Birni N’Gaoure, Niger
| | - Abdou Amza
- Programme Nationale de Santé Oculaire, Niamey, Niger
| | - Zijun Liu
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Elodie Lebas
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Emily Colby
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Lina Zhong
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Cindi Chen
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Armin Hinterwirth
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Thuy Doan
- Francis I. Proctor Foundation, University of California, San Francisco, California
- Department of Ophthalmology, University of California, San Francisco, California
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California
- Department of Ophthalmology, University of California, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
- Institute for Global Health Sciences, University of California, San Francisco, California
| | - Kieran S. O’Brien
- Francis I. Proctor Foundation, University of California, San Francisco, California
- Department of Ophthalmology, University of California, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
- Institute for Global Health Sciences, University of California, San Francisco, California
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Olatunji YA, Banjo AA, Jarde A, Salaudeen R, Ndiaye M, Galega LB, Odutola A, Hossain IM, Osuorah C, Sahito MS, Muhammad BS, Ikumapayi NU, Drammeh MM, Manjang A, Adegbola RA, Greenwood BM, Hill PC, Grant MA. Invasive bacterial disease in young infants in rural Gambia: Population-based surveillance. J Glob Health 2023; 13:04106. [PMID: 37772795 PMCID: PMC10540664 DOI: 10.7189/jogh.13.04106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Background Invasive bacterial diseases (IBD) cause significant mortality in young infants. There are limited population-based data on IBD in young infants in Sub-Saharan Africa. Methods We conducted population-based surveillance for IBD among infants aged 0-90 days in a demographic surveillance area in rural Gambia between 1 March 2011 and 31 December 2017. Infants admitted to health facilities within the study area had standardised clinical evaluation plus conventional microbiological investigation. We defined IBD as isolation of pathogenic bacteria from blood, cerebrospinal fluid, lung, or pleural aspirate. We determined incidence, aetiology and case-fatality of IBD. Results A total of 3794 infants were admitted and 3605 (95%) had at least one sample collected for culture. We detected 254 (8.0%) episodes of IBD (bacteraemia 241; meningitis 14; pneumonia seven). The incidence of IBD in infants aged 0-90 days was 25 episodes/1000 person-years (95% confidence interval (CI) = 22-28), the incidence in neonates was 50 episodes/1000 person-years (95% CI = 43-58) and the incidence in infants aged 29-90 days was 12 episodes/1000 person-years (95% CI = 9-15). The most common pathogens causing IBD were Staphylococcus aureus (n = 102, 40%), Escherichia coli (n = 37, 15%), Streptococcus pneumoniae (n = 24, 9%) and Klebsiella pneumoniae (n = 12, 5%). Case-fatality was 29% (95% CI = 23-37) in neonates and 19% (95% CI = 11-29) in infants aged 29-90 days. A minimum of 7.3% of all young infant deaths in the population were caused by IBD. Conclusions IBD are common in young infants in rural Gambia and have a high case-fatality. Strategies are needed to prevent IBD in young infants. Overcoming barriers to widespread implementation of existing vaccines and developing new vaccines against the most common pathogens causing IBD should be among top priorities for reducing the high mortality rate in young infants.
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Affiliation(s)
- Yekini A Olatunji
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Adeshola A Banjo
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Alexander Jarde
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Malick Ndiaye
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Lobga B Galega
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Aderonke Odutola
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Ilias M Hossain
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Chidiebere Osuorah
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Muhammad S Sahito
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Bilquees Shah Muhammad
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Nurudeen U Ikumapayi
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Momodou M Drammeh
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | - Ahmad Manjang
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
| | | | - Brian M Greenwood
- London School of Hygiene & Tropical Medicine, Department of Disease Control, London, England, UK
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Mackenzie A Grant
- Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Fajara Banjul, The Gambia
- London School of Hygiene & Tropical Medicine, Department of Disease Control, London, England, UK
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Dereje B, Workneh A, Megersa A, Yibabie S. Prescribing Pattern and Associated Factors in Community Pharmacies: A Cross-Sectional Study Using AWaRe Classification and WHO Antibiotic Prescribing Indicators in Dire Dawa, Ethiopia. Drugs Real World Outcomes 2023; 10:459-469. [PMID: 37300629 PMCID: PMC10491565 DOI: 10.1007/s40801-023-00367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Antimicrobials are drugs that are more likely to trigger the development of resistance naturally. Thus, they need to be prescribed, dispensed, and administered with greater caution. To underline the significance of their proper usage, antibiotics are divided as AWaRe: Access, Watch, and Reserve. Timely evidence on medicine use, prescribing patterns, and the factors affecting prescribing of antibiotic and their use percentage from AWaRe classification would help decision-makers to draft guidelines that can enable more rational use of medicines. METHODS Prospective and cross-sectional study was conducted among seven community pharmacies in Dire Dawa to assess current prescribing practices related World Health Organization (WHO) indicators and AWaRe classification including antibiotic use and associated factors. Using stratified random sampling techniques, 1200 encounters were reviewed between 1 October and 31 October 2022, and SPSS version 27 was used for the analysis. RESULTS The average of medications per prescription was 1.96. Antibiotics were included in 47.8% of encounters, while 43.1% were prescribed from the Watch groups. In 13.5% of the encounters, injections were administered. In multivariate models, patient age, gender, and the number of medications prescribed were significantly associated to prescription of antibiotics. Antibiotics were about 2.5 times more likely to be prescribed to patients under the age of 18 years than to subjects 65 years and older [adjusted odds ratio (AOR): 2.51, 95% confidence interval (CI): 1.88-5.42; P < 0.001]. Men were also more likely than women to receive an antibiotic prescription (AOR: 1.74, 95% CI: 1.18-2.33; P = 0.011). Subjects who received more than two drugs were 2.96 times more likely to receive an antibiotic drug (AOR: 2.96, 95% CI: 1.77-6.55; P < 0.003). The probability of prescribing antibiotics was increased by 2.57 for every one-unit increase in the number of medications [crude odds ratio (OR): 2.57; 95% CI: 2.16-3.47; P < 0.002]. CONCLUSION According to the present study, the amount of prescriptions with antibiotics at community pharmacies is much higher than the WHO standard (20-26.2%). The antibiotics prescribed from Access group were 55.3%, which is slightly lower than WHO recommended level (60%). The prescribing of antibiotics was significantly correlated to the patient's age, gender, and number of medications. The preprint version of the present study is available on Research Square with the following link: https://doi.org/10.21203/rs.3.rs-2547932/v1 .
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Affiliation(s)
- Beyene Dereje
- Department of Pharmacology, School of Medicine, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Alemseged Workneh
- Department of Pharmacology, School of Medicine, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Alemayehu Megersa
- Department of Pharmacology, School of Medicine, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Shegaye Yibabie
- Department of Medicine, School of Medicine, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
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Sambaza SS, Naicker N. Contribution of wastewater to antimicrobial resistance: A review article. J Glob Antimicrob Resist 2023; 34:23-29. [PMID: 37285914 DOI: 10.1016/j.jgar.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 03/15/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES Antimicrobial resistance (AMR) is a global challenge that has raised concern globally, owing to its detrimental effects on the health and economy of countries. The ever-growing threat of AMR and sources of AMR are still being investigated. Wastewater plays an important role as a habitat for bacteria and an environment conducive to gene transfer. The primary aim of this review was to highlight the contribution of wastewater to AMR. METHODS Evidence of AMR in wastewater was drawn from literature published in the last 10 years, from 2012 to 2022. RESULTS Wastewater from agricultural practices, pharmaceutical manufacturing plants, and hospital effluents was established to promote AMR. Furthermore, stress factors such as the presence of antibiotics, heavy metals, pH, and temperature initiate and propagate AMR in bacteria living in wastewater. AMR in bacteria from wastewater was established to be either natural or acquired. Wastewater treatment techniques such as membrane filtration, coagulation, adsorption, and advanced oxidation processes have been used to remove resistant bacteria with varying success levels. CONCLUSION Wastewater is a major contributor to AMR, and an understanding of its role in AMR is necessary to find a lasting solution. In this regard, the spread of AMR in wastewater should be considered a threat that requires a strategy to stop further damage.
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Affiliation(s)
| | - Nisha Naicker
- Department of Environmental Health, University of Johannesburg, Johannesburg, South Africa; Epidemiology and Surveillance, National Institute for Occupational Health, National Health Laboratory Services, Braamfontein, South Africa
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Abioye OE, Nontongana N, Osunla CA, Okoh AI. Antibiotic resistance and virulence genes profiling of Vibrio cholerae and Vibrio mimicus isolates from some seafood collected at the aquatic environment and wet markets in Eastern Cape Province, South Africa. PLoS One 2023; 18:e0290356. [PMID: 37616193 PMCID: PMC10449182 DOI: 10.1371/journal.pone.0290356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
The current study determines the density of Vibrio spp. and isolates V. cholerae and Vibrio mimicus from fish-anatomical-sites, prawn, crab and mussel samples recovered from fish markets, freshwater and brackish water. Virulence and antibiotic resistance profiling of isolates were carried out using standard molecular and microbiology techniques. Vibrio spp. was detected in more than 90% of samples [134/144] and its density was significantly more in fish than in other samples. Vibrio. cholerae and V. mimicus were isolated in at least one sample of each sample type with higher isolation frequency in fish samples. All the V. cholerae isolates belong to non-O1/non-O139 serogroup. One or more V. cholerae isolates exhibited intermediate or resistance against each of the eighteen panels of antibiotics used but 100% of the V. mimicus were susceptible to amikacin, gentamycin and chloramphenicol. Vibrio cholerae exhibited relatively high resistance against polymyxin, ampicillin and amoxicillin/clavulanate while V. mimicus isolates exhibited relatively high resistance against nitrofurantoin, ampicillin and polymixin. The multiple-antibiotic-resistance-index [MARI] for isolates ranges between 0 and 0.67 and 48% of the isolates have MARI that is >0.2 while 55% of the isolates exhibit MultiDrug Resistance Phenotypes. The percentage detection of acc, ant, drf18, sul1, mcr-1, blasvh, blaoxa, blatem, blaoxa48, gyrA, gyrB and parC resistance-associated genes were 2%, 9%, 14%, 7%, 2%, 25%, 7%, 2%, 2%, 32%, 25% and 27% respectively while that for virulence-associated genes in increasing other was ace [2%], tcp [11%], vpi [16%], ompU [34%], toxR [43%], rtxC [70%], rtxA [73%] and hyla [77%]. The study confirmed the potential of environmental non-O1/non-O139 V. cholerae and V. mimicus to cause cholera-like infection and other vibriosis which could be difficult to manage with commonly recommended antibiotics. Thus, regular monitoring of the environment to create necessary awareness for this kind of pathogens is important in the interest of public health.
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Affiliation(s)
| | - Nolonwabo Nontongana
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice, South Africa
| | - Charles A. Osunla
- Department of Microbiology, Adekunle Ajasin University, Akungba Akoko, Nigeria
| | - Anthony I. Okoh
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice, South Africa
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Iwu CD, Nontongana N, Iwu-Jaja CJ, Anyanwu BO, du Plessis E, Korsten L, Okoh AI. Spatial diarrheal disease risks and antibiogram diversity of diarrheagenic Escherichia coli in selected access points of the Buffalo River, South Africa. PLoS One 2023; 18:e0288809. [PMID: 37616257 PMCID: PMC10449160 DOI: 10.1371/journal.pone.0288809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/04/2023] [Indexed: 08/26/2023] Open
Abstract
Freshwater sources, often used for domestic and agricultural purposes in low- and middle-income countries are repositories of clinically significant bacterial pathogens. These pathogens are usually diversified in their antibiogram profiles posing public health threats. This study evaluated the spatial diarrhoeal disease risk and antibiogram diversity of diarrheagenic Escherichia coli (DEC) in four access points of the Buffalo River, Eastern Cape Province, South Africa using standard epidemiological, culture, and molecular methods. The diarrhoeal disease risk was characterised using the Monte Carlo simulation, while the antibiogram diversity was assessed using the species observed Whittaker's single alpha-diversity modelling. E. coli mean count was highest in King William's Town dam [16.0 × 102 CFU/100ml (SD: 100.0, 95% CI: 13.5 × 102 to 18.5 × 102)]. Enterohemorrhagic E. coli (stx1/stx2) was the most prevalent DEC pathotype across the study sites. A high diarrhoeal disease risk of 25.0 ×10-2 exceeding the World Health Organization's standard was recorded across the study sites. The average single and multiple antimicrobial resistance indices of the DEC to test antimicrobials were highest in the Eluxolzweni dam [0.52 (SD: 0.25, 95% CI: 0.37 to 0.67)] and King William's Town dam [0.42 (SD: 0.25, 95% CI: 0.27 to 0.57)] respectively. The prevalent antibiotic resistance genes detected were tetA, blaFOX and blaMOX plasmid-mediated AmpC, blaTEM and blaSHV extended-spectrum β-lactamases, which co-occurred across the study sites on network analysis. The phenotypic and genotypic resistance characteristics of the DEC in Maden dam (r = 0.93, p<0.00), Rooikrantz dam (r = 0.91, p<0.00), King William's Town dam (r = 0.83, p = 0.0), and Eluxolzweni dam (r = 0.91, p<0.00) were strongly correlated. At least, three phylogenetic clades of the DEC with initial steep descent alpha-diversity curves for most of the test antimicrobials were observed across the study sites, indicating high diversity. The occurrence of diversified multi drug resistant DEC with diarrhoeal disease risks in the Buffalo River substantiates the role surface water bodies play in the dissemination of drug-resistant bacterial pathogens with public health implications.
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Affiliation(s)
- Chidozie Declan Iwu
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice, South Africa
- Applied and Environmental Microbiology Research Group (AEMREG), University of Fort Hare, Alice, South Africa
| | - Nolonwabo Nontongana
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice, South Africa
- Applied and Environmental Microbiology Research Group (AEMREG), University of Fort Hare, Alice, South Africa
| | | | - Brilliance Onyinyechi Anyanwu
- Centre for Occupational Health, Safety and Environment, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
| | - Erika du Plessis
- Department of Plant and Soil Sciences, University of Pretoria, Hatfield, South Africa
- Department of Science and Technology-National Research Foundation Centre of Excellence in Food Security, Pretoria, South Africa
| | - Lise Korsten
- Department of Plant and Soil Sciences, University of Pretoria, Hatfield, South Africa
- Department of Science and Technology-National Research Foundation Centre of Excellence in Food Security, Pretoria, South Africa
| | - Anthony Ifeanyin Okoh
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice, South Africa
- Applied and Environmental Microbiology Research Group (AEMREG), University of Fort Hare, Alice, South Africa
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Almansour AM, Alhadlaq MA, Alzahrani KO, Mukhtar LE, Alharbi AL, Alajel SM. The Silent Threat: Antimicrobial-Resistant Pathogens in Food-Producing Animals and Their Impact on Public Health. Microorganisms 2023; 11:2127. [PMID: 37763971 PMCID: PMC10537193 DOI: 10.3390/microorganisms11092127] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023] Open
Abstract
The emergence of antimicrobial resistance (AMR) is a global health problem without geographic boundaries. This increases the risk of complications and, thus, makes it harder to treat infections, which can result in higher healthcare costs and a greater number of deaths. Antimicrobials are often used to treat infections from pathogens in food-producing animals, making them a potential source of AMR. Overuse and misuse of these drugs in animal agriculture can lead to the development of AMR bacteria, which can then be transmitted to humans through contaminated food or direct contact. It is therefore essential to take multifaceted, comprehensive, and integrated measures, following the One Health approach. To address this issue, many countries have implemented regulations to limit antimicrobial use. To our knowledge, there are previous studies based on AMR in food-producing animals; however, this paper adds novelty related to the AMR pathogens in livestock, as we include the recent publications of this field worldwide. In this work, we aim to describe the most critical and high-risk AMR pathogens among food-producing animals, as a worldwide health problem. We also focus on the dissemination of AMR genes in livestock, as well as its consequences in animals and humans, and future strategies to tackle this threat.
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Affiliation(s)
- Ayidh M. Almansour
- Molecular Biology Division, Reference Laboratory for Microbiology, Executive Department of Reference Laboratories, Research and Laboratories Sector, Saudi Food and Drug Authority (SFDA), Riyadh 11671, Saudi Arabia; (M.A.A.); (K.O.A.); (A.L.A.)
| | - Meshari A. Alhadlaq
- Molecular Biology Division, Reference Laboratory for Microbiology, Executive Department of Reference Laboratories, Research and Laboratories Sector, Saudi Food and Drug Authority (SFDA), Riyadh 11671, Saudi Arabia; (M.A.A.); (K.O.A.); (A.L.A.)
| | - Khaloud O. Alzahrani
- Molecular Biology Division, Reference Laboratory for Microbiology, Executive Department of Reference Laboratories, Research and Laboratories Sector, Saudi Food and Drug Authority (SFDA), Riyadh 11671, Saudi Arabia; (M.A.A.); (K.O.A.); (A.L.A.)
| | - Lenah E. Mukhtar
- Antimicrobial Resistance Division, Reference Laboratory for Microbiology, Executive Department of Reference Laboratories, Research and Laboratories Sector, Saudi Food and Drug Authority (SFDA), Riyadh 11671, Saudi Arabia;
| | - Abdulmohsen L. Alharbi
- Molecular Biology Division, Reference Laboratory for Microbiology, Executive Department of Reference Laboratories, Research and Laboratories Sector, Saudi Food and Drug Authority (SFDA), Riyadh 11671, Saudi Arabia; (M.A.A.); (K.O.A.); (A.L.A.)
| | - Sulaiman M. Alajel
- Reference Laboratory for Microbiology, Executive Department of Reference Laboratories, Research and Laboratories Sector, Saudi Food and Drug Authority (SFDA), Riyadh 11671, Saudi Arabia;
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Dheda KR, Centner CM, Wilson L, Pooran A, Grimwood S, Ghebrekristos YT, Oelofse S, Joubert IA, Esmail A, Tomasicchio M. Intensive Care Unit Sluice Room Sinks as Reservoirs and Sources of Potential Transmission of Carbapenem-Resistant Bacteria in a South African Tertiary Care Hospital. Infect Drug Resist 2023; 16:5427-5432. [PMID: 37638062 PMCID: PMC10455775 DOI: 10.2147/idr.s418620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Purpose Carbapenem-resistant bacteria (CRB) pose a major health risk to patients in intensive care units (ICU) across African hospitals. There are hardly any data about the role of hospital sinks as reservoirs of CRB in resource-poor African settings. Furthermore, the specific within-sink location of the highest concentration of pathogens and the role of splash back as a transmission mechanism remains poorly clarified. Methods We swabbed ICU sluice room sinks in a tertiary hospital in Cape Town, South Africa. Swabs were taken from four different parts of the sluice room sinks (tap-opening, trap, below the trap, and u-bend). Dilutions were prepared and plated on carbapenem-infused agar. Colonies were identified and drug resistance profiles were determined using a biochemical analyser. To evaluate the potential transmission from the sink, similar plates were placed at fixed distances from the sink when the tap was turned on and off. Results CRB were isolated from the trap, water interface below the trap, and the u-bend (the latter harboured the highest density of CRB species). Five CRB, resistant to at least 7 antibiotic classes, were isolated including Pseudomonas, Klebsiella, Citrobacter, Serratia, and Providencia. CRB could be cultured from droplets that fell on agar-containing plates placed at a varying distance from the trap. Conclusion There is a higher density of CRB in the u-bend of ICU sluice room sinks which can act as a potential source of transmission. The data inform targeted CRB transmission-interruption strategies in resource-poor settings.
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Affiliation(s)
- Khelan R Dheda
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Chad M Centner
- Division of Medical Microbiology, National Health Laboratory Services (NHLS)/Groote Schuur Hospital, Microbiology, University of Cape Town, Cape Town, South Africa
| | - Lindsay Wilson
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Anil Pooran
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Shireen Grimwood
- Division of Medical Microbiology, National Health Laboratory Services (NHLS)/Groote Schuur Hospital, Microbiology, University of Cape Town, Cape Town, South Africa
| | - Yonas T Ghebrekristos
- Division of Medical Microbiology, National Health Laboratory Services (NHLS)/Groote Schuur Hospital, Microbiology, University of Cape Town, Cape Town, South Africa
| | - Suzette Oelofse
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Ivan A Joubert
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Aliasgar Esmail
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Michele Tomasicchio
- Division of Pulmonology, Department of Medicine, Centre for Lung Infection and Immunity, University of Cape Town and UCT Lung Institute, Cape Town, South Africa
- South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
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Musa K, Okoliegbe I, Abdalaziz T, Aboushady AT, Stelling J, Gould IM. Laboratory Surveillance, Quality Management, and Its Role in Addressing Antimicrobial Resistance in Africa: A Narrative Review. Antibiotics (Basel) 2023; 12:1313. [PMID: 37627733 PMCID: PMC10451735 DOI: 10.3390/antibiotics12081313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/30/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
AMR is a major public health concern that calls for extensive work and a multidisciplinary team approach. The high prevalence of infectious diseases in African nations leads to widespread antibiotic usage and eventual antimicrobial resistance, which has significant negative effects on people's health, the economy, and society. Additionally, inadequate or nonexistent antimicrobial drug regulations, inappropriate prescription practices, and restrictions on public health prevention initiatives such as immunization, water and sanitation, and sexual health may all contribute to the emergence of AMR. Despite the need for laboratory quality assurance, many African laboratories confront substantial difficulties in implementing efficient quality assurance programs. AMR surveillance in Africa is hampered by a lack of laboratory capacity, insufficient data collection and analysis, and poor stakeholder collaboration. Several initiatives and programs, including the World Health Organization's Global Antimicrobial Resistance and Use Surveillance System (GLASS), the Africa Centres for Disease Control and Prevention (Africa CDC) Antimicrobial Resistance Surveillance Network (AMRSNET), and the Fleming Fund, a UK government initiative aimed at tackling AMR in low- and middle-income countries, have been established to strengthen AMR surveillance in Africa and globally.
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Affiliation(s)
- Khalid Musa
- Department of Medical Microbiology and Virology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK; (I.O.); (T.A.); (I.M.G.)
- Department of Acute Medicine and Infectious Diseases, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
| | - Ijeoma Okoliegbe
- Department of Medical Microbiology and Virology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK; (I.O.); (T.A.); (I.M.G.)
| | - Tassabeeh Abdalaziz
- Department of Medical Microbiology and Virology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK; (I.O.); (T.A.); (I.M.G.)
- Department of Acute Medicine and Infectious Diseases, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
| | - Ahmed Taha Aboushady
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (A.T.A.); (J.S.)
| | - John Stelling
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (A.T.A.); (J.S.)
| | - Ian M. Gould
- Department of Medical Microbiology and Virology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK; (I.O.); (T.A.); (I.M.G.)
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Nemr N, Kishk RM, Elsaid NMAB, Louis N, Fahmy E, Khattab S. Knowledge, attitude, and practice (KAP) of antimicrobial prescription and its resistance among health care providers in the COVID-19 era: A cross sectional study. PLoS One 2023; 18:e0289711. [PMID: 37561762 PMCID: PMC10414618 DOI: 10.1371/journal.pone.0289711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023] Open
Abstract
Antimicrobial resistance (AMR) is considered as a global health and development threat. During COVID-19 pandemic, there has been an increase in antimicrobial resistance. Health care providers (HCPs) play the main role in facing antibiotic resistance because they have the authority to prescribe antibiotics during clinical practice as well as in promoting patients' compliance with therapies and avoid self-medication. So, this study will serve as an important source of information in context with Covid19 pandemic in Egypt. The data was collected using a validated standardized self-administered online questionnaire compromised of four sections: socio-demographic data of the HCPs, the general knowledge on antibiotics and AMR, the HCP attitude towards antibiotic prescription and AMR and the practice in applying the appropriate antibiotic prescription. Most of HCPs (93.7%) recorded good knowledge level about antibiotic prescription and antimicrobial resistance with mean score of knowledge13.21 ± 1.83. About 79% of HCPs recorded a positive attitude towards proper antibiotic prescription with mean score of attitudes 63.02 ± 7.68. Fifty four percent of HCPs demonstrated a good level of practice with mean score of practice 9.75 ± 2.17. In conclusion, HCPs in our study have a good level of knowledge and attitude about antibiotics. However lower level of proper practice towards the problem of AMR in COVID19 era was noticed. Implementation of effective policies and guidelines is crucial to evaluate the antimicrobial use especially in the COVID-19 era to reduce the unintended consequences of the misuse of antibiotics and its impact on AMR.
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Affiliation(s)
- Nader Nemr
- Endemic and Infectious Diseases Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Rania M. Kishk
- Microbiology and Immunology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Noha M. Abu Bakr Elsaid
- Public Health, Community, Environmental and Occupational Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Department of Basic Medical Sciences, Faculty of Medicine, King Salman International University, South Sinai, Egypt
| | - Nageh Louis
- Endemic and Infectious Diseases Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Eman Fahmy
- Internal Medicine Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Sally Khattab
- Microbiology and Immunology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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43
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Aruhomukama D, Nakabuye H. Investigating the evolution and predicting the future outlook of antimicrobial resistance in sub-saharan Africa using phenotypic data for Klebsiella pneumoniae: a 12-year analysis. BMC Microbiol 2023; 23:214. [PMID: 37553587 PMCID: PMC10408162 DOI: 10.1186/s12866-023-02966-y] [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: 05/25/2023] [Accepted: 08/01/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a major public health challenge, particularly in sub-Saharan Africa (SSA). This study aimed to investigate the evolution and predict the future outlook of AMR in SSA over a 12-year period. By analysing the trends and patterns of AMR, the study sought to enhance our understanding of this pressing issue in the region and provide valuable insights for effective interventions and control measures to mitigate the impact of AMR on public health in SSA. RESULTS The study found that general medicine patients had the highest proportion of samples with AMR. Different types of samples showed varying levels of AMR. Across the studied locations, the highest resistance was consistently observed against ceftaroline (ranging from 68 to 84%), while the lowest resistance was consistently observed against ceftazidime avibactam, imipenem, meropenem, and meropenem vaborbactam (ranging from 92 to 93%). Notably, the predictive analysis showed a significant increasing trend in resistance to amoxicillin-clavulanate, cefepime, ceftazidime, ceftaroline, imipenem, meropenem, piperacillin-tazobactam, and aztreonam over time. CONCLUSIONS These findings suggest the need for coordinated efforts and interventions to control and prevent the spread of AMR in SSA. Targeted surveillance based on local resistance patterns, sample types, and patient populations is crucial for effective monitoring and control of AMR. The study also highlights the urgent need for action, including judicious use of antibiotics and the development of alternative treatment options to combat the growing problem of AMR in SSA.
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Affiliation(s)
- Dickson Aruhomukama
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Hellen Nakabuye
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda
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Akegbe H, Onyeaka H, Michael Mazi I, Alex Olowolafe O, Dolapo Omotosho A, Olatunji Oladunjoye I, Amuda Tajudeen Y, Seun Ofeh A. The need for Africa to develop capacity for vaccinology as a means of curbing antimicrobial resistance. Vaccine X 2023; 14:100320. [PMID: 37293248 PMCID: PMC10244683 DOI: 10.1016/j.jvacx.2023.100320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/08/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
The high prevalence of infectious diseases in Africa, combined with weak healthcare systems, poor antimicrobial stewardship, and an unchecked drug supply chain, is steadily reversing the trend in the fight against infectious diseases in this part of the world, posing severe threats to antimicrobial resistance (AMR). AMR continuously evolves and threatens to undermine antimicrobial efficacy and undo advances against infectious diseases. This brewing pandemic is now recognized as a significant worldwide health danger, implicated in several cases of morbidity, mortality, and increasing healthcare costs. Vaccine technology has been proven to be the principal remedy to this imminent danger since it prevents microbial infections. However, since Africa cannot produce its vaccines, it relies on external sources and, as a result, it is significantly affected by vaccine nationalism, hoarding, and instabilities in global supply chains. This has further adversely impacted the ability of African governments to regulate rollouts, protect their citizens, and ultimately rejoin the global economy. This dependency is a severe challenge to Africa's health resilience, as it is unsustainable. Given the inevitability of potential global pandemics and the alarming incidences of multi-drug resistance infections reported daily, Africa must develop the capability to produce its vaccines. The review utilized a systematic search of academic databases and grey literature, as well as a manual search of relevant reports and articles. In this review, we outline the public health threats and concerns that AMR poses to Africans, and the hurdles and advances achieved in vaccine development over the years. We also highlight possible strategies, particularly collaborative efforts, that will accelerate vaccine production and ease the strain of infectious diseases and antimicrobial resistance in Africa. Key findings indicate that Africa has significant gaps in its vaccine manufacturing and distribution capacity, with only a few countries having the ability to produce vaccines. Additionally, existing vaccine production facilities are often outdated and require significant investment to meet international standards. The review also highlights successful initiatives in Africa, such as the mRNA vaccine hub and the African Vaccine Manufacturing Initiative, which have demonstrated the potential for building local vaccine manufacturing capacity. The study concludes that Africa needs to prioritize investment in vaccine research and development, regulatory capacity, and infrastructure to build a sustainable vaccine manufacturing ecosystem. Overall, this review emphasizes the urgent need for Africa to develop its vaccine manufacturing capacity to improve vaccine access and strengthen its ability to respond to future pandemics. The findings underscore the importance of collaboration between African governments, international organizations, and the private sector to build a resilient vaccine ecosystem in Africa.
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Affiliation(s)
- Hope Akegbe
- Department of Microbiology, Faculty of Life Sciences, University of Benin, Benin City, Nigeria
| | - Helen Onyeaka
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Ifeanyi Michael Mazi
- Department of Microbiology, Faculty of Life Sciences, University of Benin, Benin City, Nigeria
| | - Opeyemi Alex Olowolafe
- Department of Microbiology, Faculty of Life Sciences, University of Benin, Benin City, Nigeria
| | | | | | - Yusuf Amuda Tajudeen
- Department of Microbiology, Faculty of Life Sciences, University of Ilorin, Ilorin, Nigeria
| | - Augustine Seun Ofeh
- Department of Microbiology, Faculty of Science, Delta State University, Abraka, Nigeria
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Abramova A, Berendonk TU, Bengtsson-Palme J. A global baseline for qPCR-determined antimicrobial resistance gene prevalence across environments. ENVIRONMENT INTERNATIONAL 2023; 178:108084. [PMID: 37421899 DOI: 10.1016/j.envint.2023.108084] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/23/2023] [Accepted: 07/02/2023] [Indexed: 07/10/2023]
Abstract
The environment is an important component in the emergence and transmission of antimicrobial resistance (AMR). Despite that, little effort has been made to monitor AMR outside of clinical and veterinary settings. Partially, this is caused by a lack of comprehensive reference data for the vast majority of environments. To enable monitoring to detect deviations from the normal background resistance levels in the environment, it is necessary to establish a baseline of AMR in a variety of settings. In an attempt to establish this baseline level, we here performed a comprehensive literature survey, identifying 150 scientific papers containing relevant qPCR data on antimicrobial resistance genes (ARGs) in environments associated with potential routes for AMR dissemination. The collected data included 1594 samples distributed across 30 different countries and 12 sample types, in a time span from 2001 to 2020. We found that for most ARGs, the typically reported abundances in human impacted environments fell in an interval from 10-5 to 10-3 copies per 16S rRNA, roughly corresponding to one ARG copy in a thousand bacteria. Altogether these data represent a comprehensive overview of the occurrence and levels of ARGs in different environments, providing background data for risk assessment models within current and future AMR monitoring frameworks.
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Affiliation(s)
- Anna Abramova
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, SE-413 46 Gothenburg, Sweden; Centre for Antibiotic Resistance research (CARe) in Gothenburg, Sweden; Division of Systems and Synthetic Biology, Department of Life Sciences, SciLifeLab, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden
| | - Thomas U Berendonk
- Institute for Hydrobiology, Technische Universität Dresden, Dresden 01062, Germany
| | - Johan Bengtsson-Palme
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10A, SE-413 46 Gothenburg, Sweden; Centre for Antibiotic Resistance research (CARe) in Gothenburg, Sweden; Division of Systems and Synthetic Biology, Department of Life Sciences, SciLifeLab, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden.
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Kiemde F, Valia D, Kabore B, Rouamba T, Kone AN, Sawadogo S, Compaore A, Salami O, Horgan P, Moore CE, Dittrich S, Nkeramahame J, Olliaro P, Tinto H. A Randomized Trial to Assess the Impact of a Package of Diagnostic Tools and Diagnostic Algorithm on Antibiotic Prescriptions for the Management of Febrile Illnesses Among Children and Adolescents in Primary Health Facilities in Burkina Faso. Clin Infect Dis 2023; 77:S134-S144. [PMID: 37490742 PMCID: PMC10368409 DOI: 10.1093/cid/ciad331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Low- and middle-income countries face significant challenges in differentiating bacterial from viral causes of febrile illnesses, leading to inappropriate use of antibiotics. This trial aimed to evaluate the impact of an intervention package comprising diagnostic tests, a diagnostic algorithm, and a training-and-communication package on antibiotic prescriptions and clinical outcomes. METHODS Patients aged 6 months to 18 years with fever or history of fever within the past 7 days with no focus, or a suspected respiratory tract infection, arriving at 2 health facilities were randomized to either the intervention package or standard practice. The primary outcomes were the proportions of patients who recovered at day 7 (D7) and patients prescribed antibiotics at day 0. RESULTS Of 1718 patients randomized, 1681 (97.8%; intervention: 844; control: 837) completed follow-up: 99.5% recovered at D7 in the intervention arm versus 100% in standard practice (P = .135). Antibiotics were prescribed to 40.6% of patients in the intervention group versus 57.5% in the control arm (risk ratio: 29.3%; 95% CI: 21.8-36.0%; risk difference [RD]: -16.8%; 95% CI: -21.7% to -12.0%; P < .001), which translates to 1 additional antibiotic prescription saved every 6 (95% CI: 5-8) consultations. This reduction was significant regardless of test results for malaria, but was greater in patients without malaria (RD: -46.0%; -54.7% to -37.4%; P < .001), those with a respiratory diagnosis (RD: -38.2%; -43.8% to -32.6%; P < .001), and in children 6-59 months old (RD: -20.4%; -26.0% to -14.9%; P < .001). Except for the period July-September, the reduction was consistent across the other quarters (P < .001). CONCLUSIONS The implementation of the package can reduce inappropriate antibiotic prescription without compromising clinical outcomes. CLINICAL TRIALS REGISTRATION clinicaltrials.gov; NCT04081051.
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Affiliation(s)
- Francois Kiemde
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Daniel Valia
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Berenger Kabore
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Alima Nadine Kone
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Seydou Sawadogo
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Adelaide Compaore
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | | | - Philip Horgan
- FIND, Geneva, Switzerland
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- Evidence and Impact Oxford, Oxford, United Kingdom
| | - Catrin E Moore
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- Centre for Neonatal and Pediatric Infection, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | - Sabine Dittrich
- FIND, Geneva, Switzerland
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Deggendorf Institute of Technology, European Campus Rottal Inn, Pfarrkirchen, Germany
| | | | - Piero Olliaro
- FIND, Geneva, Switzerland
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
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47
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Tsekleves E, de Souza D, Pickup R, Ahorlu C, Darby A. Developing home cleaning intervention through community engagement to reduce infections and antimicrobial resistance in Ghanaian homes. Sci Rep 2023; 13:10505. [PMID: 37380793 DOI: 10.1038/s41598-023-37317-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/20/2023] [Indexed: 06/30/2023] Open
Abstract
Globally Antimicrobial Resistance (AMR) constitutes a health crisis, particularly in developing countries, where infectious disease are commonly fatal. There is clear evidence for microbial exposure and infection transmission within the home. Personal and environmental hygiene are the best ways of reducing household infections thus decreasing the need for antibiotics and consequently diminishing AMR. Despite this being an obvious step, research efforts to understand the home environment and its impact on AMR, cleaning and possible interventions on household cleaning are limited. We combined design and microbiology methods in an innovative mixed-method approach. A traditional survey design (n = 240), a design ethnography (n = 12), a co-design workshop and a pre-intervention microbiological dust sample analysis was undertaken to provide insights for codesign workshops in which new cleaning practices might be developed to minimise any AMR bacteria present in the household environments located in the Greater Accra Region of Ghana. Microbiological analysis of household dust showed that 36.6% of bacterial isolates detected were found to carry at least one resistance to the panel of antibiotics tested. Four scenarios were generated from an economic segmentation of the survey data. 50 ethnographic insights were 'presented' and descriptions of 12 bacteria species that showed resistance to one or more antibiotics (representing 176 bacterial isolates that showed resistance to one or more antibiotics found in the dust samples) were presented to the participants in a codesign workshop. An intervention, a new regime of cleaning practices agreed through the co-design workshop and practiced for thirty days, was made in (n = 7) households. The high prevalence of multidrug resistance observed in this study indicate the need for antibiotics surveillance program, not only in hospital settings but also in the household environment. There is, thus, an urgent need for targeting of interventions at the household level. Activating knowledge through community engagement in the research helps in increasing public perception and breaking down the scientist-public barrier.
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Affiliation(s)
| | - Dziedzom de Souza
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Roger Pickup
- Biomedical and Life Sciences, Lancaster University, Lancaster, UK
| | - Collins Ahorlu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Andy Darby
- ImaginationLancaster, Lancaster University, Lancaster, UK
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48
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Drobish IC, Barasa IK, Otieno G, Osoo MO, Thuo SK, Belknap KS, Shirk AM, McClanahan ST, Irungu E, Riunga F, Lelei F, Rudd KE, Brotherton BJ. Prevalence of Antimicrobial Resistance and Association with Patient Outcomes in a Rural Kenyan Hospital. Am J Trop Med Hyg 2023; 108:1227-1234. [PMID: 37160272 PMCID: PMC10540121 DOI: 10.4269/ajtmh.22-0311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 02/10/2023] [Indexed: 05/11/2023] Open
Abstract
Data on antimicrobial resistance (AMR) and association with outcomes in resource-variable intensive care units (ICU) are lacking. Data currently available are limited to large, urban centers. We attempted to understand this locally through a dual-purpose, retrospective study. Cohort A consisted of adult and pediatric patients who had blood, urine, or cerebrospinal fluid cultures obtained from 2016 to 2020. A total of 3,013 isolates were used to create the Kijabe Hospital's first antibiogram. Gram-negative organisms were found to be less than 50% susceptible to third- and fourth-generation cephalosporins, 67% susceptible to piperacillin-tazobactam, 87% susceptible to amikacin, and 93% susceptible to meropenem. We then evaluated the association between AMR and clinical characteristics, management, and outcomes among ICU patients (Cohort B). Demographics, vital signs, laboratory results, management data, and outcomes were obtained. Antimicrobial resistance was defined as resistance to one or more antimicrobials. Seventy-six patients were admitted to the ICU with bacteremia during this time. Forty complete paper charts were found for review. Median age was 34 years (interquartile range, 9-51), 26 patients were male (65%), and 28 patients were older than 18 years (70%). Septic shock was the most common diagnosis (n = 22, 55%). Six patients had AMR bacteremia; Escherichia coli was most common (n = 3, 50%). There was not a difference in mortality between patients with AMR versus non-AMR infections (P = 0.54). This study found a prevalence of AMR. There was no association between AMR and outcomes among ICU patients. More studies are needed to understand the impact of AMR in resource-variable settings.
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Affiliation(s)
- Ian C. Drobish
- Department of Internal Medicine, Department of Pediatrics, University of California San Diego, San Diego, California
- Critical Care Medicine Department, NIH Clinical Center; Bethesda, Maryland
| | | | - George Otieno
- Department of Internal Medicine, AIC Kijabe Hospital, Kijabe, Kenya
| | | | - Solomon K. Thuo
- Department of Laboratory Medicine, AIC Kijabe Hospital, Kijabe, Kenya
| | - Kaya S. Belknap
- Department of Outpatient Medicine, AIC Kijabe Hospital, Kijabe, Kenya
| | | | | | | | - Felix Riunga
- Department of Infectious Diseases, Aga Khan University Hospital, Nairobi, Kenya
| | - Faith Lelei
- Department of Family Medicine, AIC Kijabe Hospital, Kijabe, Kenya
| | - Kristina E. Rudd
- Department of Critical Care Medicine, The Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - B. Jason Brotherton
- Department of Pediatrics, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Internal Medicine, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Critical Care Medicine, The Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, University of Pittsburgh, Pittsburgh, Pennsylvania
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49
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Luchen CC, Chibuye M, Spijker R, Simuyandi M, Chisenga C, Bosomprah S, Chilengi R, Schultsz C, Mende DR, Harris VC. Impact of antibiotics on gut microbiome composition and resistome in the first years of life in low- to middle-income countries: A systematic review. PLoS Med 2023; 20:e1004235. [PMID: 37368871 PMCID: PMC10298773 DOI: 10.1371/journal.pmed.1004235] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 04/13/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Inappropriate antimicrobial usage is a key driver of antimicrobial resistance (AMR). Low- and middle-income countries (LMICs) are disproportionately burdened by AMR and young children are especially vulnerable to infections with AMR-bearing pathogens. The impact of antibiotics on the microbiome, selection, persistence, and horizontal spread of AMR genes is insufficiently characterized and understood in children in LMICs. This systematic review aims to collate and evaluate the available literature describing the impact of antibiotics on the infant gut microbiome and resistome in LMICs. METHODS AND FINDINGS In this systematic review, we searched the online databases MEDLINE (1946 to 28 January 2023), EMBASE (1947 to 28 January 2023), SCOPUS (1945 to 29 January 2023), WHO Global Index Medicus (searched up to 29 January 2023), and SciELO (searched up to 29 January 2023). A total of 4,369 articles were retrieved across the databases. Duplicates were removed resulting in 2,748 unique articles. Screening by title and abstract excluded 2,666 articles, 92 articles were assessed based on the full text, and 10 studies met the eligibility criteria that included human studies conducted in LMICs among children below the age of 2 that reported gut microbiome composition and/or resistome composition (AMR genes) following antibiotic usage. The included studies were all randomized control trials (RCTs) and were assessed for risk of bias using the Cochrane risk-of-bias for randomized studies tool. Overall, antibiotics reduced gut microbiome diversity and increased antibiotic-specific resistance gene abundance in antibiotic treatment groups as compared to the placebo. The most widely tested antibiotic was azithromycin that decreased the diversity of the gut microbiome and significantly increased macrolide resistance as early as 5 days posttreatment. A major limitation of this study was paucity of available studies that cover this subject area. Specifically, the range of antibiotics assessed did not include the most commonly used antibiotics in LMIC populations. CONCLUSION In this study, we observed that antibiotics significantly reduce the diversity and alter the composition of the infant gut microbiome in LMICs, while concomitantly selecting for resistance genes whose persistence can last for months following treatment. Considerable heterogeneity in study methodology, timing and duration of sampling, and sequencing methodology in currently available research limit insights into antibiotic impacts on the microbiome and resistome in children in LMICs. More research is urgently needed to fill this gap in order to better understand whether antibiotic-driven reductions in microbiome diversity and selection of AMR genes place LMIC children at risk for adverse health outcomes, including infections with AMR-bearing pathogens.
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Affiliation(s)
- Charlie C. Luchen
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- Research Division, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Amsterdam Institute of Infection and Immunity, Infectious Diseases, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Mwelwa Chibuye
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- Research Division, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Amsterdam Institute of Infection and Immunity, Infectious Diseases, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Rene Spijker
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
| | - Michelo Simuyandi
- Research Division, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Caroline Chisenga
- Research Division, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Samuel Bosomprah
- Research Division, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Roma Chilengi
- Research Division, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Zambia National Public Health Institute, Ministry of Health, Lusaka, Zambia
- Republic of Zambia State House, Lusaka, Zambia
| | - Constance Schultsz
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- Amsterdam Institute of Infection and Immunity, Infectious Diseases, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Amsterdam UMC, location University of Amsterdam, Department of Medical Microbiology, Amsterdam, the Netherlands
| | - Daniel R. Mende
- Amsterdam Institute of Infection and Immunity, Infectious Diseases, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Amsterdam UMC, location University of Amsterdam, Department of Medical Microbiology, Amsterdam, the Netherlands
| | - Vanessa C. Harris
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- Amsterdam Institute of Infection and Immunity, Infectious Diseases, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Amsterdam UMC, location University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Amsterdam, the Netherlands
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50
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Sandoval MM, Bardach A, Rojas-Roque C, Alconada T, Gomez JA, Pinto T, Palermo C, Ciapponi A. Antimicrobial resistance of Neisseria gonorrhoeae in Latin American countries: a systematic review. J Antimicrob Chemother 2023; 78:1322-1336. [PMID: 37192385 PMCID: PMC10232280 DOI: 10.1093/jac/dkad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/23/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Detailed information is needed on the dynamic pattern of antimicrobial resistance (AMR) in Neisseria gonorrhoeae in Latin America and the Caribbean (LAC). OBJECTIVES To conduct a systematic review of AMR in N. gonorrhoeae in LAC. METHODS Electronic searches without language restrictions were conducted in PubMed, Embase, Cochrane Library, EconLIT, Cumulative Index of Nursing and Allied Health Literature, Centre for Reviews and Dissemination, and Latin American and Caribbean Literature in Health Sciences. Studies were eligible if published between 1 January 2011 and 13 February 2021, conducted in any LAC country (regardless of age, sex and population) and measured frequency and/or patterns of AMR to any antimicrobial in N. gonorrhoeae. The WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO-GASP) for LAC countries and Latin American AMR SurveillanceNetwork databases were searched. AMR study quality was evaluated according to WHO recommendations. RESULTS AMR data for 38, 417 isolates collected in 1990-2018 were included from 31 publications, reporting data from Argentina, Brazil, Colombia, Peru, Uruguay, Venezuela and WHO-GASP. Resistance to extended-spectrum cephalosporins was infrequent (0.09%-8.5%). Resistance to azithromycin was up to 32% in the published studies and up to 61% in WHO-GASP. Resistance to penicillin, tetracycline and ciprofloxacin was high (17.6%-98%, 20.7%-90% and 5.9%-89%, respectively). Resistance to gentamicin was not reported, and resistance to spectinomycin was reported in one study. CONCLUSIONS This review provides data on resistance to azithromycin, potentially important given its use as first-line empirical treatment, and indicates the need for improved surveillance of gonococcal AMR in LAC. Trial registration: Registered in PROSPERO, CRD42021253342.
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Affiliation(s)
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
| | - Carlos Rojas-Roque
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Tomás Alconada
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | | | | | - Carolina Palermo
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Agustin Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
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