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Lotto T, Renggli S, Kaale E, Masanja H, Ternon B, Décosterd LA, D'Acremont V, Genton B, Kulinkina AV. Prevalence and predictors of residual antibiotics in children's blood in community settings in Tanzania. Clin Microbiol Infect 2024; 30:1042-1048. [PMID: 38740136 DOI: 10.1016/j.cmi.2024.05.004] [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: 09/08/2023] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVES Children account for a significant proportion of antibiotic consumption in low- and middle-income countries, with overuse occurring in formal and informal health sectors. This study assessed the prevalence and predictors of residual antibiotics in the blood of children in the Mbeya and Morogoro regions of Tanzania. METHODS The cross-sectional community-based survey used two-stage cluster sampling to include children aged under 15 years. For each child, information on recent illness, healthcare-seeking behaviour, and use of antibiotics, as well as a dried blood spot sample, were collected. The samples underwent tandem mass spectrometry analysis to quantify the concentrations of 15 common antibiotics. Associations between survey variables and the presence of residual antibiotics were assessed using mixed-effects logistic regression. RESULTS In total, 1742 children were surveyed, and 1699 analysed. The overall prevalence of residual antibiotics in the blood samples was 17.4% (296/1699), the highest among children under the age of 5 years. The most frequently detected antibiotics were trimethoprim (144/1699; 8.5%), sulfamethoxazole (102/1699; 6.0%), metronidazole (61/1699; 3.6%), and amoxicillin (43/1699; 2.5%). The strongest predictors of residual antibiotics in the blood were observed presence of antibiotics at home (adjusted odds ratio [aOR] = 2.9; 95% CI, 2.0-4.1) and reported consumption of antibiotics in the last 2 weeks (aOR = 2.5; 95% CI, 1.6-3.9). However, half (145/296) of the children who had residual antibiotics in their blood, some with multiple antibiotics, had no reported history of illness or antibiotic consumption in the last 2 weeks, and antibiotics were not found at home. DISCUSSION This study demonstrated a high prevalence of antibiotic exposure among children in Tanzanian communities, albeit likely underestimated, especially for compounds with short half-lives. A significant proportion of antibiotic exposure was unexplained and may have been due to unreported self-medication or environmental pathways. Incorporating biomonitoring into surveillance strategies can help better understand exposure patterns and design antibiotic stewardship interventions.
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Affiliation(s)
- Theopista Lotto
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland; Ifakara Health Institute, Dar es Salaam, Tanzania.
| | - Sabine Renggli
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Eliangiringa Kaale
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Beatrice Ternon
- Laboratory of Clinical Pharmacology, University Hospital, Lausanne
| | - Laurent Arthur Décosterd
- Laboratory of Clinical Pharmacology, University Hospital, Lausanne; University of Lausanne, Lausanne, Switzerland
| | - Valérie D'Acremont
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland; University of Lausanne, Lausanne, Switzerland; Centre for Primary Care and Public Health, Lausanne, Switzerland
| | - Blaise Genton
- University of Lausanne, Lausanne, Switzerland; Centre for Primary Care and Public Health, Lausanne, Switzerland
| | - Alexandra V Kulinkina
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
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Hutton G, Chase C, Kennedy-Walker R, Hamilton H. Financial and economic costs of healthcare-associated infections in Africa. J Hosp Infect 2024; 150:1-8. [PMID: 38723903 DOI: 10.1016/j.jhin.2024.04.015] [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: 02/21/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) remain a global health challenge, and have elevated rates in Sub-Saharan Africa. HAIs impact patients and their families by causing illness, prolonged hospital stay, potential disability, excess costs and, sometimes, death. The costs of HAIs are increasing due to spreading antimicrobial resistance. A major risk factor for HAIs is lack of water, sanitation and hygiene (WASH); environmental cleaning and healthcare waste management. In Sub-Saharan Africa, these services are lacking in at least 50% of healthcare facilities. AIM To estimate the costs associated with HAIs at national level in 14 countries in Sub-Saharan Africa. METHODS Economic methodologies were employed to estimate the medical costs, productivity losses and value of premature death from HAIs, drawing on national statistics and published studies to populate the economic model. RESULTS In 2022, the number of HAIs was estimated at 4.8 million, resulting in 500,000 deaths. Health-related economic losses amounted to US$13 billion per year, equivalent to 1.14% of combined gross domestic product and US$15.7 per capita. Healthcare costs were US$500 per HAI, and represented 5.6% of total health expenditure. The costs of providing basic WASH were US$0.91 per capita, which, if they reduced HAIs by 50%, would result in benefit-cost ratios of 1.6 (financial healthcare savings alone) and 8.6 (all economic benefits). CONCLUSION HAIs have a major health and economic burden on African societies, and a significant proportion can be prevented. It is critical that health policy makers and practitioners dedicate policy space, resources and training to address HAIs.
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Affiliation(s)
| | - C Chase
- Water Global Practice, World Bank, Washington, DC, USA
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Kamara IF, Fofanah BD, Nuwagira I, Kamara KN, Tengbe SM, Abiri O, Kamara RZ, Lakoh S, Farma L, Kamara AK, Hailu B, Dove D, Squire JS, D'Almeida SA, Sheriff B, Mustapha A, Bawa N, Lagesse H, Koroma AT, Kanu JS. Assessment of antimicrobial stewardship programmes and antibiotic use among children admitted to two hospitals in Sierra Leone: a cross-sectional study. Antimicrob Resist Infect Control 2024; 13:80. [PMID: 39039593 PMCID: PMC11265072 DOI: 10.1186/s13756-024-01425-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 06/14/2024] [Indexed: 07/24/2024] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a global public health concern and irrational use of antibiotics in hospitals is a key driver of AMR. Even though it is not preventable, antimicrobial stewardship (AMS) programmes will reduce or slow it down. Research evidence from Sierra Leone has demonstrated the high use of antibiotics in hospitals, but no study has assessed hospital AMS programmes and antibiotic use specifically among children. We conducted the first-ever study to assess the AMS programmes and antibiotics use in two tertiary hospitals in Sierra Leone. METHODS This was a hospital-based cross-sectional survey using the World Health Organization (WHO) point prevalence survey (PPS) methodology. Data was collected from the medical records of eligible patients at the Ola During Children's Hospital (ODCH) and Makeni Regional Hospital (MRH) using the WHO PPS hospital questionnaire; and required data collection forms. The prescribed antibiotics were classified according to the WHO Access, Watch, and Reserve (AWaRe) classification. Ethics approval was obtained from the Sierra Leone Ethics and Scientific Review Committee. Statistical analysis was conducted using the SPSS version 22. RESULTS Both ODCH and MRH did not have the required AMS infrastructure; policy and practice; and monitoring and feedback mechanisms to ensure rational antibiotic prescribing. Of the 150 patients included in the survey, 116 (77.3%) were admitted at ODCH and 34 (22.7%) to MRH, 77 (51.3%) were males and 73 (48.7%) were females. The mean age was 2 years (SD=3.5). The overall prevalence of antibiotic use was 84.7% (95% CI: 77.9% - 90.0%) and 77 (83.8%) of the children aged less than one year received an antibiotic. The proportion of males that received antibiotics was higher than that of females. Most (58, 47.2 %) of the patients received at least two antibiotics. The top five antibiotics prescribed were gentamycin (100, 27.4%), ceftriaxone (76, 20.3%), ampicillin (71, 19.5%), metronidazole (44, 12.1%), and cefotaxime (31, 8.5%). Community-acquired infections were the primary diagnoses for antibiotic prescription. CONCLUSION The non-existence of AMS programmes might have contributed to the high use of antibiotics at ODCH and MRH. This has the potential to increase antibiotic selection pressure and in turn the AMR burden in the country. There is need to establish hospital AMS teams and train health workers on the rational use of antibiotics.
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Affiliation(s)
- Ibrahim Franklyn Kamara
- Reproductive Maternal Newborn Child and Adolescent Unit, Universal Health Coverage, Life Course Cluster, World Health Organization Country Office, 21 A-B Riverside Off Kingharman Road, Freetown, Sierra Leone.
- Reproductive maternal newborn child and adolescent health unit, Universal Health Coverage, Life Course Cluster, WHO Country Office in Sierra Leone, Freetown, Sierra Leone.
| | - Bobson Derrick Fofanah
- Reproductive Maternal Newborn Child and Adolescent Unit, Universal Health Coverage, Life Course Cluster, World Health Organization Country Office, 21 A-B Riverside Off Kingharman Road, Freetown, Sierra Leone
| | - Innocent Nuwagira
- Reproductive Maternal Newborn Child and Adolescent Unit, Universal Health Coverage, Life Course Cluster, World Health Organization Country Office, 21 A-B Riverside Off Kingharman Road, Freetown, Sierra Leone
| | - Kadijatu Nabie Kamara
- Ministry of Health, Fourth Floor, Youyi Building, Brookfields, Freetown, Sierra Leone
| | - Sia Morenike Tengbe
- Ministry of Health, Fourth Floor, Youyi Building, Brookfields, Freetown, Sierra Leone
| | - Onome Abiri
- Pharmacy Board Sierra Leone, New England Ville, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Rugiatu Z Kamara
- United States Centers for Disease Control and Prevention Country Office, Emergency Operation Centre, Wilkinson Road, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Ministry of Health, Fourth Floor, Youyi Building, Brookfields, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Lynda Farma
- Ministry of Health, Fourth Floor, Youyi Building, Brookfields, Freetown, Sierra Leone
| | - Abibatu Kollia Kamara
- Reproductive Maternal Newborn Child and Adolescent Unit, Universal Health Coverage, Life Course Cluster, World Health Organization Country Office, 21 A-B Riverside Off Kingharman Road, Freetown, Sierra Leone
| | - Binyam Hailu
- Reproductive Maternal Newborn Child and Adolescent Unit, Universal Health Coverage, Life Course Cluster, World Health Organization Country Office, 21 A-B Riverside Off Kingharman Road, Freetown, Sierra Leone
| | - Djossaya Dove
- Department of Demographic and Social Statistics, National Institute of Statistics, Yaoundé, Cameroon
| | | | - Selassi A D'Almeida
- Reproductive Maternal Newborn Child and Adolescent Unit, Universal Health Coverage, Life Course Cluster, World Health Organization Country Office, 21 A-B Riverside Off Kingharman Road, Freetown, Sierra Leone
| | - Bockarie Sheriff
- Reproductive Maternal Newborn Child and Adolescent Unit, Universal Health Coverage, Life Course Cluster, World Health Organization Country Office, 21 A-B Riverside Off Kingharman Road, Freetown, Sierra Leone
| | - Ayeshatu Mustapha
- Ministry of Health, Fourth Floor, Youyi Building, Brookfields, Freetown, Sierra Leone
| | - Najima Bawa
- Momentum Country and Global Leadership, Sir Samuel Lewis Road, Freetown, Sierra Leone
| | - Hailemariam Lagesse
- United Nation Children's Fund, Jomo Kenyatta Road, New England Ville, Freetown, Sierra Leone
| | | | - Joseph Sam Kanu
- Ministry of Health, Fourth Floor, Youyi Building, Brookfields, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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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] [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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Kıratlı K, Aysin M, Ali MA, Ali AM, Zeybek H, Köse Ş. Evaluation of Doctors' Knowledge, Attitudes, Behaviors, Awareness and Practices on Rational Antimicrobial Stewardship in a Training and Research Hospital in Mogadishu-Somalia. Infect Drug Resist 2024; 17:2759-2771. [PMID: 38984317 PMCID: PMC11231027 DOI: 10.2147/idr.s463197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024] Open
Abstract
Introduction Historically, antimicrobials have been used to treat microbial illnesses in humans and animals. But throughout this time, antibiotics that had been successful against particular microorganisms started to lose their effectiveness due to rising inappropriate use brought on by ignorance, negligent attitudes, and improper methods. Our goal in conducting this study was to ascertain the knowledge, attitudes, and practices of doctors with relation to the use of antibiotics in light of the growing global and Sub-Saharan African problem of antimicrobial resistance. Methods In a tertiary hospital in Mogadishu, Somalia, a cross-sectional survey study was carried out to assess experts' and research assistants' knowledge, attitudes, behavior, awareness, and practices regarding the use of antibiotics and antibiotic resistance. A questionnaire consisting of 2 sections and 22 questions was applied to the participants on a voluntary basis. Results Among the 202 doctors that participated in the study, 49 (24.3%) were specialists, and 153 (75.7%) were assistants. Prescriptions for one to ten antibiotic boxes per week on average were reported by 146 respondents (72.3%). Of the physicians, just 27 (13.4%) did not require assistance when prescribing an antibiotic. The most often accessed sources of support were experts in infectious diseases (43.1%) and national/international antimicrobial guidelines (32.2%). The top three factors contributing to antibiotic resistance in Somalia include misuse of antibiotics (61.4%), unnecessary prescriptions written by doctors (44.6%), and an absence of infectious disease specialists in most institutions (44.1%). Conclusion As an alarming level of antimicrobial resistance has been observed globally in recent years, the results of our survey will help educate our doctors by gauging their perceptions, attitudes, and knowledge about rational antibiotic use in Sub-Saharan Africa. This will provide better patient outcomes.
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Affiliation(s)
- Kazım Kıratlı
- Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Mogadishu, Somalia
| | - Murat Aysin
- Balikesir University Faculty of Medicine, Department of Public Health, Balikesir, Turkey
| | - Mukhtar Abdullahi Ali
- Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Mogadishu, Somalia
| | - Ahmed Mohamed Ali
- Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Mogadishu, Somalia
| | - Hakan Zeybek
- Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, Department of Orthopedics and Traumatology, Mogadishu, Somalia
| | - Şükran Köse
- Dokuz Eylul University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
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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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Boltena MT, Wolde M, Hailu B, El-Khatib Z, Steck V, Woldegerima S, Siraneh Y, Morankar S. Point prevalence of evidence-based antimicrobial use among hospitalized patients in sub-Saharan Africa: a systematic review and meta-analysis. Sci Rep 2024; 14:12652. [PMID: 38825623 PMCID: PMC11144712 DOI: 10.1038/s41598-024-62651-6] [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: 01/06/2024] [Accepted: 05/20/2024] [Indexed: 06/04/2024] Open
Abstract
Excessive and improper use of antibiotics causes antimicrobial resistance which is a major threat to global health security. Hospitals in sub-Saharan Africa (SSA) has the highest prevalence of antibiotic use. This systematic review and meta-analysis aimed to determine the pooled point prevalence (PPP) of evidence-based antimicrobial use among hospitalized patients in SSA. Literature was retrieved from CINAHL, EMBASE, Google Scholar, PubMed, Scopus, and Web of Science databases. Meta-analysis was conducted using STATA version 17. Forest plots using the random-effect model were used to present the findings. The heterogeneity and publication bias were assessed using the I2 statistics and Egger's test. The protocol was registered in PROSPERO with code CRD42023404075. The review was conducted according to PRISMA guidelines. A total of 26, 272 study participants reported by twenty-eight studies published from 10 countries in SSA were included. The pooled point prevalence of antimicrobial use in SSA were 64%. The pooled estimate of hospital wards with the highest antibiotic use were intensive care unit (89%). The pooled prevalence of the most common clinical indication for antibiotic use were community acquired infection (41%). The pooled point prevalence of antimicrobial use among hospitalized patients were higher in SSA. Higher use of antibiotics was recorded in intensive care units. Community acquired infection were most common clinical case among hospitalized patients. Health systems in SSA must design innovative digital health interventions to optimize clinicians adhere to evidence-based prescribing guidelines and improve antimicrobial stewardship.
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Affiliation(s)
- Minyahil Tadesse Boltena
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute's Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia.
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia.
| | - Mirkuzie Wolde
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute's Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
- University of Technology Sydney, Sydney, Australia
| | - Belachew Hailu
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | - Ziad El-Khatib
- Global Public Health Department, Karolinska Institute, Solna, Sweden
| | - Veronika Steck
- Department of Pharmacology and Therapeutics, Faculty of Life Sciences, McGill University, Montreal, Canada
| | - Selam Woldegerima
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yibeltal Siraneh
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute's Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Sudhakar Morankar
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute's Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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Lubanga AF, Bwanali AN, Kambiri F, Harawa G, Mudenda S, Mpinganjira SL, Singano N, Makole T, Kapatsa T, Kamayani M, Ssebibubbu S. Tackling antimicrobial resistance in sub-Saharan Africa: challenges and opportunities for implementing the new people-centered WHO guidelines. Expert Rev Anti Infect Ther 2024; 22:379-386. [PMID: 38809689 DOI: 10.1080/14787210.2024.2362270] [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: 03/29/2024] [Accepted: 05/28/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Antimicrobial drugs form an essential component of medical treatment in human and animal health. Resistance associated with their use has posed a global public health threat. Multiple efforts have been made at the global level directed by the World Health Organization and associated partners to develop policies aimed at combatting antimicrobial resistance. AREAS COVERED Whilst the Global Action Plan on antimicrobial resistance and people-centered framework aim to guide countries in implementing successful antimicrobial resistance policies, their adoption and success depend on different implementation contexts. Therefore, this paper highlights the challenges and opportunities for implementing the World Health Organization's people-centered approach in sub-Saharan Africa, whilst recognizing antimicrobial resistance as a multifaceted problem rooted in 'complex systems.' EXPERT OPINION The people-centered approach provides a solid framework for combating antimicrobial resistance. Countries should build sustainable national action plans, adopt the One Health approach, limit over-the-counter antibiotic consumption, and educate communities on rational antibiotic use. They should also promote inter-country collaborations and innovative solutions, strengthen drug regulatory capacities, invest in infection control, water sanitation, hygiene, diagnostics, and surveillance tools, and promote vaccine uptake to prevent drug-resistant infections.
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Affiliation(s)
- Adriano Focus Lubanga
- Education and Research, Clinical Research Education and Management Services (CREAMS), Lilongwe, Malawi
- Department of Clinical Services, Kamuzu Central Hospital (KCH), Lilongwe, Malawi
| | - Akim Nelson Bwanali
- Education and Research, Clinical Research Education and Management Services (CREAMS), Lilongwe, Malawi
- Department of Clinical Services, Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi
| | - Frank Kambiri
- Education and Research, Clinical Research Education and Management Services (CREAMS), Lilongwe, Malawi
| | - Gracian Harawa
- Antimicrobial Resistance Champion, Public Health Institute of Malawi (PHIM), Lilongwe, Malawi
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Samuel L Mpinganjira
- Department of Epidemiology and Statistics, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Nathan Singano
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Tumaini Makole
- Pharmacist, Pharmacy Council of Tanzania, Dar es Salaam, Tanzania
| | - Thandizo Kapatsa
- Department of Laboratory Science, Phalombe District Hospital, Ministry of Health, Phalombe, Malawi
| | - Mapeesho Kamayani
- Disease Surveillance, Churches Association of Zambia, Lusaka, Zambia
| | - Stuart Ssebibubbu
- Afya na Haki Institute, Department of Evidence Generated, Kampala, Uganda
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Mithi B, Luhanga M, Kaminyoghe F, Chiumia F, Banda DL, Nyama L. Antibiotic use and resistance patterns at Rumphi District Hospital in Malawi: a cross-sectional study. BMC Infect Dis 2024; 24:445. [PMID: 38671359 PMCID: PMC11046875 DOI: 10.1186/s12879-024-09333-w] [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: 09/30/2023] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Overuse of antibiotics is a key driver of antimicrobial resistance (AMR) world-wide. Malawi continues to report rising cases of AMR among both in-patients and out-patients. We investigated antibiotic use and resistance patterns among patients with suspected first line antibiotic treatment failure at Rumphi District Hospital, Malawi. METHODS We used a cross-sectional study design in which records of patients data on culture and antimicrobial sensitivity tests were extracted, alongside treatment history from 2019 to March, 2023, retrospectively. We also included findings for point prevalence survey (PPS) conducted within four hospital wards in June, 2022 by a well-trained multi-disciplinary team from within the hospital. The data was analyzed for antibiotic use, characterization of pathogens and their susceptibility patterns using Microsoft excel and STATA-14 software. RESULTS A total of 85 patients' data records were reviewed on antibiotics resistance pattern in which 54 (63.5%) were females. Patient antibiotic history captured indicated Metronidazole (23%), Gentamycin (20%) and Doxycycline (23%) as the most frequently used antibiotics among clients referred for microbiological investigations. Among locally available antibiotics with over 50% sensitivity were Chloramphenicol (61%), ciprofloxacin (55%), and ceftriaxone (54%). Penicillins were among antibiotics with highest resistance: ampicillin (100%), amoxyclav (90%), Piperacilin-tazobactam (63%). The majority of patients came from STI clinic and presented with genital discharges 44% (n = 39). Over 80% of the isolated N. gonorrhoeae exhibited a reduced susceptibility to gentamycin. Prevalence of Methicillin resistant staphylococcus Aureus (MRSA) was 46% and were mostly isolated from wound pus. Among 80 data records of the patients reviewed during PPS, Ceftriaxone (54.3%) and Metronidazole (23.3%) emerged as the most frequently used antibiotics in the wards which were prescribed empirically without a microbiological indication. CONCLUSION In this study setting, we observed high use of watch antibiotics along with problem of multi-drug resistant infections in patients experiencing clinical failure in a variety of clinical syndromes. The findings underline the need to revamp diagnostic microbiology to increase the uptake of antimicrobial susceptibility testing to guide specific prescriptions of broad-spectrum antibiotics in the watch list.
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Affiliation(s)
- Brany Mithi
- School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi.
- Ministry of Health, Rumphi District Hospital, Rumphi, Malawi.
| | - Mosen Luhanga
- Ministry of Health, Rumphi District Hospital, Rumphi, Malawi
| | | | - Francis Chiumia
- Department of Pharmacy, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Daniel L Banda
- Department of Medical Laboratory Sciences, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Lottie Nyama
- Ministry of Health, Rumphi District Hospital, Rumphi, Malawi
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Rwigi D, Nyerere AK, Diakhate MM, Kariuki K, Tickell KD, Mutuma T, Tornberg SN, Soge OO, Walson JL, Singa B, Kariuki S, Pavlinac PB, Mogeni P. Phenotypic and molecular characterization of β-lactamase-producing Klebsiella species among children discharged from hospital in Western Kenya. BMC Microbiol 2024; 24:135. [PMID: 38654237 PMCID: PMC11040804 DOI: 10.1186/s12866-024-03284-7] [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: 11/09/2023] [Accepted: 03/31/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The emergence and spread of β-lactamase-producing Klebsiella spp. has been associated with a substantial healthcare burden resulting in therapeutic failures. We sought to describe the proportion of phenotypic resistance to commonly used antibiotics, characterize β-lactamase genes among isolates with antimicrobial resistance (AMR), and assess the correlates of phenotypic AMR in Klebsiella spp. isolated from stool or rectal swab samples collected from children being discharged from hospital. METHODS We conducted a cross-sectional study involving 245 children aged 1-59 months who were being discharged from hospitals in western Kenya between June 2016 and November 2019. Whole stool or rectal swab samples were collected and Klebsiella spp. isolated by standard microbiological culture. β-lactamase genes were detected by PCR whilst phenotypic antimicrobial susceptibility was determined using the disc diffusion technique following standard microbiology protocols. Descriptive analyses were used to characterize phenotypic AMR and carriage of β-lactamase-producing genes. The modified Poisson regression models were used to assess correlates of phenotypic beta-lactam resistance. RESULTS The prevalence of β-lactamase carriage among Klebsiella spp. isolates at hospital discharge was 62.9% (154/245). Antibiotic use during hospitalization (adjusted prevalence ratio [aPR] = 4.51; 95%CI: 1.79-11.4, p < 0.001), longer duration of hospitalization (aPR = 1.42; 95%CI: 1.14-1.77, p < 0.002), and access to treated water (aPR = 1.38; 95%CI: 1.12-1.71, p < 0.003), were significant predictors of phenotypically determined β-lactamase. All the 154 β-lactamase-producing Klebsiella spp. isolates had at least one genetic marker of β-lactam/third-generation cephalosporin resistance. The most prevalent genes were blaCTX-M 142/154 (92.2%,) and blaSHV 142/154 (92.2%,) followed by blaTEM 88/154 (57.1%,) and blaOXA 48/154 (31.2%,) respectively. CONCLUSION Carriage of β-lactamase producing Klebsiella spp. in stool is common among children discharged from hospital in western Kenya and is associated with longer duration of hospitalization, antibiotic use, and access to treated water. The findings emphasize the need for continued monitoring of antimicrobial susceptibility patterns to inform the development and implementation of appropriate treatment guidelines. In addition, we recommend measures beyond antimicrobial stewardship and infection control within hospitals, improved sanitation, and access to safe drinking water to mitigate the spread of β-lactamase-producing Klebsiella pathogens in these and similar settings.
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Affiliation(s)
- Doreen Rwigi
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
- Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
| | - Andrew K Nyerere
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Mame M Diakhate
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Kevin Kariuki
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Kirkby D Tickell
- Department of Global Health, University of Washington, Seattle, Washington, USA
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Timothy Mutuma
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Olusegun O Soge
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Judd L Walson
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Benson Singa
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Samuel Kariuki
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Patricia B Pavlinac
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Polycarp Mogeni
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
- Department of Global Health, University of Washington, Seattle, Washington, USA.
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11
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Onah SI, Umar HJ. Appraising Nigeria's approach to combating antimicrobial resistance. Int J Health Plann Manage 2024; 39:556-562. [PMID: 37846033 DOI: 10.1002/hpm.3717] [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: 09/22/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023] Open
Abstract
AIM Antibiotic consumption has increased dramatically in recent years, and this increase is predominantly fuelled by low- and middle-income countries. This is a worrying report, as antimicrobial resistance (AMR) is primarily driven by antibiotic consumption. To combat AMR, the Nigerian Ministry of Health established the Antimicrobial Resistance Technical Working Group (AMR-TWG), which developed and implemented the National Action Plan on Antimicrobial Resistance. This study aims to identify and appraise the current situation in the fight against AMR in Nigeria. METHODS This study contains a qualitative descriptive assessment of the advancements and the present status of efforts to combat AMR in Nigeria following the execution of the 2017-2022 National Action Plan (NAP) for AMR. The data for this study is soured primarily from the official national policy document on AMR and the responses of the Tracking AMR Country Self-assessment Survey (TrACSS). RESULTS The results from this study reveal that there have been significant efforts aimed at addressing AMR in Nigeria. These efforts have been focused on improving public awareness of AMR, improving One Health surveillance of AMR, improving infection prevention and control, improving antimicrobial stewardship practices in the country, and investing in research on AMR. However, significant gaps still exist in each of these focus areas that can potentially undermine the attempts that have been made hitherto. CONCLUSIONS Nigeria's commitment to the fight against AMR, as exemplified by the 2017-2022 National Action Plan, needs to be sustained and reinforced to safeguard public health and promote responsible antimicrobial use.
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Affiliation(s)
| | - Hadiza Joy Umar
- Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria
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12
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Sohaili A, Asin J, Thomas PPM. The Fragmented Picture of Antimicrobial Resistance in Kenya: A Situational Analysis of Antimicrobial Consumption and the Imperative for Antimicrobial Stewardship. Antibiotics (Basel) 2024; 13:197. [PMID: 38534632 DOI: 10.3390/antibiotics13030197] [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: 12/13/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/28/2024] Open
Abstract
Antimicrobial resistance (AMR) jeopardizes the effectiveness of essential antimicrobial agents in treating infectious diseases. Accelerated by human activities, AMR is prevalent in Sub-Saharan Africa, including Kenya, due to indiscriminate antibiotic use and limited diagnostics. This study aimed to assess Kenya's AMR efforts through a situational analysis of policy efficacy, interventions, and implementation, culminating in recommendations for strengthening mitigation. Employing two methodologies, this study evaluated Kenya's AMR endeavors. A systematic scoping review summarized AMR dynamic, and an expert validated the findings, providing an on-the-ground perspective. Antibiotic resistance is driven by factors including widespread misuse in human medicine due to irrational practices, consumer demand, and substandard antibiotics. Heavy antibiotic use in the agricultural sector leads to contamination of the food chain. The National Action Plan (NAP) reflects a One Health approach, yet decentralized healthcare and funding gaps hinder its execution. Although AMR surveillance includes multiple facets, diagnostic deficiencies persist. Expert insights recognize proactive NAP but underscore implementation obstacles. Kenya grapples with escalating resistance, but commendable policy efforts exist. However, fragmented implementations and complexities persist. Addressing this global threat demands investment in healthcare infrastructure, diagnostics, international partnerships, and sustainable strategies.
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Affiliation(s)
- Aarman Sohaili
- Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Judith Asin
- Pharmaceutical Systems Strengthening Lead, Ecumenical Pharmaceutical Network, P.O. Box 749, Nairobi 00606, Kenya
| | - Pierre P M Thomas
- Institute of Public Health Genomics, Genetics and Cell Biology Cluster, GROW Research School for Oncology and Development Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
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Khan S, Madhi SA, Olwagen C. In-silico identification of potential inhibitors against FabI protein in Klebsiella pneumoniae. J Biomol Struct Dyn 2024; 42:1506-1517. [PMID: 37105229 DOI: 10.1080/07391102.2023.2200571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/02/2023] [Indexed: 04/29/2023]
Abstract
The development of new antimicrobial drugs is needed to combat multi-drug resistant and novel hypervirulent strains of Klebsiella pneumoniae (KPN) that are associated with increased morbidity and mortality globally. The FabI protein plays a crucial role in fatty acid biosynthesis and has been identified as an important target for in-silico, in-vitro, and in-vivo drug discovery. In this study we have used computer integrated-drug discovery approaches and binding-free energy calculations to identify three novel inhibitors (21272541, 67724550, and 67724551) of the FabI protein. All inhibitors showed strong affinity including van der Waals energy, electrostatic energy, polar and non-polar energies; however, the 21272541 compound was the most effective inhibitor and bound with the strongest affinity (ΔGbind -59.02 kcal/mol) to the FabI protein. Nevertheless, all three inhibitors are promising targets for new novel antimicrobial drugs that could contribute to the management of antimicrobial resistant KPN infections based on various computational analysis. Additional in-vitro and in-vivo clinical studies will be needed to confirm drug effectiveness for the treatment of KPN infections.
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Affiliation(s)
- Shama Khan
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Science, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Science, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/ National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
- Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Courtney Olwagen
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Science, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
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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: 0] [Impact Index Per Article: 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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Mudenda S, Chilimboyi R, Matafwali SK, Daka V, Mfune RL, Kemgne LAM, Bumbangi FN, Hangoma J, Chabalenge B, Mweetwa L, Godman B. Hospital prescribing patterns of antibiotics in Zambia using the WHO prescribing indicators post-COVID-19 pandemic: findings and implications. JAC Antimicrob Resist 2024; 6:dlae023. [PMID: 38389802 PMCID: PMC10883698 DOI: 10.1093/jacamr/dlae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Background Antimicrobial resistance (AMR) is a global public health problem that is fuelled by the inappropriate prescribing of antibiotics, especially those from the 'watch' and 'reserve' antibiotic lists. The irrational prescribing of antibiotics is particularly prevalent in developing countries, including Zambia. Consequently, there is a need to better understand prescribing patterns across sectors in Zambia as a basis for future interventions. This study evaluated the prescribing patterns of antibiotics using the WHO prescribing indicators alongside the 'access, watch and reserve' (AWaRe) classification system post-COVID pandemic at a faith-based hospital in Zambia. Methods A cross-sectional study was conducted from August 2023 to October 2023 involving the review of medical records at St. Francis' Mission Hospital in Zambia. A WHO-validated tool was used to evaluate antibiotic prescribing patterns alongside the AWaRe classification tool. Results Out of 800 medical records reviewed, 2003 medicines were prescribed. Each patient received an average of 2.5 medicines per prescription. Antibiotics were prescribed in 72.3% of encounters, of which 28.4% were injectable. The most frequently prescribed antibiotics were amoxicillin (23.4%-access), metronidazole (17.1%-access), ciprofloxacin (8%-watch) and ceftriaxone (7.4%-watch), with 77.1% overall from the 'access' list. Encouragingly, 96.5% of the medicines were prescribed by their generic names and 98% were from the Zambia Essential Medicines List. Conclusions There were high rates of antibiotic prescribing, including injectable antibiotics, which needs addressing going forward. It is crucial to implement targeted measures, including antimicrobial stewardship programmes, to improve future antibiotic prescribing in Zambia and reduce the risk of AMR.
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Affiliation(s)
- Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Robert Chilimboyi
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 50110, Lusaka, Zambia
- Department of Pharmacy, Saint Francis' Hospital, Private Bag 11, Katete, Zambia
| | - Scott Kaba Matafwali
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Victor Daka
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, P.O. Box 71191, Ndola, Zambia
| | - Ruth Lindizyani Mfune
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, P.O. Box 71191, Ndola, Zambia
| | | | - Flavien Nsoni Bumbangi
- Department of Medicine and Clinical Sciences, School of Medicine, Eden University, P.O. Box 30226, Lusaka, Zambia
| | - Jimmy Hangoma
- Department of Pharmacy, School of Health Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Billy Chabalenge
- Department of Medicines Control, Zambia Medicines Regulatory Authority, P.O. Box 31890, Lusaka, Zambia
| | - Larry Mweetwa
- Department of Science and Technology, Ministry of Technology and Science, Maxwell House, Los Angeles Boulevard, P. O. Box 50464, Lusaka, Zambia
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
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Makeri D, Eilu E, Odoki M, Agwu E. A Systematic Review of the Microbial Landscape of Diabetic Foot Ulcers in Uganda. Infect Drug Resist 2024; 17:143-151. [PMID: 38234374 PMCID: PMC10793123 DOI: 10.2147/idr.s446838] [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: 10/27/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024] Open
Abstract
Background Diabetes is a growing health concern globally. Poorly managed diabetes may result in diabetic foot ulcers (DFU), which can become a source of chronic infection known as diabetic foot infections. The increasing trend of diabetes in Uganda speaks to the potential for diabetic foot ulcers which may eventually become infected and their attendant impact on the quality of life of diabetic patients. This review assesses the microbial diversity of DFUs in Uganda, aiming to guide treatment and identify research gaps. Main Body of the Abstract We searched PubMed, Scopus and Embase for studies conducted in Uganda that reported isolating microorganisms from diabetic foot ulcers. Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA), we included two eligible studies that reported isolating 122 bacteria spread across eleven (11) species using swab samples and conventional culture methods. Significant isolates included World Health Organization priority pathogens including: Enterobacter specie, Staphylococcus aureus, Klebsiella pneumoniae, and Acinetobacter specie. Methicillin resistant Staphylococcus aureus (MRSA) constituted 33.3% of Staphylococci species and 26% of all bacterial isolates while extended-spectrum beta-lactamase producing Escherichia coli and Klebsiella specie constituted 14.29% of total microbial isolates. Most bacteria showed susceptibility to Imipenem, Vancomycin, Ciprofloxacin, and Clindamycin, but resistance to Cotrimoxazole and Ampicillin was noted. Short Conclusion We conclude that data on the microbiology of DFUs in Uganda is scarce; however, the bioburden of DFUs in the country is similar to those in other parts of the world, and MRSA poses a challenge to antibiotic therapy. Consequently, the continued use of swab samples and conventional culture and sensitivity methods may limit the isolation, identification, and presentation of other important isolates. We recommend characterization of bacterial isolates to better understand their genetic makeup, and the development of a national guideline for managing diabetic foot infections.
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Affiliation(s)
- Danladi Makeri
- Department of Microbiology and Immunology, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Ishaka, Uganda
| | - Emmanuel Eilu
- Department of Microbiology and Immunology, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Ishaka, Uganda
| | - Martin Odoki
- Department of Microbiology and Immunology, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Ishaka, Uganda
- Department of Microbiology and Immunology, School of Medicine, King Ceasor University, Kampala, Uganda
- Department of Applied Sciences, School of Sciences, Nkumba University, Entebbe, Uganda
| | - Ezera Agwu
- Department of Microbiology and Immunology, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Ishaka, Uganda
- Department of Microbiology and Parasitology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Mohammed Y, Muhammad AS, Zainu SM, Jimoh AK, Olowo-Okere A, Ogunyinka IA, Abubakar J, Dada KM, Egbe OE, Galalain SM. Outbreak of Multidrug-resistant Acinetobacter baumannii in a Tertiary Health Center from Northwestern Nigeria. Ann Afr Med 2024; 23:40-45. [PMID: 38358170 PMCID: PMC10922177 DOI: 10.4103/aam.aam_141_23] [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: 08/25/2023] [Revised: 09/27/2023] [Accepted: 10/04/2023] [Indexed: 02/16/2024] Open
Abstract
Background In spite of its global notoriety and WHO alarm, Acinetobacter baumannii is still an understudied critical-priority pathobiont in Nigeria. We characterized its antimicrobial susceptibility profile and resistance genes during an outbreak. Materials and Methods This cross-sectional study involved collection of patients' urine samples and swabs from unit staff's hands and ward environments for the identification of A. baumannii strains using standard morphologic and biochemical methods. The disk diffusion method was used to assess the antimicrobial susceptibility profile of the isolates with the production of extended-spectrum beta-lactamases (ESBLs) confirmed by the combined disk test screening method. Characterization of the resistance genes of the ESBL producers was carried out using polymerase chain reaction polymerase chain reaction technique. Results A. total of eight (six clinical and two nonclinical) A. baumannii isolates were identified. The overall isolate susceptibility and resistance rates to all the antimicrobial agents was 56.3% (27/48) and 35.4% (17/48), respectively. Similarly, all (8/8; 100.00%) isolates were susceptible to meropenem and 75.0% (6/8) to ampicillin-sulbactam while 62.5% (5/8) were resistant to trimethoprim-sulfamethoxazole and 50.0% (4/8) to each of ciprofloxacin and ceftazidime. In addition, 37.5% (3/8) of the isolates were multidrug resistant (MDR) with nonclinical isolates exhibiting more antimicrobial resistance than their clinical counterparts (9/12%-75.0% vs. 8/36%-22.2%). Phenotypic detection and molecular characterization revealed three ESBL-producing isolates that each harbored blaSHV and blaTEM genes with blaCTX-M gene being absent. Conclusion MDR strains of A. baumannii harboring blaSHV and blaTEM genes were recovered from clinical and environmental sources during the outbreak, which was contained with preventive measures recommended.
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Affiliation(s)
- Yahaya Mohammed
- Department of Medical Microbiology, Faculty of Basic Clinical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
- Department of Medical Microbiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Abubakar Sadiq Muhammad
- Department of Surgery, Urology Unit, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Sabitu Muhammad Zainu
- Department of Medical Microbiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Ahmed Kolawole Jimoh
- Department of Medical Microbiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Ahmed Olowo-Okere
- Department of Pharmaceutics and Pharmaceutical Microbiology, Faculty of Pharmaceutical Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Ibrahim Abayomi Ogunyinka
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Jibril Abubakar
- Department of Medical Microbiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Khadijah Muhammad Dada
- Department of Medical Microbiology, Faculty of Basic Clinical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Oloche Emmanuel Egbe
- Department of Medical Microbiology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Salma Muhammad Galalain
- Department of Biology, Faculty of Chemical and Life Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
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Kamara IF, Kanu J, Maruta A, Fofanah BD, Kamara KN, Sheriff B, Katawera V, D'Almeida SA, Musoke R, Nuwagira I, Lakoh S, Kamara RZ, Tengbe SM, Mansaray AR, Koroma Z, Thomas F, Abiri OT, Koroma AT, Russell JBW, Squire J, Vandi MA. Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology. BMJ Open 2023; 13:e078367. [PMID: 38159961 PMCID: PMC10759135 DOI: 10.1136/bmjopen-2023-078367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE Inappropriate use of antibiotics is a major driver of antibiotic resistance. A few studies conducted in Africa have documented that about half of hospitalised patients who receive antibiotics should not have received them. A few hospital-based studies that have been conducted in Sierra Leone have documented a high usage of antibiotics in hospitals. Therefore, we conducted a nationwide point prevalence survey on antibiotic use among hospitalised patients in Sierra Leone. DESIGN We conducted a hospital-based, cross-sectional survey on the use of antibiotics using the WHO point prevalence survey methodology. SETTING The study was conducted in 26 public and private hospitals that are providing inpatient healthcare services. PARTICIPANTS All patients admitted to paediatric and adult inpatient wards before or at 08:00 on the survey date were enrolled. OUTCOME MEASURES Prevalence of antibiotic use, antibiotics Access, Watch and Reserve (AWaRe) categorisation, indication for antibiotic use prevalence and proportion of bacteria culture done. RESULTS Of the 1198 patient records reviewed, 883 (73.7%, 95% CI 71.1% to 76.2%) were on antibiotics. Antibiotic use was highest in the paediatric wards (306, 85.7%), followed by medical wards (158, 71.2%), surgical wards (146, 69.5%), mixed wards (97, 68.8%) and lowest in the obstetrics and gynaecology wards (176, 65.7%). The most widely prescribed antibiotics were metronidazole (404, 22.2%), ceftriaxone (373, 20.5%), ampicillin (337, 18.5%), gentamicin (221, 12.1%) and amoxicillin (90, 5.0%). Blood culture was only done for one patient and antibiotic treatments were given empirically. The most common indication for antibiotic use was community-acquired infection (484, 51.9%) followed by surgical prophylaxis (222, 23.8%). CONCLUSION There was high usage of antibiotics in hospitals in Sierra Leone as the majority of patients admitted received an antibiotic. This has the potential to increase the burden of antibiotic resistance in the country. We, therefore, recommend the establishment of hospital antimicrobial stewardship programmes according to the WHO core components.
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Affiliation(s)
- Ibrahim Franklyn Kamara
- Reproductive Maternal Newborn Child and Adolescent Health Unit, Universal Health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Joseph Kanu
- National Disease Surveillance Programme, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
- Community Health, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Anna Maruta
- World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | | | - Kadijatu Nabie Kamara
- National Surveillance Program, Directorate of Health Security and Emergencies, Ministry of Health, Freetown, Sierra Leone
| | - Bockarie Sheriff
- Universal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Victoria Katawera
- Universal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Selassi A D'Almeida
- Universal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Robert Musoke
- Emergency Preparedness and Response, World Health Organization Country Office, Sierra Leone, Freetown, Sierra Leone
| | - Innocent Nuwagira
- World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Rugiatu Z Kamara
- US Center for Disease Control and Prevention Country Office, Sierra Leone, Freetown, Sierra Leone
| | | | - Abdul Razak Mansaray
- Laboratory, Diagnostic and Blood Services, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Microbiology, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Zikan Koroma
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Fawzi Thomas
- Pharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
| | - Onome T Abiri
- Pharmacovigilance and Clinical Trials Department, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
- Pharmacology, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Aminata Tigiedankay Koroma
- National Surveillance Program, Directorate of Health Security and Emergency, Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - James Squire
- Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Mohamed Alex Vandi
- Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
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19
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Cong W, Cheng HY, Stuart B, Liu B, Tang Y, Wang Y, AIhusein N, Wang H, Manchundiya A, Lambert H. Prevalence of antibiotic prescribing in COVID-19 patients in China and other low- and middle-income countries during the pandemic (December 2019-March 2021): a systematic review and meta-analysis. J Antimicrob Chemother 2023; 78:2787-2794. [PMID: 37883697 PMCID: PMC10689912 DOI: 10.1093/jac/dkad302] [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: 04/10/2023] [Accepted: 09/19/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVES Low- and middle-income countries (LMICs) are particularly vulnerable to the threat of antimicrobial resistance (AMR). Use of antibiotics to treat COVID-19 patients during the pandemic may have contributed to increasing the AMR burden, but systematic evidence is lacking. METHODS We searched Web of Science, EMBASE, PubMed, China National Knowledge Infrastructure (CNKI) and VIP databases from 1 December 2019 to 31 March 2021. Interventional and observation studies across all settings that reported antibiotic use in at least 10 COVID-19 patients were included. We restricted publications to English and Chinese languages. Screening and data extraction were undertaken by at least two independent reviewers. Results were synthesized using random-effects meta-analyses. Subgroup analyses and meta-regression were used to explore heterogeneities. This review was registered with PROSPERO (CRD42021288291). RESULTS We included 284 studies involving 210 611 participants in 19 countries. The antibiotic prescribing rates (APRs) in COVID-19 inpatients were 71.7% (95% CI 66.7%-76.5%) in China and 86.5% (77.1%-93.9%) in other LMICs, respectively. APR was lower in mild/moderate cases in China [66.9% (57.9%-75.4%) compared with 91.8% (71.4%-100%) in other LMICs]. High APRs were found among pregnant women and the elderly in China. Disparities in APRs of other patient groups were identified. In studies reporting bacterial infections, the prevalence was 17.3% (10.0%-25.9%) in China and 24.9% (0.1%-68.8%) in other LMICs. Several antibiotics on the WHO 'Watch' and 'Reserve' lists were prescribed frequently in LMICs. CONCLUSIONS Inappropriate antibiotic use and high prevalence of antibiotic prescribing were found in COVID-19 inpatients in many LMICs.
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Affiliation(s)
- Wenjuan Cong
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Hung-Yuan Cheng
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Beth Stuart
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London E1 2AB, UK
| | - Binjuan Liu
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Yunyi Tang
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Yi Wang
- Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, 130 Dongan Road, Shanghai 200243, China
| | - Nour AIhusein
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Hexing Wang
- Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, 130 Dongan Road, Shanghai 200243, China
| | - Amit Manchundiya
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Helen Lambert
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK
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Kawa DE, Tickler IA, Tenover FC, Shettima SA. Characterization of Beta-Lactamase and Fluoroquinolone Resistance Determinants in Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa Isolates from a Tertiary Hospital in Yola, Nigeria. Trop Med Infect Dis 2023; 8:500. [PMID: 37999619 PMCID: PMC10675496 DOI: 10.3390/tropicalmed8110500] [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: 10/03/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023] Open
Abstract
Infections due to antimicrobial resistant gram-negative bacteria cause significant morbidity and mortality in sub-Saharan Africa. To elucidate the molecular epidemiology of antimicrobial resistance in gram-negative bacteria, we characterized beta-lactam and fluoroquinolone resistance determinants in Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa isolates collected from November 2017 to February 2018 (Period 1) and October 2021 to January 2022 (Period 2) in a tertiary medical center in north-eastern Nigeria. Whole genome sequencing (WGS) was used to identify sequence types and resistance determinants in 52 non-duplicate, phenotypically resistant isolates. Antimicrobial susceptibility was determined using broth microdilution and modified Kirby-Bauer disk diffusion methods. Twenty sequence types (STs) were identified among isolates from both periods using WGS, with increased strain diversity observed in Period 2. Common ESBL genes identified included blaCTX-M, blaSHV, and blaTEM in both E. coli and K. pneumoniae. Notably, 50% of the E. coli in Period 2 harbored either blaCTX-M-15 or blaCTX-M-1 4 and phenotypically produced ESBLs. The blaNDM-7 and blaVIM-5 metallo-beta-lactamase genes were dominant in E. coli and P. aeruginosa in Period 1, but in Period 2, only K. pneumoniae contained blaNDM-7, while blaNDM-1 was predominant in P. aeruginosa. The overall rate of fluoroquinolone resistance was 77% in Period 1 but decreased to 47.8% in Period 2. Various plasmid-mediated quinolone resistance (PMQR) genes were identified in both periods, including aac(6')-Ib-cr, oqxA/oqxB, qnrA1, qnrB1, qnrB6, qnrB18, qnrVC1, as well as mutations in the chromosomal gyrA, parC and parE genes. One E. coli isolate in Period 2, which was phenotypically multidrug resistant, had ESBL blaCTX-M-15, the serine carbapenemase, blaOXA-181 and mutations in the gyrA gene. The co-existence of beta-lactam and fluoroquinolone resistance markers observed in this study is consistent with widespread use of these antimicrobial agents in Nigeria. The presence of multidrug resistant isolates is concerning and highlights the importance of continued surveillance to support antimicrobial stewardship programs and curb the spread of antimicrobial resistance.
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Affiliation(s)
- Diane E. Kawa
- Department of Medical and Scientific Affairs, Cepheid, Sunnyvale, CA 94089, USA
| | | | - Fred C. Tenover
- College of Arts and Sciences, University of Dayton, Dayton, OH 45469, USA;
| | - Shuwaram A. Shettima
- Department of Medical Microbiology, Parasitology and Immunology, Modibbo Adama University Teaching Hospital, Yola 640001, Adamawa State, Nigeria;
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21
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Nale JY, Chan B, Nnadi NE, Cheng JKJ, Matts S, Nezam-Abadi N, Turkington CJR, Charreton LM, Bola H, Nazir R, Hoza AS, Wamala SP, Ibanda I, Maina AN, Apopo AA, Msoffe VT, Moremi N, Moore GW, Asiimwe I, Namatovu A, Mutumba P, Kamya D, Nabunje R, Nakabugo I, Kazwala RR, Kangethe E, Negash AA, Watelo AK, Bukamba N, Muhindo G, Lubowa NM, Jillani N, Nyachieo A, Nasinyama G, Nakavuma J, Millard A, Nagel TE, Clokie MRJ. Novel Escherichia coli-Infecting Bacteriophages Isolated from Uganda That Target Human Clinical Isolates. PHAGE (NEW ROCHELLE, N.Y.) 2023; 4:141-149. [PMID: 37841386 PMCID: PMC10574529 DOI: 10.1089/phage.2023.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background The antimicrobial resistance catastrophe is a growing global health threat and predicted to be worse in developing countries. Phages for Global Health (PGH) is training scientists in these regions to isolate relevant therapeutic phages for pathogenic bacteria within their locality, and thus contributing to making phage technology universally available. Materials and Methods During the inaugural PGH workshop in East Africa, samples from Ugandan municipal sewage facilities were collected and two novel Escherichia coli lytic phages were isolated and characterized. Results The phages, UP19 (capsid diameter ∼100 nm, contractile tail ∼120/20 nm) and UP30 (capsid diameter ∼70 nm, noncontractile tail of ∼170/20 nm), lysed ∼82% and ∼36% of the 11 clinical isolates examined, respectively. The genomes of UP19 (171.402 kb, 282 CDS) and UP30 (49.834 kb, 75 CDS) closely match the genera Dhakavirus and Tunavirus, respectively. Conclusion The phages isolated have therapeutic potential for further development against E. coli infections.
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Affiliation(s)
- Janet Yakubu Nale
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
- Centre for Epidemiology and Planetary Health, School of Veterinary Medicine, Scotland's Rural College, Inverness, Scotland, United Kingdom
| | - Benjamin Chan
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut, USA
| | - Nnaemeka Emmanuel Nnadi
- Department of Microbiology, Faculty of Natural and Applied Sciences, Plateau State University, Bokkos, Nigeria
| | - Jeffrey Kwok Jone Cheng
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
- School of Life Sciences, The University of Warwick, Coventry, United Kingdom
| | - Susan Matts
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
| | - Neda Nezam-Abadi
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
- APC Microbiome Ireland and School of Microbiology, University College Cork, Cork, Ireland
| | - Christopher Jason Richard Turkington
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
- APC Microbiome Ireland and School of Microbiology, University College Cork, Cork, Ireland
| | - Lucie Manon Charreton
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
- Sciences et Humanités, École Supérieur de Biologie, Biochimie, Lyon, France
| | - Harroop Bola
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
- Imperial College School of Medicine, London, United Kingdom
| | - Ramez Nazir
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
- Yale-Waterbury Internal Medicine, Waterbury, Connecticut, USA
| | - Abubakar Shaaban Hoza
- Department of Veterinary Microbiology, Parasitology & Biotechnology, College of Veterinary Medicine & Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Samuel Posian Wamala
- Department of Biotechnical and Diagnostic Science, College of Veterinary Medicine, Makerere University, Kampala, Uganda
| | - Ivan Ibanda
- Department of Pharmacology and Therapeutics, School of Medicine and Surgery, King Ceasor University, Kampala, Uganda
| | - Alice Nyambura Maina
- Department of Biology, University of Nairobi, Nairobi, Kenya
- Department of Food Science and Technology, Technical University of Kenya, Nairobi, Kenya
| | | | - Venance Theophil Msoffe
- Department of Biological Sciences, Mkwawa University College of Education, The Constituent College of University of Dar es Salaam, Iringa, Tanzania
| | - Nyambura Moremi
- Department of Research, National Public Health Laboratory, Dar es Salaam, Tanzania
| | - Grace Wanjiru Moore
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ismail Asiimwe
- Department of Biomolecular Resources and Biolab Sciences, School of Biosecurity, Biotechnical and Laboratory Sciences, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Alice Namatovu
- Department of Biomolecular Resources and Biolab Sciences, School of Biosecurity, Biotechnical and Laboratory Sciences, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Paul Mutumba
- Department of Biomolecular Resources and Biolab Sciences, School of Biosecurity, Biotechnical and Laboratory Sciences, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Deus Kamya
- Department of Biomolecular Resources and Biolab Sciences, School of Biosecurity, Biotechnical and Laboratory Sciences, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Ritah Nabunje
- Department of Biomolecular Resources and Biolab Sciences, School of Biosecurity, Biotechnical and Laboratory Sciences, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Immaculate Nakabugo
- Department of Biomolecular Resources and Biolab Sciences, School of Biosecurity, Biotechnical and Laboratory Sciences, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Rudovick Ruben Kazwala
- Department of Veterinary Medicine & Public Health, College of Veterinary Medicine & Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Erastus Kangethe
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi, Kenya
| | - Abel Abera Negash
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
- Department of Microbiology, Immunology and Parasitology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Nelson Bukamba
- Mountain Gorilla Veterinary Project Inc, Department of Wildlife and Aquatic Resources Management, College of Veterinary Medicine, Makerere University Kampala, Uganda
| | | | - Nathan Musisi Lubowa
- Department of Biotechnical and Diagnostic Science, College of Veterinary Medicine, Makerere University, Kampala, Uganda
| | - Ngalla Jillani
- Phage Biology Laboratory, Institute of Primate Research, Karen Nairobi, Kenya
| | - Atunga Nyachieo
- Phage Biology Laboratory, Institute of Primate Research, Karen Nairobi, Kenya
| | - George Nasinyama
- Department of Public Health Kampala International University, Kampala, Uganda
- School of Sciences, Health Sciences, Technology, and Engineering, Unicaf University, Kampala, Uganda
| | - Jesca Nakavuma
- Department of Biomolecular Resources and Biolab Sciences, School of Biosecurity, Biotechnical and Laboratory Sciences, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Andrew Millard
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
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Yusuff SI, Tajudeen YA, Oladunjoye IO, Oladipo HJ, Bolarinwa OV, Popoola OT, Ahmed AF, Olana MD. The need to increase antimicrobial resistance surveillance among forcibly displaced persons (FDPs). Trop Dis Travel Med Vaccines 2023; 9:12. [PMID: 37653439 PMCID: PMC10472691 DOI: 10.1186/s40794-023-00198-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/19/2023] [Indexed: 09/02/2023] Open
Abstract
Antimicrobial resistance (AMR) poses a significant threat to human health as 4.95 million deaths were associated with bacterial AMR in 2019 and is projected to reach 10 million by 2050. To mitigate AMR, surveillance is an essential tool for determining the burden of AMR and providing the necessary information for its control. However, the global AMR surveillance is inadequate and particularly limited among forcibly displaced persons (FDPs) despite having higher risks of harboring these pathogens. Predisposing factors among this group include poor living conditions, limited access to treatment and diagnostic tests, and inadequate trained health professionals in refugee camps. Strengthening AMR surveillance among FDPs would address the identified gaps and facilitate formulation and implementation of evidence-based policies on AMR control and prevention response. This article provides information on the growing population of FDPs, factors contributing to the AMR burden and AMR surveillance gaps in FDPs and highlighted recommendations for control.
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Affiliation(s)
- Sodiq Inaolaji Yusuff
- Department of Medicine, Faculty of Clinical Sciences, Obafemi Awolowo University, Ibadan-Ife Rd, Ife, 220101, Osun State, Nigeria
| | - Yusuf Amuda Tajudeen
- Department of Microbiology, Faculty of Life Sciences, University of Ilorin, P.M.B. 1515, Ilorin, 240003, Nigeria
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, P.M.B 5017 G.P.O, Ibadan, Oyo State, Nigeria
| | - Iyiola Olatunji Oladunjoye
- Department of Microbiology, Faculty of Life Sciences, University of Ilorin, P.M.B. 1515, Ilorin, 240003, Nigeria
| | - Habeebullah Jayeola Oladipo
- Department of Microbiology, Faculty of Life Sciences, University of Ilorin, P.M.B. 1515, Ilorin, 240003, Nigeria
- Faculty of Pharmaceutical Sciences, University of Ilorin, P.M.B. 1515, Ilorin, 240003, Nigeria
| | | | - Olalekan Tolulope Popoola
- Department of Public Health, Health Sciences Centre, University College, Dublin, 4 Stillorgan Rd, Belfield, Dublin 4, Ireland
| | - Abdulhakeem Funsho Ahmed
- Faculty of Health Sciences, Department of Public Health, Al-Hikmah University, Ilorin, 240281, Kwara State, Nigeria
- Institute of Basic and Applied Science, Department of Science Laboratory Technology, Kwara State Polytechnic, P.M.B 1375, Ilorin, Kwara State, Nigeria
| | - Matifan Dereje Olana
- Department of Medical Laboratory Sciences, Collage of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia.
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia.
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23
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Guryanova SV. Immunomodulation, Bioavailability and Safety of Bacteriocins. Life (Basel) 2023; 13:1521. [PMID: 37511896 PMCID: PMC10381439 DOI: 10.3390/life13071521] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
The rise of antibiotic-resistant bacteria and the emergence of new pathogens have created a need for new strategies to fight against infectious diseases. One promising approach is the use of antimicrobial peptides produced by a certain species of bacteria, known as bacteriocins, which are active against other strains of the same or related species. Bacteriocins can help in the treatment and prevention of infectious diseases. Moreover, bacteriocins can be obtained in prokaryotic organisms, and contribute s to their widespread use. While the use of bacteriocins is currently limited to the food industry (for example, nisin is used as a preservative, E234), a large number of studies on their microbicidal properties suggest that their use in medicine may increase in the foreseeable future. However, for the successful use of bacteriocins in medicine, it is necessary to understand their effect on the immune system, especially in cases where immunity is weakened due to infectious processes, oncological, allergic, or autoimmune diseases. Studies on the immuno-modulatory activity of bacteriocins in animal models and human cells have revealed their ability to induce both pro-inflammatory and anti-inflammatory factors involved in the implementation of innate immunity. The influence of bacteriocins on acquired immunity is revealed by an increase in the number of T-lymphocytes with a simultaneous decrease in B-lymphocyte levels, which makes them attractive substances for reducing inflammation. The widespread use of bacteriocins in the food industry, their low toxicity, and their broad and narrow specificity are reasons for researchers to pay attention to their immunomodulatory properties and explore their medical applications. Inflammation regulation by bacteriocins can be used in the treatment of various pathologies. The aim of the review was to analyze scientific publications on the immunomodulatory activity, bioavailability, and safety of bacteriocins in order to use the data obtained to organize preclinical and clinical studies.
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Affiliation(s)
- Svetlana V Guryanova
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, 117997 Moscow, Russia
- Medical Institute, Peoples' Friendship University of Russia (RUDN University) of the Ministry of Science and Higher Education of the Russian Federation, 117198 Moscow, Russia
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Sono TM, Yeika E, Cook A, Kalungia A, Opanga SA, Acolatse JEE, Sefah IA, Jelić AG, Campbell S, Lorenzetti G, Ul Mustafa Z, Marković-Peković V, Kurdi A, Anand Paramadhas BD, Rwegerera GM, Amu AA, Alabi ME, Wesangula E, Oluka M, Khuluza F, Chikowe I, Fadare JO, Ogunleye OO, Kibuule D, Hango E, Schellack N, Ramdas N, Massele A, Mudenda S, Hoxha I, Moore CE, Godman B, Meyer JC. Current rates of purchasing of antibiotics without a prescription across sub-Saharan Africa; rationale and potential programmes to reduce inappropriate dispensing and resistance. Expert Rev Anti Infect Ther 2023; 21:1025-1055. [PMID: 37740561 DOI: 10.1080/14787210.2023.2259106] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a global concern. Currently, the greatest mortality due to AMR is in Africa. A key driver continues to be high levels of dispensing of antibiotics without a prescription. AREAS COVERED A need to document current rates of dispensing, their rationale and potential ways forward including antimicrobial stewardship programmes (ASPs). A narrative review was undertaken. The highest rates of antibiotic purchasing were in Eritrea (up to 89.2% of antibiotics dispensed), Ethiopia (up to 87.9%), Nigeria (up to 86.5%), Tanzania (up to 92.3%) and Zambia (up to 100% of pharmacies dispensing antibiotics without a prescription). However, considerable variation was seen with no dispensing in a minority of countries and situations. Key drivers of self-purchasing included high co-payment levels for physician consultations and antibiotic costs, travel costs, convenience of pharmacies, patient requests, limited knowledge of antibiotics and AMR and weak enforcement. ASPs have been introduced in some African countries along with quality targets to reduce inappropriate dispensing, centering on educating pharmacists and patients. EXPERT OPINION ASP activities need accelerating among community pharmacies alongside quality targets, with greater monitoring of pharmacists' activities to reduce inappropriate dispensing. Such activities, alongside educating patients and healthcare professionals, should enhance appropriate dispensing of antibiotics and reduce AMR.
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Affiliation(s)
- Tiyani Milta Sono
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Saselamani Pharmacy, Saselamani, South Africa
| | - Eugene Yeika
- Programs coordinator/Technical supervisor for HIV/Malaria, Delegation of Public Health, Cameroon
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Aubrey Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Sylvia A Opanga
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ho, Ghana
| | - Ana Golić Jelić
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia & Herzegovina
| | - Stephen Campbell
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
| | - Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan, Pakistan
| | - Vanda Marković-Peković
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia & Herzegovina
| | - Amanj Kurdi
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
| | - Bene D Anand Paramadhas
- Department of Health Services Management, Central Medical Stores, Ministry of Health, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Gaborone, Botswana
- DestinyMedical and Research Solutions Proprietary Limited, Gaborone, Botswana
| | - Adefolarin A Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Kingdom of Eswatini
| | - Mobolaji Eniola Alabi
- School of Pharmaceutical Sciences, College of Health Sciences,University of Kwazulu-natal (UKZN), Durban, South Africa
| | - Evelyn Wesangula
- East Central and Southern Africa Health Community, Arusha, Tanzania
| | - Margaret Oluka
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Felix Khuluza
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Ibrahim Chikowe
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Joseph O Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Uganda
| | - Dan Kibuule
- Department of Pharmacology & Therapeutics, Busitema University, Mbale, Uganda
| | - Ester Hango
- Department of Pharmacy Practice and Policy, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, SouthAfrica
| | - Nishana Ramdas
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
- Africa Center of Excellence for Infectious Diseases of Humans and Animals, School of Veterinary Meicine, University of Zambia, Lusaka, Zambia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Tirana, Albania
| | - Catrin E Moore
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
| | - Brian Godman
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho HealthSciences University, Garankuwa, Pretoria, South Africa
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Moyo P, Moyo E, Mangoya D, Mhango M, Mashe T, Imran M, Dzinamarira T. Prevention of antimicrobial resistance in sub-Saharan Africa: What has worked? What still needs to be done? J Infect Public Health 2023; 16:632-639. [PMID: 36870230 DOI: 10.1016/j.jiph.2023.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 02/23/2023] Open
Abstract
Antibiotics help in preventing and treating infections and increasing life expectancy globally. Globally, many people's lives are being threatened by the emergence of antimicrobial resistance (AMR). The cost of treating and preventing infectious diseases has increased due to AMR. Bacteria can resist the effects of antibiotics by altering drug targets, inactivating drugs, and activating drug efflux pumps. According to estimates, five million individuals died in 2019 from AMR-related causes, wherein 1.3 million deaths were directly linked to bacterial AMR. Sub-Saharan Africa (SSA) experienced the greatest mortality rate from AMR in 2019. In this article, we discuss AMR's causes and challenges SSA faces in implementing AMR prevention measures and propose recommendations to address the challenges. Antibiotic misuse and overuse, widespread usage in agriculture, and the pharmaceutical industry's absence of new antibiotic development are the factors contributing to AMR. SSA's challenges in preventing AMR include poor AMR surveillance and lack of collaboration, irrational use of antibiotics, weak medicine regulatory systems, lack of infrastructural and institutional capacities, lack of human resources, and inefficient infection prevention and control (IPC) practices. The challenges faced by countries in SSA can be addressed by increasing the public's knowledge of antibiotics and AMR, promoting antibiotic stewardship, improving AMR surveillance, promoting collaboration within and beyond countries, antibiotics regulatory enforcement, and improving the practice of IPC measures at home, food handling establishments, and healthcare facilities.
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Affiliation(s)
- Perseverance Moyo
- College of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Enos Moyo
- College of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Derek Mangoya
- College of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Malizgani Mhango
- College of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Mohd Imran
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Northern Border University, Saudi Arabia.
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Ong'era E, Kagira J, Maina N, Kiboi D, Waititu K, Michira L, Ngotho M. Prevalence and Potential Risk Factors for the Acquisition of Antibiotic-Resistant Staphylococcus spp. Bacteria Among Pastoralist Farmers in Kajiado Central Subcounty, Kenya. BIOMED RESEARCH INTERNATIONAL 2023; 2023:3573056. [PMID: 37082192 PMCID: PMC10113052 DOI: 10.1155/2023/3573056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/08/2023] [Accepted: 03/01/2023] [Indexed: 04/22/2023]
Abstract
Antimicrobial resistance (AMR) is a growing health problem globally. To address this challenge, there is a need to generate baseline data on the prevalence and AMR profile of the main disease-causing bacteria. Here, we interrogated the prevalence of bacteria in the nasal cavity of healthy pastoralists in Kajiado Central Subcounty, Kenya, and the occurrence of AMR in Staphylococcus isolates among the study subjects. Nasal swabs from 176 pastoralists were cultured, and the bacteria isolates identified using standard phenotypic and biochemical bacteriological methods. Among the obtained 195 isolates, the most prevalent isolates were coagulase-negative Staphylococcus (CoNS) (44.9%), followed by Enterococci spp. (43.2%) while Staphylococcus aureus prevalence was 8%. Antimicrobial sensitivity of the Staphylococcus spp. isolates to 14 antibiotics representing six antibiotic groups was undertaken using the Kirby-Bauer disk diffusion method. Among the CoNS, the highest resistance was reported in amoxicillin (78.7%) and ceftazidime (76%), while the most resistance for S. aureus was reported in ceftazidime (100%), amoxicillin (71.4%), and streptomycin (71.4%). From an administered questionnaire looking at gender, animal contact frequency, history of hospital visitation and antibiotic usage, and habitual intake of raw milk, the study showed that male participants had a higher risk of carrying multiple drug resistant (MDR) bacteria than females (p = 0.02, OR = 1.3). Likewise, habitual intake of raw milk was significantly associated MDR acquisition (p = 0.02, OR = 1.82). This study reveals a high prevalence of AMR Staphylococcus isolates in the study area laying a foundation for further analysis of molecular characterization of the observed resistance as well as the development of interventions that can reduce the occurrence of AMR in the study area.
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Affiliation(s)
- Edidah Ong'era
- Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya P.O. Box 62000-00200
| | - John Kagira
- Department of Animal Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya P.O. Box 62000-00200
| | - Naomi Maina
- Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya P.O. Box 62000-00200
| | - Daniel Kiboi
- Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya P.O. Box 62000-00200
| | - Kenneth Waititu
- Department of Animal Science, Institute of Primate Research, P.O. Box 24481 Karen 00502 Nairobi, Kenya
| | - Lynda Michira
- Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya P.O. Box 62000-00200
| | - Maina Ngotho
- Department of Clinical Studies, University of Nairobi, Nairobi, Kenya P.O. Box 30197-GPO
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Samuel M, Fredrick Wabwire T, Tumwine G, Waiswa P. Antimicrobial Usage by Small-Scale Commercial Poultry Farmers in Mid-Western District of Masindi Uganda: Patterns, Public Health Implications, and Antimicrobial Resistance of E. coli. Vet Med Int 2023; 2023:6644271. [PMID: 37122610 PMCID: PMC10139818 DOI: 10.1155/2023/6644271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/05/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023] Open
Abstract
Background Poultry production in Uganda is growing at a fast rate due to increasing demand, notwithstanding, poor husbandry practices, and diseases, prompting farmers to rear healthy productive flocks with antimicrobials. The study evaluated the knowledge and practices as regards the use of antibiotics among poultry farmers in Masindi district and determined the antibiotic susceptibility profiles of E. coli strains from chickens. Methods A cross-sectional study using a closed-end questionnaire was conducted in 140 selected small-scale commercial poultry farms in Masindi district between June and December, 2020. Analyzed qualitative data were presented as frequencies, percentages, and their 95% confidence intervals (95% CI). Fecal swabs from chickens were inoculated onto a MacConkey agar, and E. coli was confirmed by standard biochemical tests. Antimicrobial susceptibility was determined by the disk diffusion method for 7 antibiotics. Results Most farmers (74%) used antibiotics, mainly tetracycline (51.4%) and sulfonamides (28.6%), given to the chicks (45%), for both curative and prophylaxis purposes (80%), and via drinking water (67%). Farmers mainly used antibiotics recommended by the veterinarian (76.4%), more than relying on experience (10.7%), while 45% were involved in self-medicating the birds. On choosing the correct dosage, 45.7% read the instruction, and 42.9% consulted a veterinarian. Only 10.7% observed the drug withdrawal period, while 53.6% consumed eggs at home or sold eggs (35.7%) from birds under treatment. Of the 200 E. coli strains, 90 (45.0%) were resistant to one drug, 74 (37.0%) to two, and multidrug resistance to three classes of antibiotics was 36 (18.0%). Overall, E. coli resistance to tetracycline was (69.0%), ampicillin (37.0%), sulfonamides (36.0%), and to kanamycin (1.5%). Conclusions The small-scale poultry farmers frequently use antimicrobial drugs, mainly tetracycline and sulfonamides for curative and prophylaxis. Thus, enforcing measures against antibiotic use supported by a strong veterinary service sector and farmers' training on judicious use of antimicrobials are needed.
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Affiliation(s)
- Majalija Samuel
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Tony Fredrick Wabwire
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Gabriel Tumwine
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Peter Waiswa
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, P.O Box 7062, Kampala, Uganda
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