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Kayinamura MP, Muhirwa A, Kamaliza AC, Bigirimana Y, Rutare S, Hahirwa I, Nkubana T, Dusabe A, Munyemana JB. Prevalence of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae and Associated Clinical Implications at the University Teaching Hospital of Kigali in Rwanda. Am J Trop Med Hyg 2024; 111:565-568. [PMID: 39013384 PMCID: PMC11376162 DOI: 10.4269/ajtmh.23-0605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 05/08/2024] [Indexed: 07/18/2024] Open
Abstract
Extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae poses a global problem and complicates therapeutic choices. The paucity of data in resource-poor countries undermines the understanding of the problem's extent, and cases of antimicrobial treatment failure continue to accumulate. This study aimed to determine the prevalence and clinical implications of ESBL-producers at the University Teaching Hospital of Kigali in Rwanda. A 1-year cross-sectional retrospective study was conducted on Escherichia coli and Klebsiella pneumoniae isolated in blood and urine from January 1 to December 31, 2022. In total, 1,283 isolates were recorded. The results showed an overall prevalence of ESBL phenotypes at 300/1,283 (23.4%). Extended spectrum beta-lactamase-positive E. coli was more frequently detected than K. pneumoniae in both urine (20.6% versus 10.1%) and blood (8.8% versus 6.2%). These isolates were 100% resistant to amoxicillin-clavulanic acid, third-generation cephalosporins, piperacillin, sulbactam ampicillin, ampicillin, cefuroxime, and cefoxitin. The least resistance was observed to amikacin (18%), meropenem (10%), and polymyxin B (3%). Hospital stays ranging from 8 to 21 days were the most frequent, and the mortality rate was 10.3% in patients with ESBL cases, which was more than double the general hospital mortality rate in the same period. In conclusion, our findings indicate a high prevalence of ESBL phenotypes, high antibiotic resistance rates, prolonged hospital stays, and an increased mortality rate. These findings suggest the need for continued surveillance, planning appropriate interventions, and caution during empirical therapy.
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Affiliation(s)
| | | | | | | | - Samuel Rutare
- University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Innocent Hahirwa
- University Teaching Hospital of Kigali, Kigali, Rwanda
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | | | - Jean Bosco Munyemana
- University Teaching Hospital of Kigali, Kigali, Rwanda
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Kara A, Massaro C, Giammanco GM, Alduina R, Boussoualim N. Phylogenetic Diversity, Antibiotic Resistance, and Virulence of Escherichia coli Strains from Urinary Tract Infections in Algeria. Antibiotics (Basel) 2024; 13:773. [PMID: 39200073 PMCID: PMC11350822 DOI: 10.3390/antibiotics13080773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/23/2024] [Accepted: 08/08/2024] [Indexed: 09/01/2024] Open
Abstract
Urinary tract infections (UTIs) caused by Escherichia coli represent a significant public health concern due to the high virulence and antimicrobial resistance exhibited by these pathogens. This study aimed to analyze the phylogenetic diversity and antibiotic resistance profiles of Uropathogenic E. coli (UPEC) strains isolated from UTI patients in Algeria, focusing on virulence factors such as extended β-lactamase (ESBL) production, biofilm formation, and hemolytic activity. Phylogenetic grouping of 86 clinical imipenem resistant E. coli isolates showed the prevalence of group B2 (48.9%), followed by groups E (22.1%), unknown (12.8%), A (8.1%), and B1 (4.7%), and Clade I, D, Clade I, or Clade II (1.2%). The highest resistance rates were observed towards amoxicillin (86.04%), ticarcillin (82.55%), piperacillin (73.25%), nitrofurantoin (84.88%), and trimethoprim-sulfamethoxazole (51.16%). Notably, 69.8% of UPEC strains were multidrug-resistant (MDR) and 23.2% were extensively drug-resistant (XDR). Additionally, 48.9%, 42%, and 71% of strains demonstrated ESBL production, hemolytic activity, and weak biofilm production, respectively. Continuous monitoring and characterization of UPEC strains are essential to track the spread of the most resistant and virulent phylogenetic groups over time, facilitating rapid therapeutic decisions to treat infections and prevent the emergence of new resistant organisms, helping choose the most effective antibiotics and reducing treatment failure.
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Affiliation(s)
- Anfal Kara
- Laboratory of Applied Biochemistry, Faculty of Nature and Life Sciences, University Ferhat Abbas of Setif 1, Setif 19000, Algeria; (A.K.); (N.B.)
| | - Chiara Massaro
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Viale delle Scienze, Bldg. 16, 90128 Palermo, Italy;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy;
| | - Giovanni M. Giammanco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy;
| | - Rosa Alduina
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Viale delle Scienze, Bldg. 16, 90128 Palermo, Italy;
- NBFC, National Biodiversity Future Center, Piazza Marina 61, 90133 Palermo, Italy
| | - Naouel Boussoualim
- Laboratory of Applied Biochemistry, Faculty of Nature and Life Sciences, University Ferhat Abbas of Setif 1, Setif 19000, Algeria; (A.K.); (N.B.)
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Ashton PM, Chunga Chirambo A, Meiring JE, Patel PD, Mbewe M, Silungwe N, Chizani K, Banda H, Heyderman RS, Dyson ZA, MacPherson P, Henrion MYR, Holt KE, Gordon MA. Evaluating the relationship between ciprofloxacin prescription and non-susceptibility in Salmonella Typhi in Blantyre, Malawi: an observational study. THE LANCET. MICROBE 2024; 5:e226-e234. [PMID: 38387472 PMCID: PMC10914669 DOI: 10.1016/s2666-5247(23)00327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Ciprofloxacin is the first-line drug for treating typhoid fever in many countries in Africa with a high disease burden, but the emergence of non-susceptibility poses a challenge to public health programmes. Through enhanced surveillance as part of vaccine evaluation, we investigated the occurrence and potential determinants of ciprofloxacin non-susceptibility in Blantyre, Malawi. METHODS We conducted systematic surveillance of typhoid fever cases and antibiotic prescription in two health centres in Blantyre, Malawi, between Oct 1, 2016, and Oct 31, 2019, as part of the STRATAA and TyVAC studies. In addition, blood cultures were taken from eligible patients presenting at Queen Elizabeth Central Hospital, Blantyre, as part of routine diagnosis. Inclusion criteria were measured or reported fever, or clinical suspicion of sepsis. Microbiologically, we identified Salmonella enterica serotype Typhi (S Typhi) isolates with a ciprofloxacin non-susceptible phenotype from blood cultures, and used whole-genome sequencing to identify drug-resistance mutations and phylogenetic relationships. We constructed generalised linear regression models to investigate associations between the number of ciprofloxacin prescriptions given per month to study participants and the proportion of S Typhi isolates with quinolone resistance-determining region (QRDR) mutations in the following month. FINDINGS From 46 989 blood cultures from Queen Elizabeth Central Hospital, 502 S Typhi isolates were obtained, 30 (6%) of which had either decreased ciprofloxacin susceptibility, or ciprofloxacin resistance. From 11 295 blood cultures from STRATAA and TyVAC studies, 241 microbiologically confirmed cases of typhoid fever were identified, and 198 isolates from 195 participants sequenced (mean age 12·8 years [SD 10·2], 53% female, 47% male). Between Oct 1, 2016, and Aug 31, 2019, of 177 typhoid fever cases confirmed by whole-genome sequencing, four (2%) were caused by S Typhi with QRDR mutations, compared with six (33%) of 18 cases between Sept 1 and Oct 31, 2019. This increase was associated with a preceding spike in ciprofloxacin prescriptions. Every additional prescription of ciprofloxacin given to study participants in the preceding month was associated with a 4·2% increase (95% CI 1·8-7·0) in the relative risk of isolating S Typhi with a QRDR mutation (p=0·0008). Phylogenetic analysis showed that S Typhi isolates with QRDR mutations from September and October, 2019, belonged to two distinct subclades encoding two different QRDR mutations, and were closely related (4-10 single-nucleotide polymorphisms) to susceptible S Typhi endemic to Blantyre. INTERPRETATION We postulate a causal relationship between increased ciprofloxacin prescriptions and an increase in fluoroquinolone non-susceptibility in S Typhi. Decreasing ciprofloxacin use by improving typhoid diagnostics, and reducing typhoid fever cases through the use of an efficacious vaccine, could help to limit the emergence of resistance. FUNDING Wellcome Trust, Bill & Melinda Gates Foundation, and National Institute for Health and Care Research (UK).
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Affiliation(s)
- Philip M Ashton
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi; Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK.
| | - Angeziwa Chunga Chirambo
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi; Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK; Department of Medical Laboratory Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - James E Meiring
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Maurice Mbewe
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Niza Silungwe
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | | | - Happy Banda
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Robert S Heyderman
- Research Department of Infection, Division of Infection and Immunity, University College London, London, UK
| | - Zoe A Dyson
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, VIC, Australia; Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Peter MacPherson
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Marc Y R Henrion
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kathryn E Holt
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Melita A Gordon
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi; Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
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Bizimungu O, Crook P, Babane JF, Bitunguhari L. The prevalence and clinical context of antimicrobial resistance amongst medical inpatients at a referral hospital in Rwanda: a cohort study. Antimicrob Resist Infect Control 2024; 13:22. [PMID: 38389102 PMCID: PMC10885367 DOI: 10.1186/s13756-024-01384-7] [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: 10/28/2023] [Accepted: 02/18/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a growing global concern. AMR surveillance is a crucial component of the international response; however, passive surveillance of laboratory data is limited without corresponding patient-level clinical data. This study sought to examine the burden of AMR amongst medical inpatients in Rwanda, in the context of their clinical presentations and prior antibiotic exposures. METHODS This cohort study was conducted over a 9-month period at a tertiary referral hospital in Kigali, Rwanda. We enrolled 122 adult medical inpatients with a history of fever and a positive microbiological culture result. Data were collected regarding the clinical and microbiological aspects of their admission. RESULTS The most common diagnoses were urinary tract infection (n = 36, 30%), followed by pneumonia (n = 30, 25%) and bacteraemia (11 primary [9%] and 10 catheter-related [8%]). The most common pathogens were E. coli (n = 40, 33%) and Klebsiella pneumoniae (n = 36, 30%). The cohort were heavily antibiotic-exposed at the time of culture with 98% of patients (n = 119) having received an antibiotic prior to culture, with a median exposure of 3 days (IQR 2-4 days). Eighty patients (66%) were specifically prescribed ceftriaxone at the time of culture. Gram-negative organisms predominated (82% [100/122]) and exhibited high rates of resistance, with only 27% (21/77) being susceptible to ceftriaxone, 2.4% (2/82) susceptible to co-amoxiclav and 44% (8/18) susceptible to ciprofloxacin. Susceptibility amongst Gram-negatives was relatively preserved to amikacin (91%, 79/87) and imipenem (85%, 70/82). There were no cases of methicillin-resistant Staphylococcus aureus (0/12) or vancomycin-resistant enterococci (0/2). Discordant antibiotic therapy was significantly associated with in-hospital mortality (OR 6.87, 95%CI 1.80-45.1, p = 0.014). CONCLUSIONS This cohort highlights high rates of resistance amongst Gram-negative organisms in Rwanda, including the presence of carbapenem resistance. Nonetheless, the detailed prescribing data also highlight the challenges of using routine laboratory data to infer broader AMR prevalence. The significant exposure to empiric broad-spectrum antibiotic therapy prior to culturing introduces a selection bias and risks over-estimating the burden of resistant organisms. Broadening access to microbiological services and active surveillance outside of teaching hospitals are essential to support national and international efforts to curb the growth of AMR in low-resource settings.
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Affiliation(s)
- Olivier Bizimungu
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
- Department of Internal Medicine, Rwanda Military Hospital, Kanombe, KK 567 St, Kigali, Rwanda.
| | - Peter Crook
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Jean Félix Babane
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Léopold Bitunguhari
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
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Shaker M, Zaki A, Asser SL, Sayed IE. Trends and predictors of antimicrobial resistance among patients with urinary tract infections at a tertiary hospital facility in Alexandria, Egypt: a retrospective record-based classification and regression tree analysis. BMC Infect Dis 2024; 24:246. [PMID: 38389071 PMCID: PMC10885625 DOI: 10.1186/s12879-024-09086-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The incidence of Antimicrobial Resistance (AMR) in uropathogens varies between countries and over time. We aim to study the patterns and potential predictors of AMR among patients with UTIs admitted to the Urology Department at Alexandria University Hospital. METHODS An observational retrospective record-based study was conducted on all patients admitted to the Urology department from October 2018 to October 2020. Data collected from patients' records included: demographic data, diagnosis on admission, history of chronic diseases, duration of hospital stay, insertion of a urinary catheter, duration of the catheter in days, history of the use of antibiotics in the previous three months, and history of urinary tract operations. If UTI was documented, we abstracted data about urine culture, use of antibiotics, results of urine cultures, type of organism isolated, and sensitivity to antibiotics. We conducted a multivariable logistic regression model. We performed Classification and Regression Tree Analysis (CART) for predicting risk factors associated with drug resistance among patients with UTI. Data were analyzed using SPSS statistical package, Version 28.0, and R software (2022). RESULTS This study encompassed 469 patients with UTIs. The most commonly isolated bacterium was Escherichia coli, followed by Klebsiella pneumoniae. Multidrug resistance (MDR) was found in 67.7% (149/220) of patients with hospital-acquired UTIs and in 49.4% (83/168) of patients with community-acquired UTIs. Risk factors independently associated with antimicrobial resistance according to logistic regression analysis were the use of antibiotics within three months (AOR = 5.2, 95% CI 2.19-12.31), hospital-acquired UTI (AOR = 5.7, 95% CI 3.06-10.76), diabetes mellitus (AOR = 3.8, 95% CI 1.24-11.84), age over 60 years (AOR = 2.9, 95% CI 1.27-6.72), and recurrent UTI (AOR = 2.6, 95% CI 1.08-6.20). Classification and regression tree (CART) analysis revealed that antibiotic use in the previous three months was the most significant predictor for developing drug resistance. CONCLUSION The study concluded a high level of antimicrobial resistance as well as significant MDR predictors among hospitalized patients with UTIs. It is vital to assess resistance patterns in our hospitals frequently to improve rational antibiotic treatment as well as to sustain antimicrobial stewardship programs and a rational strategy in the use of antibiotics. Empirical therapy for UTI treatment should be tailored to the potential pathogens' susceptibility to ensure optimal treatment. Strategic antibiotic use is essential to prevent further AMR increases. Further research should focus on suggesting new biological systems or designed drugs to combat the resistance of UTI pathogens.
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Affiliation(s)
- Marian Shaker
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Adel Zaki
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Sara Lofty Asser
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Iman El Sayed
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt.
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Mosonik GC, Kombich JJ. Profiling of antibiotic resistance among uropathogens isolated from patients attending Kericho County Referral Hospital. Pan Afr Med J 2023; 45:19. [PMID: 37426467 PMCID: PMC10323814 DOI: 10.11604/pamj.2023.45.19.19585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/08/2019] [Indexed: 07/11/2023] Open
Abstract
Introduction urinary tract infection (UTI) comes second after respiratory infections in most communities and hospital settings, affecting people of all ages. Frequent use of antibiotics to manage UTI has resulted in development of resistance, calling upon policymakers to fast-track and enforce policies that guide the use of antibiotics in the country. This study intended to determine the current antibiotic resistance to uropathogens among patients attending Kericho County Referral Hospital. Methods three hundred urine samples from eligible participants were cultured and bacteria colonies identified using biochemical tests. Antibiotic sensitivity was done using Kirby Bauer disk diffusion method on Mueller Hinton Agar. Results: the aetiological agents of UTI were Staphylococcus aureus, Enterococci faecalis, E. coli, Proteus spp and Klebsiella pneumonia. Antibiotic resistance was observed among these uropathogens to commonly used antibiotics namely; ampicillin (84.3%), azithromycin (71.9%) and augmentin (69.8%). However, there were some bacteria that were susceptible to all or some commonly used antibiotics. There was moderate resistance to norfloxacin (43%) except in Staphylococcus aureus which showed 64% resistance. The isolates showed less resistance to cefoxitine (13.2%), gentamycin (11.6%) and ciprofloxacin (10%). While most bacteria showed multiple resistance to 3 drugs, some showed resistance to at most 5 drugs tested in the study. Conclusion: this study found Staphylococcus aureus to be the predominant aetiological agent of UTI. Cefoxitine, gentamycin and ciprofloxacin are good therapeutic choices for confirmed recurrent UTI when culture results are unavailable. There is need to have regular screening of aetiological agents of UTI and their resistance to antimicrobials.
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Takawira FT, Pitout JD, Thilliez G, Mashe T, Gutierrez AV, Kingsley RA, Peirano G, Matheu J, Midzi SM, Mwamakamba LW, Gally DL, Tarupiwa A, Mukavhi L, Ehlers MM, Mtapuri-Zinyowera S, Kock MM. Molecular epidemiology of extended-spectrum beta-lactamase-producing extra-intestinal pathogenic Escherichia coli strains over a 2-year period (2017-2019) from Zimbabwe. Eur J Clin Microbiol Infect Dis 2021:10.1007/s10096-021-04379-z. [PMID: 34779943 DOI: 10.1007/s10096-021-04379-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
This study was designed to characterize extended-spectrum beta-lactamase (ESBL)-producing extra-intestinal pathogenic Escherichia coli (E.coli) (ExPEC) associated with urinary tract infections in nine different geographic regions of Zimbabwe over a 2-year period (2017-2019). A total of 48 ESBL-positive isolates from urine specimen were selected for whole-genome sequencing from 1246 Escherichia coli isolates biobanked at the National Microbiology Reference laboratory using phenotypic susceptibility testing results from the National Escherichia coli Surveillance Programme to provide representation of different geographical regions and year of isolation. The majority of ESBL E. coli isolates produced cefotaximase-Munich (CTX-M)-15, CTX-M-27, and CTX-M-14. In this study, sequence types (ST) 131 and ST410 were the most predominant antimicrobial-resistant clones and responsible for the increase in ESBL-producing E. coli strains since 2017. Novel ST131 complex strains were recorded during the period 2017 to 2018, thus showing the establishment and evolution of this antimicrobial-resistant ESBL clone in Zimbabwe posing an important public health threat. Incompatibility group F plasmids were predominant among ST131 and ST410 isolates with the following replicons recorded most frequently: F1:A2:B20 (9/19, 47%), F2:A1: B (5/19, 26%), and F1:A1:B49 (8/13, 62%). The results indicate the need for continuous tracking of different ESBL ExPEC clones on a global scale, while targeting specific STs (e.g. ST131 and ST410) through control programs will substantially decrease the spread of ESBLs among ExPEC.
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Affiliation(s)
- Faustinos Tatenda Takawira
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
- National Microbiology Reference Laboratory, Harare, Zimbabwe
| | - Johann Dd Pitout
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
- Department of Microbiology, Alberta Precision Laboratories, Department Pathology and Laboratory Medicine, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Tapfumanei Mashe
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
- National Microbiology Reference Laboratory, Harare, Zimbabwe
| | | | | | - Gisele Peirano
- Department of Microbiology, Alberta Precision Laboratories, Department Pathology and Laboratory Medicine, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jorge Matheu
- World Health Organization (WHO), Geneva, Switzerland
| | | | | | - David L Gally
- Division of Infection and Immunity, The Roslin Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Andrew Tarupiwa
- National Microbiology Reference Laboratory, Harare, Zimbabwe
| | - Leckson Mukavhi
- University of Zimbabwe College of Health Sciences, Health Professions Education, Harare, Zimbabwe
| | - Marthie M Ehlers
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
- National Health Laboratory Service, Academic Division, Pretoria, South Africa
| | | | - Marleen M Kock
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa.
- National Health Laboratory Service, Academic Division, Pretoria, South Africa.
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Pediatric Febrile Urinary Tract Infection Caused by ESBL Producing Enterobacteriaceae Species. BIOMED RESEARCH INTERNATIONAL 2021; 2020:6679029. [PMID: 34692824 PMCID: PMC8526884 DOI: 10.1155/2020/6679029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Over the past decade, drug resistance pattern has worsened for many of the uropathogens due to overuse of antibiotics for empiric treatment. The burden of extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae associated urinary tract infections (UTI) has become increasingly more common, limiting treatment options among children presenting with febrile UTI. We investigated the burden and correlates of ESBL producing Enterobacteriaceae associated UTI among children and antibacterial resistance pattern. METHODS 284 midstream urine specimens were collected using standard aseptic techniques from 284 children who were diagnosed with suspected UTI. Urine culture and bacteria isolation were performed following standard bacteriological techniques. The Kirby-Bauer disk diffusion technique and the double-disc synergy test were used to investigate antibiotic susceptibility and presence of ESBL production. RESULTS UTI was confirmed using a positive urine culture for a relevant pathogen in 96/284 (33.8%) of the cases. Enterobacteriaceae accounted for 75% (72/96) of etiologies of UTI in children. The most frequent Enterobacteriaceae spp. were E. coli, 44.4% (32/72) and K. pneumonia, 27.8% (20/72). The overall multidrug resistance rate was 86.1% (62/72). ESBL-producers accounted for 41.7% (30/72) of the isolated Enterobacteriaceae. ESBL producing K. pneumonia and E. coli isolates accounted for 70% (14/20) and 37.5% (12/32), respectively. History of UTI in the past 1 year (adjusted odds ratio (AoR) = 0.08, 95%CI (0.01 - 0.57)) and medium family wealth index (AoR = 0.03, 95%CI (0.00 - 0.27)) protected from infection with ESBL-producing Enterobacteriaceae. Conclusion. ESBL production was more common in K. pneumonia and appeared to be a major factor contributing drug resistance UTI in children. The findings call for the need to incorporate ESBL testing in the routine clinical practice. The resistance level to commonly prescribed first-line antibiotics observed within Enterobacteriaceae was alarming calling for strengthened antimicrobial stewardship.
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Eger E, Heiden SE, Korolew K, Bayingana C, Ndoli JM, Sendegeya A, Gahutu JB, Kurz MSE, Mockenhaupt FP, Müller J, Simm S, Schaufler K. Circulation of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli of Pandemic Sequence Types 131, 648, and 410 Among Hospitalized Patients, Caregivers, and the Community in Rwanda. Front Microbiol 2021; 12:662575. [PMID: 34054764 PMCID: PMC8160302 DOI: 10.3389/fmicb.2021.662575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/20/2021] [Indexed: 11/13/2022] Open
Abstract
Multi-drug resistant (MDR), gram-negative Enterobacteriaceae, such as Escherichia coli (E. coli) limit therapeutic options and increase morbidity, mortality, and treatment costs worldwide. They pose a serious burden on healthcare systems, especially in developing countries like Rwanda. Several studies have shown the effects caused by the global spread of extended-spectrum beta-lactamase (ESBL)-producing E. coli. However, limited data is available on transmission dynamics of these pathogens and the mobile elements they carry in the context of clinical and community locations in Sub-Saharan Africa. Here, we examined 120 ESBL-producing E. coli strains from patients hospitalized in the University Teaching Hospital of Butare (Rwanda), their attending caregivers as well as associated community members and livestock. Based on whole-genome analysis, the genetic diversification and phylogenetics were assessed. Moreover, the content of carried plasmids was characterized and investigated for putative transmission among strains, and for their potential role as drivers for the spread of antibiotic resistance. We show that among the 30 different sequence types (ST) detected were the pandemic clonal lineages ST131, ST648 and ST410, which combine high-level antimicrobial resistance with virulence. In addition to the frequently found resistance genes blaCTX–M–15, tet(34), and aph(6)-Id, we identified csg genes, which are required for curli fiber synthesis and thus biofilm formation. Numerous strains harbored multiple virulence-associated genes (VAGs) including pap (P fimbriae adhesion cluster), fim (type I fimbriae) and chu (Chu heme uptake system). Furthermore, we found phylogenetic relationships among strains from patients and their caregivers or related community members and animals, which indicates transmission of pathogens. Also, we demonstrated the presence and potential transfer of identical/similar ESBL-plasmids in different strains from the Rwandan setting and when compared to an external plasmid. This study highlights the circulation of clinically relevant, pathogenic ESBL-producing E. coli among patients, caregivers and the community in Rwanda. Combining antimicrobial resistance with virulence in addition to the putative exchange of mobile genetic elements among bacterial pathogens poses a significant risk around the world.
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Affiliation(s)
- Elias Eger
- Pharmaceutical Microbiology, Institute of Pharmacy, University of Greifswald, Greifswald, Germany
| | - Stefan E Heiden
- Pharmaceutical Microbiology, Institute of Pharmacy, University of Greifswald, Greifswald, Germany
| | - Katja Korolew
- Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | - Claude Bayingana
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jules M Ndoli
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,University Teaching Hospital of Butare, Butare, Rwanda
| | - Augustin Sendegeya
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,University Teaching Hospital of Butare, Butare, Rwanda
| | - Jean Bosco Gahutu
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,University Teaching Hospital of Butare, Butare, Rwanda
| | - Mathis S E Kurz
- Institute of Tropical Medicine and International Health, Charité Medical University of Berlin, Berlin, Germany
| | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité Medical University of Berlin, Berlin, Germany
| | - Julia Müller
- Pharmaceutical Microbiology, Institute of Pharmacy, University of Greifswald, Greifswald, Germany
| | - Stefan Simm
- Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | - Katharina Schaufler
- Pharmaceutical Microbiology, Institute of Pharmacy, University of Greifswald, Greifswald, Germany
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10
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Dikoumba AC, Onanga R, Boundenga L, Bignoumba M, Ngoungou EB, Godreuil S. Prevalence and Characterization of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae in Major Hospitals in Gabon. Microb Drug Resist 2021; 27:1525-1534. [PMID: 33956516 DOI: 10.1089/mdr.2020.0497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
In Gabon, few data exist on extended-spectrum beta-lactamases-producing Enterobacteriaceae (ESBL-PE). This study investigated ESBL-PE prevalence and the associated resistance genes in clinical samples (n = 5,956) and anal swabs (n = 78) analyzed in eight hospitals and a medical analysis laboratory in Gabon from January 2016 to March 2018. Matrix-Assisted Laser Desorption Ionization-Time Of Flight (MALDI-TOF) mass spectrometry analysis identified 790 Enterobacteriaceae isolates (n = 712 clinical samples and n = 78 fecal samples). ESBL-PE prevalence (Müller-Hinton agar disk diffusion method and double-disk synergy test) was 11.8% (84/712) in clinical samples (15.5% from inpatients and 7.1% from outpatients; p < 0.05) and 16.7% (13/78) in carriage isolates. Most ESBL-PE were isolated from urine samples (46/84). In clinical and carriage ESBL-PE isolates, Escherichia coli was predominant (42.8% and 61.5%; phylogroups A, B1, B2, and D), followed by Klebsiella pneumoniae (41.7% and 23.1%). Multiplex PCR and bi-directional sequencing showed that CTX-M group 1 (blaCTX-M-15) was predominant in clinical and carriage ESBL-PE (94% and 92.3%) among which 85.7% and 92.3% also harbored one to three β-lactamase-encoding genes (blaTEM-1, blaOXA-1, or blaSHV-1). Resistance genes were detected in all hospitals in Gabon. ESBL-PE prevalence in Gabon has not reached alarming levels yet, but corrective and monitoring measures are needed to curb their emergence.
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Affiliation(s)
- Annicet-Clotaire Dikoumba
- Département de Biologie Médicale, Hôpital d'Instruction des Armées Omar Bongo Ondimba, Libreville, Gabon.,Laboratoire de Bactériologie de Recherche, Unité de Recherche et d'Analyses Médicales (URAM), Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon.,Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Richard Onanga
- Laboratoire de Bactériologie de Recherche, Unité de Recherche et d'Analyses Médicales (URAM), Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Larson Boundenga
- Groupe Evolution et Transmission Inter-espèces des Pathogènes, Département de Parasitologie du Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon.,Unité Maladie Émergentes Virales, Département de Virologie du Centre International de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Michelle Bignoumba
- Laboratoire de Bactériologie de Recherche, Unité de Recherche et d'Analyses Médicales (URAM), Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | - Edgard-Brice Ngoungou
- Département d'Epidémiologie, Biostatistiques et Informatique Médicale (DEBIM)/Unité de Recherche en Epidémiologie des Maladies Chroniques et Santé Environnement (UREMCSE), Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | - Sylvain Godreuil
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France.,MIVEGEC, IRD, CNRS, Université de Montpellier, Montpellier, France
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11
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Habyarimana T, Murenzi D, Musoni E, Yadufashije C, N Niyonzima F. Bacteriological Profile and Antimicrobial Susceptibility Patterns of Bloodstream Infection at Kigali University Teaching Hospital. Infect Drug Resist 2021; 14:699-707. [PMID: 33654414 PMCID: PMC7914060 DOI: 10.2147/idr.s299520] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/12/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Worldwide, bacterial bloodstream infections (BSIs) constitute an important cause of morbidity and mortality in clinical settings. Due to the limited laboratory facilities in sub-Saharan Africa, poor diagnosis of BSIs results in poor clinical outcomes and leads to a risk of antimicrobial resistance. The present work was carried out to describe the microbiological features of BSIs using the data collected from Centre Hospitalier Universitaire de Kigali (CHUK). METHODS A retrospective study was carried out at CHUK. The blood culture results of 2,910 cases - from adults, children and infants - were reviewed in the Microbiology service from October 2017 to October 2018. The following variables were considered: age, gender, admitting department, blood culture results, and antimicrobials sensitivity test results. Data were entered and analyzed using Microsoft Excel 2013. RESULTS Twelve percent (341/2,910) of blood culture results reviewed were positive with 108 (31.7%) Gram positive bacteria and 233 (68.3%) Gram negative bacteria. The most prevalent pathogens were Klebsiella pneumoniae 108 (31.7%) and Staphylococcus aureus 100 (29.3%). This study revealed a high resistance to commonly prescribed antibiotics such as penicillin, trimethoprim sulfamethoxazole, and Ampicillin with 91.8, 83.3, and 81.8% of resistance, respectively. However, bacteria were sensitive to imipenem and vancomycin with 98.1 and 94.3% of sensitivity, respectively. The pediatrics and neonatology departments showed a high number of positive culture with 97/341 (28.4%), and 93/341 (27%) respectively. The overall prevalence of multidrug resistance was 77.1%. CONCLUSION The prevalence of bacterial pathogens in BSIs was found to be high. The antibiotic resistance to the commonly used antibiotics was high. Appropriate treatment of BSIs should be based on the current knowledge of bacterial resistance pattern. This study will help in formulating management of diagnostic guidelines and antibiotic policy.
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Affiliation(s)
| | - Didier Murenzi
- Pathology Department, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - Emile Musoni
- Pathology Department, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
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12
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Mouanga Ndzime Y, Onanga R, Kassa Kassa RF, Bignoumba M, Mbehang Nguema PP, Gafou A, Lendamba RW, Mbombe Moghoa K, Bisseye C. Epidemiology of Community Origin Escherichia coli and Klebsiella pneumoniae Uropathogenic Strains Resistant to Antibiotics in Franceville, Gabon. Infect Drug Resist 2021; 14:585-594. [PMID: 33623399 PMCID: PMC7896796 DOI: 10.2147/idr.s296054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/06/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction Urinary tract infection is one of the major causes of consultation, microbiologic exploration, intensive use of antibiotics worldwide, and the second leading cause of clinical consultation in community practice. Many bacteria play a role in the urinary tract infections etiology, including Enterobacteriaceae such as Escherichia coli (E. coli) and Klebsiella spp. Objective The study’s main objective was to examine the epidemiology of E. coli and Klebsiella pneumoniae (K. pneumoniae) uropathogenic strains resistant to antibiotics in Franceville. Methodology The study was carried out between January 2018 and June 2019 in Franceville South-East Gabon. We examined a total of 1086 cytobacteriological urine samples. The identification of E. coli and K. pneumoniae strains was carried out using the Vitek-2 compact automated system and the antibiogram with the disk diffusion method according to the European Committee on Antimicrobial Susceptibility Testing recommendations. Results The prevalence of urinary tract infections was 29.2% (317/1086), of which 25.1% and 4.1% were mono-infections and co-infections, respectively. The prevalence of UTIs with E. coli was 28.7% (91/317) with a predominance of isolation in women. K. pneumoniae was responsible for 16.2% (61/317) of UTIs. E. coli and K. pneumoniae Uropathogenic strains showed resistance to beta-lactams, quinolones and cotrimoxazole, whereas Nitrofurantoin, Amikacin, Imipenem and Ertapenem were the most active antibiotics against E. coli and K. pneumoniae uropathogenic strains. Conclusion This study showed a high prevalence of urinary tract infections with a major implication of E.coli and K. pneumoniae strains. E. coli and K. pneumoniae presented high frequency of resistance to antibiotics, highlighting the need to adapt their use accordingly at the local level.
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Affiliation(s)
- Yann Mouanga Ndzime
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon.,Laboratoire de Biologie Moléculaire et Cellulaire (LABMC), Université des Sciences et Techniques de Masuku, Franceville, BP 943, Gabon
| | - Richard Onanga
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon
| | - Roland Fabrice Kassa Kassa
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon
| | - Michelle Bignoumba
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon
| | - Pierre Philippe Mbehang Nguema
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon.,Institut de Recherche en Ecologie Tropicale, Centre National de la Recherche Scientifique et Technologique (CENAREST), Libreville, BP 13354, Gabon
| | - Amahani Gafou
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon
| | - Roméo Wenceslas Lendamba
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon
| | - Kelly Mbombe Moghoa
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon
| | - Cyrille Bisseye
- Laboratoire de Biologie Moléculaire et Cellulaire (LABMC), Université des Sciences et Techniques de Masuku, Franceville, BP 943, Gabon
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13
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Katale BZ, Misinzo G, Mshana SE, Chiyangi H, Campino S, Clark TG, Good L, Rweyemamu MM, Matee MI. Genetic diversity and risk factors for the transmission of antimicrobial resistance across human, animals and environmental compartments in East Africa: a review. Antimicrob Resist Infect Control 2020; 9:127. [PMID: 32762743 PMCID: PMC7409632 DOI: 10.1186/s13756-020-00786-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/21/2020] [Indexed: 12/30/2022] Open
Abstract
Background The emergence and spread of antimicrobial resistance (AMR) present a challenge to disease control in East Africa. Resistance to beta-lactams, which are by far the most used antibiotics worldwide and include the penicillins, cephalosporins, monobactams and carbapenems, is reducing options for effective control of both Gram-positive and Gram-negative bacteria. The World Health Organization, Food and Agricultural Organization and the World Organization for Animal Health have all advocated surveillance of AMR using an integrated One Health approach. Regional consortia also have strengthened collaboration to address the AMR problem through surveillance, training and research in a holistic and multisectoral approach. This review paper contains collective information on risk factors for transmission, clinical relevance and diversity of resistance genes relating to extended-spectrum beta-lactamase-producing (ESBL) and carbapenemase-producing Enterobacteriaceae, and Methicillin-resistant Staphylococcus aureus (MRSA) across the human, animal and environmental compartments in East Africa. Main body The review of the AMR literature (years 2001 to 2019) was performed using search engines such as PubMed, Scopus, Science Direct, Google and Web of Science. The search terms included ‘antimicrobial resistance and human-animal-environment’, ‘antimicrobial resistance, risk factors, genetic diversity, and human-animal-environment’ combined with respective countries of East Africa. In general, the risk factors identified were associated with the transmission of AMR. The marked genetic diversity due to multiple sequence types among drug-resistant bacteria and their replicon plasmid types sourced from the animal, human and environment were reported. The main ESBL, MRSA and carbapenem related genes/plasmids were the blaCTX-Ms (45.7%), SCCmec type III (27.3%) and IMP types (23.8%), respectively. Conclusion The high diversity of the AMR genes suggests there may be multiple sources of resistance bacteria, or the possible exchange of strains or a flow of genes amongst different strains due to transfer by mobile genetic elements. Therefore, there should be harmonized One Health guidelines for the use of antibiotics, as well as regulations governing their importation and sale. Moreover, the trend of ESBLs, MRSA and carbapenem resistant (CAR) carriage rates is dynamic and are on rise over time period, posing a public health concern in East Africa. Collaborative surveillance of AMR in partnership with regional and external institutions using an integrated One Health approach is required for expert knowledge and technology transfer to facilitate information sharing for informed decision-making.
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Affiliation(s)
- Bugwesa Z Katale
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. .,Tanzania Commission for Science and Technology, Dar es Salaam, Tanzania. .,SACIDS Foundation for One Health (SACIDS), Sokoine University of Agriculture, Morogoro, Tanzania.
| | - Gerald Misinzo
- SACIDS Foundation for One Health (SACIDS), Sokoine University of Agriculture, Morogoro, Tanzania.,Department of Veterinary Microbiology, Parasitology and Biotechnology, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Stephen E Mshana
- SACIDS Foundation for One Health (SACIDS), Sokoine University of Agriculture, Morogoro, Tanzania.,Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Harriet Chiyangi
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,SACIDS Foundation for One Health (SACIDS), Sokoine University of Agriculture, Morogoro, Tanzania
| | - Susana Campino
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Taane G Clark
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Liam Good
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London, UK
| | - Mark M Rweyemamu
- SACIDS Foundation for One Health (SACIDS), Sokoine University of Agriculture, Morogoro, Tanzania.,Department of Veterinary Microbiology, Parasitology and Biotechnology, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Mecky I Matee
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,SACIDS Foundation for One Health (SACIDS), Sokoine University of Agriculture, Morogoro, Tanzania
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14
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van Gaalen RD, Altorf-van der Kuil W, Wegdam-Blans MCA, Aguilar Diaz JM, Beauchamp ME, Chaname Pinedo LE, de Greeff SC, Wallinga J. Determination of the time-dependent association between ciprofloxacin consumption and ciprofloxacin resistance using a weighted cumulative exposure model compared with standard models. J Antimicrob Chemother 2020; 75:2326-2333. [PMID: 32407492 DOI: 10.1093/jac/dkaa141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/18/2020] [Accepted: 03/21/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To obtain comprehensive insight into the association of ciprofloxacin use at different times in the past with the current risk of detecting resistance. METHODS This retrospective nested case-control study of ciprofloxacin users used Dutch data from the PHARMO Database Network and one laboratory for the period 2003-14. Cases and controls were selected as patients with an antibiotic susceptibility test (AST) indicating ciprofloxacin resistance or susceptibility, respectively. We performed univariable and multivariable conditional logistic regression analyses, defining time-dependent exposure using standard definitions (current ciprofloxacin use, used 0-30, 31-90, 91-180 and 181-360 days ago) and a flexible weighted cumulative effect (WCE) model with four alternative time windows of past doses (0-30, 0-90, 0-180 and 0-360 days). RESULTS The study population consisted of 230 cases and 909 controls. Under the standard exposure definitions, the association of ciprofloxacin use with resistance decreased with time [current use: adjusted OR 6.8 (95% CI 3.6-12.4); used 181-360 days ago: 1.3 (0.8-1.9)]. Under the 90 day WCE model (best-fitting model), more recent doses were more strongly associated with resistance than past doses, as was longer or repeated treatment. The 180 day WCE model, which fitted the data equally well, suggested that doses taken 91-180 days ago were also significantly associated with resistance. CONCLUSIONS The estimates for the association between ciprofloxacin use at different times and resistance show that ciprofloxacin prescribers should consider ciprofloxacin use 0-180 days ago to ensure that patients receive suitable treatment. The OR of ciprofloxacin resistance could be reduced by eliminating repeated ciprofloxacin prescription within 180 days and by treating for no longer than necessary.
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Affiliation(s)
- Rolina D van Gaalen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Wieke Altorf-van der Kuil
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | - Jessica M Aguilar Diaz
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Marie-Eve Beauchamp
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Linda E Chaname Pinedo
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Sabine C de Greeff
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jacco Wallinga
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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15
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Singh I, Murtaza SM, Kaur IS, Agrawal V. Curative Efficacy of Fosfomycin Tromethamine Versus Ciprofloxacin in the Initial Therapy of Uncomplicated UTI—a Prospective Open-Label Randomised Controlled Clinical Study. Indian J Surg 2020. [DOI: 10.1007/s12262-019-01947-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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16
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Elshamy AA, Aboshanab KM, Yassien MA, Hassouna NA. Prevalence of plasmid-mediated resistance genes among multidrug-resistant uropathogens in Egypt. Afr Health Sci 2020; 20:190-198. [PMID: 33402907 PMCID: PMC7750051 DOI: 10.4314/ahs.v20i1.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The emergence of multidrug-resistant (MDR) uropathogens has become a public health threat and current knowledge of the genotypic basis of bacterial resistance is essential for selecting appropriate treatment options. Objectives To determine the prevalence of antimicrobial resistance among MDR uropathogens and to elucidate the molecular bases of plasmid-mediated resistance. Methods Bacterial isolates were recovered from urine specimens of 150 out-patients with signs and symptoms of urinary tract infections (UTIs) at El-Demerdash Hospital, Cairo, Egypt. Standard methods were used for identification, antimicrobial susceptibility testing was performed according to CLSI guidelines. Results Among the recovered isolates, 22.7% and 77.3% were Gram-positive, and negative, respectively. Of which; 43.3% were MDR with 60% harboring plasmids. Extended spectrum β-lactamase (ESBL) genes blaCTX-M, blaSHV, and blaTEM were detected on plasmids of 89.7%, 41%, and 84.6% of the tested isolates, respectively. The aminoglycoside resistance gene aac6′-Ib/aac-6′-Ib-cr was found on plasmids of 92.3% of the tested isolates followed by qnrS (92.3%), qnrB (46.2%), and qnrA (7.7%). The most prevalent quinolone efflux pump gene was oqxB (38.5%), followed by oqxA (20.5%), then qepA (10.3%). Conclusion High levels of resistance to nitrofurans, β-lactam/β-lactamase inhibitor, cephalosporins, aminoglycosides, and fluoroquinolones were detected, and their use as empirical treatment for UTIs has become questionable.
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Affiliation(s)
- Ann A Elshamy
- Department of Microbiology & Immunology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Khaled M Aboshanab
- Department of Microbiology & Immunology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Mahmoud A Yassien
- Department of Microbiology & Immunology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Nadia A Hassouna
- Department of Microbiology & Immunology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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17
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Phylogenetic grouping and biofilm formation of multidrug resistant Escherichia coli isolates from humans, animals and food products in South-West Nigeria. SCIENTIFIC AFRICAN 2019. [DOI: 10.1016/j.sciaf.2019.e00158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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18
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Mansouri F, Sheibani H, Javedani Masroor M, Afsharian M. Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and urinary tract infections in pregnant/postpartum women: A systematic review and meta-analysis. Int J Clin Pract 2019; 73:e13422. [PMID: 31532050 DOI: 10.1111/ijcp.13422] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/17/2019] [Accepted: 09/13/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Urinary tract infections (UTI) and asymptomatic bacteriuria (AB) during pregnancy can result in considerable maternal and foetal adverse outcomes. Production of extended-spectrum beta-lactamase (ESBL) is a major antibiotic resistance mechanism by Enterobacteriaceae. OBJECTIVES To determine the global prevalence of ESBL-producing (ESBL-P) Enterobacteriaceae in symptomatic UTI/AB among pregnant/postpartum females. DATA SOURCES A systematic review of the PubMed, Embase, Scopus, WOS (Web of Science), ProQuest and the grey literature was conducted. STUDY SELECTION AND DATA EXTRACTION Studies that reported the frequency of ESBL-P Enterobacteriaceae in pregnant/postpartum women with UTI and/or AB were eligible. First, the titles and abstracts of the retrieved articles were reviewed. Then, the full texts of the remained articles were reviewed. SYNTHESIS In order to estimate the pooled prevalence and the 95% confidence interval (95% CI), meta-analysis was performed using the random-effects model. RESULTS Twenty-three studies (six from Africa, two from North America, one from South America, 12 from Asia and two European studies) that reported data on 20 033 Enterobacteriaceae strains were included. The pooled prevalence of ESBL-P Enterobacteriaceae was 25% (95% CI 18%, 32%); I2 = 98.8%. The estimated prevalence (95% CI) rates were 45% (22, 67%) in Africa, 33% (22, 44%) in India, 15% (6, 24%) in other Asian countries, 5% (2, 8%) in Europe, 4% (1, 11%) in South America and 3% (1, 5%) in North America (P < .001). This estimate was 21% (95% CI 11, 31%) in patients with symptomatic UTI and it was 28% (95% CI 15, 41%) in patients with AB (P = .40). CONCLUSIONS The prevalence of ESBL-P Enterobacteriaceae among pregnant women with UTI/AB was significant and geographic region was a major source for heterogeneity. The findings could be taken into account by healthcare providers and programmers in the management and antibiotic selection of UTI/AB during pregnancy, especially in high prevalence areas.
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Affiliation(s)
- Feizollah Mansouri
- Infectious Diseases Department, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hossein Sheibani
- Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mojgan Javedani Masroor
- Research and Clinical Center of Gynecology and Fertility, Shahid Akbar-Abadi Hospital, Iran University of Medical Science, Tehran, Iran
| | - Mandana Afsharian
- Infectious Diseases Department, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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19
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Ouchar Mahamat O, Lounnas M, Hide M, Dumont Y, Tidjani A, Kamougam K, Abderrahmane M, Benavides J, Solassol J, Bañuls AL, Jean-Pierre H, Carrière C, Godreuil S. High prevalence and characterization of extended-spectrum ß-lactamase producing Enterobacteriaceae in Chadian hospitals. BMC Infect Dis 2019; 19:205. [PMID: 30819135 PMCID: PMC6396450 DOI: 10.1186/s12879-019-3838-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 02/20/2019] [Indexed: 11/15/2022] Open
Abstract
Background Extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-PE) represent a major problem in the management of nosocomial infections. However, ESBL-PE are not systematically monitored in African countries. The aim of this study was to determine ESBL-PE prevalence in patients from three hospitals in N’Djamena, the capital city of Chad, and to characterize the genetic origin of the observed resistance. Methods From January to March 2017, 313 non-duplicate isolates were recovered from various clinical specimens obtained from 1713 patients in the three main hospitals of N’Djamena. Bacterial species were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Susceptibility to 28 antibiotics was tested using the disk diffusion method on Müller-Hinton agar, and ESBL production was confirmed with the double-disc synergy test. The most prevalent ESBL genes associated with the observed resistance were detected using multiplex PCR followed by double-stranded DNA sequencing. Results Among the 313 isolates, 197 belonged to the Enterobacteriaceae family. The overall ESBL-PE prevalence was 47.72% (n = 94/197), with a higher rate among inpatients compared with outpatients (54.13% vs. 34.37%). ESBL-PE prevalence was highest in older patients (≥60 years of age). E. coli was the most common ESBL-producer organism (63.8%), followed by K. pneumoniae (21.2%). ESBL-PE were mainly found in urine samples (75%). The CTX-M-1 group was dominant (96.7% of the 94 ESBL-PE isolates, CTX-M-15 enzyme), followed by the CTX-M-9 group (4.1%). 86% of resistant isolates harbored more than one ESBL-encoding gene. ESBL production was also associated with the highest levels of resistance to non-β-lactam drugs. Conclusions The prevalence of ESBL-PE harboring resistant genes encoding ESBLs of the CTX-M-1 group was high (48%) among clinical isolates of three main hospitals in Chad, suggesting an alarming spread of ESBL-PE among patients. Electronic supplementary material The online version of this article (10.1186/s12879-019-3838-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Oumar Ouchar Mahamat
- Centre Hospitalier Universitaire de Montpellier, Laboratoire de Bactériologie, Université de Montpellier, Montpellier, France. .,UMR MIVEGEC IRD-CNRS-Université de Montpellier, Laboratory of Bacteriology CHU, Arnaud de Villeneuve 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex 5, France. .,Service de laboratoire, Hôpital de la Mère et de l'Enfant, N'Djaména, Chad.
| | - Manon Lounnas
- Centre Hospitalier Universitaire de Montpellier, Laboratoire de Bactériologie, Université de Montpellier, Montpellier, France.,UMR MIVEGEC IRD-CNRS-Université de Montpellier, Laboratory of Bacteriology CHU, Arnaud de Villeneuve 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Mallorie Hide
- UMR MIVEGEC IRD-CNRS-Université de Montpellier, Laboratory of Bacteriology CHU, Arnaud de Villeneuve 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Yann Dumont
- Centre Hospitalier Universitaire de Montpellier, Laboratoire de Bactériologie, Université de Montpellier, Montpellier, France
| | | | - Kadidja Kamougam
- Service de laboratoire, Hôpital Général des Références Nationale, N'Djaména, Chad
| | | | - Julio Benavides
- Departamento de Ecología y Biodiversidad, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - Jérôme Solassol
- Centre Hospitalier Universitaire de Montpellier, Département Bio-pathologie cellulaire et tissulaire des tumeurs, Université de Montpellier, Montpellier, France
| | - Anne-Laure Bañuls
- UMR MIVEGEC IRD-CNRS-Université de Montpellier, Laboratory of Bacteriology CHU, Arnaud de Villeneuve 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex 5, France.,Laboraoire Mixte International DRISA, IRD, Montpellier, France
| | - Hélène Jean-Pierre
- Centre Hospitalier Universitaire de Montpellier, Laboratoire de Bactériologie, Université de Montpellier, Montpellier, France
| | - Christian Carrière
- Centre Hospitalier Universitaire de Montpellier, Laboratoire de Bactériologie, Université de Montpellier, Montpellier, France
| | - Sylvain Godreuil
- Centre Hospitalier Universitaire de Montpellier, Laboratoire de Bactériologie, Université de Montpellier, Montpellier, France.,UMR MIVEGEC IRD-CNRS-Université de Montpellier, Laboratory of Bacteriology CHU, Arnaud de Villeneuve 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex 5, France.,Laboraoire Mixte International DRISA, IRD, Montpellier, France
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20
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Mitgang EA, Hartley DM, Malchione MD, Koch M, Goodman JL. Review and mapping of carbapenem-resistant Enterobacteriaceae in Africa: Using diverse data to inform surveillance gaps. Int J Antimicrob Agents 2018; 52:372-384. [DOI: 10.1016/j.ijantimicag.2018.05.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 01/05/2023]
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21
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Abrar S, Hussain S, Khan RA, Ul Ain N, Haider H, Riaz S. Prevalence of extended-spectrum-β-lactamase-producing Enterobacteriaceae: first systematic meta-analysis report from Pakistan. Antimicrob Resist Infect Control 2018; 7:26. [PMID: 29484173 PMCID: PMC5819302 DOI: 10.1186/s13756-018-0309-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/26/2018] [Indexed: 12/18/2022] Open
Abstract
Background South-Asia is known as a hub for multidrug-resistant (MDR) bacteria. Unfortunately, proper surveillance and documentation of MDR pathogens is lacking in Pakistan. The alarming increase in the prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is a serious problem. From this perspective, we analysed published data regarding ESBL-producing Enterobacteriaceae in different regions of Pakistan. Methods A meta-analysis was performed to determine the prevalence of ESBL-producing Enterobacteriaceae in Pakistan. A Web-based search was conducted in electronic databases, including PubMed, Scopus and PakMedi Net (for non-indexed Pakistani journals). Articles published (in either indexed or non-indexed journals) between January 2002 and July 2016 were included in the study. Relevant data were extracted, and statistical analysis was performed using the Metaprop command of STATA version 14.1. Results A total of 68 studies were identified from the electronic data base search, and 55 of these studies met our inclusion criteria. Pakistan’s overall pooled proportion of ESBL-producers was 0.40 (95% CI: 0.34–0.47). The overall heterogeneity was significant (I2 = 99.75%, p < 0.001), and significant ES = 0 (Z = 18.41, p < 0.001) was found. OXA, SHV, TEM and CTX-M were the most commonly found gene variants for ESBLs in these studies. Conclusion The prevalence of ESBL-producing Enterobacteriaceae is high in Pakistan. Little is known about the annual frequency of ESBLs and their prevalence in different provinces of Pakistan. No data are available regarding ESBL frequency in Baluchistan. This underscores an urgent demand for regular surveillance to address this antimicrobial resistance problem. Surveillance to better understand the annual ESBL burden is crucial to improve national and regional guidelines.
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Affiliation(s)
- Samyyia Abrar
- 1Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
| | - Shahida Hussain
- 1Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
| | - Rehan Ahmad Khan
- 3College of Statistical and Actuarial Sciences, University of the Punjab, Lahore, Pakistan
| | - Noor Ul Ain
- 1Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
| | - Hayat Haider
- 1Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
| | - Saba Riaz
- 1Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan.,Citilab and Research center, Lahore, Pakistan
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22
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Sonda T, Kumburu H, van Zwetselaar M, Alifrangis M, Mmbaga BT, Lund O, Aarestrup FM, Kibiki G. Prevalence and risk factors for CTX-M gram-negative bacteria in hospitalized patients at a tertiary care hospital in Kilimanjaro, Tanzania. Eur J Clin Microbiol Infect Dis 2018; 37:897-906. [PMID: 29464424 PMCID: PMC5917002 DOI: 10.1007/s10096-018-3196-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 01/18/2018] [Indexed: 12/19/2022]
Abstract
Emergence and spread of extended spectrum beta-lactamase (ESBL)-producing gram-negative bacteria, mainly due to CTX-M, is a major global public health problem. Patients infected with ESBL-producing gram-negative bacteria have an increased risk of treatment failure and death. We investigated the prevalence and risk factors for CTX-M gram-negative bacteria isolated from clinical specimens of patients hospitalized at a tertiary care hospital in Kilimanjaro, Tanzania. Isolated gram-negative bacteria from inpatients admitted at Kilimanjaro Christian Medical Centre (KCMC) between August 2013 and August 2015 were fully genome sequenced. The prevalence of ESBL-producing gram-negative bacteria was determined based on the presence of blaCTX-M. The odds ratio (OR) and risk factors for ESBL-producing gram-negative bacteria due to CTX-M were assessed using logistic regression models. The overall CTX-M prevalence (95% CI) was 13.6% (10.1–18.1). Adjusted for other factors, the OR of CTX-M gram-negative bacteria for patients previously hospitalized was 0.26 (0.08–0.88), p = 0.031; the OR for patients currently on antibiotics was 4.02 (1.29–12.58), p = 0.017; the OR for patients currently on ceftriaxone was 0.14 (0.04–0.46), p = 0.001; and the OR for patients with wound infections was 0.24 (0.09–0.61), p = 0.003. The prevalence of ESBL-producing gram-negative bacteria due to CTX-M in this setting is relatively low compared to other previous reports in similar settings. However, to properly stop further spread in the hospital, we recommend setting up a hospital surveillance system that takes full advantage of the available next-generation sequencing facility to routinely screen for all types of bacterial resistance genes.
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Affiliation(s)
- Tolbert Sonda
- Kilimanjaro Christian Medical Centre, Kilimanjaro Clinical Research Institute, Moshi, Tanzania. .,Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - Happiness Kumburu
- Kilimanjaro Christian Medical Centre, Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Marco van Zwetselaar
- Kilimanjaro Christian Medical Centre, Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Michael Alifrangis
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre, Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Ole Lund
- Centre for Biological Sequence Analysis, Technical University of Denmark, Lyngby, Denmark
| | - Frank M Aarestrup
- DTU-Food, Centre for Genomic Epidemiology, Technical University of Denmark, Lyngby, Denmark
| | - Gibson Kibiki
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.,East African Health Research Commission, Bujumbura, Burundi
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Saravanan M, Ramachandran B, Barabadi H. The prevalence and drug resistance pattern of extended spectrum β–lactamases (ESBLs) producing Enterobacteriaceae in Africa. Microb Pathog 2018; 114:180-192. [DOI: 10.1016/j.micpath.2017.11.061] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 11/27/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
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24
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Sobke A, Makarewicz O, Baier M, Bär C, Pfister W, Gatermann SG, Pletz MW, Forstner C. Empirical treatment of lower urinary tract infections in the face of spreading multidrug resistance: in vitro study on the effectiveness of nitroxoline. Int J Antimicrob Agents 2017; 51:213-220. [PMID: 29111434 DOI: 10.1016/j.ijantimicag.2017.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/18/2017] [Accepted: 10/21/2017] [Indexed: 10/18/2022]
Abstract
The spread of antimicrobial resistance challenges the empirical treatment of urinary tract infections (UTIs). Among others, nitrofurantoin is recommended for first-line treatment, but acceptance among clinicians is limited due to chronic nitrofurantoin-induced lung toxicity and insufficient coverage of Enterobacteriaceae other than Escherichia coli. Nitroxoline appears to be an alternative to nitrofurantoin owing to its favourable safety profile, however data on its current in vitro susceptibility are sparse. In this study, susceptibility to nitroxoline was tested against 3012 urinary clinical isolates (including multidrug-resistant bacteria and Candida spp.) by disk diffusion test and/or broth microdilution. At least 91% of all Gram-negatives (n = 2000), Gram-positives (n = 403) and yeasts (n = 132) had inhibition zone diameters for nitroxoline ≥18 mm. Except for Pseudomonas aeruginosa, nitroxoline MIC90 values were ≤16 mg/L and were 2- to >16-fold lower compared with nitrofurantoin. In extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureus (MRSA), MIC90 values of nitroxoline were two-fold higher compared with non-ESBL-producing enterobacteria and methicillin-susceptible S. aureus (MSSA). The in vitro efficacies of nitroxoline and nitrofurantoin against ATCC strains of E. coli, Enterococcus faecalis and Proteus mirabilis were compared by time-kill curves in Mueller-Hinton broth and artificial urine. Nitroxoline was non-inferior against E. coli, P. mirabilis and E. faecalis in artificial urine. In conclusion, nitroxoline showed a broad antimicrobial spectrum, with inhibition zone diameters and MICs of nitroxoline well below the EUCAST breakpoint for E. coli for most organisms, and thus may also be a target for therapy of uncomplicated UTIs.
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Affiliation(s)
- A Sobke
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - O Makarewicz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - M Baier
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - C Bär
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - W Pfister
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - S G Gatermann
- Department of Medical Microbiology, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - M W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - C Forstner
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany; Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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25
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Taitt CR, Leski TA, Erwin DP, Odundo EA, Kipkemoi NC, Ndonye JN, Kirera RK, Ombogo AN, Walson JL, Pavlinac PB, Hulseberg C, Vora GJ. Antimicrobial resistance of Klebsiella pneumoniae stool isolates circulating in Kenya. PLoS One 2017; 12:e0178880. [PMID: 28575064 PMCID: PMC5456380 DOI: 10.1371/journal.pone.0178880] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/19/2017] [Indexed: 01/08/2023] Open
Abstract
We sought to determine the genetic and phenotypic antimicrobial resistance (AMR) profiles of commensal Klebsiella spp. circulating in Kenya by testing human stool isolates of 87 K. pneumoniae and three K. oxytoca collected at eight locations. Over one-third of the isolates were resistant to ≥3 categories of antimicrobials and were considered multidrug-resistant (MDR). We then compared the resistance phenotype to the presence/absence of 238 AMR genes determined by a broad-spectrum microarray and PCR. Forty-six genes/gene families were identified conferring resistance to β-lactams (ampC/blaDHA, blaCMY/LAT, blaLEN-1, blaOKP-A/OKP-B1, blaOXA-1-like family, blaOXY-1, blaSHV, blaTEM, blaCTX-M-1 and blaCTX-M-2 families), aminoglycosides (aac(3)-III, aac(6)-Ib, aad(A1/A2), aad(A4), aph(AI), aph3/str(A), aph6/str(B), and rmtB), macrolides (mac(A), mac(B), mph(A)/mph(K)), tetracyclines (tet(A), tet(B), tet(D), tet(G)), ansamycins (arr), phenicols (catA1/cat4, floR, cmlA, cmr), fluoroquinolones (qnrS), quaternary amines (qacEΔ1), streptothricin (sat2), sulfonamides (sul1, sul2, sul3), and diaminopyrimidines (dfrA1, dfrA5, dfrA7, dfrA8, dfrA12, dfrA13/21/22/23 family, dfrA14, dfrA15, dfrA16, dfrA17). This is the first profile of genes conferring resistance to multiple categories of antimicrobial agents in western and central Kenya. The large number and wide variety of resistance genes detected suggest the presence of significant selective pressure. The presence of five or more resistance determinants in almost two-thirds of the isolates points to the need for more effective, targeted public health policies and infection control/prevention measures.
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Affiliation(s)
- Chris Rowe Taitt
- Center for Bio/Molecular Science & Engineering, Naval Research Laboratory, Washington, DC United States of America
| | - Tomasz A. Leski
- Center for Bio/Molecular Science & Engineering, Naval Research Laboratory, Washington, DC United States of America
| | - Daniel P. Erwin
- US Army Medical Research Directorate-Kenya, Walter Reed Army Institute of Research, Kericho, Kenya
| | - Elizabeth A. Odundo
- KEMRI/US Army Medical Research Directorate-Kenya, Walter Reed Army Institute of Research, Kericho, Kenya
| | - Nancy C. Kipkemoi
- KEMRI/US Army Medical Research Directorate-Kenya, Walter Reed Army Institute of Research, Kericho, Kenya
| | - Janet N. Ndonye
- KEMRI/US Army Medical Research Directorate-Kenya, Walter Reed Army Institute of Research, Kericho, Kenya
| | - Ronald K. Kirera
- KEMRI/US Army Medical Research Directorate-Kenya, Walter Reed Army Institute of Research, Kericho, Kenya
| | - Abigael N. Ombogo
- KEMRI/US Army Medical Research Directorate-Kenya, Walter Reed Army Institute of Research, Kericho, Kenya
| | - Judd L. Walson
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Departments of Pediatrics, Medicine, and Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Patricia B. Pavlinac
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Christine Hulseberg
- US Army Medical Research Directorate-Kenya, Walter Reed Army Institute of Research, Kericho, Kenya
| | - Gary J. Vora
- Center for Bio/Molecular Science & Engineering, Naval Research Laboratory, Washington, DC United States of America
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26
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Manishimwe R, Nishimwe K, Ojok L. Assessment of antibiotic use in farm animals in Rwanda. Trop Anim Health Prod 2017; 49:1101-1106. [PMID: 28526987 DOI: 10.1007/s11250-017-1290-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 04/19/2017] [Indexed: 12/01/2022]
Abstract
The irrational use of antibiotics in humans and animals is highly related to the emergence and increase of antibiotic-resistant bacteria worldwide. A cross-sectional survey aimed at evaluating the current level of practices regarding antibiotic use in farm animals in Rwanda was carried out countrywide. Interviews were conducted on 229 farmers rearing different types of animals. The study has revealed that almost all respondent farmers could name at least one antibiotic used in farm animals and peni-streptomycin was named by most of them (95.6%). The use of antibiotics in farm animals was observed in the majority of respondents (97.4%). It was found that 44.4 and 26.5% of respondents reported that they used antibiotics for disease prevention and growth promotion, respectively. The use of non-prescribed antibiotics in animals was also reported by more than the half of respondent farmers (55.6%). The majority of farmers had a moderate level of practices regarding antibiotic use in farm animals (73.5%), very few had a high level (26%) and only one respondent had a low level. The high level of practices in regard to antibiotic use in animals was associated with the location of the farm, the type of reared animals, and the rearing system. The results of this study give an insight into antibiotics usage practices in farm animals in Rwanda. The generated information can guide sensitizations and promotions of the prudent use of antibiotics among farmers in order to limit the increase of antibiotic resistance in the country.
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Affiliation(s)
- Rosine Manishimwe
- School of Animal Sciences and Veterinary Medicine, University of Rwanda, PO Box 57, Nyagatare, Rwanda
| | - Kizito Nishimwe
- School of Food Sciences and Technology, University of Rwanda, PO Box 3900, Kigali, Rwanda.
| | - Lonzy Ojok
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
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Masika WG, O’Meara WP, Holland TL, Armstrong J. Contribution of urinary tract infection to the burden of febrile illnesses in young children in rural Kenya. PLoS One 2017; 12:e0174199. [PMID: 28323886 PMCID: PMC5360311 DOI: 10.1371/journal.pone.0174199] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/06/2017] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The clinical features of UTI in young children may not localize to the urinary tract and closely resemble other febrile illnesses. In malaria endemic areas, a child presenting with fever is often treated presumptively for malaria without investigation for UTI. Delayed or inadequate treatment of UTI increases the risk of bacteremia and renal scarring in young children and subsequently complications as hypertension and end stage renal disease in adulthood. METHODS A cross-sectional study was carried out in a hospital in western Kenya. Inpatients and outpatients 2 months to five years with axillary temperature ≥37.5°C and no antibiotic use in the previous week were enrolled between September 2012 and April 2013. Urine dipstick tests, microscopy, and cultures were done and susceptibility patterns to commonly prescribed antibiotics established. UTI was defined as presence of pyuria (a positive urine dipstick or microscopy test) plus a positive urine culture. RESULTS A total of 260 subjects were recruited; 45.8% were female and the median age was 25months (IQR: 13, 43.5). The overall prevalence of UTI was 11.9%. Inpatients had a higher prevalence compared to outpatients (17.9% v 7.8%, p = 0.027). UTI co-existed with malaria but the association was not significant (OR 0.80, p = 0.570). The most common organisms isolated were Escherichia coli (64.5%) and Staphylococcus aureus (12.9%) and were sensitive to ciproflaxin, cefuroxime, ceftriaxone, gentamycin and nitrofurantoin but largely resistant to more commonly used antibiotics such as ampicillin (0%), amoxicillin (16.7%), cotrimoxazole (16.7%) and amoxicillin-clavulinate (25%). CONCLUSION Our study demonstrates UTI contributes significantly to the burden of febrile illness in young children and often co-exists with other infections. Multi-drug resistant organisms are common therefore choice of antimicrobial therapy should be based on local sensitivity pattern.
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Affiliation(s)
- Wechuli Geoffrey Masika
- Department of Family Medicine, Webuye Sub-County Hospital, Webuye, Kenya
- Department of Family Medicine, Kabarak University, Kabarak, Kenya
| | - Wendy Prudhomme O’Meara
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
- School of Public Health, Moi University College of Health Sciences, Eldoret, Kenya
| | - Thomas L. Holland
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Janice Armstrong
- Department of Family Medicine, Webuye Sub-County Hospital, Webuye, Kenya
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Kurz MSE, Bayingana C, Ndoli JM, Sendegeya A, Durst A, Pfüller R, Gahutu JB, Mockenhaupt FP. Intense pre-admission carriage and further acquisition of ESBL-producing Enterobacteriaceae among patients and their caregivers in a tertiary hospital in Rwanda. Trop Med Int Health 2017; 22:210-220. [PMID: 27935649 DOI: 10.1111/tmi.12824] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the presence and risk factors of intestinal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) among patients admitted to the University Teaching Hospital of Butare and among their attending caregivers, and to analyse the acquisition of ESBL-PE carriage during hospital stay and associated factors. METHODS We screened 392 patients and their attending caregivers at admission and discharge for ESBL-PE carriage. Bacterial species were determined using the API-20E system, and antimicrobial susceptibility testing was performed by agar disc diffusion. Data on socio-economic status, diet, behaviour, household assets, livestock and hospital procedures were collected. RESULTS At admission, 50% of the patients showed intestinal ESBL-PE carriage (Escherichia coli, 51%; Klebsiella pneumoniae, 39%; Enterobacter cloacae, 19%) as did 37% of their caregivers. Co-resistance was common but no carbapenem resistance was detected. At discharge, the proportion of ESBL-PE-colonised patients increased to 65% (caregivers, 47%) with almost complete carriage in paediatric patients (93%). The acquisition rate among initially non-colonised patients was 55% (or, 71/1000 patient days). Independent predictors of admission carriage included a colonised caregiver, prior antibiotic intake, egg consumption and neglecting to boil drinking water, whereas being a paediatric patient, undergoing surgery and male gender predicted acquisition during hospitalisation. CONCLUSIONS Abundant admission carriage of ESBL-PE and a high acquisition rate in a Rwandan university hospital point to potential intrahospital transmission and community dissemination. Caregivers are an additional source of possible spread. Risk factors of colonisation such as diet and water source need to be tackled to prevent the further emergence and spread of ESBL-PE.
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Affiliation(s)
- Mathis S E Kurz
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Claude Bayingana
- University Teaching Hospital of Butare and School of Medicine and Pharmacy, University of Rwanda, Butare, Rwanda
| | - Jules M Ndoli
- University Teaching Hospital of Butare and School of Medicine and Pharmacy, University of Rwanda, Butare, Rwanda
| | - Augustin Sendegeya
- University Teaching Hospital of Butare and School of Medicine and Pharmacy, University of Rwanda, Butare, Rwanda
| | - Anita Durst
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Jean Bosco Gahutu
- University Teaching Hospital of Butare and School of Medicine and Pharmacy, University of Rwanda, Butare, Rwanda
| | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Carroll M, Rangaiahagari A, Musabeyezu E, Singer D, Ogbuagu O. Five-Year Antimicrobial Susceptibility Trends Among Bacterial Isolates from a Tertiary Health-Care Facility in Kigali, Rwanda. Am J Trop Med Hyg 2016; 95:1277-1283. [PMID: 27799637 DOI: 10.4269/ajtmh.16-0392] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/20/2016] [Indexed: 11/07/2022] Open
Abstract
Antimicrobial resistance (AMR) is a global public health threat. There is limited information from Rwanda on AMR trends. This longitudinal study aimed to describe temporal trends of antibiotic susceptibility among common bacteria. We collated the antimicrobial susceptibility results of bacteria cultured from clinical specimens collected from inpatients and outpatients and submitted to the microbiology laboratory at King Faisal Hospital, Kigali, Rwanda, from January 1, 2009, to December 31, 2013. Differences in antimicrobial susceptibility between the first and fifth year of the study for each bacterial species was assessed using χ2 test. Of 5,296 isolates collected, 46.7% were Escherichia coli, 18.4% were Klebsiella spp., 5.9% were Acinetobacter spp., 7.1% were Pseudomonas spp., 11.7% were Staphylococcus aureus, and 10.3% were Enterococcus spp. Colistin and imipenem had greatest activity against gram-negative bacteria. Acinetobacter spp. showed the greatest resistance profile to antimicrobials tested, relative to other gram-negative bacteria. Vancomycin retained excellent activity against S. aureus and Enterococcus species (average susceptibility was 100% and 99.4%, respectively). Trend analysis determined that resistance to imipenem increased significantly among Klebsiella, E. coli, Pseudomonas, and Acinetobacter isolates; there was also rising resistance to colistin among E. coli and Pseudomonas species. Only E. coli demonstrated increased resistance to gentamicin. For gram-positive pathogens, vancomycin susceptibility increased over time for Enterococcus species, but was unchanged for S. aureus Our data suggest that resistance to imipenem and colistin are rising among gram-negative bacteria in Rwanda. Proper infection control practices and antimicrobial stewardship will be important to address this emerging threat.
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Affiliation(s)
| | - Ashok Rangaiahagari
- Department of Microbiology, SMBT Institute of Medical Science and Research Center, Nashik, India.,King Faisal Hospital, Kigali, Rwanda
| | | | - Donald Singer
- Fellowship of Postgraduate Medicine, London, United Kingdom
| | - Onyema Ogbuagu
- Yale AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut.
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Bacterial Etiology and Antibiotic Resistance Profile of Community-Acquired Urinary Tract Infections in a Cameroonian City. Int J Microbiol 2016; 2016:3240268. [PMID: 27667998 PMCID: PMC5030431 DOI: 10.1155/2016/3240268] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/22/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction. Community-acquired urinary tract infections (CAUTIs) are usually treated empirically. Geographical variations in etiologic agents and their antibiotic sensitivity patterns are common. Knowledge of antibiotic resistance trends is important for improving evidence-based recommendations for empirical treatment of UTIs. Our aim was to determine the major bacterial etiologies of CAUTIs and their antibiotic resistance patterns in a cosmopolitan area of Cameroon for comparison with prescription practices of local physicians. Methods. We performed a cross-sectional descriptive study at two main hospitals in Yaoundé, collecting a clean-catch mid-stream urine sample from 92 patients having a clinical diagnosis of UTI. The empirical antibiotherapy was noted, and identification of bacterial species was done on CLED agar; antibiotic susceptibility testing was performed using the Kirby-Bauer disc diffusion method. Results. A total of 55 patients had samples positive for a UTI. Ciprofloxacin and amoxicillin/clavulanic acid were the most empirically prescribed antibiotics (30.9% and 23.6%, resp.); bacterial isolates showed high prevalence of resistance to both compounds. Escherichia coli (50.9%) was the most common pathogen, followed by Klebsiella pneumoniae (16.4%). Prevalence of resistance for ciprofloxacin was higher compared to newer quinolones. Conclusions. E. coli and K. pneumoniae were the predominant bacterial etiologies; the prevalence of resistance to commonly prescribed antibiotics was high.
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Sonda T, Kumburu H, van Zwetselaar M, Alifrangis M, Lund O, Kibiki G, Aarestrup FM. Meta-analysis of proportion estimates of Extended-Spectrum-Beta-Lactamase-producing Enterobacteriaceae in East Africa hospitals. Antimicrob Resist Infect Control 2016; 5:18. [PMID: 27186369 PMCID: PMC4868002 DOI: 10.1186/s13756-016-0117-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/09/2016] [Indexed: 01/16/2023] Open
Abstract
Background A high proportion of Extended-Spectrum-Beta-Lactamase (ESBL) producing Enterobacteriaceae is causing common infections in all regions of the world. The burden of antibiotic resistance due to ESBL in East Africa is large but information is scarce and thus it is unclear how big the problem really is. To gain insight into the magnitude and molecular epidemiology of ESBL-producing Enterobacteriaceae in East Africa a literature search was performed in PubMed on 31 July 2015 to retrieve articles with relevant information on ESBL. Methods and results Meta-analysis was performed to determine overall proportion estimate of ESBL-producing Enterobacteriaceae. A total of 4076 bacterial isolates were included in the analysis. The overall pooled proportion of ESBL-producing Enterobacteriaceae among included surveys done in East African hospitals was found to be 0.42 (95 % CI: 0.34–0.50). Heterogeneity (I2) between countries’ proportions in ESBL was significantly high (96.95 % and p < 0.001). The frequently detected genes encoding ESBL were CTX-M, TEM, SHV and OXA while the most infrequent reported genes were KPC and NDM. Conclusion The available studies show a very wide variation in resistance due to ESBL between countries. This highlights a need for active surveillance systems which can help understand the actual epidemiology of ESBL, aid in formulating national or regional guidelines for proper screening of ESBL, and support developing standardized approaches for managing patients colonized with ESBL. Electronic supplementary material The online version of this article (doi:10.1186/s13756-016-0117-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tolbert Sonda
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania ; Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Happiness Kumburu
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania ; Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Marco van Zwetselaar
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Michael Alifrangis
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark ; Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole Lund
- Centre for Biological Sequence Analysis, Technical University of Denmark, Copenhagen, Denmark
| | - Gibson Kibiki
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania ; Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Frank M Aarestrup
- Centre for Genomic Epidemiology, Technical University of Denmark, Copenhagen, Denmark
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Vardakas KZ, Legakis NJ, Triarides N, Falagas ME. Susceptibility of contemporary isolates to fosfomycin: a systematic review of the literature. Int J Antimicrob Agents 2016; 47:269-85. [DOI: 10.1016/j.ijantimicag.2016.02.001] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/22/2016] [Indexed: 02/01/2023]
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Multidrug Resistant CTX-M-Producing Escherichia coli: A Growing Threat among HIV Patients in India. J Pathog 2016; 2016:4152704. [PMID: 27123344 PMCID: PMC4829713 DOI: 10.1155/2016/4152704] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/06/2016] [Indexed: 12/01/2022] Open
Abstract
Extended Spectrum β-Lactamases (ESBLs) confer resistance to third-generation cephalosporins and CTX-M types have emerged as the most prominent ESBLs worldwide. This study was designed to determine the prevalence of CTX-M positive ESBL-producing urinary E. coli isolates from HIV patients and to establish the association of multidrug resistance, phylogeny, and virulence profile with CTX-M production. A total of 57 ESBL producers identified among 76 E. coli strains isolated from HIV patients from South India were screened for blaCTX-M, AmpC production, multidrug resistance, and nine virulence associated genes (VAGs), fimH, pap, afa/dra, sfa/foc, iutA, fyuA, iroN, usp, and kpsMII. The majority (70.2%) of the ESBL producers harbored blaCTX-M and were AmpC coproducers. Among the CTX-M producers, 47.5% were found to be UPEC, 10% harbored as many as 7 VAGs, and 45% possessed kpsMII. Multidrug resistance (CIPRSXTRGENR) was significantly more common among the CTX-M producers compared to the nonproducers (70% versus 41.2%). However, 71.4% of the multidrug resistant CTX-M producers exhibited susceptibility to nitrofurantoin thereby making it an effective alternative to cephalosporins/fluoroquinolones. The emergence of CTX-M-producing highly virulent, multidrug resistant uropathogenic E. coli is of significant public health concern in countries like India with a high burden of HIV/AIDS.
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Chalmers L, Cross J, Chu CS, Phyo AP, Trip M, Ling C, Carrara V, Watthanaworawit W, Keereecharoen L, Hanboonkunupakarn B, Nosten F, McGready R. The role of point-of-care tests in antibiotic stewardship for urinary tract infections in a resource-limited setting on the Thailand-Myanmar border. Trop Med Int Health 2015; 20:1281-9. [PMID: 25963224 PMCID: PMC4758398 DOI: 10.1111/tmi.12541] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective Published literature from resource‐limited settings is infrequent, although urinary tract infections (UTI) are a common cause of outpatient presentation and antibiotic use. Point‐of‐care test (POCT) interpretation relates to antibiotic use and antibiotic resistance. We aimed to assess the diagnostic accuracy of POCT and their role in UTI antibiotic stewardship. Methods One‐year retrospective analysis in three clinics on the Thailand–Myanmar border of non‐pregnant adults presenting with urinary symptoms. POCT (urine dipstick and microscopy) were compared to culture with significant growth classified as pure growth of a single organism >105 CFU/ml. Results In 247 patients, 82.6% female, the most common symptoms were dysuria (81.2%), suprapubic pain (67.8%) and urinary frequency (53.7%). After excluding contaminated samples, UTI was diagnosed in 52.4% (97/185); 71.1% (69/97) had a significant growth on culture, and >80% of these were Escherichia coli (20.9% produced extended‐spectrum β‐lactamase (ESBL)). Positive urine dipstick (leucocyte esterase ≥1 and/or nitrate positive) compared against positive microscopy (white blood cell >10/HPF, bacteria ≥1/HPF, epithelial cells <5/HPF) had a higher sensitivity (99% vs. 57%) but a lower specificity (47% vs. 89%), respectively. Combined POCT resulted in the best sensitivity (98%) and specificity (81%). Nearly one in ten patients received an antimicrobial to which the organism was not fully sensitive. Conclusion One rapid, cost‐effective POCT was too inaccurate to be used alone by healthcare workers, impeding antibiotic stewardship in a high ESBL setting. Appropriate prescribing is improved with concurrent use and concordant results of urine dipstick and microscopy.
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Affiliation(s)
- Lauren Chalmers
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Jessica Cross
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Cindy S Chu
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Aung Pyae Phyo
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Margreet Trip
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Clare Ling
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Verena Carrara
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Wanitda Watthanaworawit
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Lily Keereecharoen
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Borimas Hanboonkunupakarn
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - François Nosten
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Enhancement of herpes simplex virus (HSV) infection by seminal plasma and semen amyloids implicates a new target for the prevention of HSV infection. Viruses 2015; 7:2057-73. [PMID: 25903833 PMCID: PMC4411690 DOI: 10.3390/v7042057] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 04/01/2015] [Accepted: 04/09/2015] [Indexed: 12/02/2022] Open
Abstract
Human herpesviruses cause different infectious diseases, resulting in world-wide health problems. Sexual transmission is a major route for the spread of both herpes simplex virus-1 (HSV-1) and -2. Semen plays an important role in carrying the viral particle that invades the vaginal or rectal mucosa and, thereby, initiates viral replication. Previously, we demonstrated that the amyloid fibrils semenogelin (SEM) and semen-derived enhancer of viral infection (SEVI), and seminal plasma (SP) augment cytomegalovirus infection (Tang et al., J. Virol 2013). Whether SEM or SEVI amyloids or SP could also enhance other herpesvirus infections has not been examined. In this study, we found that the two amyloids as well as SP strongly enhance both HSV-1 and -2 infections in cell culture. Along with SP, SEM and SEVI amyloids enhanced viral entry and increased infection rates by more than 10-fold, as assessed by flow cytometry assay and fluorescence microscopy. Viral replication was increased by about 50- to 100-fold. Moreover, viral growth curve assays showed that SEM and SEVI amyloids, as well as SP, sped up the kinetics of HSV replication such that the virus reached its replicative peak more quickly. The interactions of SEM, SEVI, and SP with HSVs are direct. Furthermore, we discovered that the enhancing effects of SP, SEM, and SEVI can be significantly reduced by heparin, a sulfated polysaccharide with an anionic charge. It is probable that heparin abrogates said enhancing effects by interfering with the interaction of the viral particle and the amyloids, which interaction results in the binding of the viral particles and both SEM and SEVI.
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Ntirenganya C, Manzi O, Muvunyi CM, Ogbuagu O. High prevalence of antimicrobial resistance among common bacterial isolates in a tertiary healthcare facility in Rwanda. Am J Trop Med Hyg 2015; 92:865-70. [PMID: 25646259 DOI: 10.4269/ajtmh.14-0607] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 12/17/2014] [Indexed: 11/07/2022] Open
Abstract
Antimicrobial resistance (AMR) is a serious public health threat in both developed and developing countries. Many developing countries, including Rwanda, lack adequate surveillance systems, and therefore, the prevalence of AMR is not well-known. We conducted a prospective observational study to assess the prevalence of AMR among common bacterial isolates from clinical specimens obtained from patients on the medical wards of Kigali University Teaching Hospital (KUTH). We evaluated the antibiotic sensitivity patterns of bacterial pathogens cultured from urine, blood, sputum, and wound swab specimens obtained over a 6-month period (July 1 to December 30, 2013). There were 154 positive cultures from specimens obtained from 141 unique patients over the study period. Urine, blood, wound swab, and sputum cultures comprised 55.2%, 25.3%, 16.2%, and 3.3% of the total specimens evaluated; 31.4% and 58.7% of Escherichia coli and Klebsiella isolates, respectively, were resistant to at least one of the third generation cephalosporins. Eight percent of E. coli isolates were resistant to imipenem; 82% and 6% of Staphylococcus aureus strains were oxacillin- and vancomycin-resistant respectively. Antimicrobial resistance rates are high in Rwanda and pose a serious therapeutic challenge to the management of common infections.
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Affiliation(s)
- Cyprien Ntirenganya
- Department of Medicine, Kigali University Teaching Hospital, Kigali, Rwanda; Department of Clinical Biology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Olivier Manzi
- Department of Medicine, Kigali University Teaching Hospital, Kigali, Rwanda; Department of Clinical Biology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Claude Mambo Muvunyi
- Department of Medicine, Kigali University Teaching Hospital, Kigali, Rwanda; Department of Clinical Biology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut
| | - Onyema Ogbuagu
- Department of Medicine, Kigali University Teaching Hospital, Kigali, Rwanda; Department of Clinical Biology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut
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Anago E, Ayi-Fanou L, Akpovi CD, Hounkpe WB, Agassounon-Djikpo Tchibozo M, Bankole HS, Sanni A. Antibiotic resistance and genotype of beta-lactamase producing Escherichia coli in nosocomial infections in Cotonou, Benin. Ann Clin Microbiol Antimicrob 2015; 14:5. [PMID: 25595314 PMCID: PMC4304606 DOI: 10.1186/s12941-014-0061-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Beta lactams are the most commonly used group of antimicrobials worldwide. The presence of extended-spectrum lactamases (ESBL) affects significantly the treatment of infections due to multidrug resistant strains of gram-negative bacilli. The aim of this study was to characterize the beta-lactamase resistance genes in Escherichia coli isolated from nosocomial infections in Cotonou, Benin. Methods Escherichia coli strains were isolated from various biological samples such as urine, pus, vaginal swab, sperm, blood, spinal fluid and catheter. Isolated bacteria were submitted to eleven usual antibiotics, using disc diffusion method according to NCCLS criteria, for resistance analysis. Beta-lactamase production was determined by an acidimetric method with benzylpenicillin. Microbiological characterization of ESBL enzymes was done by double disc synergy test and the resistance genes TEM and SHV were screened by specific PCR. Results ESBL phenotype was detected in 29 isolates (35.5%). The most active antibiotic was imipenem (96.4% as susceptibility rate) followed by ceftriaxone (58.3%) and gentamicin (54.8%). High resistance rates were observed with amoxicillin (92.8%), ampicillin (94%) and trimethoprim/sulfamethoxazole (85.7%). The genotype TEM was predominant in ESBL and non ESBL isolates with respectively 72.4% and 80%. SHV-type beta-lactamase genes occurred in 24.1% ESBL strains and in 18.1% of non ESBL isolates. Conclusion This study revealed the presence of ESBL producing Eschericiha coli in Cotonou. It demonstrated also high resistance rate to antibiotics commonly used for infections treatment. Continuous monitoring and judicious antibiotic usage are required.
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Affiliation(s)
- Eugénie Anago
- Laboratoire de Biochimie et de Biologie Moléculaire, Institut des Sciences Biomédicales Appliquées, 03 BP 0420, Cotonou, Bénin. .,Laboratoire de Recherche en Biologie Appliquée (LARBA), Ecole Polytechnique d'Abomey-Calavi, Université d'Abomey-Calavi, B.P. 2009, Cotonou, Bénin.
| | - Lucie Ayi-Fanou
- Laboratoire de Biochimie et de Biologie Moléculaire, Institut des Sciences Biomédicales Appliquées, 03 BP 0420, Cotonou, Bénin.
| | - Casimir D Akpovi
- Laboratoire de Recherche en Biologie Appliquée (LARBA), Ecole Polytechnique d'Abomey-Calavi, Université d'Abomey-Calavi, B.P. 2009, Cotonou, Bénin.
| | - Wilfried B Hounkpe
- Laboratoire de Biochimie et de Biologie Moléculaire, Institut des Sciences Biomédicales Appliquées, 03 BP 0420, Cotonou, Bénin.
| | - Micheline Agassounon-Djikpo Tchibozo
- Laboratoire de Génétique et des Biotechnologies, Faculté des Sciences et Techniques (FAST), Université d'Abomey-Calavi (UAC), 01 BP 1636 RP, Cotonou, Bénin.
| | - Honoré S Bankole
- Laboratoire de Recherche en Biologie Appliquée (LARBA), Ecole Polytechnique d'Abomey-Calavi, Université d'Abomey-Calavi, B.P. 2009, Cotonou, Bénin.
| | - Ambaliou Sanni
- Laboratoire de Biochimie et de Biologie Moléculaire, Institut des Sciences Biomédicales Appliquées, 03 BP 0420, Cotonou, Bénin.
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Male infertility: a public health issue caused by sexually transmitted pathogens. Nat Rev Urol 2014; 11:672-87. [PMID: 25330794 DOI: 10.1038/nrurol.2014.285] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sexually transmitted diseases (STDs) are caused by several pathogens, including bacteria, viruses and protozoa, and can induce male infertility through multiple pathophysiological mechanisms. Additionally, horizontal transmission of STD pathogens to sexual partners or vertical transmission to fetuses and neonates is possible. Chlamydia trachomatis, Ureaplasma spp., human papillomavirus, hepatitis B and hepatitis C viruses, HIV-1 and human cytomegalovirus have all been detected in semen from symptomatic and asymptomatic men with testicular, accessory gland and urethral infections. These pathogens are associated with poor sperm quality and decreased sperm concentration and motility. However, the effects of these STD agents on semen quality are unclear, as are the effects of herpes simplex virus type 1 and type 2, Neisseria gonorrhoeae, Mycoplasma spp., Treponema pallidum and Trichomonas vaginalis, because few studies have evaluated the influence of these pathogens on male infertility. Chronic or inadequately treated infections seem to be more relevant to infertility than acute infections are, although in many cases the exact aetiological agents remain unknown.
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Kariuki S, Dougan G. Antibacterial resistance in sub-Saharan Africa: an underestimated emergency. Ann N Y Acad Sci 2014; 1323:43-55. [PMID: 24628272 PMCID: PMC4159419 DOI: 10.1111/nyas.12380] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Antibacterial resistance-associated infections are known to increase morbidity, mortality, and cost of treatment, and to potentially put others in the community at higher risk of infections. In high-income countries, where the burden of infectious diseases is relatively modest, resistance to first-line antibacterial agents is usually overcome by use of second- and third-line agents. However, in developing countries where the burden of infectious diseases is high, patients with antibacterial-resistant infections may be unable to obtain or afford effective second-line treatments. In sub-Saharan Africa (SSA), the situation is aggravated by poor hygiene, unreliable water supplies, civil conflicts, and increasing numbers of immunocompromised people, such as those with HIV, which facilitate both the evolution of resistant pathogens and their rapid spread in the community. Because of limited capacity for disease detection and surveillance, the burden of illnesses due to treatable bacterial infections, their specific etiologies, and the awareness of antibacterial resistance are less well established in most of SSA, and therefore the ability to mitigate their consequences is significantly limited.
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Affiliation(s)
- Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - Gordon Dougan
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
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Microbiologic Spectrum and Antibiotic Susceptibility Pattern among Patients with Urinary and Respiratory Tract Infection. Int J Microbiol 2014; 2014:682304. [PMID: 25053948 PMCID: PMC4098766 DOI: 10.1155/2014/682304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 06/10/2014] [Accepted: 06/11/2014] [Indexed: 11/25/2022] Open
Abstract
Aim. To demonstrate the prevalence of isolated organisms in urinary/respiratory tract infections and their antibiotic susceptibilities in a tertiary care center. Methods and Material. Between January 2008 and January 2010, patients referring to the clinic of cardiology or those admitted to the cardiac wards were enrolled in this cross-sectional descriptive study. Urine and sputum sampling was done for all the patients and the specimens underwent microbiologic examination and, in case of isolation of microorganism, antibiotic disk diffusion test was performed. Results. Escherichia coli (E. coli) was the most prevalent isolated organism in-hospital and community-acquired UTIs and was highly resistant to cephalothin in all the samples followed by cotrimoxazole, and ceftriaxone. It revealed high sensitivity to imipenem, amikacin, and nitrofurantoin. Acinetobacter constituted the most prevalent organism isolated from respiratory secretions and represented the highest resistance to ceftriaxone and the greatest sensitivity to imipenem. Conclusions. E. coli and Acinetobacter remain the most common uropathogenic and respiratory organisms, respectively. However, their increasing resistance to wide-spectrum imipenem, meropenem, and vancomycin is a major concern.
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Irenge LM, Kabego L, Vandenberg O, Chirimwami RB, Gala JL. Antimicrobial resistance in urinary isolates from inpatients and outpatients at a tertiary care hospital in South-Kivu Province (Democratic Republic of Congo). BMC Res Notes 2014; 7:374. [PMID: 24943866 PMCID: PMC4074390 DOI: 10.1186/1756-0500-7-374] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 06/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rate of antimicrobial resistant isolates among pathogens causing urinary tract infections (UTIs) in Democratic Republic of Congo (DRC) is not known. The aim of the current study was to determine this rate at the Bukavu Provincial General Hospital (province of South-Kivu, DRC). FINDINGS A total of 643 isolates (both from inpatients and outpatients) collected from September 2012 to August 2013 were identified using biochemical methods, and tested for antimicrobial susceptibility. The isolates were further screened for Extended-Spectrum Beta-Lactamases (ESBL) production. Beta-lactamase AmpC phenotype was investigated in 20 antibiotic-resistant isolates.Escherichia coli (58.5%), Klebsiella spp. (21.9%) and Enterobacter spp. (16.2%) were the most frequent uropathogens encountered. Rare uropathogens included Citrobacter spp., Proteus spp., and Acinetobacter spp. Resistance was significantly more present in inpatients isolates (22.1% of isolates) when compared to outpatients isolates (8.4% of isolates), (p-value <0.001). Antibiotic-resistant isolates displayed resistance to common antimicrobial drugs used for UTIs treatment in South Kivu province, namely: ciprofloxacin, ampicillin and third generation cephalosporins. ESBL-phenotype was present in 92.9% of antibiotic-resistant isolates. Only amikacin, nitrofurantoin and imipenem displayed satisfactory activity against antibiotic resistant isolates. CONCLUSIONS This study confirms the presence of antibiotic-resistant uropathogens (mainly ESBL-producers isolates) at the Bukavu General Hospital. This study should serve as a wake-up call and help to raise awareness about the threat to public health of antibiotic resistance in this DRC province.
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Affiliation(s)
- Leonid M Irenge
- Bukavu General Hospital/Université Catholique de Bukavu, P,O, Box 285, Bukavu, Democratic Republic of Congo.
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Leopold SJ, van Leth F, Tarekegn H, Schultsz C. Antimicrobial drug resistance among clinically relevant bacterial isolates in sub-Saharan Africa: a systematic review. J Antimicrob Chemother 2014; 69:2337-53. [PMID: 24879668 DOI: 10.1093/jac/dku176] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about the prevalence of antimicrobial resistance (AMR) amongst bacterial pathogens in sub-Saharan Africa (sSA), despite calls for continent-wide surveillance to inform empirical treatment guidelines. METHODS We searched PubMed and additional databases for susceptibility data of key pathogens for surveillance, published between 1990 and 2013. Extracted data were standardized to a prevalence of resistance in populations of isolates and reported by clinical syndrome, microorganism, relevant antimicrobial drugs and region. RESULTS We identified 2005 publications, of which 190 were analysed. Studies predominantly originated from east sSA (61%), were hospital based (60%), were from an urban setting (73%) and reported on isolates from patients with a febrile illness (42%). Quality procedures for susceptibility testing were described in <50% of studies. Median prevalence (MP) of resistance to chloramphenicol in Enterobacteriaceae, isolated from patients with a febrile illness, ranged between 31.0% and 94.2%, whilst MP of resistance to third-generation cephalosporins ranged between 0.0% and 46.5%. MP of resistance to nalidixic acid in Salmonella enterica Typhi ranged between 15.4% and 43.2%. The limited number of studies providing prevalence data on AMR in Gram-positive pathogens or in pathogens isolated from patients with a respiratory tract infection, meningitis, urinary tract infection or hospital-acquired infection suggested high prevalence of resistance to chloramphenicol, trimethoprim/sulfamethoxazole and tetracycline and low prevalence to third-generation cephalosporins and fluoroquinolones. CONCLUSIONS Our results indicate high prevalence of AMR in clinical bacterial isolates to antimicrobial drugs commonly used in sSA. Enhanced approaches for AMR surveillance are needed to support empirical therapy in sSA.
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Affiliation(s)
- Stije J Leopold
- Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank van Leth
- Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Hayalnesh Tarekegn
- Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Constance Schultsz
- Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Dibua UME, Onyemerela IS, Nweze EI. Frequency, urinalysis and susceptibility profile of pathogens causing urinary tract infections in Enugu State, southeast Nigeria. Rev Inst Med Trop Sao Paulo 2014; 56:55-9. [PMID: 24553609 PMCID: PMC4085832 DOI: 10.1590/s0036-46652014000100008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 04/18/2013] [Indexed: 11/22/2022] Open
Abstract
Objective: This study was designed to determine the frequency and
causative agent(s) of urinary tract infections (UTIs) in individuals with symptoms of
urinary tract infections in Enugu State of Southeast Nigeria, and to determine the
antibiotic susceptibility pattern of microbial agents isolated from urine
culture. Methods: The study involved 211 individuals (149 females and 62 males)
clinically suspected for UTI. Urine samples were collected by the mid-stream ‘clean
catch’ method and tested using standard procedures. Antibiotic susceptibility of the
isolated pathogens was tested using the Kirby-Bauer technique according to the
Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Microscopy of centrifuged urine samples showed 16 patients had
pyuria while 54 had pus cells. Calcium oxalate crystals were found in 14 samples.
Urinalysis performed with urine samples showed 17 had protein; seven were nitrite
positive and three had moderate to high glucose concentration. Fifty-four urine
samples (36.2%) from females and 12 (19.4%) from males showed significant growth upon
culture. Gram stain and biochemical tests identified nine different organisms with
Escherichia coli as the most common isolated species. Forty three
randomly selected strains were further tested for their susceptibility against a
panel of antibiotics. Thirty isolates (81.08%) were resistant to four or more
antibiotics with the highest resistance shown by E. coli (76.67%).
All the Gram- negative isolates were resistant to Ampicilox, Cefuroxime and
Amoxicillin. Conclusion: Urinary tract infections were found more in females in the
area under study. As found in other studies, E. coli was the most
predominant isolate, although other organisms seem to be on the increase.
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Affiliation(s)
- Uju M E Dibua
- Department of Microbiology, University of Nigeria, Nsukka, Nigeria, Department of Microbiology, University of Nigeria, Nsukka, Nigeria
| | - Ifeoma S Onyemerela
- Department of Microbiology, University of Nigeria, Nsukka, Nigeria, Department of Microbiology, University of Nigeria, Nsukka, Nigeria
| | - Emeka I Nweze
- Department of Microbiology, University of Nigeria, Nsukka, Nigeria, Department of Microbiology, University of Nigeria, Nsukka, Nigeria
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Storberg V. ESBL-producing Enterobacteriaceae in Africa - a non-systematic literature review of research published 2008-2012. Infect Ecol Epidemiol 2014; 4:20342. [PMID: 24765249 PMCID: PMC3955770 DOI: 10.3402/iee.v4.20342] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 01/21/2014] [Accepted: 02/12/2014] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBL) has been found all over the world, and risk factors for acquiring these bacteria involve hospital care and antibiotic treatment. Surveillance studies are present in Europe, North America, and Asia, but there is no summarizing research published on the situation in Africa. AIM This review aims to describe the prevalence of ESBL-producing Enterobacteriaceae in hospital and community settings in Africa and the ESBL genes involved. METHOD A non-systematic literature search was performed in PubMed. All articles published between 2008 and 2012 were screened and read in full text. Relevant articles were assessed for quality of evidence and included in the review. Articles were divided into regional areas in Africa and tabulated. RESULTS ESBL-producing Enterobacteriaceae in hospitalized patients and in communities varies largely between countries and specimens but is common in Africa. ESBLs (class A and D) and plasmid-encoded AmpC (pAmpC) were regularly found, but carbapenemases were also present. CONCLUSION ESBL-producing Enterobacteriaceae in hospital and community settings in Africa is common. Surveillance of antimicrobial resistance needs to be implemented in Africa to tailor interventions targeted at stopping the dissemination of ESBL-producing Enterobacteriaceae.
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Affiliation(s)
- Viktor Storberg
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
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Tansarli GS, Poulikakos P, Kapaskelis A, Falagas ME. Proportion of extended-spectrum -lactamase (ESBL)-producing isolates among Enterobacteriaceae in Africa: evaluation of the evidence--systematic review. J Antimicrob Chemother 2014; 69:1177-84. [DOI: 10.1093/jac/dkt500] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Ablove T, Patankar M, Seo S. Prevention of recurrent urinary tract infections by intravesical administration of heparin: a pilot study. Ther Adv Urol 2013; 5:303-9. [PMID: 24294288 DOI: 10.1177/1756287213504804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To assess the effect of bladder instillations using heparin on the rate of urinary tract infections in women resistant to standard therapy. PATIENTS AND METHODS The medical records of all women who received bladder instillations between May 2009 and January of 2010 at the University of Wisconsin urogynecology clinic were reviewed. Eighteen women (mean age 67 years) with a history of recurrent urinary tract infections received intravesical instillations (heparin 40,000 U, 2% lidocaine 8 ml, sodium bicarbonate 4 ml) once weekly for 6 weeks. Patients were considered resistant to standard therapy if their condition failed to respond to chronic suppression antibiotic therapy; they had chronic infections and for this reason could not be placed on chronic suppression; or they were not candidates for chronic suppression due to drug allergies. The number of urinary tract infections was monitored during treatment and for 6 months after therapy. The urinary tract infection rates were compared with the rates of urinary tract infection in the 6 months before treatment. RESULTS Seventy-eight percent of patients responded to therapy. Subjects were thought to have responded to therapy if there was a greater than 50% reduction in the rate of urinary tract infection. Other variables reviewed included evidence of chronic infection, hormonal status, glomerular filtration rate, age, body mass index, antibiotic allergies, diabetes, hypertension, and chronic antibiotic therapy during bladder instillations. None of these variables were found to be statistically significant. CONCLUSION Bladder instillations decreased the rate of urinary tract infection in this pilot study; this effect persisted into the post-treatment period. More research is needed to confirm these preliminary findings.
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Affiliation(s)
- Tova Ablove
- Department of Obstetrics and Gynecology, University of Wisconsin, 600 Highland Avenue, H4/656 CSC, Madison, WI 53792, USA
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Søraas A, Sundsfjord A, Sandven I, Brunborg C, Jenum PA. Risk factors for community-acquired urinary tract infections caused by ESBL-producing enterobacteriaceae--a case-control study in a low prevalence country. PLoS One 2013; 8:e69581. [PMID: 23936052 PMCID: PMC3720588 DOI: 10.1371/journal.pone.0069581] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 06/14/2013] [Indexed: 01/13/2023] Open
Abstract
Community-acquired urinary tract infection (CA-UTI) is the most common infection caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, but the clinical epidemiology of these infections in low prevalence countries is largely unknown. A population based case-control study was conducted to assess risk factors for CA-UTI caused by ESBL-producing E. coli or K. pneumoniae. The study was carried out in a source population in Eastern Norway, a country with a low prevalence of infections caused by ESBL-producing Enterobacteriaceae. The study population comprised 100 cases and 190 controls with CA-UTI caused by ESBL-producing and non-ESBL-producing E. coli or K. pneumoniae, respectively. The following independent risk factors of ESBL-positive UTIs were identified: Travel to Asia, The Middle East or Africa either during the past six weeks (Odds ratio (OR) = 21; 95% confidence interval (CI): 4.5–97) or during the past 6 weeks to 24 months (OR = 2.3; 95% CI: 1.1–4.4), recent use of fluoroquinolones (OR = 16; 95% CI: 3.2–80) and β-lactams (except mecillinam) (OR = 5.0; 95% CI: 2.1–12), diabetes mellitus (OR = 3.2; 95% CI: 1.0–11) and recreational freshwater swimming the past year (OR = 2.1; 95% CI: 1.0–4.0). Factors associated with decreased risk were increasing number of fish meals per week (OR = 0.68 per fish meal; 95% CI: 0.51–0.90) and age (OR = 0.89 per 5 year increase; 95% CI: 0.82–0.97). In conclusion, we have identified risk factors that elucidate mechanisms and routes for dissemination of ESBL-producing Enterobacteriaceae in a low prevalence country, which can be used to guide appropriate treatment of CA-UTI and targeted infection control measures.
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Affiliation(s)
- Arne Søraas
- Department of Medical Microbiology, Vestre Viken Hospital Trust, Bærum, Norway.
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Analysis of the spectrum and antibiotic resistance of uropathogens in vitro: results based on a retrospective study from a tertiary hospital. Am J Infect Control 2013; 41:601-6. [PMID: 23352074 DOI: 10.1016/j.ajic.2012.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 09/26/2012] [Accepted: 09/26/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Antibiotic resistance of uropathogens in urinary tract infections (UTIs) is increasing worldwide. This study aimed to compare the spectrum and antimicrobial resistance of uropathogens in community-acquired UTIs (CAUTIs) and nosocomial-acquired UTIs (NAUTIs) at a tertiary hospital in China. METHODS Retrospective analysis of uropathogens from UTI patients was performed at Zhong Da Hospital. RESULTS A total of 1129 strains was isolated from 653 community-acquired and 476 nosocomial-acquired infections. Escherichia coli was the most common uropathogen, accounting for 55.9% of the CAUTIs and 27.1% of the NAUTIs. Among the CAUTIs, Escherichia coli was followed in prevalence by Enterococcus spp (12.9%) and Proteus mirabilis (3.7%). Among the NAUTIs, Escherichia coli was followed by Enterococcus spp (15.3%) and Klebsiella pneumoniae (6.9%). The proportion of fungi in the NAUTIs (23.7%) was higher than that in the CAUTIs (3.1%) (P < .05). Extended-spectrum β-lactamase-producing strains of E coli accounted for 70.6% of the NAUTIs and 47.3% of the CAUTIs. Carbapenems, amikacin, and nitrofurantoin were active agents against E coli. The resistance rates of E coli to cephalosporins, ampicillin, ampicillin/sulbactam, quinolones, and gentamicin were higher in the NAUTIs than in the CAUTIs (P < .05). CONCLUSION The distribution of species was different between CAUTIs and NAUTIs. Higher antibiotic resistance rates were observed in the NAUTIs than in the CAUTIs.
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Evaluation of antimicrobial susceptibility of Enterobacteriaceae causing urinary tract infections in Africa. Antimicrob Agents Chemother 2013; 57:3628-39. [PMID: 23689709 DOI: 10.1128/aac.00359-13] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Our objective was to evaluate the antimicrobial susceptibility of Enterobacteriaceae causing urinary tract infections (UTIs) in adults in Africa. The PubMed database was systematically searched to identify relevant studies published after 2000. Google, World Health Organization, and African Field Epidemiology networks were also searched. Twenty-eight studies, accounting for 381,899 urine isolates from 14 African countries, met the inclusion criteria. Escherichia coli, Klebsiella spp., and Proteus spp. were the most commonly encountered uropathogens. Cefotaxime, imipenem, fosfomycin, and ciprofloxacin were the antibiotics with the highest activity against E. coli isolates from outpatients, with susceptibility being 92 to 99, 100, 100, and 68 to 91%, respectively. The susceptibility among Klebsiella spp. isolates from outpatients varied from 80 to 100% for amikacin and from 53 to 100% for ciprofloxacin, while susceptibility was 74 to 78, 97, and 77% for ciprofloxacin, amikacin, and fosfomycin, respectively, among Klebsiella species isolates from inpatients or patients with hospital-acquired UTIs. With regard to Proteus spp., the highest activity was observed among fluoroquinolones; 71 to 100% of the P. mirabilis isolates were susceptible to ciprofloxacin in four studies, and 74 to 100% of the P. vulgaris isolates were susceptible to ofloxacin in two studies. The currently available evidence suggests that the antimicrobial susceptibility patterns of Enterobacteriaceae uropathogens in African countries were similar to those in countries of southeast Europe. Further original studies are warranted from African countries for which there is limited published data.
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Sasirekha B. Prevalence of ESBL, AmpC β-lactamases and MRSA among uropathogens and its antibiogram. EXCLI JOURNAL 2013; 12:81-8. [PMID: 26417218 PMCID: PMC4531790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 01/29/2013] [Indexed: 11/03/2022]
Abstract
Urinary tract infections (UTIs) are one of the most common bacterial infections in humans. Current knowledge on antimicrobial susceptibility pattern is essential for appropriate therapy. Therefore the aim of the present study was to determine the distribution and antibiotic susceptibility pattern of bacterial strains, with special reference to ESBL, AmpC β-lactamase and MRSA production. A total of 325 clinical isolates were collected from UTI patients from various tertiary care hospitals over a period of 6 months (June 2011 to December 2011). The antimicrobial susceptibility to various drugs was studied by the disc diffusion method as guided by CLSI guidelines. Confirmation of the extended spectrum β-lactamase (ESBL), AmpC β-lactamase and methicillin resistant Staphylococcus aureus (MRSA) production was done by an E-test respectively. Of the 325 isolates, 225 were characterized as gram negative and 77 isolates as S. aureus isolates. The majority (69.3 %) of the isolates were from females compared to males (30.7 %). Prevalence of ESBL and AmpC β-lactamase and the coexistence of the phenotype (ESBL+ AmpC β-lactamase) and MRSA in the urinary isolates were found to be 48.9 %, 20.4 %, 6.2 % and 27.5 % respectively. Ampicillin/sulbactam, norfloxacin should be no longer considered as first line of drugs for UTI, because of high resistance. Parentral drugs such as aminoglycosides, carbapenems and piperacillin/tazobactum can be the alternative choice for complicated UTI. Also, control measures such as judicious use of antibiotics, formulation of infection committee may control the spread of resistance.
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Affiliation(s)
- B Sasirekha
- Department of Microbiology, Center for Post Graduate Studies, Jain University, Bangalore, Karnataka- 560 011, India,*To whom correspondence should be addressed: B Sasirekha, Department of Microbiology, Center for Post Graduate Studies, Jain University, Bangalore, Karnataka- 560 011, India, Phone: +91 080 43226500, E-mail:
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