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Arowolo MT, Orababa OQ, Olaitan MO, Osibeluwo BV, Essiet UU, Batholomew OH, Ogunrinde OG, Lagoke OA, Soriwei JD, Ishola OD, Ezeani OM, Onishile AO, Olumodeji E. Prevalence of carbapenem resistance in Acinetobacter baumannii and Pseudomonas aeruginosa in sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2023; 18:e0287762. [PMID: 38015906 PMCID: PMC10684001 DOI: 10.1371/journal.pone.0287762] [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: 10/04/2022] [Accepted: 06/13/2023] [Indexed: 11/30/2023] Open
Abstract
Carbapenems are effective drugs against bacterial pathogens and resistance to them is considered a great public health threat, especially in notorious nosocomial pathogens like Acinetobacter baumannii and Pseudomonas aeruginosa. In this study, we aimed to determine the prevalence of carbapenem resistance in A. baumannii and P. aeruginosa infections in Sub-Saharan Africa. Databases (PubMed, Scopus, Web of Science, and African Journal Online) were systematically searched following the Preferred Reporting Items for Systematic review and meta-analysis protocols (PRISMA-P) 2020 statements for articles reporting carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) prevalence between 2012 and 2022. Pooled prevalence was determined with the random effect model and funnel plots were used to determine heterogeneity in R. A total of 47 articles were scanned for eligibility, among which 25 (14 for carbapenem-resistant A. baumannii and 11 for carbapenem-resistant P. aeruginosa) were included in the study after fulfilling the eligibility criteria. The pooled prevalence of CRPA in the present study was estimated at 8% (95% CI; 0.02-0.17; I2 = 98%; P <0.01). There was high heterogeneity (Q = 591.71, I2 = 98.9%; P<0.0001). In addition, this study's pooled prevalence of CRAB was estimated at 20% (95% CI; 0.04-0.43; I2 = 99%; P <0.01). There was high heterogeneity (Q = 1452.57, I2 = 99%; P<0.0001). Also, a funnel plot analysis of the studies showed high degree of heterogeneity. The carbapenemase genes commonly isolated from A. baumannii in this study include blaOXA23, blaOXA48, blaGES., blaNDM, blaVIM, blaOXA24, blaOXA58, blaOXA51, blaSIM-1, blaOXA40, blaOXA66, blaOXA69, blaOXA91, with blaOXA23 and blaVIM being the most common. On the other hand, blaNDM, blaVIM, blaIMP, blaOXA48, blaOXA51, blaSIM-1, blaOXA181, blaKPC, blaOXA23, blaOXA50 were the commonly isolated carbapenemase genes in P. aeruginosa, among which blaVIM and blaNDM genes were the most frequently isolated. Surveillance of drug-resistant pathogens in Sub-Saharan Africa is essential in reducing the region's disease burden. This study has shown that the region has significantly high multidrug-resistant pathogen prevalence. This is a wake-up call for policymakers to put in place measures to reduce the spread of these critical priority pathogens.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jeffrey Difiye Soriwei
- Department of Public Health in Microbiology, University of Bedfordshire, Luton, United Kingdom
| | | | | | - Aminat Oyeronke Onishile
- Faculty of Health Studies, School of Nursing and Healthcare Leadership, University of Bradford, West Yorkshire, England, United Kingdom
| | - Elizabeth Olumodeji
- Department of Biology, Texas Women University, Denton, TX, United States of America
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Kainga H, Phonera MC, Chikowe I, Chatanga E, Nyirongo H, Luwe M, Mponela J, Kachisi V, Kamanga N, Chulu J, Njunga G, Nabadda D, Fonchin A, Kallu SA, Mudenda S, Tembo R, Zulu M, Mwaba F, Mbewe N, Mpundu P, Samutela MT, Munyeme M, Muma JB, Simulundu E. Determinants of Knowledge, Attitude, and Practices of Veterinary Drug Dispensers toward Antimicrobial Use and Resistance in Main Cities of Malawi: A Concern on Antibiotic Stewardship. Antibiotics (Basel) 2023; 12:antibiotics12010149. [PMID: 36671349 PMCID: PMC9855151 DOI: 10.3390/antibiotics12010149] [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: 11/28/2022] [Revised: 12/29/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
Antimicrobial resistance (AMR) is an emerging challenge to global public health. The use of antibiotics in the veterinary field is one of the contributing factors to AMR mostly due to poor knowledge, attitudes, and practices (KAP) of dispensers. Veterinary drug dispensers are expected to guide clients on indications, contraindications, and withdrawal periods of veterinary drugs. This study assessed veterinary drug dispensers' KAP toward AMR and associated potential contributing factors. A cross-sectional study, using a structured questionnaire, was conducted in three main cities of Malawi, namely Mzuzu, Lilongwe, and Blantyre. A total of 68 agrovet shops were selected using a simple random sampling technique. The KAP level was presented descriptively. Bivariate and multivariable analyses were run to investigate the relationships between the independent and outcome variable. Overall, the KAP score for knowledge, attitude, and practices was 46.7%, 49.2%, and 41.6%, respectively. The significant determinants of the knowledge were the practice of asking for a written prescription (OR: 16.291, 95% CI: 11.6-24.2) (p = 0.024), female (OR: 0.609, 95% CI: 0.3-0.9) (p = 0.001), and old age (≥35) (OR: 0.227, 95% CI: 0.1-0.5) (p = 0.04). Poor knowledge, negative attitude, and poor practices were observed among most of the participants. Sensitization and training on AMR and antimicrobial stewardship are recommended to address the KAP score gaps and the observed determinants among veterinary drug dispensers.
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Affiliation(s)
- Henson Kainga
- Department of Veterinary Epidemiology and Public Health, Faculty of Veterinary Medicine, Lilongwe University of Agriculture and Natural Resources, Lilongwe 207203, Malawi
- Correspondence: or ; Tel.: +265-996-618-212
| | - Marvin Collen Phonera
- Department of Animal Health and Livestock Development, Ministry of Agriculture, Lilongwe 207203, Malawi
| | - Ibrahim Chikowe
- Pharmacy Department, Kamuzu University of Health Sciences (KUHES), Blantyre P.O. Box 360, Malawi
| | - Elisha Chatanga
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine, Lilongwe University of Agriculture and Natural Resources, Lilongwe 207203, Malawi
| | - Hlupikire Nyirongo
- Department of Veterinary Epidemiology and Public Health, Faculty of Veterinary Medicine, Lilongwe University of Agriculture and Natural Resources, Lilongwe 207203, Malawi
| | - Mike Luwe
- Department of Animal Health and Livestock Development, Ministry of Agriculture, Lilongwe 207203, Malawi
| | - James Mponela
- Department of Animal Health and Livestock Development, Ministry of Agriculture, Lilongwe 207203, Malawi
| | | | - Nathani Kamanga
- Department of Animal Health and Livestock Development, Ministry of Agriculture, Lilongwe 207203, Malawi
| | - Julius Chulu
- Department of Animal Health and Livestock Development, Ministry of Agriculture, Lilongwe 207203, Malawi
| | - Gilson Njunga
- Department of Animal Health and Livestock Development, Ministry of Agriculture, Lilongwe 207203, Malawi
| | - Daisy Nabadda
- Department of Biosecurity, Ecosystems and Public Health, College of Veterinary Medicine, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Alyce Fonchin
- Community Initiative for Sustainable Development, Manko-Bamenda P.O. Box 356, Cameroon
| | - Simegnew Adugna Kallu
- College of Veterinary Medicine, Haramaya University, Dire Dawa P.O. Box 138, Ethiopia
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Rabecca Tembo
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Mildred Zulu
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Florence Mwaba
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Natalia Mbewe
- Department of Basic and Clinical Nursing Sciences, School of Nursing Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Prudence Mpundu
- Department of Environmental and Occupational Health, Levy Mwanawasa Medical University, Lusaka P.O. Box 33991, Zambia
| | - Mulemba Tillika Samutela
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka P.O. Box 10101, Zambia
| | - Musso Munyeme
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 10101, Zambia
| | - John Bwalya Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 10101, Zambia
| | - Edgar Simulundu
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 10101, Zambia
- Macha Research Trust, Choma P.O. Box 20100, Zambia
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Molecular Epidemiological Characterisation of ESBL- and Plasmid-Mediated AmpC-Producing Escherichia coli and Klebsiella pneumoniae at Kamuzu Central Hospital, Lilongwe, Malawi. Trop Med Infect Dis 2022; 7:tropicalmed7090245. [PMID: 36136656 PMCID: PMC9501462 DOI: 10.3390/tropicalmed7090245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
The global rise in infections caused by multidrug resistant (MDR) Enterobacterales poses a public health problem. We have performed a molecular epidemiological characterisation of representative plasmid-mediated AmpC (pAmpC) and ESBL-positive clinical isolates of Escherichia coli (n = 38) and Klebsiella pneumoniae (n = 17) from a tertiary hospital in Malawi collected in 2017. BlaCTX-M-15 was the most prevalent ESBL-determinant in E. coli (n = 30/38) and K. pneumoniae (n = 17/17), whereas blaCMY-2 was detected in nearly all AmpC-phenotype E. coli (n = 15/17). Whole genome sequencing revealed dominant globally disseminated E. coli sequence types (STs); ST410 (n = 16), ST131 (n = 7), and ST617 (n = 6). The ST distribution in K. pneumoniae was more diverse but included ST101 (n = 2), ST14 (n = 2), and ST340 (n = 2), all considered high-risk MDR clones. The isolates expressed an MDR profile, including resistance against commonly used antibiotics, such as fluoroquinolones, aminoglycosides, and/or trimethoprim-sulfamethoxazole, and harboured corresponding resistance determinants. Clonal analyses of the major STs of E. coli revealed closely related genetic clusters within ST410, ST131, and ST617 supporting within-hospital transmission between patients and/or via a common reservoir. The overall findings add to the limited knowledge on the molecular epidemiology of MDR E. coli and K. pneumoniae in Malawi and may help health policy makers to identify areas to target when addressing this major threat of antibiotic resistance.
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