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Cai S, Wang Z, Han X, Hu H, Quan J, Jiang Y, Du X, Zhou Z, Yu Y. The correlation between intestinal colonization and infection of carbapenem-resistant Klebsiella pneumoniae: A systematic review. J Glob Antimicrob Resist 2024; 38:187-193. [PMID: 38777180 DOI: 10.1016/j.jgar.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 04/24/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
As a widely spread Gram-negative bacteria, Klebsiella pneumoniae (KP) mainly causes acquired infections in hospitals, such as lung infections, urinary tract infections, and bloodstream infections. In recent years, the number of multidrug-resistant KP strains has increased dramatically, posing a great threat to human health. Carbapenem-resistant KP (CRKP) can be colonized in human body, especially in gastrointestinal tract, and some colonized patients can be infected during hospitalization, among which invasive operation, underlying disease, admission to intensive care unit, antibiotic use, severity of the primary disease, advanced age, operation, coma, and renal failure are common risk factors for secondary infection. Active screening and preventive measures can effectively prevent the occurrence of CRKP infection. Based on the epidemiological status, this study aims to discuss the correlation between colonization and secondary infection induced by CRKP and risk factors for their happening and provide some reference for nosocomial infection prevention and control.
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Affiliation(s)
- Shiqi Cai
- Department of Infectious Diseases, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhengan Wang
- Department of Infectious Diseases, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinhong Han
- Department of Infectious Diseases, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huangdu Hu
- Department of Infectious Diseases, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingjing Quan
- Department of Infectious Diseases, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Jiang
- Department of Infectious Diseases, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoxing Du
- Department of Infectious Diseases, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhihui Zhou
- Department of Infectious Diseases, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Rwigi D, Nyerere AK, Diakhate MM, Kariuki K, Tickell KD, Mutuma T, Tornberg SN, Soge OO, Walson JL, Singa B, Kariuki S, Pavlinac PB, Mogeni P. Phenotypic and molecular characterization of β-lactamase-producing Klebsiella species among children discharged from hospital in Western Kenya. BMC Microbiol 2024; 24:135. [PMID: 38654237 PMCID: PMC11040804 DOI: 10.1186/s12866-024-03284-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/31/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The emergence and spread of β-lactamase-producing Klebsiella spp. has been associated with a substantial healthcare burden resulting in therapeutic failures. We sought to describe the proportion of phenotypic resistance to commonly used antibiotics, characterize β-lactamase genes among isolates with antimicrobial resistance (AMR), and assess the correlates of phenotypic AMR in Klebsiella spp. isolated from stool or rectal swab samples collected from children being discharged from hospital. METHODS We conducted a cross-sectional study involving 245 children aged 1-59 months who were being discharged from hospitals in western Kenya between June 2016 and November 2019. Whole stool or rectal swab samples were collected and Klebsiella spp. isolated by standard microbiological culture. β-lactamase genes were detected by PCR whilst phenotypic antimicrobial susceptibility was determined using the disc diffusion technique following standard microbiology protocols. Descriptive analyses were used to characterize phenotypic AMR and carriage of β-lactamase-producing genes. The modified Poisson regression models were used to assess correlates of phenotypic beta-lactam resistance. RESULTS The prevalence of β-lactamase carriage among Klebsiella spp. isolates at hospital discharge was 62.9% (154/245). Antibiotic use during hospitalization (adjusted prevalence ratio [aPR] = 4.51; 95%CI: 1.79-11.4, p < 0.001), longer duration of hospitalization (aPR = 1.42; 95%CI: 1.14-1.77, p < 0.002), and access to treated water (aPR = 1.38; 95%CI: 1.12-1.71, p < 0.003), were significant predictors of phenotypically determined β-lactamase. All the 154 β-lactamase-producing Klebsiella spp. isolates had at least one genetic marker of β-lactam/third-generation cephalosporin resistance. The most prevalent genes were blaCTX-M 142/154 (92.2%,) and blaSHV 142/154 (92.2%,) followed by blaTEM 88/154 (57.1%,) and blaOXA 48/154 (31.2%,) respectively. CONCLUSION Carriage of β-lactamase producing Klebsiella spp. in stool is common among children discharged from hospital in western Kenya and is associated with longer duration of hospitalization, antibiotic use, and access to treated water. The findings emphasize the need for continued monitoring of antimicrobial susceptibility patterns to inform the development and implementation of appropriate treatment guidelines. In addition, we recommend measures beyond antimicrobial stewardship and infection control within hospitals, improved sanitation, and access to safe drinking water to mitigate the spread of β-lactamase-producing Klebsiella pathogens in these and similar settings.
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Affiliation(s)
- Doreen Rwigi
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
- Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
| | - Andrew K Nyerere
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Mame M Diakhate
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Kevin Kariuki
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Kirkby D Tickell
- Department of Global Health, University of Washington, Seattle, Washington, USA
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Timothy Mutuma
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Olusegun O Soge
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Judd L Walson
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Benson Singa
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Samuel Kariuki
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Patricia B Pavlinac
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Polycarp Mogeni
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
- Department of Global Health, University of Washington, Seattle, Washington, USA.
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Blaikie JM, Sapula SA, Siderius NL, Hart BJ, Amsalu A, Leong LE, Warner MS, Venter H. Resistome Analysis of Klebsiella pneumoniae Complex from Residential Aged Care Facilities Demonstrates Intra-facility Clonal Spread of Multidrug-Resistant Isolates. Microorganisms 2024; 12:751. [PMID: 38674695 PMCID: PMC11051875 DOI: 10.3390/microorganisms12040751] [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: 12/22/2023] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Antimicrobial-resistant Klebsiella pneumoniae is one of the predominant pathogens in healthcare settings. However, the prevalence and resistome of this organism within residential aged care facilities (RACFs), which are potential hotspots for antimicrobial resistance, remain unexplored. Here, we provide a phenotypic and molecular characterization of antimicrobial-resistant K. pneumoniae isolated from RACFs. K. pneumoniae was isolated from urine, faecal and wastewater samples and facility swabs. The antimicrobial susceptibility profiles of all the isolates were determined and the genomic basis for resistance was explored with whole-genome sequencing on a subset of isolates. A total of 147 K. pneumoniae were isolated, displaying resistance against multiple antimicrobials. Genotypic analysis revealed the presence of beta-lactamases and the ciprofloxacin-resistance determinant QnrB4 but failed to confirm the basis for the observed cephalosporin resistance. Clonal spread of the multidrug-resistant, widely disseminated sequence types 323 and 661 was observed. This study was the first to examine the resistome of K. pneumoniae isolates from RACFs and demonstrated a complexity between genotypic and phenotypic antimicrobial resistance. The intra-facility dissemination and persistence of multidrug-resistant clones is concerning, given that residents are particularly vulnerable to antimicrobial resistant infections, and it highlights the need for continued surveillance and interventions to reduce the risk of outbreaks.
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Affiliation(s)
- Jack M. Blaikie
- UniSA Clinical and Health Sciences, Health and Biomedical Innovation, University of South Australia, Adelaide, SA 5000, Australia; (J.M.B.); (S.A.S.); (N.L.S.); (B.J.H.); (A.A.); (L.E.X.L.)
| | - Sylvia A. Sapula
- UniSA Clinical and Health Sciences, Health and Biomedical Innovation, University of South Australia, Adelaide, SA 5000, Australia; (J.M.B.); (S.A.S.); (N.L.S.); (B.J.H.); (A.A.); (L.E.X.L.)
| | - Naomi L. Siderius
- UniSA Clinical and Health Sciences, Health and Biomedical Innovation, University of South Australia, Adelaide, SA 5000, Australia; (J.M.B.); (S.A.S.); (N.L.S.); (B.J.H.); (A.A.); (L.E.X.L.)
| | - Bradley J. Hart
- UniSA Clinical and Health Sciences, Health and Biomedical Innovation, University of South Australia, Adelaide, SA 5000, Australia; (J.M.B.); (S.A.S.); (N.L.S.); (B.J.H.); (A.A.); (L.E.X.L.)
| | - Anteneh Amsalu
- UniSA Clinical and Health Sciences, Health and Biomedical Innovation, University of South Australia, Adelaide, SA 5000, Australia; (J.M.B.); (S.A.S.); (N.L.S.); (B.J.H.); (A.A.); (L.E.X.L.)
- Department of Medical Microbiology, University of Gondar, Gondar 196, Ethiopia
| | - Lex E.X. Leong
- UniSA Clinical and Health Sciences, Health and Biomedical Innovation, University of South Australia, Adelaide, SA 5000, Australia; (J.M.B.); (S.A.S.); (N.L.S.); (B.J.H.); (A.A.); (L.E.X.L.)
- Microbiology and Infectious Diseases, SA Pathology, Adelaide, SA 5000, Australia;
| | - Morgyn S. Warner
- Microbiology and Infectious Diseases, SA Pathology, Adelaide, SA 5000, Australia;
- School of Medicine, University of Adelaide, Adelaide, SA 5000, Australia
- Infectious Diseases Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Henrietta Venter
- UniSA Clinical and Health Sciences, Health and Biomedical Innovation, University of South Australia, Adelaide, SA 5000, Australia; (J.M.B.); (S.A.S.); (N.L.S.); (B.J.H.); (A.A.); (L.E.X.L.)
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Ruef M, Emonet S, Merglen A, Dewez JE, Obama BM, Catho G, Andrey DO, Kowalski M, Harbarth S, Combescure C, Wagner N, Galetto-Lacour A. Carriage of third-generation cephalosporin-resistant and carbapenem-resistant Enterobacterales among children in sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine 2024; 70:102508. [PMID: 38500839 PMCID: PMC10945212 DOI: 10.1016/j.eclinm.2024.102508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/09/2024] [Accepted: 02/16/2024] [Indexed: 03/20/2024] Open
Abstract
Background The increasing resistance of Enterobacterales to third-generation cephalosporins and carbapenems in sub-Saharan Africa (SSA) is a major public health concern. We did a systematic review and meta-analysis of studies to estimate the carriage prevalence of Enterobacterales not susceptible to third-generation cephalosporins or carbapenems among paediatric populations in SSA. Methods We performed a systematic literature review and meta-analysis of cross-sectional and cohort studies to estimate the prevalence of childhood (0-18 years old) carriage of extended-spectrum cephalosporin-resistant Enterobacterales (ESCR-E) or carbapenem-resistant Enterobacterales (CRE) in SSA. Medline, EMBASE and the Cochrane Library were searched for studies published from 1 January 2005 to 1 June 2022. Studies with <10 occurrences per bacteria, case reports, and meta-analyses were excluded. Quality and risk of bias were assessed using the Newcastle-Ottawa scale. Meta-analyses of prevalences and odds ratios were calculated using generalised linear mixed-effects models. Heterogeneity was assessed using I2 statistics. The protocol is available on PROSPERO (CRD42021260157). Findings Of 1111 studies examined, 40 met our inclusion criteria, reporting on the carriage prevalence of Enterobacterales in 9408 children. The pooled carriage prevalence of ESCR-E was 32.2% (95% CI: 25.2%-40.2%). Between-study heterogeneity was high (I2 = 96%). The main sources of bias pertained to participant selection and the heterogeneity of the microbiological specimens. Carriage proportions were higher among sick children than healthy ones (35.7% vs 16.9%). The pooled proportion of nosocomial acquisition was 53.8% (95% CI: 32.1%-74.1%) among the 922 children without ESCR-E carriage at hospital admission. The pooled odds ratio of ESCR-E carriage after antibiotic treatment within the previous 3 months was 3.20 (95% CI: 2.10-4.88). The proportion of pooled carbapenem-resistant for Enterobacterales was 3.6% (95% CI: 0.7%-16.4%). Interpretation This study suggests that ESCR-E carriage among children in SSA is frequent. Microbiology capacity and infection control must be scaled-up to reduce the spread of those multidrug-resistant microorganisms. Funding There was no funding source for this study.
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Affiliation(s)
- Micaela Ruef
- Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephane Emonet
- Division of Infectious Diseases, Hospital of Valais, Sion, and Faculty of Medicine, Geneva, Switzerland
| | - Arnaud Merglen
- Division of General Paediatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Juan Emmanuel Dewez
- Medical Department, Médecins Sans Frontières, Operational Centre Geneva, Geneva, Switzerland
| | - Basilice Minka Obama
- Paediatric Infectious Diseases Unit, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Regional Hospital Centre for Ebolowa, Cameroon
| | - Gaud Catho
- Infectious Diseases Division, Central Institute, Hospital of Valais, Switzerland
- Infection Control Division, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Diego O. Andrey
- Division of Infectious Diseases, Department of Medicine and Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Morgane Kowalski
- Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Programme and World Health Organization Collaborating Centre on Infection Prevention and Control and Antimicrobial Resistance, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Christophe Combescure
- Centre for Clinical Research, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Noémie Wagner
- Medical Department, Médecins Sans Frontières, Operational Centre Geneva, Geneva, Switzerland
- Paediatric Infectious Diseases Unit, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Annick Galetto-Lacour
- Division of Paediatric Emergency Medicine, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Schotte U, Ehlers J, Nieter J, Rakotozandrindrainy R, Wolf SA, Semmler T, Frickmann H, Poppert S, Ewers C. ESBL-Type and AmpC-Type Beta-Lactamases in Third Generation Cephalosporin-Resistant Enterobacterales Isolated from Animal Feces in Madagascar. Animals (Basel) 2024; 14:741. [PMID: 38473126 DOI: 10.3390/ani14050741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 03/14/2024] Open
Abstract
Third generation cephalosporin-resistant (3GCR) Enterobacterales are known to be prevalent in Madagascar, with high colonization or infection rates in particular in Madagascan patients. Extended spectrum beta-lactamases (ESBLs) have been reported to be the predominant underlying resistance mechanism in human isolates. So far, little is known on antimicrobial resistance and its molecular determinants in Enterobacterales and other bacteria causing enteric colonization of Madagascan wild animals. To address this topic, swabs from 49 animal stool droppings were collected in the Madagascan Tsimanapesotsa National Park and assessed by cultural growth of bacterial microorganisms on elective media. In addition to 7 Acinetobacter spp., a total of 31 Enterobacterales growing on elective agar for Enterobacterales could be isolated and subjected to whole genome sequencing. Enterobacter spp. was the most frequently isolated genus, and AmpC-type beta-lactamases were the quantitatively dominating molecular resistance mechanism. In contrast, the blaCTX-M-15 gene, which has repeatedly been associated with 3GC-resistance in Madagascan Enterobacterales from humans, was detected in a single Escherichia coli isolate only. The identification of the fosfomycin-resistance gene fosA in a high proportion of isolates is concerning, as fosfomycin is increasingly used to treat infections caused by multidrug-resistant bacteria. In conclusion, the proof-of-principle assessment indicated a high colonization rate of resistant bacteria in stool droppings of Madagascan wild animals with a particular focus on 3GCR Enterobacterales. Future studies should confirm these preliminary results in a more systematic way and assess the molecular relationship of animal and human isolates to identify potential routes of transmission.
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Affiliation(s)
- Ulrich Schotte
- Department A-Veterinary Medicine, Central Institute of the Bundeswehr Medical Service Kiel, 24119 Kronshagen, Germany
| | - Julian Ehlers
- Bernhard Nocht Institute for Tropical Medicine Hamburg, 20359 Hamburg, Germany
| | - Johanna Nieter
- Department A-Veterinary Medicine, Central Institute of the Bundeswehr Medical Service Kiel, 24119 Kronshagen, Germany
| | | | - Silver A Wolf
- Genome Competence Centre, Robert Koch Institute, 13353 Berlin, Germany
| | - Torsten Semmler
- Genome Competence Centre, Robert Koch Institute, 13353 Berlin, Germany
| | - Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany
| | - Sven Poppert
- Bernhard Nocht Institute for Tropical Medicine Hamburg, 20359 Hamburg, Germany
| | - Christa Ewers
- Institute for Hygiene and Infectious Diseases of Animals, University of Giessen, 35392 Giessen, Germany
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Abera D, Alemu A, Mihret A, Negash AA, Abegaz WE, Cadwell K. Colonization with extended spectrum beta-lactamase and carbapenemases producing Enterobacteriaceae among hospitalized patients at the global level: A systematic review and meta-analysis. PLoS One 2023; 18:e0293528. [PMID: 38011148 PMCID: PMC10681255 DOI: 10.1371/journal.pone.0293528] [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: 02/04/2023] [Accepted: 10/11/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Gut commensal bacteria can mediate resistance against pathogenic bacteria. However, exposure to antibiotics and hospitalization may facilitate the emergence of multidrug resistant bacteria. We aimed to conduct a systematic review and meta-analysis to provide comprehensive evidence about colonization rate of extended spectrum beta-lactamase and carbapenemases producing Enterobacteriaceae. METHOD We used PubMed, Google Scholar and Web of Science data bases to search studies from January 1, 2016 to August10, 2022 about colonization rate of extended spectrum beta-lactamase and carbapenemase producing Enterobacteriaceae. Data were extracted from eligible studies and analyzed using Stata version 16 software. The quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal tools, and publication bias was assessed using funnel plot and eggers test. RESULTS We identified 342 studies from the comprehensive data search and data were extracted from 20 studies. The pooled estimate of extended spectrum beta-lactamase and carbapenemase producing Enterobacteriaceae were 45.6%(95%CI: 34.11-57-10) and 16.19% (95% CI: 5.46-26.91) respectively. The predominant extended spectrum beta-lactamase producers were E. coli,32.99% (95% CI: 23.28-42.69) and K. pneumoniae, 11.43% (95% CI:7.98-14.89). Prolonged hospitalization was linked to carbapenemase producing Enterobacteriaceae colonization with the odds of 14.77 (95% CI: -1.35-30.90) at admission and 45.63 (95% CI: 0.86-92.12) after ≥7 days of admission. CONCLUSION The pooled estimate of extended spectrum beta-lactamase and carbapenemase producing Enterobacteriaceae were high. This indicates the need for strong mitigation strategies to minimize the spread of multidrug-resistant bacteria at the healthcare facilities.
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Affiliation(s)
- Dessie Abera
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ayinalem Alemu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopoia
| | - Adane Mihret
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Abel Abera Negash
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Woldaregay Erku Abegaz
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ken Cadwell
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, United States of America
- Department of Medicine, Division of Gastroenterology and Hepatology, New York University Langone Health, New York, NY, United States of America
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Temsegen W, Gorems K, Mekonnen M, Fufa D, Kassa T. Fecal Carriage of Extended-Spectrum β-Lactamase and Carbapenemase-Producing Enterobacteriaceae Among Oncology and Non-Oncology Patients at Jimma Medical Center in Ethiopia: A Comparative Cross-Sectional Study. Cancer Manag Res 2023; 15:1217-1231. [PMID: 37933318 PMCID: PMC10625765 DOI: 10.2147/cmar.s422376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023] Open
Abstract
Purpose Extended-spectrum β-lactamase (ESBL) and carbapenemase-producing Enterobacteriaceae (CPE) are among the major threats to global health because of their encoded protection against key antibiotics. Methods A comparative cross-sectional study was conducted among oncology and non-oncology patient groups (1:1; n = 214) on a consecutive sampling approach. Stool or rectal swab was collected from June 2021 to November 2021 and screened for ESBL-PE and CPE using ChromID-ESBL media. Confirmation for the enzymes was made by using combination disc and modified carbapenem inactivation methods, respectively. Disk diffusion method was used to determine antimicrobial susceptibility testing following the recommendations of CLSI 2022. SPSS software version 23 was used for data analysis. Results Fecal carriage prevalence of ESBL-PE was found in 90 (84.1%) of oncology participants and in 77 (71.9%) of non-oncology patients (p = 0.032). Escherichia coli was the most common ESBL-PE isolate in 82 (62.5%) and 68 (88.3%) of oncology and non-oncology patients, followed by Klebsiella oxytoca [15 (11.5%) versus 6 (7.8%)], respectively. Out of the total ESBL-PE isolates from both oncology and non-oncology patient groups, the maximum level of resistance was observed against ciprofloxacin 177 (86.3%), trimethoprim-sulfamethoxazole 103 (80.3%), tetracycline 97 (75.8%), whereas enhanced susceptibility was appreciated to tigecycline 200 (97.6%), meropenem 162 (79.0%), and ertapenem 145 (70.7%) with no significant difference between oncology and non-oncology group. Carbapenemase-producing isolates from oncology patients were 12 (11.2%), whereas it was 4 (3.7%) (p = 0.611) from non-oncology group. Bacterial isolates from oncology in this study showed a trend of multiple drug resistance of 113 (88.3%). Conclusion The results revealed alarmingly high carriage rates of ESBL and CPE among all study participants. Moreover, the isolates showed increased resistance rates to alternative drugs and had multiple antibiotic-resistant patterns. Hence, it is important to emphasize strict adherence to antimicrobial stewardship program as well as infection prevention and control practices.
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Affiliation(s)
- Wubalech Temsegen
- School of Medical Laboratory Science, Faculty of Health Sciences, Jimma University, Jimma, Ethiopia
- Microbiology Diagnostic Laboratory Unit of Jimma Medical Center, Jimma, Ethiopia
| | - Kasahun Gorems
- Microbiology Diagnostic Laboratory Unit of Jimma Medical Center, Jimma, Ethiopia
- Department of Microbiology, Immunology and Parsitology, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mekidim Mekonnen
- School of Medical Laboratory Science, Faculty of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Diriba Fufa
- Department of Pediatrics & Child Health, School of Medicine, Jimma University, Jimma, Ethiopia
| | - Tesfaye Kassa
- School of Medical Laboratory Science, Faculty of Health Sciences, Jimma University, Jimma, Ethiopia
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Bah SY, Kujabi MA, Darboe S, Kebbeh N, Kebbeh BFK, Kanteh A, Bojang R, Lawn JE, Kampmann B, Sesay AK, de Silva TI, Brotherton H. Acquisition and carriage of genetically diverse multi-drug resistant gram-negative bacilli in hospitalised newborns in The Gambia. COMMUNICATIONS MEDICINE 2023; 3:79. [PMID: 37270610 PMCID: PMC10239441 DOI: 10.1038/s43856-023-00309-6] [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: 12/05/2022] [Accepted: 05/25/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND This detailed genomic study characterised multi-drug resistant-Gram negative bacilli (MDR-GNB) carriage in neonates < 2 kg and paired mothers at a low-resource African hospital. METHODS This cross-sectional cohort study was conducted at the neonatal referral unit in The Gambia with weekly neonatal skin and peri-anal sampling and paired maternal recto-vaginal swabs. Prospective bacteriological culture used MacConkey agar with species identification by API20E and API20NE. All GNB isolates underwent whole genome sequencing on Illumina Miseq platform. Multi-Locus Sequence Typing and SNP-distance analysis identified strain type and relatedness. RESULTS 135 swabs from 34 neonates and 21 paired mothers, yielded 137 GNB isolates, of which 112 are high quality de novo assemblies. Neonatal MDR-GNB carriage prevalence is 41% (14/34) at admission with 85% (11/13) new acquisition by 7d. Multiple MDR and ESBL-GNB species are carried at different timepoints, most frequently K. pneumoniae and E. coli, with heterogeneous strain diversity and no evidence of clonality. 111 distinct antibiotic resistance genes are mostly beta lactamases (Bla-AMPH, Bla-PBP, CTX-M-15, Bla-TEM-105). 76% (16/21) and 62% (13/21) of mothers have recto-vaginal carriage of ≥1 MDR-GNB and ESBL-GNB respectively, mostly MDR-E. coli (76%, 16/21) and MDR-K. pneumoniae (24%, 5/21). Of 21 newborn-mother dyads, only one have genetically identical isolates (E. coli ST131 and K. pneumoniae ST3476). CONCLUSIONS Gambian hospitalised neonates exhibit high MDR and ESBL-GNB carriage prevalence with acquisition between birth and 7d with limited evidence supporting mother to neonate transmission. Genomic studies in similar settings are required to further understand transmission and inform targeted surveillance and infection prevention policies.
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Affiliation(s)
- Saikou Y Bah
- The Florey Institute of Host-Pathogen Interactions, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Mariama A Kujabi
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Saffiatou Darboe
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Ngange Kebbeh
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Bunja F K Kebbeh
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Abdoulie Kanteh
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | | | - Joy E Lawn
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health London School of Hygiene & Tropical Medicine, London, UK
| | - Beate Kampmann
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
- Department of Clinical Research, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Institut fur Internationale Gesundheit and Centre for Global Health, Charite Universitatsmedizin, Berlin, Germany
| | - Abdul K Sesay
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Thushan I de Silva
- The Florey Institute of Host-Pathogen Interactions, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia
| | - Helen Brotherton
- MRC Unit, The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia.
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health London School of Hygiene & Tropical Medicine, London, UK.
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Harbaoui S, Ferjani S, Abbassi M, Saidani M, Gargueh T, Ferjani M, Hammi Y, Boutiba‐Ben Boubaker I. Genetic heterogeneity and predominance of
bla
CTX‐M
‐15
in cefotaxime‐resistant
Enterobacteriaceae
isolates colonizing hospitalized children in Tunisia. Lett Appl Microbiol 2022; 75:1460-1474. [DOI: 10.1111/lam.13812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 07/25/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022]
Affiliation(s)
- S. Harbaoui
- Université de Tunis El Manar, Faculté de Médecine de Tunis, LR99ES09 Laboratoire de recherche « Résistance aux antimicrobiens » 1006 Tunis Tunisie
| | - S. Ferjani
- Université de Tunis El Manar, Faculté de Médecine de Tunis, LR99ES09 Laboratoire de recherche « Résistance aux antimicrobiens » 1006 Tunis Tunisie
| | - M.S. Abbassi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, LR99ES09 Laboratoire de recherche « Résistance aux antimicrobiens » 1006 Tunis Tunisie
- Université de Tunis El Manar, Institut de la recherche vétérinaire de Tunisie Tunis Tunisie
| | - M. Saidani
- Université de Tunis El Manar, Faculté de Médecine de Tunis, LR99ES09 Laboratoire de recherche « Résistance aux antimicrobiens » 1006 Tunis Tunisie
- CHU Charles Nicolle Service de Microbiologie 1006 Tunis Tunisie
| | - T. Gargueh
- CHU Charles Nicolle Service de Pédiatrie 1006 Tunis Tunisie
| | - M. Ferjani
- CHU Charles Nicolle Service de Pédiatrie 1006 Tunis Tunisie
| | - Y. Hammi
- CHU Charles Nicolle Service de Pédiatrie 1006 Tunis Tunisie
| | - I. Boutiba‐Ben Boubaker
- Université de Tunis El Manar, Faculté de Médecine de Tunis, LR99ES09 Laboratoire de recherche « Résistance aux antimicrobiens » 1006 Tunis Tunisie
- CHU Charles Nicolle Service de Microbiologie 1006 Tunis Tunisie
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Gastrointestinal colonization of Extended-Spectrum Beta lactamase producing bacteria among children below five years of age hospitalized with fever in Dar es Salaam, Tanzania. J Glob Antimicrob Resist 2022; 30:107-114. [PMID: 35667646 DOI: 10.1016/j.jgar.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/16/2022] [Accepted: 05/26/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Gastrointestinal colonization of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) is of concern because prior colonization increases risk for subsequent infections. To date, the link between ESBL-PE fecal carriage and the risk of subsequent ESBL-PE infection has not been well established, and information on carriage of such pathogens among children with invasive infections such as blood stream infections (BSI) remains to be explored worldwide. METHODS This cross-sectional study was conducted among childrenunder the age of 5 years admitted for febrile illness in Dar es Salaam, Tanzania, between March 2017 and July 2018. We used rectal swabs to screen for ESBL-PE using selective media, ChromID® ESBL. Bacterial isolates were identified by MALDI-TOF.Blood cultures were drawn from all children. Antimicrobial susceptibility testingwas done using disk diffusion method. ESBL alleles were identified by Real-Time PCR and sequencing. RESULTS The overall prevalence of ESBL-PE carriage was 56% (112/200) and washighestamong children 4-6 months old (17/21, 81%) (p =0.05). Children with BSI had high ESBL-PE carriage (78.4%) compared to those without BSI (53.1%)(p=0.02; AOR 3.4, 95% CI1.20-9.58).The most common isolate was E.coli (64/112, 45%). Sixteen pairs of ESBL-PEisolates(from the gut and from blood)had similar antimicrobial susceptibility profile. We detectedblaCTX-M gene in 97% of all phenotypically detected ESBL-PE; among those,blaCTX-M-15 was dominant (99%). CONCLUSIONS We report a high prevalence of ESBL-PEfecal carriage among children with BSI in Tanzania. Colonization of ESBL-PEwasa risk factor for ESBL-BSI.
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Shenkute D, Legese MH, Yitayew B, Mitiku A, Engidaye G, Gebremichael S, Asrat D, Woldeamanuel Y. High Magnitude of Fecal Carriage of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae at Debre Berhan Comprehensive Specialized Hospital, Ethiopia. Infect Drug Resist 2022; 15:2445-2458. [PMID: 35586558 PMCID: PMC9109895 DOI: 10.2147/idr.s356807] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Gastrointestinal colonization rate of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) is the major risk factor for infection and dissemination of resistance clones in healthcare facilities. This study aimed to investigate the magnitude of the fecal carriage of ESBL-PE and associated factors among hospitalized patients at Debre Berhan Comprehensive Specialized Hospital, North Shoa, Amhara Regional State, Ethiopia. Methods A hospital-based cross-sectional study was conducted among 383 hospitalized patients from November 2020 to March 2021. Stool sample or rectal swab was aseptically collected and cultured on different culture media for isolation of Enterobacteriaceae. Identification was done by conventional biochemical tests. Screening of extended-spectrum beta-lactamase (ESBL) production was done by using cefotaxime and ceftazidime and confirmed by the combination disk method. Data analysis was performed by Statistical Package for Social Sciences software version 25 and a P-value ≤0.05 was considered as statistically significant. Results From the total of 383 hospitalized patients, a total of 347 Enterobacteriaceae were isolated. The overall gastrointestinal colonization rate of ESBL-PE was 47.3% (164/347). The predominant ESBL-PE were E. coli 54.9% (90/164) and K. pneumoniae 33.5% (55/164). The overall multi-drug resistance rate (MDR) was 87.8% (305/347). The highest resistance was observed to ampicillin (98.3%), followed by gentamicin (80.7%), and tetracycline (73.3%), respectively. ESBL-PE were highly susceptible to meropenem (90.2%) and imipenem (89.0%). History of antibiotic use in the past 3 months (p<0.001), admission in the neonatal intensive care unit (p=0.023), and presence of chronic disease (p<0.001) were independently associated with fecal carriage of ESBL-PE. Conclusion The magnitude of ESBL-PE and MDR was high in the study area. Meropenem and imipenem were active against ESBL-PE. Therefore, strict infection control measure is needed in the study area to limit the infection and dissemination of ESBL-PE.
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Affiliation(s)
- Demissew Shenkute
- Department of Medical Laboratory Science, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
- Correspondence: Demissew Shenkute, Email
| | - Melese Hailu Legese
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Berhanu Yitayew
- Department of Medical Laboratory Science, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Asaye Mitiku
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Getabalew Engidaye
- Department of Medical Laboratory Science, Debre Berhan Health Science College, Debre Berhan, Ethiopia
| | - Saba Gebremichael
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Daniel Asrat
- Department of Microbiology, Immunology, and Parasitology, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - Yimtubezinash Woldeamanuel
- Department of Microbiology, Immunology, and Parasitology, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
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Zhang Y, Xu S, Yang Y, Chou SH, He J. A 'time bomb' in the human intestine-the multiple emergence and spread of antibiotic-resistant bacteria. Environ Microbiol 2021; 24:1231-1246. [PMID: 34632679 DOI: 10.1111/1462-2920.15795] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022]
Abstract
Antibiotics have a strong killing effect on bacteria and are the first choice for the prevention and treatment of bacterial infectious diseases. Therefore, they have been widely used in the medical field, animal husbandry and planting industry. However, with the massive use of antibiotics, more and more antibiotic-resistant bacteria (ARB) have emerged. Because human intestines are rich in nutrients, have suitable temperature, and are high in bacterial abundance, they can easily become a hotbed for the spread of ARB and antibiotic-resistant genes (ARGs). When opportunistic pathogenic bacteria in the intestine acquire ARGs, the infectious diseases caused by such opportunistic pathogens will become more difficult to treat, or even impossible to cure. Therefore, ARB in the human intestine are like a 'time bomb'. In this review, we discuss the sources of intestinal ARB and the transmission routes of ARGs in the human intestine from the perspective of One Health. Further, we describe various methods to prevent the emergence of ARB and inhibit the spread of ARGs in the human intestine. Finally, we may be able to overcome ARB in the human intestine using an interdisciplinary 'One Health' approach.
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Affiliation(s)
- Yuling Zhang
- State Key Laboratory of Agricultural Microbiology & Hubei Hongshan Laboratory, College of Life Science and Technology, Huazhong Agricultural University, Wuhan, Hubei, 430070, China
| | - Siyang Xu
- State Key Laboratory of Agricultural Microbiology & Hubei Hongshan Laboratory, College of Life Science and Technology, Huazhong Agricultural University, Wuhan, Hubei, 430070, China
| | - Yijun Yang
- State Key Laboratory of Agricultural Microbiology & Hubei Hongshan Laboratory, College of Life Science and Technology, Huazhong Agricultural University, Wuhan, Hubei, 430070, China
| | - Shan-Ho Chou
- State Key Laboratory of Agricultural Microbiology & Hubei Hongshan Laboratory, College of Life Science and Technology, Huazhong Agricultural University, Wuhan, Hubei, 430070, China
| | - Jin He
- State Key Laboratory of Agricultural Microbiology & Hubei Hongshan Laboratory, College of Life Science and Technology, Huazhong Agricultural University, Wuhan, Hubei, 430070, China
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High prevalence of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae fecal carriage among children under five years in Addis Ababa, Ethiopia. PLoS One 2021; 16:e0258117. [PMID: 34597328 PMCID: PMC8486131 DOI: 10.1371/journal.pone.0258117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/17/2021] [Indexed: 12/29/2022] Open
Abstract
Background Extended-spectrum beta-lactamase (ESBL) producing bacteria present an ever-growing burden in the hospital and community settings. Data on the prevalence of ESBL fecal carriage remain scarce in Ethiopia. Therefore, this study aimed to determine the prevalence of ESBL producing Escherichia coli and Klebsiella pneumoniae fecal carriage among children under five years in Addis Ababa, Ethiopia. Methods A facility-based cross-sectional study was conducted from April to May 2017. A total of 269 fecal/rectal swab samples were cultured on MacConkey agar. All positive cultures were characterized by colony morphology, Gram stain, and standard biochemical tests. Further, bacteria identification, antimicrobial susceptibility testing, and phenotypic detection of ESBL production were performed using VITEK 2 Compact as per the instruction of the manufacturer. Socio-demographic and risk factors data were collected using questionnaires. Data were entered by EPI INFO version 7.2.1.0 and analyzed by SPSS version 20. Results The overall prevalence of ESBL-producing E. coli and K. pneumoniae was 17.1% (46/269; 95% CI: 12.9%–22.7%). A total of 47 isolates were ESBL-positive, of which, 83.0% were E. coli and 17.0% were K. pneumoniae. ESBL producing E. coli and K. pneumoniae isolates were also showed high levels of MDR (93.6%) and high rates of co-resistance to aminoglycosides, fluoroquinolones, and trimethoprim-sulfamethoxazole. However, all isolates were carbapenem susceptible. In the risk factors analysis, Children’s mothers who had lower educational level (primary school) (OR: 2.472, 95% CI: 1.323–4.618, P = 0.0062) and children who used tap water for drinking (OR: 1.714, 95% CI: 1.001–3.659, P = 0.048) were found to be significantly associated with higher ESBL fecal carriage. Conclusions In this study, the high prevalence rate of ESBL producing E. coli and K. pneumoniae fecal carriage and high level of multidrug resistance among ESBL producing E. coli and K. pneumoniae were demonstrated. This suggested that the necessity of routine screening of ESBL is crucial for the early detection and appropriate antibiotics selection for infection caused by ESBL producing pathogens.
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Duong BT, Duong MC, Campbell J, Nguyen VMH, Nguyen HH, Bui TBH, Nguyen VVC, McLaws ML. Antibiotic-Resistant Gram-negative Bacteria Carriage in Healthcare Workers Working in an Intensive Care Unit. Infect Chemother 2021; 53:546-552. [PMID: 34405594 PMCID: PMC8511367 DOI: 10.3947/ic.2021.0040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/01/2021] [Indexed: 12/05/2022] Open
Abstract
Little is known about antibiotic-resistant Gram-negative bacteria (GNB) intestinal carriage among healthcare workers (HCWs) in Vietnam. All HCWs at a tertiary intensive care units were asked to undertake weekly rectal swabs. Among 40 participants, 65% (26/40) carried extended spectrum β-lactamases (ESBL)/AmpC β-lactamase-producing Escherichia coli. Two HCWs colonized with ESBL/AmpC β-lactamase-producing Klebsiella pneumoniae. One HCW colonized with Acinetobacter baumannii. No one carried Pseudomonas spp.. A quarter (10/40) of HCWs were identified as persistent and frequent carriers. There is an urgent need to screen antibiotic-resistant GNB among HCWs and improve HCWs' hand hygiene compliance to reduce the transmission of antibiotic-resistant GNB in the hospital.
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Affiliation(s)
- Bich Thuy Duong
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Minh Cuong Duong
- School of Population Health, University of New South Wales, Sydney, Australia.
| | - James Campbell
- Oxford University Clinical Research Unit - Vietnam, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Mary Louise McLaws
- School of Population Health, University of New South Wales, Sydney, Australia
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Rakotondrasoa A, Passet V, Herindrainy P, Garin B, Kermorvant-Duchemin E, Delarocque-Astagneau E, Guillemot D, Huynh BT, Brisse S, Collard JM. Characterization of Klebsiella pneumoniae isolates from a mother-child cohort in Madagascar. J Antimicrob Chemother 2021; 75:1736-1746. [PMID: 32303060 DOI: 10.1093/jac/dkaa107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To define characteristics of Klebsiella pneumoniae isolated from carriage and infections in mothers and their neonates belonging to a paediatric cohort in Madagascar. METHODS A total of 2000 mothers and their 2001 neonates were included. For each mother, vaginal and stool samples were collected at the birth. Additionally, upon suspicion of infection, samples were collected from suspected infected body sites in 121 neonates. Genomic sequences of all isolated K. pneumoniae were used for phylogenetic analyses and to investigate the genomic content of antimicrobial resistance genes, virulence genes and plasmid replicon types. RESULTS Five percent (n = 101) of mothers were K. pneumoniae positive. Of 251 collected K. pneumoniae isolates, 102 (40.6%) were from mothers and 149 (59.3%) were from neonates. A total of 49 (19.5%; all from infants except 1) isolates were from infected body sites. MLST identified 108 different STs distributed over the six K. pneumoniae phylogroups Kp1 to Kp6. We found 65 (25.8%) ESBL producers and a total of 101 (40.2%) MDR isolates. The most common ESBL gene was blaCTX-M-15 (in 99.3% of isolates expressing ESBL). One isolate co-harboured blaCTX-M-15 and blaNDM-1 genes. Three isolates from infected body sites belonged to hypervirulent-associated ST23 (n = 1) and ST25 (n = 2). We observed two cases of mother-to-child transmission and sustained K. pneumoniae carriage was identified in 10 neonates, with identical isolates observed longitudinally over the course of 18 to 115 days. CONCLUSIONS This study revealed substantial genetic diversity and a high rate of antimicrobial resistance among K. pneumoniae isolated from both carriage and infections in Madagascar.
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Affiliation(s)
| | - Virginie Passet
- Institut Pasteur, Biodiversity & Epidemiology of Bacterial Pathogens, Paris, France
| | - Perlinot Herindrainy
- Epidemiology & Public Health Unit, Institut Pasteur Madagascar, Antananarivo, Madagascar
| | - Benoit Garin
- Laboratoire Immuno-Hématologie CHU Pointe-à-Pitre, 97159, Abymes, Guadeloupe, France
| | - Elsa Kermorvant-Duchemin
- Université Paris Descartes et AP-HP, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Elisabeth Delarocque-Astagneau
- UMR1181 Biostatistique, Biomathématique, Pharmacoépidémiologie et Maladies Infectieuses (B2PHI), Institut Pasteur, Paris, France
| | - Didier Guillemot
- UMR1181 Biostatistique, Biomathématique, Pharmacoépidémiologie et Maladies Infectieuses (B2PHI), Institut Pasteur, Paris, France
| | - Bich-Tram Huynh
- UMR1181 Biostatistique, Biomathématique, Pharmacoépidémiologie et Maladies Infectieuses (B2PHI), Institut Pasteur, Paris, France
| | - Sylvain Brisse
- Institut Pasteur, Biodiversity & Epidemiology of Bacterial Pathogens, Paris, France
| | - Jean-Marc Collard
- Experimental Bacteriology Unit, Institut Pasteur Madagascar, Antananarivo, Madagascar
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Qureshi S, Maria N, Zeeshan M, Irfan S, Qamar FN. Prevalence and risk factors associated with multi-drug resistant organisms (MDRO) carriage among pediatric patients at the time of admission in a tertiary care hospital of a developing country. A cross-sectional study. BMC Infect Dis 2021; 21:547. [PMID: 34107903 PMCID: PMC8191205 DOI: 10.1186/s12879-021-06275-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/06/2021] [Indexed: 01/02/2023] Open
Abstract
Background The rise of Multidrug-resistant organisms (MDROs) poses a considerable burden on the healthcare systems, particularly in low-middle income countries like Pakistan. There is a scarcity of data on the carriage of MDRO particularly in the pediatrics population therefore, we aimed to determine MDRO carriage in pediatric patients at the time of admission to a tertiary care hospital in Karachi, Pakistan, and to identify the risk factors associated with it. Methods A cross-sectional study conducted at the pediatric department of Aga Khan University Hospital (AKUH) from May to September 2019 on 347 children aged 1–18 years. For identification of MDRO (i.e., Extended Spectrum Beta-Lactamase (ESBL) producers, Carbapenem Resistant Enterobacteriaceae (CRE), Vancomycin Resistant Enterococci (VRE), Methicillin Resistant Staphylococcus aureus (MRSA), Multidrug-resistant (MDR) Acinetobacter species and MDR Pseudomonas aeruginosa), nasal swabs and rectal swabs or stool samples were cultured on specific media within 72 h of hospitalization. Data was collected on a predesigned structured questionnaire on demographics, prior use of antibiotics for > 48 h in the last 6 months, history of vaccination in last 6 months, exposure to health care facility regardless of the time of exposure, ICU stay for > 72 h, and about the prior use of medical devices (urinary catheter, central venous lines etc.) in last 1 year. Statistical analysis was performed by Standard statistical software. Results Out of 347 participants, 237 (68.3%) were found to be MDRO carriers. Forty nine nasal swabs from 346 children (14.2%) showed growth of MRSA. The majority of the stool/rectal swabs (n = 222 of 322; 69%) collected were positive for MDRO. The most isolated species were ESBL Escherichia coli 174/222 (78.3%) followed by ESBL Enterobacter species 37/222 (16.7%) and ESBL Klebsiella pneumoniae 35/222 (15.8%). On univariate analysis, none of the risk factors showed statistically significant association with MDRO carriage. Conclusion Overall, a high prevalence of MDRO carriage was identified among admitted pediatric patients. Implementation of systematic screening may help to identify true burden of MDROs carriage in the health care settings.
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Affiliation(s)
- Sonia Qureshi
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Noshi Maria
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Mohammad Zeeshan
- Department of Microbiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Seema Irfan
- Department of Microbiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan.
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Sanke-Waïgana H, Mbecko JR, Ngaya G, Manirakiza A, Alain BA. 2003-2019: explosive spread of enterobacteria producing extended-spectrum beta-lactamases in Bangui Central African Republic. Pan Afr Med J 2021; 39:22. [PMID: 34394813 PMCID: PMC8348255 DOI: 10.11604/pamj.2021.39.22.28812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/20/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction the spread of enterobacteria producing extended-broad-spectrum beta-lactamases (ESBL) is a global public health-problem. In a study carried in 2003-2005 at the Pasteur Institute in Bangui, 450 enterobacteria were identified in clinical isolates, of which 17 were ESBL (prevalence: 3.78%). The aim of this study was to update this data. Methods from May 2018 to April 2019, a total of 941 enterobacteria were isolated and identified under identical conditions of recruitment and with the same techniques used in the previous study: phenotypic identification using Api 20E strips (bioMérieux SA, Marcy-l'Etoile, France) and antimicrobial drug susceptibility using the disk diffusion method (Bio-Rad antibiotic discs, Marnes la Coquette, France). Resistance genes were identified by polymerase chain reaction (PCR) and sequencing. Results from May 2018 to April 2019, a total of 941 enterobacteria were isolated of which 478 were ESBL, thus amounting to a prevalence of 50.80%. The genetic profiles of the bla CTX-M resistance genes exhibited the emergence of the CTX-M28 variant (CTX-M1 group) and variants of the M2 and M9 groups. There was also a notable increase, from 35 to 64%, in the ESBL with a bla SHV gene. Conclusion this study documents a 13 fold increase in the prevalence of ESBL derived from clinical isolates of the bacteriology laboratory of the Institute Pasteur in Bangui, by comparing its data with that of the publication by Frank et al. 2006. Together with this increase a significant diversification of the circulating CTX-M resistance genes was noticed.
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Affiliation(s)
- Hugues Sanke-Waïgana
- Clinical Laboratory, Pasteur Institute of Bangui, Bangui, Central African Republic.,Laboratory of Medical and Experimental Bacteriology Pasteur Institute of Bangui, Bangui, Central African Republic
| | - Jean-Robert Mbecko
- Clinical Laboratory, Pasteur Institute of Bangui, Bangui, Central African Republic.,Laboratory of Medical and Experimental Bacteriology Pasteur Institute of Bangui, Bangui, Central African Republic
| | - Gilles Ngaya
- Clinical Laboratory, Pasteur Institute of Bangui, Bangui, Central African Republic
| | - Alexandre Manirakiza
- Epidemiology Unit, Pasteur Institute of Bangui, Bangui, Central African Republic
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Bayleyegn B, Fisaha R, Kasew D. Fecal carriage of extended spectrum beta-lactamase producing Enterobacteriaceae among HIV infected children at the University of Gondar Comprehensive Specialized Hospital Gondar, Ethiopia. AIDS Res Ther 2021; 18:19. [PMID: 33882946 PMCID: PMC8061171 DOI: 10.1186/s12981-021-00347-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/12/2021] [Indexed: 12/31/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) and extended spectrum beta lactamase (ESBL) producing Enterobacteriaceae infections are the major challenges in sub-Saharan Africa. Data on the carriage rate of ESBL producing Enterobacteriaceae among HIV infected children is lacking in Ethiopia. Hence this study was aimed to investigate fecal carriage of ESBL producing Enterobacteriaceae among HIV infected children at the University of Gondar comprehensive Specialized Hospital. Methods A cross-sectional study was conducted among HIV infected children from January to April 2020. Stool specimens were collected from 161 study participants by convenient sampling and cultured on MacConkey agar. Biochemical identification, antimicrobial susceptibility testing including ESBL production were carried out. Data were analyzed by SPSS version-20 and P-value < 0.05 on multivariate logistic regression analysis was regarded as statistically significant. Results From a total of 161 study participants male to female ratio was 1:1.1. Moreover; 96.3% of participants were in HIV stage-I and 90.1% had at least a year highly active antiretroviral therapy exposure. A total of 186 Enterobacteriaceae, with E. coli 60% and K. pneumonia 16.13% predominance were isolated from 161 participants. Majority of isolates were most resistant to amoxicillin (95.1%) and sensitive to CHL (94.1%), CXT (91.4%) and CAZ (91.4%). There were 71(38.17%) multidrug resistant isolates, 13 of which were also ESBL producers. The overall ESBL carriage rate was 32/161 (19.9%). History of antibiotic use was the independent factor associated with ESBL carriage (AOR 3.23 (95% CI 1.054–9.88)) and P-value of 0.04. Conclusion ESBL carriage rate of HIV infected children was considerable. Previous antibiotic use was the independent factor. Regular screening for antibiotic resistance on HIV patients before prescription and large-scale antibiotic resistance survey including healthy community may be important.
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Ogunbosi BO, Moodley C, Naicker P, Nuttall J, Bamford C, Eley B. Colonisation with extended spectrum beta-lactamase-producing and carbapenem-resistant Enterobacterales in children admitted to a paediatric referral hospital in South Africa. PLoS One 2020; 15:e0241776. [PMID: 33156820 PMCID: PMC7647087 DOI: 10.1371/journal.pone.0241776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/21/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION There are few studies describing colonisation with extended spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) and carbapenem-resistant Enterobacterales (CRE) among children in sub-Saharan Africa. Colonisation often precedes infection and multi-drug-resistant Enterobacterales are important causes of invasive infection. METHODS In this prospective cross-sectional study, conducted between April and June 2017, 200 children in a tertiary academic hospital were screened by rectal swab for EBSL-PE and CRE. The resistance-conferring genes were identified using polymerase chain reaction technology. Risk factors for colonisation were also evaluated. RESULTS Overall, 48% (96/200) of the children were colonised with at least one ESBL-PE, 8.3% (8/96) of these with 2 ESBL-PE, and one other child was colonised with a CRE (0.5% (1/200)). Common colonising ESBL-PE were Klebsiella pneumoniae (62.5%, 65/104) and Escherichia coli (34.6%, 36/104). The most frequent ESBL-conferring gene was blaCTX-M in 95% (76/80) of the isolates. No resistance- conferring gene was identified in the CRE isolate (Enterobacter cloacae). Most of the Klebsiella pneumoniae isolates were susceptible to piperacillin/tazobactam (86.2%) and amikacin (63.9%). Similarly, 94.4% and 97.2% of the Escherichia coli isolates were susceptible to piperacillin/tazobactam and amikacin, respectively. Hospitalisation for more than 7 days before study enrolment was associated with ESBL-PE colonisation. CONCLUSION Approximately half of the hospitalised children in this study were colonised with ESBL-PE. This highlights the need for improved infection prevention and control practices to limit the dissemination of these microorganisms.
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Affiliation(s)
- Babatunde O. Ogunbosi
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Clinton Moodley
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Preneshni Naicker
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - James Nuttall
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Colleen Bamford
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Brian Eley
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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Kagia N, Kosgei P, Ooko M, Wafula L, Mturi N, Anampiu K, Mwarumba S, Njuguna P, Seale AC, Berkley JA, Bottomley C, Scott JAG, Morpeth SC. Carriage and Acquisition of Extended-spectrum β-Lactamase-producing Enterobacterales Among Neonates Admitted to Hospital in Kilifi, Kenya. Clin Infect Dis 2020; 69:751-759. [PMID: 30830952 PMCID: PMC6695508 DOI: 10.1093/cid/ciy976] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/30/2018] [Indexed: 12/18/2022] Open
Abstract
Background Infections caused by extended-spectrum β-lactamase–producing Enterobacterales (ESBL-E) among hospitalized neonates in sub-Saharan Africa pose significant clinical challenges. Data on prevalence and acquisition of ESBL-E carriage among hospitalized neonates in the region are few, and risk factors for transmission are not clearly defined. Methods In a cohort study of consecutive neonatal admissions to Kilifi County Hospital from July 2013 through August 2014, we estimated ESBL-E carriage prevalence on admission using rectal swab cultures and identified risk factors using logistic regression. Using twice-weekly follow-up swabs, we estimated the incidence and identified risk factors for ESBL-E acquisition in hospital using Poisson regression. Results The prevalence of ESBL-E carriage at admission was 10% (59/569). Cesarean delivery, older neonatal age, and smaller household size were significant risk factors. Of the 510 infants admitted without ESBL-E carriage, 238 (55%) acquired carriage during their hospital stay. The incidence of acquisition was 21.4% (95% confidence interval, 19.0%–24.0%) per day. The rate was positively associated with the number of known neonatal ESBL-E carriers and with the total number of neonates on the same ward. Conclusions Carriage of ESBL-E was common among neonates on admission, and in-hospital acquisition was rapid. The dissemination and selection of ESBL-E appears to be driven by hospital exposures, operative delivery, and neonatal ward patient density. Further attention to infection control, patient crowding, and carriage surveillance is warranted.
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Affiliation(s)
- Ngure Kagia
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research- Coast, Kilifi
| | - Patrick Kosgei
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research- Coast, Kilifi
| | - Michael Ooko
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research- Coast, Kilifi
| | - Leonard Wafula
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research- Coast, Kilifi
| | - Neema Mturi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research- Coast, Kilifi
| | - Kirimi Anampiu
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research- Coast, Kilifi
| | - Salim Mwarumba
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research- Coast, Kilifi
| | - Patricia Njuguna
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research- Coast, Kilifi
| | - Anna C Seale
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research- Coast, Kilifi.,Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom
| | - James A Berkley
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research- Coast, Kilifi.,Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
| | - Christian Bottomley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom
| | - J Anthony G Scott
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research- Coast, Kilifi.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Susan C Morpeth
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Centre for Geographic Medicine Research- Coast, Kilifi.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom.,Counties Manukau District Health Board, Auckland, New Zealand
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21
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Kibwana UO, Majigo M, Kamori D, Manyahi J. High fecal carriage of extended Beta Lactamase producing Enterobacteriaceae among adult patients admitted in referral hospitals in Dar es Salaam, Tanzania. BMC Infect Dis 2020; 20:557. [PMID: 32736605 PMCID: PMC7393831 DOI: 10.1186/s12879-020-05272-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 07/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multi-drug resistance pathogens such as Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae (ESBL-PE) are of great global health concern, since they are associated with increased morbidity and mortality. Even in the absence of infections caused by these pathogens, colonization is a great threat and can lead to cross transfer among hospitalized patients. To date data on carriage of these pathogens is still limited in Tanzania. Therefore, this study aimed to determine ESBL-PE fecal carriage rate and associated factors among hospitalized patients at Referral hospitals in Dar es Salaam. METHODS This was a cross sectional study conducted from May to July 2017 among patients admitted in three referral hospitals in Dar es Salaam, Tanzania. Rectal swabs were collected and screened for ESBL production using MacConkey agar supplemented with Ceftazidime 2 μg/ml. Phenotypic confirmation of ESBL-PE was done by double disk diffusion method. Statistical analysis was performed using Statistical Package for Social Sciences (SPPS) software version 20. RESULTS Of the 196 enrolled participants, 59.7% (117/196) were confirmed to carry ESBL-PE. Diarrheic patients (57/79) had statistically significant high prevalence of ESBL colonization compared to those without diarrhea (60/117) (p = 0.01). A total of 131 ESBL-PE were isolated from 117 patients, whereby, Escherichia coli accounted for 68.7%, Klebsiella pneumoniae 28.2% and Citrobacter species 0.8%. ESBL-PE carriage was significantly higher in patients with diarrhea compared to those without diarrhea (72% vs 53.1%, p = 0.01). Recent antibiotic use was independently associated with carriage of ESBL-PE (aOR 14.65, 95%CI 3.07-69.88, p = 0.01). CONCLUSIONS High prevalence of fecal carriage of ESBL-PE was observed in patients admitted in tertiary hospitals in Dar es Salaam, Tanzania. The use of antibiotics was associated with carriage of ESBL producers among the study population.
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Affiliation(s)
- Upendo O Kibwana
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences Dar es Salaam, P.O. Box 65001, Dar es Salaam, Tanzania.
| | - Mtebe Majigo
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences Dar es Salaam, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Doreen Kamori
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences Dar es Salaam, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Joel Manyahi
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences Dar es Salaam, P.O. Box 65001, Dar es Salaam, Tanzania
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Crellen T, Turner P, Pol S, Baker S, Nguyen Thi Nguyen T, Stoesser N, Day NPJ, Turner C, Cooper BS. Transmission dynamics and control of multidrug-resistant Klebsiella pneumoniae in neonates in a developing country. eLife 2019; 8:e50468. [PMID: 31793878 PMCID: PMC6977969 DOI: 10.7554/elife.50468] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/26/2019] [Indexed: 12/11/2022] Open
Abstract
Multidrug-resistant Klebsiella pneumoniae is an increasing cause of infant mortality in developing countries. We aimed to develop a quantitative understanding of the drivers of this epidemic by estimating the effects of antibiotics on nosocomial transmission risk, comparing competing hypotheses about mechanisms of spread, and quantifying the impact of potential interventions. Using a sequence of dynamic models, we analysed data from a one-year prospective carriage study in a Cambodian neonatal intensive care unit with hyperendemic third-generation cephalosporin-resistant K. pneumoniae. All widely-used antibiotics except imipenem were associated with an increased daily acquisition risk, with an odds ratio for the most common combination (ampicillin + gentamicin) of 1.96 (95% CrI 1.18, 3.36). Models incorporating genomic data found that colonisation pressure was associated with a higher transmission risk, indicated sequence type heterogeneity in transmissibility, and showed that within-ward transmission was insufficient to maintain endemicity. Simulations indicated that increasing the nurse-patient ratio could be an effective intervention.
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Affiliation(s)
- Thomas Crellen
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityBangkokThailand
- Nuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Paul Turner
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityBangkokThailand
- Nuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
- Cambodia-Oxford Medical Research UnitAngkor Hospital for ChildrenSiem ReapCambodia
| | - Sreymom Pol
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityBangkokThailand
- Cambodia-Oxford Medical Research UnitAngkor Hospital for ChildrenSiem ReapCambodia
| | - Stephen Baker
- Nuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
- Oxford University Clinical Research UnitCentre for Tropical MedicineHo Chi Minh CityViet Nam
| | - To Nguyen Thi Nguyen
- Oxford University Clinical Research UnitCentre for Tropical MedicineHo Chi Minh CityViet Nam
| | - Nicole Stoesser
- Nuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Nicholas PJ Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityBangkokThailand
- Nuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
| | - Claudia Turner
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityBangkokThailand
- Nuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
- Cambodia-Oxford Medical Research UnitAngkor Hospital for ChildrenSiem ReapCambodia
| | - Ben S Cooper
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical MedicineMahidol UniversityBangkokThailand
- Nuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
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23
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Lewis JM, Lester R, Garner P, Feasey NA. Gut mucosal colonisation with extended-spectrum beta-lactamase producing Enterobacteriaceae in sub-Saharan Africa: a systematic review and meta-analysis. Wellcome Open Res 2019; 4:160. [PMID: 31976380 PMCID: PMC6957024 DOI: 10.12688/wellcomeopenres.15514.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E) threaten human health; and, in areas of sub-Saharan Africa (sSA) where carbapenems are not available, may render ESBL-E infections untreatable. Gut mucosal colonisation probably occurs before infection, making prevention of colonisation an attractive target for intervention, but the epidemiology of ESBL-E in sSA is poorly described. Objectives: Describe ESBL-E colonisation prevalence in sSA and risk factors associated with colonisation. Methods: Studies included were prospective cross-sectional or cohort studies reporting gut mucosal ESBL-E colonisation in any population in sSA. We searched PubMed and Scopus on 18 December 2018. We summarise the range of prevalence across sites and tabulated risk factors for colonisation. The protocol was registered (Prospero ID
CRD42019123559). Results: From 2975 abstracts we identified 32 studies including a total of 8619 participants from a range of countries and settings. Six studies were longitudinal; no longitudinal studies followed patients beyond hospital discharge. Prevalence varied between 5 and 84% with a median of 31%, with a relationship to setting: pooled ESBL-E colonisation in community studies was 18% (95% CI 12 to 28, 12 studies); in studies recruiting people at admission to hospital colonisation was 32% (95% CI 24 to 41% 8 studies); and for inpatients, colonisation was 55% (95% CI 49 to 60%, 7 studies). Antimicrobial use was associated with increased risk of ESBL-E colonisation, and protected water sources or water treatment by boiling may reduce risk. Conclusions: ESBL-E colonisation is common in sSA, but how people become carriers and why is not well understood. To inform the design of interventions to interrupt transmission in this setting requires longitudinal, community studies.
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Affiliation(s)
- Joseph M Lewis
- Liverpool School of Tropical Medicine, Liverpool, Merseyside, L3 5QA, UK.,Malawi Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Rebecca Lester
- Liverpool School of Tropical Medicine, Liverpool, Merseyside, L3 5QA, UK.,Malawi Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Paul Garner
- Liverpool School of Tropical Medicine, Liverpool, Merseyside, L3 5QA, UK
| | - Nicholas A Feasey
- Liverpool School of Tropical Medicine, Liverpool, Merseyside, L3 5QA, UK.,Malawi Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
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24
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Lewis JM, Lester R, Garner P, Feasey NA. Gut mucosal colonisation with extended-spectrum beta-lactamase producing Enterobacteriaceae in sub-Saharan Africa: a systematic review and meta-analysis. Wellcome Open Res 2019; 4:160. [PMID: 31976380 PMCID: PMC6957024 DOI: 10.12688/wellcomeopenres.15514.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 08/06/2023] Open
Abstract
Background: Extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E) threaten human health; and, in areas of sub-Saharan Africa (sSA) where carbapenems are not available, may render ESBL-E infections untreatable. Gut mucosal colonisation probably occurs before infection, making prevention of colonisation an attractive target for intervention, but the epidemiology of ESBL-E in sSA is poorly described. Objectives: Describe ESBL-E colonisation prevalence in sSA and risk factors associated with colonisation. Methods: Studies included were prospective cross-sectional or cohort studies reporting gut mucosal ESBL-E colonisation in any population in sSA. We searched PubMed and Scopus on 18 December 2018. We summarise the range of prevalence across sites and tabulated risk factors for colonisation. The protocol was registered (Prospero ID CRD42019123559). Results: From 2975 abstracts we identified 32 studies including a total of 8619 participants from a range of countries and settings. Six studies were longitudinal; no longitudinal studies followed patients beyond hospital discharge. Prevalence varied between 5 and 84% with a median of 31%, with a relationship to setting: pooled ESBL-E colonisation in community studies was 18% (95% CI 12 to 28, 12 studies); in studies recruiting people at admission to hospital colonisation was 32% (95% CI 24 to 41% 8 studies); and for inpatients, colonisation was 55% (95% CI 49 to 60%, 7 studies). Antimicrobial use was associated with increased risk of ESBL-E colonisation, and protected water sources or water treatment by boiling may reduce risk. Conclusions: ESBL-E colonisation is common in sSA, but how people become carriers and why is not well understood. To inform the design of interventions to interrupt transmission in this setting requires longitudinal, community studies.
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Affiliation(s)
- Joseph M. Lewis
- Liverpool School of Tropical Medicine, Liverpool, Merseyside, L3 5QA, UK
- Malawi Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Rebecca Lester
- Liverpool School of Tropical Medicine, Liverpool, Merseyside, L3 5QA, UK
- Malawi Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Paul Garner
- Liverpool School of Tropical Medicine, Liverpool, Merseyside, L3 5QA, UK
| | - Nicholas A. Feasey
- Liverpool School of Tropical Medicine, Liverpool, Merseyside, L3 5QA, UK
- Malawi Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
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Peters C, Dulon M, Nienhaus A, Schablon A. Occupational Infection Risk with Multidrug-Resistant Organisms in Health Personnel-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111983. [PMID: 31167449 PMCID: PMC6604006 DOI: 10.3390/ijerph16111983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/27/2019] [Accepted: 05/29/2019] [Indexed: 12/19/2022]
Abstract
The increase in multi-drug-resistant organisms (MDROs) in the last years has become a public health problem. MDROs are partially responsible for numerous nosocomial infections, extended hospital stays, high costs, and high mortality. In addition to methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), Gram-negative bacteria are also a key area of focus. The knowledge of MDROs among the medical staff in the occupational context is limited, with the exception of MRSA. Therefore, a systematic review was carried out to determine the occupational risk for employees posed by MDROs. The search included studies from the year 2000 onwards among personnel who had contact with MDROs. A total of 22 primarily cross-sectional studies in hospital or geriatric care settings were found, with large differences regarding number of participants, examination method, inclusion of a control group, and study quality. The most frequently examined pathogens were extended-spectrum ß-lactamase (ESBL)-producing bacteria with a prevalence of 2.6-48.5%, VRE (0-9.6%), and MRSA (0.9-14.5%). There are only few qualitatively good studies available on MDROs' risk infection for employees in the health service. Any comparison of the results was limited by data heterogeneity. More research is required to describe the occupational risk of infection with MDROs.
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Affiliation(s)
- Claudia Peters
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany.
| | - Madeleine Dulon
- Department of Occupational Medicine, Public health and Hazardous Substances, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, 22089 Hamburg, Germany.
| | - Albert Nienhaus
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany.
- Department of Occupational Medicine, Public health and Hazardous Substances, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, 22089 Hamburg, Germany.
| | - Anja Schablon
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany.
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Abstract
BACKGROUND Little is known about early-onset neonatal bacterial infections (EONBI) in Madagascar. Our aim was to determine their epidemiology to improve their management. METHODS Inborn neonates at risk for EONBI and admitted in the neonatal unit of 2 tertiary hospitals in Antananarivo, Madagascar, were included in a prospective study from April 2012 to March 2013. Using a clinical algorithm, blood culture, gastric fluid culture and C-reactive protein dosage were performed in newborns at high risk of infection, that is, peri partum fever, prematurity <35 weeks' gestation or birth weight <2000 g, or presenting with clinical signs of infection. EONBI was defined as a bacteremia occurring within the first week of life. RESULTS Among 307 neonates, 75 (24.4%) had an EONBI caused by 1 (n = 59) or 2 (n = 16) bacteria (91 isolates). Gram-negative bacteria were predominant (n = 62, 82.7%), including Enterobacter cloacae (n = 26), Klebsiella pneumoniae (n = 14), Escherichia coli (n = 7) and Proteus mirabilis (n = 2). Group B Streptococcus, Acinetobacter baumanii and Enterococcus sp. represented 3.6%, 8.2% and 12.1% of the isolates, respectively. All E. cloacae and 12/14 (85.7%) K. pneumoniae were extended-spectrum β-lactamase producers. At all, 41/91 (45.1%) bacteria were multidrug-resistant (MDR) and 34/75 (45.3%) newborns had an EONBI caused by an MDR bacteria. Neonatal asphyxia was the only factor associated with multidrug resistance (odds ratio: 4.52; CI: 1.20-16.94; P = 0.025). The EONBI-related mortality (n = 20/75, 26.7%) rose up to 38.2% (n = 13/34) in case of MDR bacteria. CONCLUSIONS The epidemiology of EONBIs in Madagascar is comparable to that found in many low-income countries. Prevention, including improvement of hygiene during resuscitation for neonatal asphyxia, is likely to be more effective in reducing EONBI-related morbidity and mortality than using new antibiotics to counter resistance.
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Tfifha M, Ferjani A, Mallouli M, Mlika N, Abroug S, Boukadida J. Carriage of multidrug-resistant bacteria among pediatric patients before and during their hospitalization in a tertiary pediatric unit in Tunisia. Libyan J Med 2018; 13:1419047. [PMID: 29277142 PMCID: PMC5757224 DOI: 10.1080/19932820.2017.1419047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The pandemic spread of multidrug-resistant (MDR) bacteria (i.e., methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum b-lactamase-producing Enterobacteriaceae (ESBLPE), vancomycin-resistant enterococci, carbapenemase-producing Enterobacteriaceae (CPE), multiresistant Pseudomonas aeruginosa and multiresistant Acinetobacter baumannii) pose a threat to healthcare Worldwide. We found limited data of MDR bacteria in pediatric patients hospitalized in Tunisian tertiary healthcare.The aim of the study is to evaluate the acquisition rate of MDR acquisition during hospitalization and to explore some of the associated risk factors for both carriage and acquisition at the pediatric department, Sahloul University Hospital. During September and October 2016, newly admitted patients were screened, at admission, during care and at discharge. Risk factors for colonization were explored by multivariate analysis. Of 112 newly admitted patients, 8.92% were colonized with at least one MDR. No risk factor was identified at admission. During hospitalization, five newly acquisition MDR (4.9%) were detected and eight (7.84%) at discharge. The specie most frequently detected on admission was Escherichia coli (50%), whereas, on discharge, Escherichia coli and K. pneumoniae were the species most frequently detected (52.7%). The pediatric intensive care unit (PICU) hospitalization, the length of hospital stay (more than 3days) and age under 2 years were identified as risk factor for acquisition of MDR during hospitalization. We identified several independent risk factors for contracting MDR bacteria during hospitalization in a tertiary pediatric department. The incidence of symptomatic MDR Infection among those colonized should be under close surveillance and long-term screening for those children is required. An institutional screening program for MDR especially in PICU might be discussed in regards to cost effectiveness.
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Affiliation(s)
- Miniar Tfifha
- a Pediatric Department, Sahloul Hospital, UR02SP13 , CHU Farhat Hached , Sousse , Tunisia
| | - Asma Ferjani
- b Microbiology and Immunology Department, UR02SP13 , CHU Farhat Hached , Sousse , Tunisia
| | - Manel Mallouli
- c Faculty of Medicine , University of Sousse , Sousse , Tunisia
| | - Nesrine Mlika
- d Pediatric Department , Sahloul Hospital , Sousse , Tunisia
| | - Saoussen Abroug
- d Pediatric Department , Sahloul Hospital , Sousse , Tunisia
| | - Jalel Boukadida
- b Microbiology and Immunology Department, UR02SP13 , CHU Farhat Hached , Sousse , Tunisia
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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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Stanley IJ, Kajumbula H, Bazira J, Kansiime C, Rwego IB, Asiimwe BB. Multidrug resistance among Escherichia coli and Klebsiella pneumoniae carried in the gut of out-patients from pastoralist communities of Kasese district, Uganda. PLoS One 2018; 13:e0200093. [PMID: 30016317 PMCID: PMC6049918 DOI: 10.1371/journal.pone.0200093] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 06/19/2018] [Indexed: 01/21/2023] Open
Abstract
Background Antimicrobial resistance is a worldwide public health emergency that requires urgent attention. Most of the effort to prevent this coming catastrophe is occurring in high income countries and we do not know the extent of the problem in low and middle-income countries, largely because of low laboratory capacity coupled with lack of effective surveillance systems. We aimed at establishing the magnitude of antimicrobial resistance among Escherichia coli and Klebsiella pneumoniae carried in the gut of out-patients from pastoralist communities of rural Western Uganda. Methods A cross-sectional study was carried out among pastoralists living in and around the Queen Elizabeth Protected Area (QEPA). Stool samples were collected from individuals from pastoralist communities who presented to the health facilities with fever and/or diarrhea without malaria and delivered to the microbiology laboratory of College of Health Sciences-Makerere University for processing, culture and drug susceptibility testing. Results A total of 300 participants fulfilling the inclusion criteria were recruited into the study. Three hundred stool samples were collected, with 209 yielding organisms of interest. Out of 209 stool samples that were positive, 181 (89%) grew E. coli, 23 (11%) grew K. pneumoniae and five grew Shigella. Generally, high antibiotic resistance patterns were detected among E. coli and K. pneumoniae isolated. High resistance against cotrimoxazole 74%, ampicillin 67%, amoxicillin/clavulanate 37%, and ciprofloxacin 31% was observed among the E. coli. In K. pneumoniae, cotrimoxazole 68% and amoxicillin/clavulanate 46%, were the most resisted antimicrobials. Additionally, 57% and 82% of the E. coli and K. pneumoniae respectively were resistant to at least three classes of the antimicrobials tested. Resistance to carbapenems was not detected among K. pneumoniae and only 0.6% of the E. coli were resistant to carbapenems. Isolates producing ESBLs comprised 12% and 23% of E. coli and K. pneumoniae respectively. Conclusion We demonstrated high antimicrobial resistance, including multidrug resistance, among E. coli and K. pneumoniae isolates from pastoralist out-patients. We recommend a One Health approach to establish the sources and drivers of this problem to inform public health.
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Affiliation(s)
- Iramiot Jacob Stanley
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda.,Department of Microbiology and Immunology, Faculty of Health Sciences, Busitema University, Kampala, Uganda
| | - Henry Kajumbula
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joel Bazira
- Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, Kampala, Uganda
| | - Catherine Kansiime
- One Health Central and Eastern Africa (OHCEA) network, School of Public Health, Makerere University, Kampala, Uganda
| | - Innocent B Rwego
- One Health Central and Eastern Africa (OHCEA) network, School of Public Health, Makerere University, Kampala, Uganda.,Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University Kampala, Uganda.,Ecosystem Health Division, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States of America
| | - Benon B Asiimwe
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda
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Herindrainy P, Rabenandrasana MAN, Andrianirina ZZ, Rakotoarimanana FMJ, Padget M, de Lauzanne A, Ndir A, Kermorvant-Duchemin E, Garin B, Piola P, Collard JM, Guillemot D, Huynh BT, Delarocque-Astagneau E. Acquisition of extended spectrum beta-lactamase-producing enterobacteriaceae in neonates: A community based cohort in Madagascar. PLoS One 2018; 13:e0193325. [PMID: 29494706 PMCID: PMC5832238 DOI: 10.1371/journal.pone.0193325] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/08/2018] [Indexed: 01/09/2023] Open
Abstract
In low and middle income countries (LMICs), where the burden of neonatal sepsis is the highest, the spread of extended spectrum beta-lactamase-producing enterobacteriaceae (ESBL-PE) in the community, potentially contributing to the neonatal mortality, is a public health concern. Data regarding the acquisition of ESBL-PE during the neonatal period are scarce. The routes of transmission are not well defined and particularly the possible key role played by pregnant women. This study aimed to understand the neonatal acquisition of ESBL-PE in the community in Madagascar. The study was conducted in urban and semi-rural areas. Newborns were included at birth and followed-up during their first month of life. Maternal stool samples at delivery and six stool samples in each infant were collected to screen for ESBL-PE. A Cox proportional hazards model was performed to identify factors associated with the first ESBL-PE acquisition. The incidence rate of ESBL-PE acquisition was 10.4 cases/1000 newborn-days [95% CI: 8.0–13.4 cases per 1000 newborn-days]. Of the 83 ESBL-PE isolates identified, Escherichia coli was the most frequent species (n = 28, 34.1%), followed by Klebsiella pneumoniae (n = 20, 24.4%). Cox multivariate analysis showed that independent risk factors for ESBL-PE acquisition were low birth weight (adjusted Hazard-ratio (aHR) = 2.7, 95% CI [1.2; 5.9]), cesarean-section, (aHR = 3.4, 95% CI [1.7; 7.1]) and maternal use of antibiotics at delivery (aHR = 2.2, 95% CI [1.1; 4.5]). Our results confirm that mothers play a significant role in the neonatal acquisition of ESBL-PE. In LMICs, public health interventions during pregnancy should be reinforced to avoid unnecessary caesarean section, unnecessary antibiotic use at delivery and low birth weight newborns.
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Affiliation(s)
| | | | | | | | - Michael Padget
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases Unit, Institut Pasteur, INSERM, UVSQ, Paris, France
| | - Agathe de Lauzanne
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Awa Ndir
- Epidemiology and Infectious Diseases Unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - Elsa Kermorvant-Duchemin
- Paris Descartes University and AP-HP, Necker-Enfants Malades University Hospital, Department of Neonatology, Paris, France
| | - Benoit Garin
- Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Patrice Piola
- Epidemiology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Jean-Marc Collard
- Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Didier Guillemot
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases Unit, Institut Pasteur, INSERM, UVSQ, Paris, France
| | - Bich-Tram Huynh
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases Unit, Institut Pasteur, INSERM, UVSQ, Paris, France
- * E-mail:
| | - Elisabeth Delarocque-Astagneau
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases Unit, Institut Pasteur, INSERM, UVSQ, Paris, France
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Moremi N, Claus H, Vogel U, Mshana SE. Faecal carriage of CTX-M extended-spectrum beta-lactamase-producing Enterobacteriaceae among street children dwelling in Mwanza city, Tanzania. PLoS One 2017; 12:e0184592. [PMID: 28898269 PMCID: PMC5595323 DOI: 10.1371/journal.pone.0184592] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/25/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Data on ESBL carriage of healthy people including children are scarce especially in developing countries. We analyzed the prevalence and genotypes of ESBL-producing Enterobacteriaceae (EPE) in Tanzanian street children with rare contact to healthcare facilities but significant interactions with the environment, animals and other people. METHODOLOGY/ PRINCIPLE FINDINGS Between April and July 2015, stool samples of 107 street children, who live in urban Mwanza were analyzed for EPE. Intestinal carriage of EPE was found in 34 (31.8%, 95% CI; 22.7-40.3) children. Of the 36 isolates from 34 children, 30 (83.3%) were Escherichia coli (E. coli) and six Klebsiella pneumoniae (K. pneumoniae). Out of 36 isolates, 36 (100%), 35 (97%), 25 (69%) and 16 (44%) were resistant to tetracycline, trimethoprim-sulfamethoxazole, ciprofloxacin and gentamicin, respectively. Beta-lactamase genes and the multilocus sequence types of E. coli and K. pneumoniae were characterized. ESBL gene blaCTX-M-15 was detected in 75% (27/36) of ESBL isolates. Sequence types (STs) 131, 10, 448 and 617 were the most prevalent in E. coli. Use of local herbs (OR: 3.5, 95% CI: 1.51-8.08, P = 0.003) and spending day and night on streets (OR: 3.6, 95% CI: 1.44-8.97, P = 0.005) were independent predictors of ESBL carriage. CONCLUSIONS/ SIGNIFICANCE We observed a high prevalence of blaCTX-M-15 in EPE collected from street children in Tanzania. Detection of E. coli STs 131, 10, 38 and 648, which have been observed worldwide in animals and people, highlights the need for multidisciplinary approaches to understand the epidemiology and drivers of antimicrobial resistance in low-income countries.
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Affiliation(s)
- Nyambura Moremi
- Department of Microbiology and Immunology, Catholic University of Health and Allied SciencesBugando, Mwanza, Tanzania
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Heike Claus
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Ulrich Vogel
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied SciencesBugando, Mwanza, Tanzania
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He X, Xie M, Li S, Ye J, Peng Q, Ma Q, Lu X, Zhong B. Antimicrobial resistance in bacterial pathogens among hospitalized children with community acquired lower respiratory tract infections in Dongguan, China (2011-2016). BMC Infect Dis 2017; 17:614. [PMID: 28893195 PMCID: PMC5594502 DOI: 10.1186/s12879-017-2710-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 08/31/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Bacterial pathogens are a major cause of childhood community acquired lower respiratory tract infections (CA-LRTIs), and few data described the impact of antimicrobial resistance on children with CA-LRTIs. This study aims to investigate the antimicrobial resistance in common bacterial agents among hospitalized children with CA-LRTIs between 2011 and 2016 in Dongguan, China. METHODS Sputum samples were collected from hospitalized children (0-5 years old) with CA-LRTIs in Dongguan Children's Hospital. Bacterial pathogens were detected using traditional culture methods, and disc diffusion tests were used to determine antibiotic resistance. RESULTS Among the 2360 samples analyzed, 342 (14.5%) were positive for bacterial infection. The most prevalent pathogen was MSSA (2.3%), followed by MRSA (1.5%), E. coli (1.7%), E. coli ESBLs (1.2%), K. pneumonia ESBLs (1.5%), K. pneumonia (1.4%) and S. pneumonia (1.3%). Of the hospitalized patients with bacteria causing of CA-LRTIs, 90.1% were less than 1-year-old. MSSA and MRSA were more commonly isolated in infants less than 3 months. E. coli, K. pneumonia and K. pneumonia ESBLs were more common bacteria causing CA-LRTIs in infants less than 1 month. Resistance levels to penicillins, fluoroquinolones, macrolides, cephalosporins, carbapenems and vancomycin varied in different bacteria. CONCLUSIONS S. aureus, E coli and K. pneumonia were the common bacterial isolates recovered from chidren with CA-LTRIs during 2011-2015. Age group of under 1 year old was at a high risk of bacterial infections. Many isolates showed antibiotic resistance level was associated with antibiotic usage in clinic. Increasing surveillance of antibiotic resistance is urgently needed and develops better strategies to cure the antibiotic abuse in China.
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Affiliation(s)
- Xiaoguang He
- Department of Pediatric Respiratory Medicine, Dongguan Children's Hospital, Xihu Third Road NO. 68, Dongguan, Guangdong, 523325, China.,Department of Pathogenic Microorganism, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China.,Dongguan Key Laboratory of Pediatric Genetic and Infectious Diseases, Dongguan, Guangdong, China
| | - Mingyu Xie
- Department of Pediatric Respiratory Medicine, Dongguan Children's Hospital, Xihu Third Road NO. 68, Dongguan, Guangdong, 523325, China.,Department of Pathogenic Microorganism, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China.,Dongguan Key Laboratory of Pediatric Genetic and Infectious Diseases, Dongguan, Guangdong, China
| | - Siping Li
- Department of Pediatric Respiratory Medicine, Dongguan Children's Hospital, Xihu Third Road NO. 68, Dongguan, Guangdong, 523325, China.,Department of Pathogenic Microorganism, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China.,Dongguan Key Laboratory of Pediatric Genetic and Infectious Diseases, Dongguan, Guangdong, China
| | - Junqin Ye
- Department of Pediatric Respiratory Medicine, Dongguan Children's Hospital, Xihu Third Road NO. 68, Dongguan, Guangdong, 523325, China.,Department of Pathogenic Microorganism, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China.,Dongguan Key Laboratory of Pediatric Genetic and Infectious Diseases, Dongguan, Guangdong, China
| | - Qi Peng
- Department of Pediatric Respiratory Medicine, Dongguan Children's Hospital, Xihu Third Road NO. 68, Dongguan, Guangdong, 523325, China.,Department of Pathogenic Microorganism, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China.,Dongguan Key Laboratory of Pediatric Genetic and Infectious Diseases, Dongguan, Guangdong, China
| | - Qiang Ma
- Department of Pediatric Respiratory Medicine, Dongguan Children's Hospital, Xihu Third Road NO. 68, Dongguan, Guangdong, 523325, China.,Department of Pathogenic Microorganism, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China.,Dongguan Key Laboratory of Pediatric Genetic and Infectious Diseases, Dongguan, Guangdong, China
| | - Xiaomei Lu
- Department of Pediatric Respiratory Medicine, Dongguan Children's Hospital, Xihu Third Road NO. 68, Dongguan, Guangdong, 523325, China. .,Department of Pathogenic Microorganism, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China. .,Dongguan Key Laboratory of Pediatric Genetic and Infectious Diseases, Dongguan, Guangdong, China.
| | - Baimao Zhong
- Department of Pediatric Respiratory Medicine, Dongguan Children's Hospital, Xihu Third Road NO. 68, Dongguan, Guangdong, 523325, China. .,Department of Pathogenic Microorganism, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China. .,Dongguan Key Laboratory of Pediatric Genetic and Infectious Diseases, Dongguan, Guangdong, China.
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Medboua-Benbalagh C, Touati A, Kermas R, Gharout-Sait A, Brasme L, Mezhoud H, Touati D, Guillard T, de Champs C. Fecal Carriage of Extended-Spectrum β-Lactamase-ProducingEnterobacteriaceaeStrains Is Associated with Worse Outcome in Patients Hospitalized in the Pediatric Oncology Unit of Beni-Messous Hospital in Algiers, Algeria. Microb Drug Resist 2017; 23:757-763. [DOI: 10.1089/mdr.2016.0153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Abdelaziz Touati
- Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, Bejaia, Algérie
| | - Rachida Kermas
- Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, Bejaia, Algérie
| | - Alima Gharout-Sait
- Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, Bejaia, Algérie
| | - Lucien Brasme
- Laboratoire de Bactériologie–Virologie-Hygiène Hospitalière, CHU Reims, Hôpital Robert DEBRE, Reims, France
- EA4687 SFR CAP-Santé [FED 4231], Université de Reims-Champagne-Ardenne, Reims, France
| | - Halima Mezhoud
- Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, Bejaia, Algérie
| | - Djamila Touati
- Laboratoire Mère et Enfant, CHU Beni-Messous, Alger, Algérie
| | - Thomas Guillard
- Laboratoire de Bactériologie–Virologie-Hygiène Hospitalière, CHU Reims, Hôpital Robert DEBRE, Reims, France
- EA4687 SFR CAP-Santé [FED 4231], Université de Reims-Champagne-Ardenne, Reims, France
| | - Christophe de Champs
- Laboratoire de Bactériologie–Virologie-Hygiène Hospitalière, CHU Reims, Hôpital Robert DEBRE, Reims, France
- EA4687 SFR CAP-Santé [FED 4231], Université de Reims-Champagne-Ardenne, Reims, France
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Gay N, Belmonte O, Collard JM, Halifa M, Issack MI, Mindjae S, Palmyre P, Ibrahim AA, Rasamoelina H, Flachet L, Filleul L, Cardinale E. Review of Antibiotic Resistance in the Indian Ocean Commission: A Human and Animal Health Issue. Front Public Health 2017; 5:162. [PMID: 28730149 PMCID: PMC5498788 DOI: 10.3389/fpubh.2017.00162] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/21/2017] [Indexed: 01/21/2023] Open
Abstract
Antimicrobial resistance (AMR) is a major threat to human, animal health, and environment worldwide. For human, transmission occurred through a variety of routes both in health-care settings and community. In animals, AMR was reported in livestock, pets, and wildlife; transmission of AMR can be zoonotic with the probably most important route being foodborne transmission. The Indian Ocean Commission (IOC), composed of Comoros, Madagascar, Mauritius, Reunion (France), and Seychelles recognized the surveillance of AMR in both animal and human as a main public health priority for the region. Mayotte, French overseas territory, located in Comoros archipelago, was also included in this review. This review summarized our best epidemiological knowledge regarding AMR in Indian Ocean. We documented the prevalence, and phenotypic and genotypic profiles of prone to resistance Gram-positive and Gram-negative bacteria both in animals and humans. Our review clearly pointed out extended-spectrum β-lactamase and carbapenemase-producing Enterobacteriaceae as main human and animal health issue in IOC. However, publications on AMR are scarce, particularly in Comoros, Mayotte, and Seychelles. Thus, research and surveillance priorities were recommended (i) estimating the volume of antimicrobial drugs used in livestock and human medicine in the different territories [mainly third generation cephalosporin (3GC)]; (ii) developing a “One Health” surveillance approach with epidemiological indicators as zoonotic foodborne pathogen (i.e., couple Escherichia coli resistance to 3GC/carbapenems); (iii) screening travelers with a history of hospitalization and consumption of antibiotic drug returning from at risk areas (e.g., mcr-1 transmission with China or hajj pilgrims) allowing an early warning detection of the emergence for quick control measures implementation in IOC.
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Affiliation(s)
- Noellie Gay
- Animals, Health, Territories, Risks and Ecosystems Unit, Department of Animal Health, French Agricultural Research Center for International Development (CIRAD), Montpellier, France
| | - Olivier Belmonte
- Bacteriology Laboratory, Félix Guyon Hospital, Saint-Denis, Reunion
| | - Jean-Marc Collard
- Experimental Bacteriology Unit, Pasteur Institute of Madagascar, Antananarivo, Madagascar
| | | | | | | | | | | | | | - Loïc Flachet
- Health Monitoring Unit, Indian Ocean Commission, Port-Louis, Mauritius
| | - Laurent Filleul
- Regional Unit of Indian Ocean, Santé Publique France, Saint-Denis, Reunion
| | - Eric Cardinale
- Animals, Health, Territories, Risks and Ecosystems Unit, Department of Animal Health, French Agricultural Research Center for International Development (CIRAD), Montpellier, France.,Health Monitoring Unit, Indian Ocean Commission, Port-Louis, Mauritius
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Yamamoto S, Asakura H, Igimi S. Recent Trends for the Prevalence and Transmission Risk of Extended Spectrum β-Lactamases (ESBL) Producing Bacteria in Foods. Food Hygiene and Safety Science (Shokuhin Eiseigaku Zasshi) 2017; 58:1-11. [PMID: 28260727 DOI: 10.3358/shokueishi.58.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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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Magwenzi MT, Gudza-Mugabe M, Mujuru HA, Dangarembizi-Bwakura M, Robertson V, Aiken AM. Carriage of antibiotic-resistant Enterobacteriaceae in hospitalised children in tertiary hospitals in Harare, Zimbabwe. Antimicrob Resist Infect Control 2017; 6:10. [PMID: 28096978 PMCID: PMC5225579 DOI: 10.1186/s13756-016-0155-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/26/2016] [Indexed: 04/16/2023] Open
Abstract
Background Extended-spectrum β-lactamase-producing and gentamicin resistant Enterobacteriaceae are increasingly recognised as a major cause of infection in low-income countries. We assessed the prevalence of gastrointestinal carriage of these bacteria in hospitalised children in Harare, Zimbabwe. Methods We conducted a cohort study in paediatric inpatients at two tertiary-referral hospitals between May and July 2015. Rectal swabs and faecal samples were collected within 24 h of admission and further follow-up samples were collected on alternate days during hospitalization. Disc-based, selective and enrichment methods were used to detect carriage of these two forms of resistance. Standard methods were used to confirm resistance status and determine the susceptibility of resistant isolates to other commonly-used antibiotics. Results One hundred and sixty four paediatric inpatient admissions (median age = 1.0 year, IQR = 0.2–2.2years) were enrolled, and an average of 1.9 faecal samples per patient were collected. On admission, 68/164 (41%) patients had both ESBL and gentamicin-resistant Enterobacteriaceae detected, 18 (11%) had ESBL only, 17 (10%) had gentamicin resistance only and 61 (37%) had negative screening for both forms of resistance. During hospitalisation, 32/164 (20%) patients were found to have a type of resistant organism which was not present in their admission sample. We found that faecal samples and use of a selective enrichment broth enhanced the detection of resistant organisms. Amongst resistant bacteria isolated, there were high levels of resistance to ciprofloxacin and chloramphenicol, but not ertapenem. Conclusions More than half of children had enteric carriage of a clinically-relevant form of antibiotic resistance on admission to public-sector hospitals in urban Zimbabwe. Additionally, a fifth of children acquired a further form of resistance during hospitalisation. Urgent action is needed to tackle the spread of antibiotic resistant enteric bacteria in African hospitals.
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Affiliation(s)
- Marcelyn T Magwenzi
- College of Health Sciences, Department of Medical Microbiology, University of Zimbabwe, PO Box A178, Harare, Zimbabwe
| | | | - Hilda A Mujuru
- College of Health Sciences, Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe ; Harare Central Hospital, Harare, Zimbabwe
| | - Mutsa Dangarembizi-Bwakura
- College of Health Sciences, Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe ; Parirenyatwa Group of Hospitals, Harare, Zimbabwe
| | - Valerie Robertson
- College of Health Sciences, Department of Medical Microbiology, University of Zimbabwe, PO Box A178, Harare, Zimbabwe ; Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Alexander M Aiken
- Biomedical Research and Training Institute, Harare, Zimbabwe ; London School of Hygiene and Tropical Medicine, London, UK
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38
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Tellevik MG, Blomberg B, Kommedal Ø, Maselle SY, Langeland N, Moyo SJ. High Prevalence of Faecal Carriage of ESBL-Producing Enterobacteriaceae among Children in Dar es Salaam, Tanzania. PLoS One 2016; 11:e0168024. [PMID: 27936054 PMCID: PMC5148075 DOI: 10.1371/journal.pone.0168024] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/25/2016] [Indexed: 11/18/2022] Open
Abstract
Background Faecal carriage of ESBL-producing bacteria is a potential risk for transmission and infection. Little is known about faecal carriage of antibiotic resistance in Tanzania. This study aimed to investigate the prevalence of faecal carriage of ESBL-producing Enterobacteriaceae and to identify risk factors for carriage among young children in Tanzania. Methodology/Principal Findings From August 2010 to July 2011, children below 2 years of age were recruited in Dar es Salaam, including healthy community children (n = 250) and children hospitalized due to diarrhoea (n = 250) or other diseases (n = 103). ChromID ESBL agar and ChromID CARBA SMART agar were used for screening. Antimicrobial susceptibility testing was performed by the disk diffusion method. ESBL genotypes were identified by Real-Time PCR and sequencing. The overall prevalence of ESBL carriage was 34.3% (207/ 603). The prevalence of ESBL carriage was significantly higher among hospitalized children (50.4%), compared to community children (11.6%; P < 0.001; OR = 7.75; 95% CI: 4.99–12.03). We found high prevalence of Multidrug-resistance (94%) among Escherichia coli and Klebsiella pneumoniae isolates. No resistance to carbapenems was detected. For the majority of isolates (94.7%) we detected a blaCTX-M-15-like gene. In addition, the plasmid mediated AmpC beta-lactamase CMY-2 was detected for the first time in Tanzania. ESBL prevalence was significantly higher among HIV positive (89.7%) than HIV negative (16.9%) children (P = 0.001; OR = 9.99; 95% CI: 2.52–39.57). Use of antibiotics during the past 14 days and age below 1 year was also associated with ESBL carriage. Conclusions/Significance We report a high rate of faecal carriage of ESBL-producing Enterobacteriaceae among children below 2 years of age in Tanzania, particularly those with HIV-infection. Resistance to a majority of the available antimicrobials commonly used for children in Tanzania leaves few treatment options for infections when caused by these bacteria.
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Affiliation(s)
- Marit G. Tellevik
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Blomberg
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Øyvind Kommedal
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Samuel Y. Maselle
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nina Langeland
- National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Sabrina J. Moyo
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- * E-mail:
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Padget M, Tamarelle J, Herindrainy P, Ndir A, Diene Sarr F, Richard V, Piola P, Guillemot D, Delarocque-Astagneau E. A community survey of antibiotic consumption among children in Madagascar and Senegal: the importance of healthcare access and care quality. J Antimicrob Chemother 2016; 72:564-573. [PMID: 28115503 DOI: 10.1093/jac/dkw446] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/21/2016] [Accepted: 09/22/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Antibiotic resistance is growing in low-income countries (LICs). Children in LICs are particularly at risk. Information on antibiotic consumption is needed to control the development and spread of resistant bacteria. METHODS To measure antibiotic consumption and related factors, a community survey was undertaken in two sites in Madagascar (Antananarivo and Moramanga) and in Senegal (Guediawaye) among children under 2. Face-to-face interviews were conducted with parents or caregivers of eligible children. Regression analysis was used to determine variables associated with reported antibiotic consumption. Availability of health structures and health policies were also investigated. RESULTS Population estimates for antibiotic consumption in the last 3 months were 37.2% (95% CI 33.4%-41.2%) in Guediawaye, 29.3% (95% CI 25.0%-34.1%) in Antananarivo and 24.6% (95% CI 20.6%-29.1%) in Moramanga. In all sites, the large majority of antibiotics were taken with a prescription (92.2%, 87.0% and 92.0% for Antananarivo, Moramanga and Guediawaye, respectively) and purchased in pharmacies (89.4%, 73.5% and 78.5%, respectively). Living in houses without flushing toilets and baby age were significantly associated with any antibiotic consumption after adjusting for site. A higher density of public health structures was associated with lower antibiotic consumption levels, while a higher density of private pharmacies was associated with higher levels across sites. CONCLUSIONS These data are crucial for the implementation of local programmes aimed at optimizing antibiotic consumption. Factors such as density of healthcare facilities, prescriber training and national policy must be taken into account when developing strategies to optimize antibiotic consumption in LICs.
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Affiliation(s)
- Michael Padget
- INSERM 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), F-75015, Paris, France .,Institut Pasteur, B2PHI, F-75015, Paris, France.,Université de Versailles Saint-Quentin, UMR 1181, B2PHI, F-78180, Montigny-le-Bretonneux, France
| | - Jeanne Tamarelle
- INSERM 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), F-75015, Paris, France.,Institut Pasteur, B2PHI, F-75015, Paris, France.,Université de Versailles Saint-Quentin, UMR 1181, B2PHI, F-78180, Montigny-le-Bretonneux, France
| | - Perlinot Herindrainy
- Epidemiology and Infectious Disease Unit, Institut Pasteur, Antananarivo, Madagascar
| | - Awa Ndir
- Epidemiology and Infectious Disease Unit, Institut Pasteur, Dakar, Senegal
| | | | - Vincent Richard
- Epidemiology and Infectious Disease Unit, Institut Pasteur, Dakar, Senegal
| | - Patrice Piola
- Epidemiology and Infectious Disease Unit, Institut Pasteur, Antananarivo, Madagascar
| | - Didier Guillemot
- INSERM 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), F-75015, Paris, France.,Institut Pasteur, B2PHI, F-75015, Paris, France.,Université de Versailles Saint-Quentin, UMR 1181, B2PHI, F-78180, Montigny-le-Bretonneux, France.,AP-HP, Raymond-Poincaré Hospital, F-92380, Garches, France
| | - Elisabeth Delarocque-Astagneau
- INSERM 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), F-75015, Paris, France.,Institut Pasteur, B2PHI, F-75015, Paris, France.,Université de Versailles Saint-Quentin, UMR 1181, B2PHI, F-78180, Montigny-le-Bretonneux, France
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Ouedraogo AS, Sanou M, Kissou A, Sanou S, Solaré H, Kaboré F, Poda A, Aberkane S, Bouzinbi N, Sano I, Nacro B, Sangaré L, Carrière C, Decré D, Ouégraogo R, Jean-Pierre H, Godreuil S. High prevalence of extended-spectrum ß-lactamase producing enterobacteriaceae among clinical isolates in Burkina Faso. BMC Infect Dis 2016; 16:326. [PMID: 27400864 PMCID: PMC4939587 DOI: 10.1186/s12879-016-1655-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 06/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background Nothing is known about the epidemiology and resistance mechanisms of extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-PE) in Burkina Faso. The objective of this study was to determine ESBL-PE prevalence and to characterize ESBL genes in Burkina Faso. Methods During 2 months (June-July 2014), 1602 clinical samples were sent for bacteriologic investigations to the microbiology laboratories of the tree main hospitals of Burkina Faso. Isolates were identified by mass spectrometry using a matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) BioTyper. Antibiotic susceptibility was tested using the disk diffusion method on Müller-Hinton agar. The different ESBL genes in potential ESBL-producing isolates were detected by PCR and double stranded DNA sequencing. Escherichia coli phylogenetic groups were determined using a PCR-based method. Results ESBL-PE frequency was 58 % (179 strains among the 308 Enterobacteriaceae isolates identified in the collected samples; 45 % in outpatients and 70 % in hospitalized patients). The CTX-M-1 group was dominant (94 %, CTX-M-15 enzyme), followed by the CTX-M-9 group (4 %). ESBL producers were more often found in E. coli (67.5 %) and Klebsiella pneumoniae (26 %) isolates. E. coli isolates (n = 202; 60 % of all Enterobacteriaceae samples) were distributed in eight phylogenetic groups (A = 49, B1 = 15, B2 = 43, C = 22, Clade I = 7, D = 37, F = 13 and 16 unknown); 22 strains belonged to the sequence type ST131. No association between a specific strain and ESBL production was detected. Conclusions This report shows the alarming spread of ESBL genes in Burkina Faso. Public health efforts should focus on education (population and healthcare professionals), surveillance and promotion of correct and restricted antibiotic use to limit their dissemination.
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Affiliation(s)
- Abdoul-Salam Ouedraogo
- Centre Hospitalier Universitaire Souro Sanou, BP 676, Bobo Dioulasso, Burkina Faso. .,Centre Hospitalier Régional Universitaire (CHRU) de Montpellier, Département de Bactériologie-Virologie, Montpellier, France. .,Université Montpellier 1, Montpellier, France. .,INSERM U1058 "Infection by HIV and by agents with mucocutaneous tropism: from pathogenesis to prevention" and Department of Bacteriology-Virology, CHU Arnaud de Villeneuve, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex 5, France.
| | - Mahamadou Sanou
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Aimée Kissou
- Centre Hospitalier Universitaire Souro Sanou, BP 676, Bobo Dioulasso, Burkina Faso
| | - Soufiane Sanou
- Centre Hospitalier Universitaire Souro Sanou, BP 676, Bobo Dioulasso, Burkina Faso
| | - Hermann Solaré
- Centre Hospiatlier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Firmin Kaboré
- Centre Hospitalier Universitaire Souro Sanou, BP 676, Bobo Dioulasso, Burkina Faso
| | - Armel Poda
- Centre Hospitalier Universitaire Souro Sanou, BP 676, Bobo Dioulasso, Burkina Faso
| | - Salim Aberkane
- Centre Hospitalier Régional Universitaire (CHRU) de Montpellier, Département de Bactériologie-Virologie, Montpellier, France.,Université Montpellier 1, Montpellier, France.,INSERM U1058 "Infection by HIV and by agents with mucocutaneous tropism: from pathogenesis to prevention" and Department of Bacteriology-Virology, CHU Arnaud de Villeneuve, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Nicolas Bouzinbi
- Centre Hospitalier Régional Universitaire (CHRU) de Montpellier, Département de Bactériologie-Virologie, Montpellier, France.,Université Montpellier 1, Montpellier, France.,INSERM U1058 "Infection by HIV and by agents with mucocutaneous tropism: from pathogenesis to prevention" and Department of Bacteriology-Virology, CHU Arnaud de Villeneuve, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Idrissa Sano
- Centre Hospiatlier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Boubacar Nacro
- Centre Hospitalier Universitaire Souro Sanou, BP 676, Bobo Dioulasso, Burkina Faso
| | - Lassana Sangaré
- Centre Hospiatlier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Christian Carrière
- Centre Hospitalier Régional Universitaire (CHRU) de Montpellier, Département de Bactériologie-Virologie, Montpellier, France.,Université Montpellier 1, Montpellier, France.,INSERM U1058 "Infection by HIV and by agents with mucocutaneous tropism: from pathogenesis to prevention" and Department of Bacteriology-Virology, CHU Arnaud de Villeneuve, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
| | - Dominique Decré
- CIMI, team E13 (bacteriology), Sorbonne University, UPMC Université Paris 06 CR7, F-75013, Paris, France.,INSERM U1135, CIMI, team E13, Paris, France.,AP-HP, Microbiology, St-Antoine Hospital, Paris, France
| | - Rasmata Ouégraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Hélène Jean-Pierre
- Centre Hospitalier Régional Universitaire (CHRU) de Montpellier, Département de Bactériologie-Virologie, Montpellier, France
| | - Sylvain Godreuil
- Centre Hospitalier Régional Universitaire (CHRU) de Montpellier, Département de Bactériologie-Virologie, Montpellier, France.,Université Montpellier 1, Montpellier, France.,INSERM U1058 "Infection by HIV and by agents with mucocutaneous tropism: from pathogenesis to prevention" and Department of Bacteriology-Virology, CHU Arnaud de Villeneuve, 371 avenue du doyen Gaston Giraud, 34295, Montpellier Cedex 5, France
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Naas T, Cuzon G, Robinson AL, Andrianirina Z, Imbert P, Ratsima E, Ranosiarisoa ZN, Nordmann P, Raymond J. Neonatal infections with multidrug-resistant ESBL-producing E. cloacae and K. pneumoniae in Neonatal Units of two different Hospitals in Antananarivo, Madagascar. BMC Infect Dis 2016; 16:275. [PMID: 27287441 PMCID: PMC4902894 DOI: 10.1186/s12879-016-1580-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 05/18/2016] [Indexed: 11/10/2022] Open
Abstract
Background We investigated the molecular mechanism of ß-lactam resistance in extended-spectrum ß-lactamase (ESBL)-producing Enterobacterial strains isolated in neonatal units of different hospitals in Anatnanarivo, Madagascar. Methods Bacteria were identified by standard biochemical methods, disc diffusion antibiograms and Etest. Resistance genes were sought by PCR. Strains were characterized by Rep-PCR (Diversilab), plasmid analysis and rep-typing. Results From April 2012 to March 2013, 29 ESBL-producing E. cloacae and 15 K. pneumoniae were isolated from blood culture (n = 32) or gastric samples (n = 12) performed at day 0 or 2 from 39/303 newborns suspected of early neonatal infection. These infants were treated with expanded spectrum cephalosporins, due to lack of carbapenems, leading to a high mortality rate (45 %). Isolates recovered were all, but 4, multidrug resistant, particularly to fluoroquinolones (FQ) except for 21 E. cloacae isolates. Isolates produced TEM-1 and CTX-M-15 ß-lactamases and their genes were located on several self-transferable plasmids of variable sizes sizes that could not be linked to a major plasmid incompatibility group. E. cloacae isolates belonged to 6 Rep-types among which two counted for 11 isolates each. The FQ resistant E. cloacae isolates belonged to one clone, whereas the FQ susceptible E. cloacae isolates belonged to four clones. The K. pneumoniae isolates belonged to 9 Rep-types among which one included five isolates. Conclusion This study is the first molecular characterization of ESBL-producing isolates from neonatology units in Madagascar, a country with limited epidemiological data. It revealed an important multi-clonal dissemination of CTX-M-15-producing isolates reflecting both the high community carriage and the very early nosocomial contamination of the neonates.
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Affiliation(s)
- T Naas
- Bacteriologie, APHP, EA7361 Univ Paris Sud, Le Kremlin-Bicetre, France.
| | - G Cuzon
- Bacteriologie, APHP, EA7361 Univ Paris Sud, Le Kremlin-Bicetre, France
| | - A L Robinson
- Service de Pédiatrie, Hôpital Tsaralanana, Antananarivo, Madagascar
| | - Z Andrianirina
- Service de Néonatologie, Hôpital Soavinandriana, Antananarivo, Madasgascar
| | - P Imbert
- Hôpital Begin, Vincennes, France
| | - E Ratsima
- Institut Pasteur, Antananarivo, Madagascar
| | - Z N Ranosiarisoa
- Service de Néonatologie, Hôpital Befelatanana, Antananarivo, Madagascar
| | - P Nordmann
- Medical Microbiology, Fribourg Univ, Fribourg, Switzerland
| | - J Raymond
- University Paris Descartes Bacteriologie, Hôpital Cochin, Paris, France.
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Mshana SE, Falgenhauer L, Mirambo MM, Mushi MF, Moremi N, Julius R, Seni J, Imirzalioglu C, Matee M, Chakraborty T. Predictors of blaCTX-M-15 in varieties of Escherichia coli genotypes from humans in community settings in Mwanza, Tanzania. BMC Infect Dis 2016; 16:187. [PMID: 27129719 PMCID: PMC4850702 DOI: 10.1186/s12879-016-1527-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae commonly cause infections worldwide. Bla CTX-M-15 has been commonly detected in hospital isolates in Mwanza, Tanzania. Little is known regarding the faecal carriage of ESBL isolates and bla CTX-M-15 allele among humans in the community in developing countries. METHODS A cross-sectional study involving 334 humans from the community settings in Mwanza City was conducted between June and September 2014. Stool specimens were collected and processed to detect ESBL producing enterobacteriaceae. ESBL isolates were confirmed using disc approximation method, commercial ESBL plates and VITEK-2 system. A polymerase chain reaction and sequencing based allele typing for CTX-M ESBL genes was performed to 42 confirmed ESBL isolates followed by whole genome sequence of 25 randomly selected isolates to detect phylogenetic groups, sequence types plasmid replicon types. RESULTS Of 334 humans investigated, 55 (16.5 %) were found to carry ESBL-producing bacteria. Age, history of antibiotic use and history of admission were independent factors found to predict ESBL-carriage. The carriage rate of ESBL-producing Escherichia coli was significantly higher than that of Klebsiella pneumoniae (15.1 % vs. 3.8 %, p = 0.026). Of 42 ESBL isolates, 37 (88.1 %) were found to carry the bla CTX-M-15 allele. Other transferrable resistance genes were aac(6')Ib-cr, aac(3)-IIa, aac(3)-IId, aadA1, aadA5, strA, strB and qnrS1. Eight multi-locus sequence types (ST) were detected in 25 E. coli isolates subjected to genome sequencing. ST-131 was detected in 6 (24 %), ST-38 in 5 (20 %) and 5 (20 %) clonal complex - 10(ST-617, ST-44) of isolates. The pathogenic phylogenetic groups D and B2 were detected in 8/25 (32 %) and 6/25 (24 %) of isolates respectively. BlaCTX-M-15 was found to be located in multiple IncY and IncF plasmids while in 13/25(52 %) of cases it was chromosomally located. CONCLUSION The overlap of multi-drug resistant bacteria and diversity of the genotypes carrying CTX-M-15 in the community and hospitals requires an overall approach that addresses social behaviour and activity, rationalization of the antibiotic stewardship policy and a deeper understanding of the ecological factors that lead to persistence and spread of such alleles.
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Affiliation(s)
- Stephen E Mshana
- Department of Microbiology/Immunology Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, BOX 1464, Mwanza, Tanzania.
| | - Linda Falgenhauer
- Institute of Medical Microbiology, Justus-Liebig University, Schubertstrasse 81, 35392, Giessen, Germany.,Germany and German Center for Infection Research DZIF, Partner site Giessen-Marburg-Langen, Campus Giessen, Giessen, Germany
| | - Mariam M Mirambo
- Department of Microbiology/Immunology Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, BOX 1464, Mwanza, Tanzania
| | - Martha F Mushi
- Department of Microbiology/Immunology Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, BOX 1464, Mwanza, Tanzania
| | - Nyambura Moremi
- Department of Microbiology/Immunology Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, BOX 1464, Mwanza, Tanzania
| | - Rechel Julius
- Department of Microbiology/Immunology Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, BOX 1464, Mwanza, Tanzania
| | - Jeremiah Seni
- Department of Microbiology/Immunology Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, BOX 1464, Mwanza, Tanzania
| | - Can Imirzalioglu
- Institute of Medical Microbiology, Justus-Liebig University, Schubertstrasse 81, 35392, Giessen, Germany.,Germany and German Center for Infection Research DZIF, Partner site Giessen-Marburg-Langen, Campus Giessen, Giessen, Germany
| | - Mecky Matee
- Department of Microbiology/Immunology, Muhimbili University of Health and Allied Sciences, BOX 65001, Dar es Salaam, Tanzania
| | - Trinad Chakraborty
- Institute of Medical Microbiology, Justus-Liebig University, Schubertstrasse 81, 35392, Giessen, Germany.,Germany and German Center for Infection Research DZIF, Partner site Giessen-Marburg-Langen, Campus Giessen, Giessen, Germany
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Social structure and Escherichia coli sharing in a group-living wild primate, Verreaux's sifaka. BMC Ecol 2016; 16:6. [PMID: 26868261 PMCID: PMC4751723 DOI: 10.1186/s12898-016-0059-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 01/28/2016] [Indexed: 12/05/2022] Open
Abstract
Background Epidemiological models often use information on host social contacts to predict the potential impact of infectious diseases on host populations and the efficiency of control measures. It can be difficult, however, to determine whether social contacts are actually meaningful predictors of transmission. We investigated the role of host social structure in the transmission of Escherichia coli in a wild population of primates, Verreaux’s sifakas (Propithecus verreauxi). Using multilocus sequence typing (MLST), we compared genetic similarities between E. coli isolates from different individuals and groups to infer transmission pathways. Results Correlation of social and transmission networks revealed that membership to the same group significantly predicted sharing of E. coli MLST sequence types (ST). Intergroup encounter rate and a measure of space-use sharing provided equally potent explanations for type sharing between social groups when closely related STs were taken into account, whereas animal age, sex and dispersal history had no influence. No antibiotic resistance was found, suggesting low rates of E. coli spillover from humans into this arboreal species. Conclusions We show that patterns of E. coli transmission reflect the social structure of this group-living lemur species. We discuss our results in the light of the species’ ecology and propose scent-marking, a type of social contact not considered in previous epidemiological studies, as a likely route of transmission between groups. However, further studies are needed to explicitly test this hypothesis and to further elucidate the relative roles of direct contact and environmental transmission in pathogen transfer. Electronic supplementary material The online version of this article (doi:10.1186/s12898-016-0059-y) contains supplementary material, which is available to authorized users.
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Micheel V, Hogan B, Rakotoarivelo RA, Rakotozandrindrainy R, Razafimanatsoa F, Razafindrabe T, Rakotondrainiarivelo JP, Crusius S, Poppert S, Schwarz NG, May J, Frickmann H, Hagen RM. Identification of nasal colonization with β-lactamase-producing Enterobacteriaceae in patients, health care workers and students in Madagascar. Eur J Microbiol Immunol (Bp) 2015; 5:116-25. [PMID: 25908994 DOI: 10.1556/eujmi-d-15-00001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 01/07/2015] [Indexed: 12/21/2022] Open
Abstract
This study assesses the nasal occurrence of β-lactamase-producing Enterobacteriaceae both in patients in a hospital department of infectious diseases at admission and in healthy Madagascan students and health care workers. Nasal swabs from 681 students, 824 health care workers, and 169 patients were obtained in Antananarivo, Madagascar, and transferred to Germany. Screening for β-lactamase (ESBL, ampC) producing Enterobacteriaceae was performed by cultural and molecular approaches, comprising Brilliance ESBL agar, E-testing, ABCD-testing, and commercial hyplex ESBL and SuperBug ID PCR. Regarding ESBL-positive strains and strains with resistance against at least three out of the four tested bactericidal antibiotic drugs, 0.3% (five out of 1541) of the students and health care workers group showed nasal colonization, whereas colonization was observed in 7.1% (12 out of 169) of the hospitalized patients at admission. No appreciably reduced detection rates after sample storage and intercontinental transport were observed. A considerable proportion of nasal colonization with cephalosporin-resistant Enterobacteriaceae was demonstrated in Madagascan hospital patients at admission, posing a risk of developing future endogenous infections. The nasal colonization of healthy individuals was negligible. Good storage and transport stability of Enterobacteriaceae will allow for future studies even in areas difficult to access.
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Alizade H, Fallah F, Ghanbarpour R, Aflatoonian MR, Goudarzi H, Sharifi H. Phylogenetic groups, extended-spectrum β-lactamases and metallo-β-lactamase in Escherichia coli isolated from fecal samples of patients with diarrhea in Iran. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2015; 8:207-14. [PMID: 26328043 PMCID: PMC4553161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 02/08/2015] [Indexed: 11/21/2022]
Abstract
AIM The aims of this study were to investigate the phenotypic and genotypic of extended-spectrum β-lactamase (ESBL) and metallo-β-lactamases (MBLs) and determine phylogenetic background E. coli isolates from fecal samples of patients with diarrhea in Kerman, southeast of Iran. BACKGROUND The emergence of ESBLs and MBLs-producing E. coli caused problems in antibiotic treatments. E. coli strains can be assigned to four main phylog-groups, including: A, B1, B2 and D. PATIENTS AND METHODS E. coli isolates (n=216) were obtained from fecal samples of patients with diarrhea between June and December 2013. ESBLs and MBLs were confirmed by disk-diffusion and broth micro-dilution methods. Using PCR, the ESBL-positive isolates were screened to determine the phylo-groups and the presence of bla CTX-M-15, bla OXA-1, bla PER-1, bla VIM and bla IMP genes. RESULTS ESBL-positive isolates (n= 56) were detected. Among ESBL-positive isolates, 51 isolates were positive for bla CTX-M15 and one isolate was positive for both bla CTX-M-15 and bla OXA-1 genes. None of the isolates were positive for bla PER-1, bla VIM and bla IMP genes. PCR assay for phylotyping of isolates indicated that the isolates were belonged to groups A (54.16%), B1 (11.11%), B2 (12.96%) and D (21.75%). The isolates possessed bla CTX-M-15 gene were belonged to A (35 isolates), B1 (5), B2 (3) and D (8) phylo-groups. CONCLUSION Our results indicate that bla CTX-M-15 gene is widespread among diarrheagenic E. coli isolates. ESBL-producing E. coli isolates were disseminated among a diversity of phylo-groups. Further studies are necessary to identify the ESBL genes in relation to phylogenetic groups.
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Affiliation(s)
- Hesam Alizade
- Department of Microbiology, International Branch, Shahid Beheshti Universityof Medical science, Tehran, Iran
| | - Fatemeh Fallah
- Department of Microbiology, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Reza Ghanbarpour
- Molecular Microbiology Department, Faculty of Veterinary Medicine, Shahid Bahonar University, Kerman, Iran
| | - Mohammad Reza Aflatoonian
- Research Center for Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran
| | - Hossein Goudarzi
- Department of Microbiology, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Hamid Sharifi
- Department of Food Hygiene and Public Health, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Iran,Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medic al Sciences, Iran
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46
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Saha R, Das S, De K, Singh T, Kumari A. Fecal Carriage of Escherichia coli from Pediatric Patients with Diarrhea and Asymptomatic Healthy Individuals. J Glob Infect Dis 2014; 6:194-5. [PMID: 25538460 PMCID: PMC4265837 DOI: 10.4103/0974-777x.145256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Rumpa Saha
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, New Delhi, India
| | - Shukla Das
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, New Delhi, India
| | - Kaustuv De
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, New Delhi, India
| | - Taru Singh
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, New Delhi, India
| | - Ankita Kumari
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, New Delhi, India
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Uzunović S, Bedenić B, Budimir A, Kamberović F, Ibrahimagić A, Delić-Bikić S, Sivec S, Meštrović T, Varda Brkić D, Rijnders MIA, Stobberingh EE. Emergency (clonal spread) of methicillin-resistant Staphylococcus aureus (MRSA), extended spectrum (ESBL)--and AmpC beta-lactamase-producing Gram-negative bacteria infections at Pediatric Department, Bosnia and Herzegovina. Wien Klin Wochenschr 2014; 126:747-56. [PMID: 25193483 DOI: 10.1007/s00508-014-0597-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 08/09/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE Aim of this study was to investigate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum (ESBL) and plasmid-mediated AmpC beta-lactamase producing Gram-negative bacteria in children. METHODS Antibiotic susceptibility of MRSA and beta-lactamase producing Gram-negative bacteria was determined by disc diffusion and broth microdilution methods according to CLSI guidelines. Methicillin resistance was confirmed by the presence of mecA gene by PCR. The genetic characterization of S. aures was performed using spa-typing and the algorithm based upon repeat pattern (BURP). Double-disk synergy test was used to screen for ESBL production. PCR was used to detect bla ESBL alleles. Genetic relatedness of the strains was tested by pulsed-field gel electrophoresis (PFGE). RESULTS Among 23 MRSA, 12 (52.2 %) were obtained from newborns. MLST CC152 (spa-CC 355-595) (Balkan clone) was the most prevalent, 20 (87 %) cases. Among 24 beta-lactamase producing Gram-negative bacteria, 10 (41.7 %) were obtained from each newborns and one-year-old children; 14 (58.3 %) were from urine. Among 11 Klebsiella strains isolated from urine eight (73 %) produced CTX-M-15, and one CTX-M-3 beta-lactamase. Twenty (83 %) of CTX-M producers were coproduced by other types of beta-lactamases. Fifteen (65.2 %) MRSA isolates were clonally related. Five clones among 13 K. pneumoniae isolates were detected by PFGE suggesting clonal spread of β-lactamase producing Gram-negative bacteria. CONCLUSION Pediatric infections caused by clonal spread of MRSA and beta-lactamase-producing Gram-negative bacteria are of major concern. Proper infection control measures should be implemented in order to avoid the transmission and major outbreaks.
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Affiliation(s)
- Selma Uzunović
- Department of Laboratory Diagnostics, Cantonal Public Health Institute of Zenica, Fra I. Jukića 2, 72000, Zenica, Bosnia and Herzegovina,
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48
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Faecal carriage of extended-spectrumβ-lactamase (ESBL)-producing enterobacteria in liver disease patients from two hospitals in Egypt and France: a comparative epidemiological study. Epidemiol Infect 2014; 143:1247-55. [DOI: 10.1017/s0950268814001812] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
SUMMARYThis study aimed to assess and compare the epidemiology of faecal carriage of extended spectrumβ-lactamase-producing enterobacteria (ESBL-E) in Hepatology departments of two hospitals specializing in liver diseases, Theodor Bilharz Research Institute (TBRI) in Cairo (Egypt) and Beaujon Hospital (Bj) in Clichy (France). CTX-M groups were identified by PCR, and TEM and SHV derivatives with the check-point system. Phylogenetic groups ofE. coliwere determined by multiplex PCR, and clone ST131 by PCR of genepabB. Prevalence of ESBL-E was 77·6% (45/58) in TBRI and 6·5% (13/199) in Bj (P < 10−7). Previous hospitalization was more common (P = 0·003) in Bj patients (93%) than in TBRI patients (45%) suggesting high prevalence of ESBL-E in the Egyptian community. The presence ofE. coliB2 ST131 among ESBL-E faecalE. coliin Egypt confirms its pervasiveness in the community and raises concern regarding this highly virulent and resistant clone.
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Nelson E, Kayega J, Seni J, Mushi MF, Kidenya BR, Hokororo A, Zuechner A, Kihunrwa A, Mshana SE. Evaluation of existence and transmission of extended spectrum beta lactamase producing bacteria from post-delivery women to neonates at Bugando Medical Center, Mwanza-Tanzania. BMC Res Notes 2014; 7:279. [PMID: 24886506 PMCID: PMC4014626 DOI: 10.1186/1756-0500-7-279] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 04/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extended spectrum beta-lactamase producing bacteria (ESBL) are common causes of neonatal sepsis worldwide. Neonatal sepsis due to ESBL is associated with increased morbidity and mortality at Bugando Medical Centre (BMC). Due to limited information on the sources of these ESBL strains at BMC, this study was conducted to evaluate the existence, magnitude and transmission of ESBL from post-delivery women to neonates at BMC, Mwanza-Tanzania. RESULTS A cross-sectional study was conducted at obstetrics and neonatal wards from May to July 2013, involving post-delivery women and their neonates. Rectal swabs were collected and processed to identify the ESBL strains and their antimicrobial susceptibility patterns. Patients' data were obtained using a standardized data collection tool. We enrolled 113 women and 126 neonates with mean age of 26.5 ± 5.5 years and median gestation age [IQR] of 39 [35-40] weeks respectively. The prevalence of ESBL carriage among women and neonates were 15% (17/113) and 25.4% (32/126) respectively. The acquisition of ESBL isolates among neonates on day 1, day 3 and day 7 were 60.0% (21/35), 25.7% (9/35) and 14.3% (5/35) respectively. There was no phenotypic similarity between ESBL strains from women and their respective neonates, suggesting other sources of transmission. Neonates given antibiotics were more likely to carry ESBL than those not given [100% (32/32) versus 86% (81/94), p = 0.018]. CONCLUSION The carriage rate of ESBL strains among post-delivery women and neonates at BMC is high. Our findings suggest that neonates acquire these strains from sources other than post-delivery women and more than half acquire them on the first day of life. More studies are recommended to further explore the sources of ESBL strains among neonates.
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Affiliation(s)
| | | | - Jeremiah Seni
- Department of Microbiology/Immunology, Catholic University of Health and Allied Sciences, P,O, Box 1464, Mwanza, Tanzania.
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Trends in human fecal carriage of extended-spectrum β-lactamases in the community: toward the globalization of CTX-M. Clin Microbiol Rev 2014; 26:744-58. [PMID: 24092853 DOI: 10.1128/cmr.00023-13] [Citation(s) in RCA: 473] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
In the last 10 years, extended-spectrum β-lactamase-producing enterobacteria (ESBL-E) have become one of the main challenges for antibiotic treatment of enterobacterial infections, largely because of the current CTX-M enzyme pandemic. However, most studies have focused on hospitalized patients, though today it appears that the community is strongly affected as well. We therefore decided to devote our investigation to trends in ESBL-E fecal carriage rates and comprehensively reviewed data from studies conducted on healthy populations in various parts of the world. We show that (i) community ESBL-E fecal carriage, which was unknown before the turn of the millennium, has since increased significantly everywhere, with developing countries being the most affected; (ii) intercontinental travel may have emphasized and globalized the issue; and (iii) CTX-M enzymes, especially CTX-M-15, are the dominant type of ESBL. Altogether, these results suggest that CTX-M carriage is evolving toward a global pandemic but is still insufficiently described. Only a better knowledge of its dynamics and biology will lead to further development of appropriate control measures.
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