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Kedišaletše M, Phumuzile D, Angela D, Andrew W, Mae NF. Epidemiology, risk factors, and clinical outcomes of carbapenem-resistant Enterobacterales in Africa: A systematic review. J Glob Antimicrob Resist 2023; 35:297-306. [PMID: 37879456 DOI: 10.1016/j.jgar.2023.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES Carbapenem-resistant Enterobacterales (CRE) commonly cause hospital-acquired infections and hospital outbreaks worldwide, with an alarming increase in Africa, necessitating review of regional CRE epidemiological trends. METHODS A systematic review was conducted using PRISMA guidelines, searching PubMed, Scopus and Web of Science databases for studies describing CRE distribution, risk factors for CRE acquisition and clinical outcome of CRE infections in Africa. RESULTS One-hundred and sixty-nine studies were included, with the majority from North Africa (92/169, 54.4%). Most studies (136/169; 80.4%) focused only on infection, with a total of 15666 CRE isolates (97.4% clinical infection, 2.6% colonisation). The leading bacterial species included Klebsiella (72.2%), Escherichia coli (13.5%), and Enterobacter (8.3%). The most frequently detected carbapenemases were NDM (43.1%) and OXA-48-like (42.9%). Sequence types were reported in 44 studies, with ST101 and ST147 most commonly reported in K. pneumoniae, and ST410, ST167 and ST38 in E. coli. Previous antibiotic use, prior hospitalisation, surgical procedures, indwelling devices, intensive care unit admission and prolonged hospital stay, were the most frequent factors associated with CRE infection/colonisation. Crude mortality for CRE infection was 37%. CONCLUSION Although K. pneumoniae and E. coli remain the most frequent CRE in Africa, observed sequence types are not the commonly reported global 'high-risk' clones. The distribution of species and carbapenemases differs across African regions, while risk factors for CRE colonisation/infection, and patient outcomes are similar to those reported globally. There are limited data on CREs from parts of Africa, highlighting the need to strengthen epidemiologic surveillance programmes in the region.
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Affiliation(s)
- Moloto Kedišaletše
- Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Dube Phumuzile
- Synthetic Biology Center, NextGeneration Health, Council for Scientific and Industrial Research, Pretoria, South Africa
| | - Dramowski Angela
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Whitelaw Andrew
- Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Newton-Foot Mae
- Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
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Yusuf I, Arzai AH, Yusha U M, Garba L, Haruna M, Getso MI. Cross-sectional survey of knowledge and attitudes of healthcare workers and community members toward the Ebola virus disease and antimicrobial resistance pathogens outbreaks in Nigeria. Pan Afr Med J 2021; 40:116. [PMID: 34887990 PMCID: PMC8627141 DOI: 10.11604/pamj.2021.40.116.20561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 01/13/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction the 2014 Ebola virus disease (EVD) outbreak in Nigeria has further raised the awareness of health-care workers (HCWs) and community members (MCs) on the threat posed by infectious diseases and the need for improvement on infection control practices. However, awareness of dangers of increasing incidences of antimicrobial resistance (AMR) in hospitals and communities remained low. Methods a cross-sectional survey of awareness of 195 HCWs and 265 MCs toward EVD and AMR was conducted through a structured questionnaire. Results majority of HCWs (95.4%) and MCs (82.8%) still have knowledge of EVD´s danger and give reasons like its unique way of killing and unavailability of drugs for their awareness. Only 17.2% of MCs are aware of AMR as a problem, and only 3.4% of MCs and 10.3% of HCWs agreed that AMR is more dangerous than EVD. On the contrary, 76.4% of doctors, 95.1% nurses, 67.9% laboratory scientists, 66.7% pharmacists, 77.4% students and 100% of civil servants, drivers and religious leaders believed that EVD is more horrific and spread faster. They both attributed the rapid awareness of EVD in Nigeria, despite being new at the time of the outbreak, to the seriousness with which stakeholders and the media fought EVD, the gesture AMR is yet to receive. Though both HCWs and MCs agreed that prevention, not treatment is the best option to tackle Ebola like-diseases, but surprisingly, about 37% and 65% of HCWs and MCs respectively, still believe that traditional medicines can be used to treat Ebola related illnesses. Conclusion AMR awareness remains low among MCs and some HCWs when compared with EVD. It is recommended that efforts put in place during EVD outbreak by all stakeholders and the media need to be doubled to increase the knowledge of both HCWs and MCs toward AMR.
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Affiliation(s)
- Ibrahim Yusuf
- Department of Microbiology, Faculty of Life Sciences, Bayero University, Kano, PMB 3011, Kano, Nigeria
| | - Auwalu Halliru Arzai
- Department of Microbiology, Faculty of Life Sciences, Bayero University, Kano, PMB 3011, Kano, Nigeria
| | - Muhammad Yusha U
- Department of Microbiology, Faculty of Life Sciences, Bayero University, Kano, PMB 3011, Kano, Nigeria
| | - Lawal Garba
- Department of Microbiology, Gombe State University, Gombe, Nigeria
| | - Musa Haruna
- Department of Biology, Kano University of Science and Technology, Wudil, Kano, Nigeria
| | - Muhammad Ibrahim Getso
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, PMB 3011, Kano, Nigeria
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Multidrug-Resistant and Carbapenemase-Producing Enterobacteriaceae in Addis Ababa, Ethiopia. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9999638. [PMID: 34195291 PMCID: PMC8214486 DOI: 10.1155/2021/9999638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 11/18/2022]
Abstract
Background The emergence and spread of multi-drug resistant (MDR) bacteria have become a public health problem in recent years. For the last many years, carbapenem antibiotics have been used successfully to treat infections caused by MDR Enterobacteriaceae. However, recently, Enterobacteriaceae producing carbapenemases have emerged, which confer broad resistance to most β-lactam antibiotics including carbapenems. Therefore, this study is aimed at determining the magnitude of MDR and carbapenemase-producing Enterobacteriaceae (CPE) isolated from various clinical specimens in Addis Ababa, Ethiopia. Methods A cross-sectional study was conducted from January to April 2018. A total of 312 Enterobacteriaceae isolates were identified from various clinical specimens. The Phoenix automated system (BD Phoenix100) was used for bacterial identification and antimicrobial susceptibility testing. Potential carbapenemase producers were confirmed by the modified carbapenem inactivation test, and KPC, MBL, and OXA-48 were phenotypically characterized by the disk diffusion method. The data obtained were entered and analyzed using SPSS version 20 software. Descriptive statistics, chi square, bivariate and multivariable logistic regression analyses were performed. P value ≤ 0.05 with corresponding 95% confidence interval was considered for statistical significance. Results A total of 312 Enterobacteriaceae were recovered. Of these isolates, 68.6% were MDR and 2.6% were CPE with different classes including OXA-48 1.6% (5/312), MBL 0.6% (2/312), and KPC and OXA-48 0.3% (1/312). The predominant bacterial isolates were E. coli 72.4% (226/312) followed by K. pneumoniae 13.8% (43/312). The antibiotic resistance rates of CPE isolates were significantly higher than other MDRE including ampicillin (100% versus 77.6%), cefoxitin (75% versus 20.6%), and piperacillin/tazobactam (50% versus 13.1%). Conclusion In this study, a relatively higher prevalence of MDR was observed, and the highest resistance was recorded against ampicillin, amoxicillin with clavulanic acid, and sulfamethoxazole-trimethoprim. Detection of CPE is important for implementing appropriate antimicrobial therapy and in controlling the spread of the infection. Furthermore, continuous screening and investigations, including genotypic characterization of CPE, are required for the prevention and control of the spread of antimicrobial-resistant pathogens.
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The Emergence of Klebsiella pneumoniae with Reduced Susceptibility Against Third Generation Cephalosporins and Carbapenems in Lagos Hospitals, Nigeria. Antibiotics (Basel) 2021; 10:antibiotics10020142. [PMID: 33535654 PMCID: PMC7912815 DOI: 10.3390/antibiotics10020142] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 11/17/2022] Open
Abstract
This study investigated the prevalence of Klebsiella (K.) pneumoniae isolates among clinical samples of patients in four medical centers in Lagos, Nigeria and the burden of extended-spectrum beta-lactamases (ESBL) and carbapenem-resistant K. pneumoniae (CRKP) strains. Different samples (stool, blood, urine, wound swabs and nasal swabs) from 127 patients with suspected Gram-negative infections based on on-site performed Gram-stain from four public hospitals between March and September 2015 were analyzed. K. pneumoniae was identified in 43 (34%) patients. Resistance rates of these 43 strains according to the CLSI breakpoints were as followed: cotrimoxazole (90.7%), cefuroxime (74.4%), ofloxacin (55.8%), ceftazidime (46.5%), and cefixime (35%). Three isolates (7%) were resistant to imipenem. All isolates were susceptible to amoxicillin/clavulanic acid and nitrofurantoin. The prevalence of ESBL-producing, MDR and CRKP strains was 69.8%, 62.8%, and 7.0%, respectively. Of the ESBL-producing isolates, two K. pneumoniae isolates obtained from urine harbored both blaSHV and blaCTX-M-1, and a third isolate from urine harbored only the blaCTX-M-1. This study revealed the emergence of CRKP isolates and blaCTX-M-1 and blaSHV co-harboring K. pneumoniae strains in Lagos hospitals. The emergence of CRKP strains is an early warning signal for carbapenem antibiotics’ prudent use with concern for their efficacies.
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Tawfick MM, Alshareef WA, Bendary HA, Elmahalawy H, Abdulall AK. The emergence of carbapenemase bla NDM genotype among carbapenem-resistant Enterobacteriaceae isolates from Egyptian cancer patients. Eur J Clin Microbiol Infect Dis 2020; 39:1251-1259. [PMID: 32062725 DOI: 10.1007/s10096-020-03839-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/03/2020] [Indexed: 02/07/2023]
Abstract
Carbapenem resistance among Enterobacteriaceae is a major concern that is increasingly reported worldwide. The objective of this study is to determine the incidence of carbapenem resistance as well as to investigate for carbapenemase-encoding genes among Enterobacteriaceae clinical isolates from cancer patients at different cancer institutes in Egypt. This determination was a cross-sectional study with a total of 135 clinical isolates collected over a period of 1 year. All isolates were sub-cultured on ChromID agar and subjected to phenotypic and molecular detection of carbapenemases. Most of the Enterobacteriaceae isolates were MDR with high resistance rates against tested antimicrobials. Overall, the results of PCR assays revealed that 89.62% (121/135) of isolates harbored one or more of the carbapenemase-encoding genes, while phenotypic assays revealed the production of carbapenemases in 68.88% (93/135) of isolates. BlastN analysis against the non-redundant genome sequences available in the GenBank database revealed that the blaNDM-1 gene was the most prevalent genotype of carbapenemases in 93/135 (68.88%), followed by blaOXA-48 44/135 (32.59%), blaOXA-23 42/135 (31.11%), and blaKPC-2 2/135 (1.48%). Klebsiella pneumoniae isolates harbored the highest number of carbapenemase-encoding genes 34/121 (28.09%). The high prevalence of carbapenemases and/or their encoding genes among MDR Enterobacteriaceae bacteria in Egypt is alarming, thus, the management of serious infections caused by Enterobacteriaceae, particularly in cancer patients will be challenging to clinicians. Carbapenemase blaNDM genotype is emerging in cancer healthcare settings in Egypt, which could be the cause of the current increase in carbapenemase-producing Enterobacteriaceae.
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Affiliation(s)
- Mahmoud M Tawfick
- Department of Microbiology and Immunology, Faculty of Pharmacy (Boys), Al-Azhar University, Cairo, Egypt
- Department of Microbiology and Immunology, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA), 6th October City, Giza, 11787, Egypt
| | - Walaa A Alshareef
- Department of Microbiology and Immunology, Faculty of Pharmacy, October 6 University, Giza, Egypt
| | - Hager A Bendary
- Department of Microbiology and Immunology, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt
| | - Hadir Elmahalawy
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Abeer K Abdulall
- Department of Microbiology and Immunology, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt.
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Ibadin EE, Eghiomon A, Idemudia NL, Anogie NA, Eriamiatoe RE, Dedekumah EI, Aguh OD, Igbarumah IO, Omoregie R. Phenotypic Distribution of Serine- and Zinc-Type Carbapenemases Among Clinical Bacterial Isolates in a Tertiary Hospital in Benin, Nigeria. INTERNATIONAL JOURNAL OF ENTERIC PATHOGENS 2020. [DOI: 10.34172/ijep.2020.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Serine and zinc type carbapenemases are distributed in many genera of bacteria and are typically associated with specific regions or countries. Objectives: This study phenotypically determined the prevalence of serine and zinc-type carbapenemases among Gram-negative bacilli recovered from clinical specimens in Benin, Nigeria. Materials and Methods: Totally, 158 consecutive non-duplicate bacterial isolates (gram-negative bacilli) recovered from clinical samples were screened for serine and zinc-type carbapenemases using the simplified carbapenemase inactivation (sCIM) and ethylenediaminetetraacetic acid -double-disc synergy test methods. Results: The isolates recovered from clinical specimens included 126 Enterobacteriaceae (79.7%), 7 Acinetobacter spp (3.7%), and 28oxidase positive gram negative bacilli (17.7%). Twenty-eight isolates (17.7%) out of the 158 tested samples were carbapenemase positive. There was no significant difference in the prevalence of serine- and zinc-type carbapenemases (P=0.0748). However, the prevalence of zinc-type carbapenemase was significantly higher in Pseudomonas aeruginosa compared with other isolates (P=0.0028) while that of serinetype carbapenemase was not affected by the type of clinical isolates (P=0.7216). Finally, the prevalence of both serine- and zinc-type carbapenemases were not affected (P>0.05) by clinical specimens and the source of isolates (in-patient vs. out-patient) respectively. Conclusion: In general, the prevalence of zinc-type (12%) carbapenemases was insignificantly higher than that of serine-type (5.7%) carbapenemases. The measures to reduce infections caused by carbapenemase-producing organisms (CPOs) are advocated accordingly.
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Affiliation(s)
- Ephraim E. Ibadin
- Medical Microbiology Division, Medical Laboratory Services, University of Benin Teaching Hospital, Benin, Nigeria
| | - Angela Eghiomon
- Medical Microbiology Division, Medical Laboratory Services, University of Benin Teaching Hospital, Benin, Nigeria
| | - Nosakhare L. Idemudia
- Medical Microbiology Division, Medical Laboratory Services, University of Benin Teaching Hospital, Benin, Nigeria
- Anti-retroviral Laboratory Unit, Medical Microbiology Division, Medical Laboratory Services, University of Benin Teaching Hospital, Benin, Nigeria
| | - Nana A. Anogie
- Medical Microbiology Division, Medical Laboratory Services, University of Benin Teaching Hospital, Benin, Nigeria
| | - Richard E. Eriamiatoe
- Medical Microbiology Division, Medical Laboratory Services, University of Benin Teaching Hospital, Benin, Nigeria
| | - Eghonghon I. Dedekumah
- Medical Microbiology Division, Medical Laboratory Services, University of Benin Teaching Hospital, Benin, Nigeria
| | - Obiorah D. Aguh
- Medical Microbiology Division, Medical Laboratory Services, University of Benin Teaching Hospital, Benin, Nigeria
| | - Isaac O. Igbarumah
- Medical Microbiology Division, Medical Laboratory Services, University of Benin Teaching Hospital, Benin, Nigeria
| | - Richard Omoregie
- Medical Microbiology Division, Medical Laboratory Services, University of Benin Teaching Hospital, Benin, Nigeria
- School of Medical Laboratory Sciences, University of Benin Teaching Hospital, Benin, Nigeria
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Musa BM, Imam H, Lendel A, Abdulkadir I, Gumi HS, Aliyu MH, Habib AG. The burden of extended-spectrum β-lactamase-producing Enterobacteriaceae in Nigeria: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2020; 114:241-248. [PMID: 31925440 DOI: 10.1093/trstmh/trz125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/18/2019] [Accepted: 11/04/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Antibiotic resistance on account of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) has become a major public health concern in developing countries. The presence of ESBL-PE is associated with increased morbidity, mortality and healthcare costs. There is no active antimicrobial surveillance mechanism in Nigeria. The aim of this study is to determine a precise estimate of the burden of ESBL-PE in Nigeria. We employed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and searched electronic databases for suitable studies. We derived pooled prevalence estimates using random effects models and assessed trends with meta-regression. We found 208 studies, with 38 satisfying our inclusion criteria. The overall pooled prevalence of ESBL-PE in Nigeria was 34.6% (95% CI 26.8 to 42.3%) and increased at a rate of 0.22% per year (p for trend=0.837). In summary, we found the prevalence of ESBL-PE in Nigeria to be high and recommend a robust national survey to provide a more detailed picture of the epidemiology of ESBL-PE in Nigeria.
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Affiliation(s)
- Baba M Musa
- Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria. 700241
- Africa Center of Excellence of Population Health and Policy (ACEPHAP) Bayero University, Kano, Nigeria
| | - Hassana Imam
- Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria. 700241
| | - Anastasia Lendel
- Center for Medicine, Health and Society 300 Calhoun Hall, Vanderbilt University, Nashville, TN 37240, USA
| | - Isa Abdulkadir
- Department of Pediatrics, Ahmadu Bello University Teaching Hospital,Zaria, Nigeria
| | - Halima S Gumi
- North Devon District Hospital, Barnstable, EX31 1NR, UK
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, 2525 West End Avenue, Suite 725, Nashville, Tennessee, 37203-1738, USA
| | - Abdulrazaq G Habib
- Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria. 700241
- Africa Center of Excellence of Population Health and Policy (ACEPHAP) Bayero University, Kano, Nigeria
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Adesina T, Nwinyi O, De N, Akinnola O, Omonigbehin E. First Detection of Carbapenem-Resistant Escherichia fergusonii Strains Harbouring Beta-Lactamase Genes from Clinical Samples. Pathogens 2019; 8:pathogens8040164. [PMID: 31557915 PMCID: PMC6963453 DOI: 10.3390/pathogens8040164] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 01/10/2023] Open
Abstract
Recently discovered extraintestinal Escherichia fergusonii obtained from non-clinical samples has exhibited the potential for acquiring multiple beta-lactamase genes, just like many extraintestinal Escherichia coli strains. Albeit, they are often omitted or classified as E. coli. This study aimed to, therefore, identify carbapenem-resistant extended-spectrum beta-lactamase (ESBL) producing E. fergusonii isolates from clinical samples, determine their evolutionary relatedness using 16S rRNA sequencing analysis and screen for beta-lactamase genes. A total of 135 septic wound samples were obtained from patients on referral at a General Hospital in Lagos, Nigeria. For the phenotypic identification of isolates from culture-positive samples, morphological, and physiological tests were carried out. Identities of the isolates harbouring beta-lactamase genes were assigned to their genus strains using the 16S rRNA sequencing. The Kirby Bauer disc diffusion technique and double-disc synergy test were used to screen isolates for multidrug resistance and ESBL production. Carbapenem-resistant ESBL producing isolates were screened for beta-lactamase genes in a polymerase chain reaction. Three E. fergusonii isolates (CR11, CR35 and CR49) were obtained during this study. E. fergusonii strains were motile, non-lactose and non-sorbitol fermenting but positive for cellobiose and adonitol fermentation. The I6S rRNA assigned the phenotypically identified isolates to E. fergusonii species. All three isolates were multidrug-resistant, carbapenem-resistant and ESBL producers. Isolates CR11 and CR35 harboured cefotaximase (CTX-M) and temoniera (TEM) beta-lactamase genes while CR49 harboured sulfhydryl variable (SHV) beta-lactamase gene. We herein report the detection of multiple beta-lactamase genes in carbapenem-resistant ESBL producing E. fergusonii from clinical samples.
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Affiliation(s)
- Tomilola Adesina
- Department of Microbiology, College of Science and Technology, Covenant University, 112103 Ota, Nigeria.
| | - Obinna Nwinyi
- Department of Microbiology, College of Science and Technology, Covenant University, 112103 Ota, Nigeria.
| | - Nandita De
- Department of Microbiology, College of Science and Technology, Covenant University, 112103 Ota, Nigeria.
| | - Olayemi Akinnola
- Department of Microbiology, College of Science and Technology, Covenant University, 112103 Ota, Nigeria.
| | - Emmanuel Omonigbehin
- Department of Microbiology, College of Science and Technology, Covenant University, 112103 Ota, Nigeria.
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Beyene D, Bitew A, Fantew S, Mihret A, Evans M. Multidrug-resistant profile and prevalence of extended spectrum β-lactamase and carbapenemase production in fermentative Gram-negative bacilli recovered from patients and specimens referred to National Reference Laboratory, Addis Ababa, Ethiopia. PLoS One 2019; 14:e0222911. [PMID: 31553773 PMCID: PMC6760794 DOI: 10.1371/journal.pone.0222911] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 09/10/2019] [Indexed: 12/17/2022] Open
Abstract
Background The emergence of multidrug-resistance (MDR), production of extended-spectrum β-lactamases, and carbapenemase in members of fermentative gram-negative bacilli are a serious threat to public health. Objective The aim of this study was to determine the burden of multi-drug resistance, the production of extended-spectrum β-lactamases (ESBLs), and carbapenemase in fermentative Gram-negative bacilli in Ethiopian Public Health Institute. Materials and methods A cross-sectional study was carried out from December 2017 to June 2018. Different clinical samples were collected, inoculated, and incubated according to standard protocols related to each sample. Bacterial identification was performed by using the VITEKR 2 compact system using the GNR card. Antimicrobial susceptibility testing was carried out by the Kirby-Bauer disc diffusion method. Production of ESBL and carbapenemase were confirmed by combination disc and modified Hodge Test method respectively. Results A total of 238 fermentative Gram-negative bacilli were recovered during the study period, among which E.coli were the predominant isolates followed by K. pneumoniae. The highest percentage of antibiotic resistance was noted against ampicillin (100%) followed by trimethoprim/sulfamethoxazole (81.9%). The isolates showed better sensitivity towards carbapenem drugs. Out of 238 isolates, 94.5% were MDR and of which 8.8% and 0.8% were extensively and pan drug resistant, respectively. Nearly 67% and 2% of isolates were producers of ESBL and carbapenemase, respectively. The isolation rates of MDR, ESBL, and carbapenemase producing stains of the isolates were ≥70% in intensive care unit while the isolation rates in other wards were ≤25%. Conclusions The findings of this study revealed that the burden of MDR and ESBL was high and carbapenemase producing isolates were also identified which is concerning. This situation warrants a consistent surveillance of antimicrobial resistance of fermentative Gram-negative bacilli and implementation of an efficient infection control program.
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Affiliation(s)
- Degefu Beyene
- Ethiopian Public Health Institute, Clinical Bacteriology and Mycology Research Case Team, Addis Ababa, Ethiopia
- * E-mail:
| | - Adane Bitew
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Surafel Fantew
- Ethiopian Public Health Institute, Clinical Bacteriology and Mycology Research Case Team, Addis Ababa, Ethiopia
| | - Amete Mihret
- Ethiopian Public Health Institute, Clinical Bacteriology and Mycology Research Case Team, Addis Ababa, Ethiopia
| | - Martin Evans
- American Society for Microbiology, New York, New York, United States of America
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Ssekatawa K, Byarugaba DK, Wampande E, Ejobi F. A systematic review: the current status of carbapenem resistance in East Africa. BMC Res Notes 2018; 11:629. [PMID: 30170613 PMCID: PMC6119249 DOI: 10.1186/s13104-018-3738-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/28/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE In this systematic review, we present the molecular epidemiology and knowledge gaps of the carbapenem resistance in East Africa as well as the future probable research interventions that can be used to address the emergence of carbapenem resistance in the region. RESULTS The 17 articles which presented concrete information about the prevalence of carbapenem resistance in East Africa were reviewed. Tanzania exhibited the highest level of carbapenem resistance at 35% while DRC had the lowest level at 0.96%. Uganda was the only country with studies documenting CR obtained amongst hospital environment isolates with incidence ranging from 21% in Pseudomonas aeruginosa to 55% in Acinetobacter baumannii. Carbapenem resistance was more exhibited in A. baumannii (23%), followed by P. aeruginosa (17%), Klebsiella pneumoniae (15%), Proteus mirabilis (14%) and Escherichia coli (12%) mainly isolated from respiratory tract, blood, urine and wound/pus. The regional genetic determinants of carbapenem resistance detected were blaIMP, blaVIM-1 blaSPM-l, blaNDM-1, blaOXA-23 blaOXA-24, blaOXA-58 and blaKPC.
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Affiliation(s)
- Kenneth Ssekatawa
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P. O. Box 7062, Kampala, Uganda
- Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University-Western Campus, P. O. Box 71, Bushenyi, Uganda
| | - Dennis K. Byarugaba
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Edward Wampande
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Francis Ejobi
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P. O. Box 7062, Kampala, Uganda
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Humayun A, Siddiqui FM, Akram N, Saleem S, Ali A, Iqbal T, Kumar A, Kamran R, Bokhari H. Incidence of metallo-beta-lactamase-producing Klebsiella pneumoniae isolates from hospital setting in Pakistan. Int Microbiol 2018; 21:73-78. [PMID: 30810920 DOI: 10.1007/s10123-018-0006-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 10/16/2022]
Abstract
The aim of this study was monitoring and surveillance in different wards of the PIMS hospital, Islamabad, to understand emerging challenges of antibiotic resistance in particular association with most virulent serotypes of Klebsiella pneumoniae. The study was conducted during March 2015 to September 2015. The study showed that rate of isolation of K. pneumoniae was 37% (103 positives out of a total of 277 clinical samples) and 7.7% (8) were phenotypically and genotypically confirmed to be metallo-β-lactamase resistant (carbapenem resistant) and all of them were multidrug resistant (MDR). These carbapenem-resistant isolates were isolated from blood, endotracheal tubes, and pus. Molecular screening for the presence of integrons indicated that distribution of class I integrons (87.5% of carbapenem-resistant K. pneumoniae isolates) was higher than class II integrons (1.25%) among given isolates. The study indicated that exposure of metallo-beta-lactamase-producing strains through hospitalizations increases the chances of spread of MDR pathogens. There is an urgent need for effective surveillance and monitoring strategies to control the spread of extremely resistant K. pneumoniae implicated in nosocomial infections leading to the increased health burden and enforcement of policy guideline on appropriate antibiotics usage.
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Affiliation(s)
- Aqsa Humayun
- Department of Biosciences, COMSATS Institute of Information Technology, Islamabad, Pakistan
| | - Fariha Masood Siddiqui
- Department of Biosciences, COMSATS Institute of Information Technology, Islamabad, Pakistan
| | - Neelam Akram
- Department of Biosciences, COMSATS Institute of Information Technology, Islamabad, Pakistan
| | - Sidra Saleem
- Department of Biosciences, COMSATS Institute of Information Technology, Islamabad, Pakistan
| | - Amjad Ali
- Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad, Pakistan
| | - Tariq Iqbal
- PIMS Hospital, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Ashok Kumar
- PIMS Hospital, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Rubina Kamran
- PIMS Hospital, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Habib Bokhari
- Department of Biosciences, COMSATS Institute of Information Technology, Islamabad, Pakistan.
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Carbapenemase-Producing Enterobacteriaceae Isolates from Edo State, Nigeria. Antimicrob Agents Chemother 2017; 61:AAC.00255-17. [PMID: 28607027 PMCID: PMC5527642 DOI: 10.1128/aac.00255-17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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