Multicountry Distribution and Characterization of Extended-spectrum β-Lactamase–associated Gram-negative Bacteria From Bloodstream Infections in Sub-Saharan Africa

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  Toy, Trevor ; Pak, Gi Deok ; Duc, Trung Pham ; Campbell, James I ; El Tayeb, Muna Ahmed ; Von Kalckreuth, Vera ; Im, Justin ; Panzner, Ursula ; Cruz Espinoza, Ligia Maria ; Eibach, Daniel ; Dekker, Denise Myriam ; Park, Se Eun ; Jeon, Hyon Jin ; Konings, Frank ; Mogeni, Ondari D ; Cosmas, Leonard ; Bjerregaard-Andersen, Morten ; Gasmelseed, Nagla ; Hertz, Julian T ; Jaeger, Anna ; Krumkamp, Ralf ; Ley, Benedikt ; Thriemer, Kamala ; Kabore, Leon Parfait ; Niang, Aissatou ; Raminosoa, Tiana Mirana ; Sampo, Emmanuel ; Sarpong, Nimako ; Soura, Abdramane ; Owusu-Dabo, Ellis ; Teferi, Mekonnen ; Yeshitela, Biruk ; Poppert, Sven ; May, Jürgen ; Kim, Jerome H ; Chon, Yun ; Park, Jin Kyung ; Aseffa, Abroaham ; Breiman, Robert F ; Schütt-Gerowitt, Heidi ; Aaby, Peter ; Adu-Sarkodie, Yaw ; Crump, John A ; Rakotozandrindrainy, Raphaël ; Meyer, Christian G ; Sow, Amy Gassama ; Clemens, John D ; Wierzba, Thomas F ; Baker, Stephen ; Marks, Florian
• Description:
  Background
  
  Antimicrobial resistance (AMR) is a major global health concern, yet, there are noticeable gaps in AMR surveillance data in regions such as sub-Saharan Africa. We aimed to measure the prevalence of extended-spectrum β-lactamase (ESBL) producing Gram-negative bacteria in bloodstream infections from 12 sentinel sites in sub-Saharan Africa.
  
  Methods
  
  Data were generated during the Typhoid Fever Surveillance in Africa Program (TSAP), in which standardized blood cultures were performed on febrile patients attending 12 health facilities in 9 sub-Saharan African countries between 2010 and 2014. Pathogenic bloodstream isolates were identified at the sites and then subsequently confirmed at a central reference laboratory. Antimicrobial susceptibility testing, detection of ESBL production, and conventional multiplex polymerase chain reaction (PCR) testing for genes encoding for β-lactamase were performed on all pathogens.
  
  Results
  
  Five hundred and five pathogenic Gram-negative bloodstream isolates were isolated during the study period and available for further characterization. This included 423 Enterobacteriaceae. Phenotypically, 61 (12.1%) isolates exhibited ESBL activity, and genotypically, 47 (9.3%) yielded a PCR amplicon for at least one of the screened ESBL genes. Among specific Gram-negative isolates, 40 (45.5%) of 88 Klebsiella spp., 7 (5.7%) of 122 Escherichia coli, 6 (16.2%) of 37 Acinetobacter spp., and 2 (1.3%) of 159 of nontyphoidal Salmonella (NTS) showed phenotypic ESBL activity.
  
  Conclusions
  
  Our findings confirm the presence of ESBL production among pathogens causing bloodstream infections in sub-Saharan Africa. With few alternatives for managing ESBL-producing pathogens in the African setting, measures to control the development and proliferation of AMR organisms are urgently needed.
  
  
• Subjects:
  Adolescent Adult Anti-Bacterial Agents Beta-Lactamases Child Child, Preschool Drug Resistance, Multiple, Bacterial Gram-Negative Bacteria Gram-Negative Bacterial Infections Humans Infant Infant, Newborn Microbial Sensitivity Tests Middle Aged Prevalence Sentinel Surveillance Young Adult

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• Source:
  Clin Infect Dis. 2019; 69(Suppl 6):S449-S458
• Pubmed ID:
  31665776
• Pubmed Central ID:
  PMC6821266
• Document Type:
  Journal Article
• Place as Subject:
  Africa South of the Sahara
• Volume:
  69
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:77b019345f3036002d0deb8e2eb3d3afdd60f0417285d5fad023399e6d2404dc
• Download URL:
  https://stacks.cdc.gov/view/cdc/89737/cdc_89737_DS1.pdf
• File Type:
  [PDF - 537.98 KB ]