학술논문
Multicountry Distribution and Characterization of Extended-spectrum β-Lactamase–associated Gram-negative Bacteria From Bloodstream Infections in Sub-Saharan Africa.
Document Type
Article
Author
Toy, Trevor; Pak, Gi Deok; Duc, Trung Pham; Campbell, James I; Tayeb, Muna Ahmed El; Kalckreuth, Vera Von; Im, Justin; Panzner, Ursula; Espinoza, Ligia Maria Cruz; 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
Source
Subject
*BACTEREMIA diagnosis
*BACTEREMIA
*BLOOD
*CELL culture
*CLINICAL pathology
*DRUG resistance in microorganisms
*ENTEROBACTERIACEAE
*ESCHERICHIA coli
*GRAM-negative bacteria
*GRAM-negative bacterial diseases
*HEALTH facilities
*HYDROLASES
*KLEBSIELLA
*MICROBIAL sensitivity tests
*POLYMERASE chain reaction
*POPULATION geography
*PUBLIC health surveillance
*SALMONELLA
*TYPHOID fever
*PHENOTYPES
*GENETIC testing
*DISEASE prevalence
*GRAM-negative aerobic bacteria
*GENOTYPES
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Language
ISSN
1058-4838
Abstract
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. [ABSTRACT FROM AUTHOR]