Multicountry Distribution and Characterization of Extended-spectrum β-Lactamase-associated Gram-negative Bacteria From Bloodstream Infections in Sub-Saharan Africa.
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.
Toy, T; Pak, GD; Duc, TP; Campbell, JI; El Tayeb, MA; Von Kalckreuth, V; Im, J; Panzner, U; Cruz Espinoza, LM; Eibach, D; Dekker, DM; Park, SE; Jeon, HJ; Konings, F; Mogeni, OD; Cosmas, L; Bjerregaard-Andersen, M; Gasmelseed, N; Hertz, JT; Jaeger, A; Krumkamp, R; Ley, B; Thriemer, K; Kabore, LP; Niang, A; Raminosoa, TM; Sampo, E; Sarpong, N; Soura, A; Owusu-Dabo, E; Teferi, M; Yeshitela, B; Poppert, S; May, J; Kim, JH; Chon, Y; Park, JK; Aseffa, A; Breiman, RF; Schütt-Gerowitt, H; Aaby, P; Adu-Sarkodie, Y; Crump, JA; Rakotozandrindrainy, R; Meyer, CG; Sow, AG; Clemens, JD; Wierzba, TF; Baker, S; Marks, F
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