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

• Type of Material: Article
• Authors: Trevor Toy, International Vaccine Institute; Gi Deok Pak, International Vaccine Institute; Pham Duc Trung, University of Oxford; James I Campbell, University of Oxford; Muna Ahmed El Tayeb, University of Gezira; Vera Von Kalckreuth, International Vaccine Institute; Justin Im, International Vaccine Institute; Ursula Panzner, International Vaccine Institute; Ligia Maria Cruz Espinoza, International Vaccine Institute; Daniel Eibach, Bernhard Nocht Institute for Tropical Medicine; Denise Myriam Dekker, Bernhard Nocht Institute for Tropical Medicine; Se Eun Park, International Vaccine Institute; Hyon Jin Jeon, International Vaccine Institute; Frank Konings, International Vaccine Institute; Ondari D Mogeni, International Vaccine Institute; Leonard Cosmas, Centers for Disease Control and Prevention; Morten Bjerregaard-Andersen, Bandim Health Project; Nagla Gasmelseed, University of Gezira; Julian T Hertz, Kilimanjaro Christian Medical Centre; Robert F Breiman, Emory University
• Language: English
• Date: 2019-11-15
• Publisher: Oxford University Press (OUP): Policy B - Oxford Open Option C
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/cid/ciz450
• Title of Journal or Parent Work: Clinical Infectious Diseases
• ISSN: 1058-4838
• Volume: 69
• Issue: Supplement_6
• Start Page: S449
• End Page: S458
• Grant/Funding Information: This article was published as part of the supplement “Severe Typhoid Fever in Africa (SETA) Program” sponsored by the International Vaccine Institute.; The International Vaccine Institute acknowledges its donors including the Republic of Korea and the Swedish International Development Cooperation Agency.; This research was funded by the Bill & Melinda Gates Foundation (OPP1127988).; This publication was made possible through a grant from the Bill & Melinda Gates Foundation (OPP1201031).
• Keywords: surveillance; extended-spectrum beta-lactamase; antibiotic resistance; Immunology; Science & Technology; Infectious Diseases; GENES; ESBL; Africa; Microbiology; antimicrobial resistance; MULTIPLEX PCR; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

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.