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. 2019 Oct 30;69(Suppl 6):S449-S458.
doi: 10.1093/cid/ciz450.

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

Trevor Toy  1 , Gi Deok Pak  1 , Trung Pham Duc  2 , James I Campbell  2 , Muna Ahmed El Tayeb  3 , Vera Von Kalckreuth  1 , Justin Im  1 , Ursula Panzner  1 , Ligia Maria Cruz Espinoza  1 , Daniel Eibach  4 , Denise Myriam Dekker  4   5 , Se Eun Park  1 , Hyon Jin Jeon  1   6 , Frank Konings  1 , Ondari D Mogeni  1   7 , Leonard Cosmas  8 , Morten Bjerregaard-Andersen  9   10 , Nagla Gasmelseed  3   11 , Julian T Hertz  12   13 , Anna Jaeger  4 , Ralf Krumkamp  4 , Benedikt Ley  1   14 , Kamala Thriemer  1   14 , Leon Parfait Kabore  15 , Aissatou Niang  16 , Tiana Mirana Raminosoa  17 , Emmanuel Sampo  18 , Nimako Sarpong  19 , Abdramane Soura  18 , Ellis Owusu-Dabo  19   20 , Mekonnen Teferi  21 , Biruk Yeshitela  21 , Sven Poppert  22 , Jürgen May  4   5 , Jerome H Kim  1 , Yun Chon  1 , Jin Kyung Park  1 , Abroaham Aseffa  21 , Robert F Breiman  7   23 , Heidi Schütt-Gerowitt  1   24 , Peter Aaby  9   10 , Yaw Adu-Sarkodie  19   25 , John A Crump  12   13   26   27 , Raphaël Rakotozandrindrainy  17 , Christian G Meyer  28   29 , Amy Gassama Sow  16   30 , John D Clemens  31   32   33 , Thomas F Wierzba  1 , Stephen Baker  2   6 , Florian Marks  1   6
Affiliations

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

Trevor Toy et al. Clin Infect Dis. .

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.

Keywords: Africa; ESBL; antibiotic resistance; antimicrobial resistance; extended-spectrum β-lactamase; surveillance.

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Figures

Figure 1.
Figure 1.
Flow diagram of bloodstream infection Gram-negative bacterial isolates for ESBL analyses. Abbreviation: ESBL, extended-spectrum β-lactamase.
See this image and copyright information in PMC

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