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

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AUTHORS

Trevor Toy, Gi Deok Pak, Trung Pham Duc, James I Campbell, Muna Ahmed El Tayeb, Vera Von Kalckreuth, Justin Im, Ursula Panzner, Ligia Maria Cruz Espinoza, Daniel Eibach, Denise Myriam Dekker, Se Eun Park, Hyon Jin Jeon, Frank Konings, Ondari D Mogeni, Leonard Cosmas, Morten Bjerregaard-Andersen, Nagla Gasmelseed, Julian T Hertz, Anna Jaeger, Ralf Krumkamp, Benedikt Ley, Kamala Thriemer, Leon Parfait Kabore, Aissatou Niang, Tiana Mirana Raminosoa, Emmanuel Sampo, Nimako Sarpong, Abdramane Soura, Ellis Owusu-Dabo, Mekonnen Teferi, Biruk Yeshitela, Sven Poppert, Jürgen May, Jerome H Kim, Yun Chon, Jin Kyung Park, Abroaham Aseffa, Robert F Breiman, Heidi Schütt-Gerowitt, Peter Aaby, Yaw Adu-Sarkodie, John A Crump, Raphaël Rakotozandrindrainy, Christian G Meyer, Amy Gassama Sow, John D Clemens, Thomas F Wierzba, Stephen Baker, Florian Marks

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.

Click here to read the article, published in Clinical Infectious Diseases.