Eibach Daniel, Belmar Campos Cristina, Krumkamp Ralf, Al-Emran Hassan M, Dekker Denise, Boahen Kennedy Gyau, Kreuels Benno, Adu-Sarkodie Yaw, Aepfelbacher Martin, Park Se Eun, Panzner Ursula, Marks Florian, May Jürgen
Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str.74, 20359 Hamburg, Germany.
University Medical Centre Hamburg-Eppendorf (UKE), Martinist. 52, 20246 Hamburg, Germany.
Int J Med Microbiol. 2016 Jun;306(4):249-54. doi: 10.1016/j.ijmm.2016.05.006. Epub 2016 May 10.
High prevalence of Extended Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae threatens treatment options for invasive bloodstream infections in sub-Saharan Africa.
To explore the frequency and genotype distribution of ESBL producing Enterobacteriaceae causing bloodstream infections in a primary health care setting in rural Ghana.
Blood cultures from all patients with fever ≥38°C within 24h after admission (community-acquired) and from all neonates with suspected neonatal sepsis (hospital-acquired) were obtained. ESBL-producing isolates were characterized by combined disc test and by amplifying the blaCTX-M, blaTEM and blaSHV genes. Multilocus sequence typing (MLST) was performed for all ESBL-producing Klebsiella pneumoniae and Escherichia coli isolates, and all K. pneumoniae isolates were differentiated by pulsed-field gel electrophoresis (PFGE).
Among 426 Enterobacteriaceae isolated from blood cultures, non-typhoid Salmonella (n=215, 50.8%), S. Typhi (n=110, 26.0%), E. coli (n=50, 11.8%) and K. pneumoniae (n=41, 9.7%) were the most frequent. ESBL-producing isolates were restricted to the CTX-M-15 genotype and the species K. pneumoniae (n=34, 82.9%), Enterobacter cloacae complex (n=2, 66.7%) and E. coli (n=5, 10.0%). The rates of ESBL-producers in K. pneumoniae were 55.6% and 90.6% in community-acquired and neonatal bloodstream infections, respectively. MLST and PFGE analysis identified four outbreak clusters among neonates.
Considering the rural primary health care study setting, the high proportion of ESBL-producing Klebsiella pneumoniae is worrisome and might be devastating in the absence of second line antibiotics. Therefore, enhanced diagnostic laboratories for surveillance purposes and sustainable hospital hygiene measures must be considered to prevent further spread of multidrug resistant bacteria within rural communities.
产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌的高流行率威胁着撒哈拉以南非洲侵袭性血流感染的治疗选择。
探讨在加纳农村的一个初级卫生保健机构中，引起血流感染的产ESBL肠杆菌科细菌的频率和基因型分布。
采集所有入院后24小时内体温≥38°C的患者（社区获得性）以及所有疑似新生儿败血症的新生儿（医院获得性）的血培养样本。通过复合纸片法以及扩增blaCTX-M、blaTEM和blaSHV基因对产ESBL的分离株进行鉴定。对所有产ESBL的肺炎克雷伯菌和大肠埃希菌分离株进行多位点序列分型（MLST），并通过脉冲场凝胶电泳（PFGE）对所有肺炎克雷伯菌分离株进行区分。
在从血培养中分离出的426株肠杆菌科细菌中，非伤寒沙门菌（n = 215，50.8%）、伤寒沙门菌（n = 110，26.0%）、大肠埃希菌（n = 50，11.8%）和肺炎克雷伯菌（n = 41，9.7%）最为常见。产ESBL的分离株仅限于CTX-M-15基因型以及肺炎克雷伯菌（n = 34，82.9%）、阴沟肠杆菌复合体（n = 2，66.7%）和大肠埃希菌（n = 5，10.0%）。在社区获得性血流感染和新生儿血流感染中，肺炎克雷伯菌中产ESBL菌株的比例分别为55.6%和90.6%。MLST和PFGE分析在新生儿中鉴定出四个暴发聚集性病例。
考虑到农村初级卫生保健研究环境，产ESBL的肺炎克雷伯菌比例较高令人担忧，并且在没有二线抗生素的情况下可能具有毁灭性。因此，必须考虑加强用于监测目的的诊断实验室以及可持续的医院卫生措施，以防止多重耐药菌在农村社区进一步传播。
