Moirongo Rehema Moraa, Lorenz Eva, Ntinginya Nyanda E, Dekker Denise, Fernandes José, Held Jana, Lamshöft Maike, Schaumburg Frieder, Mangu Chacha, Sudi Lwitiho, Sie Ali, Souares Aurelia, Heinrich Norbert, Wieser Andreas, Mordmüller Benjamin, Owusu-Dabo Ellis, Adegnika Akim Ayola, Coulibaly Boubacar, May Jürgen, Eibach Daniel
Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Heidelberg, Munich, Tübingen, Germany.
Front Microbiol. 2020 Sep 25;11:567235. doi: 10.3389/fmicb.2020.567235. eCollection 2020.
Antimicrobial resistance (AMR) thwarts the curative power of drugs and is a present-time global problem. We present data on antimicrobial susceptibility and resistance determinants of bacteria the WHO has highlighted as being key antimicrobial resistance concerns in Africa, to strengthen knowledge of AMR patterns in the region.
Blood, stool, and urine specimens of febrile patients, aged between ≥ 30 days and ≤ 15 years and hospitalized in Burkina Faso, Gabon, Ghana, and Tanzania were cultured from November 2013 to March 2017 (Patients > 15 years were included in Tanzania). Antimicrobial susceptibility testing was performed for all Enterobacterales and isolates using disk diffusion method. Extended-spectrum beta-lactamase (ESBL) production was confirmed by double-disk diffusion test and the detection of , and . Multilocus sequence typing was conducted for ESBL-producing and , ciprofloxacin-resistant and . Ciprofloxacin-resistant were screened for plasmid-mediated resistance genes and mutations in . isolates were tested for the presence of and Panton-Valentine Leukocidin and further genotyped by typing.
Among 4,052 specimens from 3,012 patients, 219 cultures were positive of which 88.1% ( = 193) were Enterobacterales and 7.3% ( = 16) . The prevalence of ESBL-producing Enterobacterales (all CTX-M15 genotype) was 45.2% (14/31; 95% CI: 27.3, 64.0) in Burkina Faso, 25.8% (8/31; 95% CI: 11.9, 44.6) in Gabon, 15.1% (18/119; 95% CI: 9.2, 22.8) in Ghana and 0.0% (0/12; 95% CI: 0.0, 26.5) in Tanzania. ESBL positive non-typhoid ( = 3) were detected in Burkina Faso only and methicillin-resistant ( = 2) were detected in Ghana only. While sequence type (ST)131 predominated among ESBL (39.1%;9/23), STs among ESBL were highly heterogenous. Ciprofloxacin resistant nt were commonest in Burkina Faso (50.0%; 6/12) and all harbored genes. were found in 81.3% .
Our findings reveal a distinct susceptibility pattern across the various study regions in Africa, with notably high rates of ESBL-producing Enterobacterales and ciprofloxacin-resistant nt in Burkina Faso. This highlights the need for local AMR surveillance and reporting of resistances to support appropriate action.
抗菌药物耐药性（AMR）阻碍了药物的治疗效果，是当前的一个全球性问题。我们提供了世界卫生组织强调的在非洲作为关键抗菌药物耐药性问题的细菌的药敏和耐药决定因素的数据，以加强对该地区AMR模式的了解。
2013年11月至2017年3月期间，对在布基纳法索、加蓬、加纳和坦桑尼亚住院的年龄在≥30天至≤15岁之间的发热患者的血液、粪便和尿液标本进行培养（坦桑尼亚纳入了年龄>15岁的患者）。使用纸片扩散法对所有肠杆菌科细菌和分离株进行药敏试验。通过双纸片扩散试验以及对blaCTX-M、blaSHV和blaTEM的检测来确认超广谱β-内酰胺酶（ESBL）的产生。对产ESBL的大肠埃希菌和肺炎克雷伯菌、耐环丙沙星的大肠埃希菌和肺炎克雷伯菌进行多位点序列分型。对耐环丙沙星的大肠埃希菌进行质粒介导的耐药基因筛查以及gyrA中的突变检测。对金黄色葡萄球菌分离株检测PVL毒素（Panton-Valentine Leukocidin）的存在，并通过spa分型进一步进行基因分型。
在来自3012名患者的4052份标本中，219份培养物呈阳性，其中88.1%（n = 193）为肠杆菌科细菌，7.3%（n = 16）为金黄色葡萄球菌。产ESBL的肠杆菌科细菌（均为CTX-M15基因型）的患病率在布基纳法索为45.2%（14/31；95%CI：27.3，64.0），在加蓬为25.8%（8/31；95%CI：11.9，44.6），在加纳为15.1%（18/119；95%CI：9.2，22.8），在坦桑尼亚为0.0%（0/12；95%CI：0.0，26.5）。仅在布基纳法索检测到ESBL阳性的非伤寒沙门菌（n = 3），仅在加纳检测到耐甲氧西林金黄色葡萄球菌（n = 2）。虽然序列型（ST）131在产ESBL的大肠埃希菌中占主导（39.1%；9/23），但产ESBL的肺炎克雷伯菌中的序列型高度异质。耐环丙沙星的非伤寒沙门菌在布基纳法索最为常见（50.0%；6/12），且均携带qnr基因。81.3%的金黄色葡萄球菌检测到PVL毒素。
我们的研究结果揭示了非洲不同研究地区不同的药敏模式，布基纳法索产ESBL的肠杆菌科细菌和耐环丙沙星的非伤寒沙门菌比例显著较高。这突出了进行本地AMR监测和报告耐药情况以支持采取适当行动的必要性。
