Department of Biological Sciences, Faculty of Sciences, Eduardo Mondlane University, Maputo, MZ, Mozambique.
Department of Animal Health and Epidemiology, Faculty of Veterinary Medicine, Eduardo Mondlane University, Maputo, MZ, Mozambique.
BMC Infect Dis. 2023 Apr 21;23(1):255. doi: 10.1186/s12879-023-08219-7.
Antibacterial resistance is a growing concern worldwide, including in Mozambique. Diarrhea is an important cause of mortality in Mozambique, yet few local studies have reported on the resistance of bacterial pathogens in this context. Therefore, this study aims to characterize antibiotic susceptibility patterns of Salmonella, Shigella and Campylobacter spp. among patients with diarrhea, including those who are HIV-infected and-uninfected.
We conducted antibiotic susceptibility testing on 157 stool isolates recovered from 129 patients aged between 0 and 80 years with diarrhea, including HIV infected (n = 68) and-uninfected individuals (n = 61), assisted at two health centers in Maputo city. The isolates comprised of 99 Salmonella, 45 Shigella and 13 Campylobacter strains. The Kirby-Bauer disk diffusion method was used on Mueller-Hinton II agar for Salmonella and Shigella spp., while Mueller-Hinton II agar with 5% defibrinated sheep blood was used for Campylobacter spp. We tested six antibiotics listed on the national essential medicines list, including ciprofloxacin, erythromycin, azithromycin, trimethoprim-sulfamethoxazole, gentamicin, and tetracycline.
All isolates were resistant to at least one antibiotic. A high percentage of Salmonella spp. isolates were found to be resistant to trimethoprim-sulfamethoxazole (89.9%, n = 89), erythromycin (88.9%, n = 88) and tetracycline (76.8%, n = 76). In addition, 86.6% (n = 39) and 68.9% (n = 31) of Shigella isolates were resistant to trimethoprim-sulfamethoxazole and tetracycline, respectively. The majority of Campylobacter isolates (92.3%, n = 12) were resistant to erythromycin, azithromycin and tetracycline. Multidrug resistance (MDR) was observed in 79.8% of Salmonella spp., 76.9% of Campylobacter spp., and 57.8% of Shigella spp. Drug susceptibility profiles for Salmonella spp. and Campylobacter were similar in both HIV-1 infected and uninfected patients. However, Shigella spp. isolates obtained from patients without HIV infection were significantly more likely to be resistant to erythromycin, azithromycin or to exhibit multidrug resistance than those obtained from patients with HIV-1 infection (p < 0.05). All Shigella spp. and Campylobacter spp. isolates were susceptible to gentamicin.
Our study highlights concerning rates of antibiotic resistance and MDR among diarrheal bacterial pathogens in Mozambique. Further research is needed to understand the impact of HIV, ART therapy and immunosuppression on antibiotic resistance. Urgent interventions are essential to prevent the spread of resistant strains.
抗菌药物耐药性是全球范围内日益关注的问题，莫桑比克也不例外。腹泻是莫桑比克导致死亡的一个重要原因，但很少有当地研究报告过这方面细菌病原体的耐药情况。因此，本研究旨在描述腹泻患者中沙门氏菌、志贺氏菌和弯曲菌属的抗生素敏感性模式，包括 HIV 感染和未感染的患者。
我们对来自莫桑比克马普托市两家卫生中心的 129 名年龄在 0 至 80 岁之间腹泻患者的 157 份粪便分离株进行了抗生素敏感性测试，其中包括 HIV 感染（n=68）和未感染（n=61）的个体。分离株包括 99 株沙门氏菌、45 株志贺氏菌和 13 株弯曲菌。用 Kirby-Bauer 纸片扩散法对 Mueller-Hinton II 琼脂上的沙门氏菌和志贺氏菌进行药敏试验，而弯曲菌则在含有 5%去纤维绵羊血的 Mueller-Hinton II 琼脂上进行药敏试验。我们测试了国家基本药物清单上列出的六种抗生素，包括环丙沙星、红霉素、阿奇霉素、复方磺胺甲噁唑、庆大霉素和四环素。
所有分离株均对至少一种抗生素耐药。沙门氏菌属分离株对复方磺胺甲噁唑（89.9%，n=89）、红霉素（88.9%，n=88）和四环素（76.8%，n=76）的耐药率较高。此外，39%（n=39）和 68.9%（n=31）的志贺氏菌分离株分别对复方磺胺甲噁唑和四环素耐药。大多数弯曲菌属分离株（92.3%，n=12）对红霉素、阿奇霉素和四环素耐药。沙门氏菌属、弯曲菌属和志贺氏菌属的多重耐药（MDR）分别为 79.8%、76.9%和 57.8%。沙门氏菌属和弯曲菌属的药敏谱在 HIV-1 感染和未感染的患者中相似。然而，未感染 HIV 的患者中分离的志贺氏菌属分离株对红霉素、阿奇霉素或表现出 MDR 的可能性明显高于感染 HIV-1 的患者（p<0.05）。所有志贺氏菌属和弯曲菌属分离株均对庆大霉素敏感。
本研究强调了莫桑比克腹泻性细菌病原体中令人担忧的抗生素耐药率和 MDR 问题。需要进一步研究了解 HIV、ART 治疗和免疫抑制对抗生素耐药性的影响。迫切需要采取干预措施，以防止耐药菌株的传播。
