Parra Gemma, Lautenbach Ebbing, Mosepele Mosepele, Mannathoko Naledi, Gross Robert, Call Douglas R, Ramay Brooke M, Omulo Sylvia, Girish Kumar C P, Bhatnagar Tarun, Chowdhury Fahmida, Mah-E-Muneer Syeda, Araos Rafael, Munita Jose M, Acevedo Johanna, Mahon Garrett, Smith Rachel M, Styczynski Ashley
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road, MS A-24, Atlanta, GA, 30329, USA.
University of Pennsylvania, Philadelphia, PA, USA.
Sci Rep. 2025 Jul 1;15(1):21275. doi: 10.1038/s41598-025-94750-3.
The recognized burden of antimicrobial resistance (AR) is greatest in low- and middle-income countries (LMICs), but limitations in surveillance preclude accurate estimates of AR. We aimed to evaluate colonization in communities and hospitals across six LMICs for two clinically-important pathogens: extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE). Participants in hospitals and communities provided rectal swabs or stool samples for ESCrE and CRE identification. Isolates recovered from selective agars underwent confirmatory identification and antibiotic susceptibility testing (AST) using Vitek 2, MALDI-TOF, and/or disc diffusion testing. ESCrE and CRE were defined based on established breakpoints of phenotypic resistance to third-generation cephalosporins and carbapenems, respectively, to calculate prevalence of colonization. Community prevalence estimates were weighted to account for sampling design differences. A total of 10,139 participants across the 6 countries provided samples; 63% were females with a median age of 35 years (range: 0-99). Colonization with ESCrE in hospitals was high in all sites (range 34-84%). In communities, ESCrE colonization ranged from 22 to 77%. Prevalence of CRE colonization in hospitals ranged from 7 to 36% and in communities ranged from < 1 to 14%. These findings reveal a high burden of AR colonization in LMICs in both communities and hospitals. Cost-effective strategies to reduce AR colonization burden are needed in LMICs.
抗菌药物耐药性（AR）在低收入和中等收入国家（LMICs）造成的公认负担最为沉重，但监测方面的局限使得无法准确估算AR情况。我们旨在评估六个LMICs国家社区和医院中两种具有临床重要性的病原体的定植情况：对超广谱头孢菌素耐药的肠杆菌科细菌（ESCrE）和对碳青霉烯类耐药的肠杆菌科细菌（CRE）。医院和社区的参与者提供直肠拭子或粪便样本，用于ESCrE和CRE的鉴定。从选择性琼脂平板上分离出的菌株使用Vitek 2、基质辅助激光解吸电离飞行时间质谱（MALDI-TOF）和/或纸片扩散法进行确证鉴定和药敏试验（AST）。ESCrE和CRE分别根据对第三代头孢菌素和碳青霉烯类药物表型耐药的既定断点进行定义，以计算定植率。社区患病率估计值经过加权处理，以考虑抽样设计差异。六个国家共有10,139名参与者提供了样本；63%为女性，中位年龄为35岁（范围：0至99岁）。所有地点医院中ESCrE的定植率都很高（范围为34%-84%）。在社区中，ESCrE定植率在22%至77%之间。医院中CRE定植率在7%至36%之间，社区中在<1%至14%之间。这些发现揭示了LMICs国家社区和医院中AR定植的沉重负担。LMICs需要采取具有成本效益的策略来减轻AR定植负担。
