A Multicountry Molecular Analysis of<i>Salmonella enterica</i>Serovar Typhi With Reduced Susceptibility to Ciprofloxacin in Sub-Saharan Africa

Al‐Emran, Hassan M.; Eibach, Daniel; Krumkamp, Ralf; Ali, Mohammad; Baker, Stephen; Biggs, Holly M.; Bjerregaard-Andersen, Morten; Breiman, Robert F.; Clemens, John D.; Crump, John A.; Espinoza, Ligia María Cruz; Deerin, Jessica Fung; Dekker, Denise; Sow, Amy Gassama; Hertz, Julian T.; Im, Justin; Ibrango, Samuel; Kalckreuth, Vera von; Kabore, Leon Parfait; Konings, Frank; Løfberg, Sandra Valborg; Meyer, Christian G.; Mintz, Eric D.; Montgomery, Joel M.; Olack, Beatrice; Pak, Gi Deok; Panzner, Ursula; Park, Se Eun; Razafindrabe, Jean Luco Tsiriniaina; Rabezanahary, Henintsoa; Rakotondrainiarivelo, Jean Philibert; Rakotozandrindrainy, Raphäel; Raminosoa, Tiana Mirana; Schütt-Gerowitt, Heidi; Sampo, Emmanuel; Soura, Abdramane; Tall, Adama; Warren, Michelle R.; Wierzba, Thomas F.; May, Jürgen; Marks, Florian

doi:10.1093/cid/civ788

Cited by 35 publications

(44 citation statements)

References 30 publications

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“…On the whole, more studies have implicated mutations in gyrA , gyrB , parC and parE as the major mechanism of FQ resistance as the PMQR genes only mediate low-level FQ resistance [9–11,13]. This can be seen in our findings in which mutations in these four genes (except in parE in most isolates) were found in all isolates as compared to the PMQR genes that were not found in all strains.…”

Section: Discussionsupporting

confidence: 60%

Genomic and phenotypic characterisation of fluoroquinolone resistance mechanisms in Enterobacteriaceae in Durban, South Africa

Sekyere

Amoako

2017

PLoS ONE

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Resistance to fluoroquinolones (FQ) is being increasingly reported and found to be mediated by efflux pumps, plasmid-mediated quinolone resistance genes (PMQR) and mutations in gyrA, gyrB, parC and parE. However, studies reporting on FQ resistance mechanisms (FQRM), particularly in Africa, are focused mostly on Salmonella. This study used a whole-genome-based approach to describe FQRM in forty-eight clinical Enterobacteriaceae isolates comprising of Klebsiella pneumoniae (n = 21), Serratia marcescens (n = 12), Enterobacter spp. (n = 10), Citrobacter freundii (n = 3), Escherichia coli (n = 1), and Klebsiella michiganensis (n = 1) with reduced susceptibility to FQ in Enterobacteriaceae. All the isolates exhibited exceptionally high-level resistance (MIC of 4-512mg/L) to all three FQs, which could not be reversed by carbonyl cyanide m-chlorophenyl hydrazine (CCCP), verapamil (VRP) or reserpine (RSP). PMQR genes such as oqxAB (n = 43), aac(6’)-Ib-cr (n = 28), and qnr(S1, B1, B2, B9, B49, B66) (n = 23) were identified without transposons or integrons in their immediate environments. Multiple and diverse mutations were found in gyrA (including S83I/Y and T/I83I/T), gyrB, parC and parE, which were clonally specific. There were vertical and horizontal transmission of high-level FQ resistance in Enterobacteriaceae in hospitals in Durban, South Africa, which are mediated by efflux, PMQR genes, and gyrA, gyrB, parC and parE mutations.

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Section: Discussionsupporting

confidence: 60%

Genomic and phenotypic characterisation of fluoroquinolone resistance mechanisms in Enterobacteriaceae in Durban, South Africa

Sekyere

Amoako

2017

PLoS ONE

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“…The fluoroquinolones were endorsed as an option for typhoid during the late 1990s consequent to the emergence of MDR strains which could be orally administered and were found highly effective with minimal side effects; although the use was initially restricted in children due to the possible adverse effects on the growth of long bones [15]. Fluoroquinolone resistance among S. Typhi isolates is now widespread in Asian countries and in Africa approximately 10% isolates are reported to develop resistance to the fluoroquinolones as a result of mutations in the gyrA gene [16,17]. The accumulation of mutations in the quinolone-resistant determining region (gyrA and parC) is resulting in a gradual increase of the MIC of ciprofloxacin for S. Typhi strains.…”

Section: Discussionmentioning

confidence: 99%

Extended-spectrum beta-lactamases producing extensively drug-resistant Salmonella Typhi in Punjab, Pakistan

Saeed

Rasool

Rasheed

et al. 2020

J Infect Dev Ctries

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Introduction: The multidrug-resistant (MDR) Salmonella enterica serovar Typhi isolates have been increasingly reported from the Asian and African countries. The emergence of isolates with decreased susceptibility to fluoroquinolones and cephalosporins has worsened the situation. Recently, an outbreak from Sindh, Pakistan was reported caused by extensively drug-resistant (XDR) S. Typhi strains. Methodology: In the present study, a total of 82 cases of typhoid have been investigated during 2018 from the febrile children referred to a tertiary care hospital in the population-wise largest province (Punjab) of Pakistan. S. Typhi was identified by standard microbiological techniques and isolates were characterized for antimicrobial resistance profiling and minimum inhibitory concentrations were determined. The presence of various ESBL genes in S. Typhi was confirmed by the PCR. Results: Out of the 82 isolates tested, 35 (43%) were found to be XDR; resistant to the first-line drugs. The resistance to third-generation cephalosporins was mainly mediated by extended-spectrum beta-lactamases i.e. blaTEM and blaCTX-M genes. Conclusions: The higher prevalence of ESBL producing Salmonella typhi clinical strains raises the concern about transmission prevention and infection management in the community as well as clinical settings. Moreover, the study highlights the problem concerning the declining antibiotic arsenal for the therapeutic management of typhoid fever and the emergence and spread of XDR strains in Pakistan.

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“… 15 Similar results have been observed in a number of African countries such as Kenya, 40 Tanzania, Burkina Faso, Guinea Bissau, and Madagascar. 41 Low MDR and/or reduced fluoroquinolone susceptibility has also been documented in West African countries, such as Senegal and Ghana. 41 , 42 Our findings are also consistent with MDR S. Typhi isolates reported in several sites in sub-Saharan Africa, and reduced susceptibility to ciprofloxacin identified in S. Typhi from Kibera, Kenya, and Pietermaritzburg, South Africa in recent time.…”

Section: Discussionmentioning

confidence: 99%

Typhoid Fever: Tracking the Trend in Nigeria

Akinyemi

Oyefolu

Mutiu

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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Abstract.Typhoid fever continues to pose a serious health challenge in developing countries. A reliable database on positive blood cultures is essential for prompt interventions. To generate reliable data on Salmonella enterica serovar Typhi (S. Typhi)–positive blood culture trends in typhoidal Salmonella in Nigeria alongside changing contextual factors and antimicrobial resistance patterns, a retrospective cohort study was conducted in two hospitals in Lagos between 1993 and 2015. Medical records of typhoid patients were reviewed for positive culture and antibiogram, using standard procedures and analyzed. Additional data were retrieved from a previous study in seven facilities in Abuja and three hospitals in Kano from 2008 to 2017 and 2013 to 2017, respectively. A declining trend in percent positivity of S. Typhi was observed in Abuja with more erratic trends in Lagos and Kano. In Lagos, more than 80% of the isolates from the entire study period exhibited multiple drug resistance with a generally increasing trend. Of the chosen contextual factors, improvements were recorded in female literacy, access to improved water supply, diarrheal mortality in children younger than 5 years, gross domestic product, and poverty while access to improved sanitation facilities decreased over time nationally. Typhoid fever still poses a serious health challenge in Nigeria and in antibiotic resistance, and is a major health security issue. A combined approach that includes the use of typhoid vaccines, improvements in sanitation, and safe water supply is essential.

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A Multicountry Molecular Analysis ofSalmonella entericaSerovar Typhi With Reduced Susceptibility to Ciprofloxacin in Sub-Saharan Africa

Cited by 35 publications

References 30 publications

Genomic and phenotypic characterisation of fluoroquinolone resistance mechanisms in Enterobacteriaceae in Durban, South Africa

Genomic and phenotypic characterisation of fluoroquinolone resistance mechanisms in Enterobacteriaceae in Durban, South Africa

Extended-spectrum beta-lactamases producing extensively drug-resistant Salmonella Typhi in Punjab, Pakistan

Typhoid Fever: Tracking the Trend in Nigeria

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