Antimicrobial resistance of Vibrio cholerae from sub-Saharan Africa: A systematic review

Abstract

BackgroundThe World Health Assembly adopted the Global Action Plan on Antimicrobial Resistance, which includes improving the knowledge base through surveillance and research. Noteworthily, the World Health Organization has advocated a Global Antimicrobial Resistance Surveillance System to address the plan’s surveillance objective, with most African countries enrolling in or after 2017.AimThe aim of this article was to review prior data on antimicrobial resistance of Vibrio cholerae from sub-Saharan Africa with a view for future control and intervention strategies.MethodsWe used the Preferred Reporting Items for Systematic Review and Meta-Analysis (or ‘PRISMA’) guidelines to search the PubMed and African Journals Online databases, as well as additional articles provided by the Nigeria Centre for Disease Control, for articles reporting on the antibiotic susceptibility of V. cholerae between January 2000 and December 2017.ResultsWe identified 340 publications, of which only 25 (reporting from 16 countries within the sub-Saharan African region) were eligible. The majority (20; 80.0%) of the cholera toxigenic V. cholerae isolates were of the serogroup O1 of the El Tor biotype with Ogawa and Inaba serotypes predominating. Resistance was predominantly documented to trimethoprim-sulphamethoxazole (50% of the studies), ampicillin (43.3% of the studies), chloramphenicol (43.3% of the studies) and streptomycin (30% of the studies). Resistance mechanisms were reported in 40% of the studies.ConclusionOur results demonstrate a documented antimicrobial resistance of V. cholerae to multiple antibiotic classes, including cell wall active agents and antimetabolites with evidence of phenotypic/genotypic resistance to fluoroquinolones.

Molecular detection of Vibrio cholerae from human stool collected from SK Hospital, Mymensingh, and their antibiogram

“…All these three isolates were found highly sensitive to azithromycin, gentamycin, chloramphenicol, and norfloxacin (Table 1). But recently, resistant against azithromycin and chloramphenicol has appeared as an emerging phenomenon in some isolates of Vibrio such as V. fluvialis and V. cholerae , respectively [36,37]. Interestingly, all three (100%) isolates were found resistant to oxacillin followed by tetracycline ( n = 2, 66.67%) and streptomycin ( n = 1, 33.33%).…”

Prevalence of Antibiotic Resistance in Vibrio cholerae: A Meta-analysis

“…This atypical biotype diffuses mobile genetic elements, which are capable of self-transmission and integration into chromosomes, facilitating rapid spread and constant acquisition of resistance genes. It is also associated with more virulence and widespread drug resistance (6). Antimicrobial resistance (AMR) in V. cholerae strains is progressively increasing worldwide.…”

“…Antimicrobial resistance (AMR) in V. cholerae strains is progressively increasing worldwide. Antimicrobial resistance is widespread in V. cholerae strains and currently threatens the effective treatment and control of cholera, especially in low and middle-income countries (6).…”

Antimicrobial resistance surveillance in Africa: Successes, gaps and a roadmap for the future

“…14 Community-acquired resistance was underrepresented, although there was a major review on AMR in Vibrio cholerae O1. 15 The articles included opinion pieces, general and systematic reviews and original research. What we missed was more original research with a wider range of country submissions and better regional representation, more articles looking at One Health, veterinary medicine and AMR, more studies with data on AMR in community-acquired pathogens and AMR trend data by country, including bacteria, fungi and parasitic infections, and better detail on antiretroviral resistance in HIV infection.…”

“…Quality routine culture and susceptibility testing can easily and cost-effectively provide high-quality surveillance data. However, as Omar et al, 3 Smith, 12 Gellband 13 and Mohammed et al 15 all demonstrate, additional valuable information can be gleaned from surveillance systems that use whole genome sequencing and this is something that developing systems should consider. For quality assurance, which is a hallmark of a standard surveillance system, it will be important for laboratories to be registered and participate in an external quality assessment scheme operating to internationally recognised standards, some of which are supported by WHO and other partners and are therefore potentially more affordable for laboratories in our African setting.…”