Emergence of vancomycin-resistant Enterococcus at a tertiary paediatric hospital in South Africa

Lochan, Harsha; Moodley, Clinton; Rip, Diane; Bamford, Colleen; Hendricks, Marc; Davidson, Alan; Eley, Brian

doi:10.7196/samj.2016.v106i6.10858

Cited by 15 publications

(15 citation statements)

References 11 publications

(12 reference statements)

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“…Erm (B) (≥348), vanC ‐2/3 (162), vanB (≥140), vanC (≥120), and strA (≥120) were the major resistance genes. The VAN‐resistant isolates were from patients with hematological malignancies, bacteremia, pigs, wastewater, and underground water . E. faecium ST25 and ST23 and E. faecalis ST23, ST25, and ST780 were resistant clones isolated from sewage water, treated effluent, and hospital waste .…”

Section: Resultsmentioning

confidence: 99%

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Molecular epidemiology and mechanisms of antibiotic resistance inEnterococcusspp.,Staphylococcusspp., andStreptococcusspp. in Africa: a systematic review from a One Health perspective

Sekyere

Mensah

2019

Annals of the New York Academy of Sciences

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A systematic review of antibiotic‐resistant Gram‐positive bacteria in Africa from a One Health perspective is lacking. Here, we report result from a search for English‐language articles on the resistance mechanisms and clonality of Gram‐positive bacteria in Africa between 2007 and 2019 reported in PubMed, Web of Science, ScienceDirect, and African Journals OnLine; 172 studies from 22 different African countries were identified. Resistance genes, such as mecA, erm(B), erm(C), tet(M), tet(K), tet(L), vanB, vanA, vanC, and tet(O), were found to be common. Staphylococcus spp., Enterococcus spp., and Streptococcus spp. were the main species reported by the studies, with clones such as Staphylococcus aureus ST5 (n = 218 isolates), ST8 (n = 127 isolates), ST80 (n = 133 isolates), and ST88 (n = 117 isolates), and mobile genetic elements such as IS16 (n = 28 isolates), IS256 (n = 96), Tn916 (n = 107 isolates), and SCCmec (n = 4437 isolates) identified. SCCmec IV (n = 747 isolates) was predominant, followed by SCCmec III (n = 305 isolates), SCCmec II (n = 163 isolates), SCCmec V (n = 135 isolates), and SCCmec I (n = 79 isolates). Resistance to penicillin (n = 5926 isolates), tetracycline (n = 5300 isolates), erythromycin (n = 5151 isolates), rifampicin (n = 3823 isolates), gentamycin (n = 3494 isolates), sulfamethoxazole/trimethoprim (n = 3089 isolates), and ciprofloxacin (n = 2746 isolates) was common in most reports from 22 countries. Clonal dissemination of resistance across countries and between humans, animals, and the environment was observed. Resistance rates ranged from 1.4% to 100% for 15 of the studies; 10 were One Health–related studies. Strict infection control measures, antimicrobial stewardship, and periodic One Health epidemiological surveillance studies are needed to monitor and contain the threat of increasing antibiotic resistance in Africa.

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Section: Resultsmentioning

confidence: 99%

“…Specifically, S. aureus ST5 is among the frequently reported clones in Asia, and recent evidence suggests that it has spread from hospitals into communities, resulting in CA‐MRSA . Similarly, Lochan et al . isolated resistant E. faecium ST80 from humans in South Africa, and this clone was reported for the first time by Dziri et al .…”

Section: Discussionmentioning

confidence: 95%

Molecular epidemiology and mechanisms of antibiotic resistance inEnterococcusspp.,Staphylococcusspp., andStreptococcusspp. in Africa: a systematic review from a One Health perspective

Sekyere

Mensah

2019

Annals of the New York Academy of Sciences

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“…[5,22]. Daptomycin is a preferred agent for the treatment of bacteremia, IE, UTI, CNS infection, IAI, and SSSI, but higher doses should be considered for the treatment of serious VRE infections, and synergy with a β-lactam can be attempted for refractory cases [ 5,[23][24][25][26][27]. In the present study; Enterococcus strains resistant to aminoglycoside, quinolones, benzylpenicillin and β-lactams were tested for Daptomycin E-test and all were showed susceptibility to daptomycin.…”

Section: Identification and Antibiotic Susceptibility Of Enterococcusmentioning

confidence: 99%

Incidence and Antimicrobial Susceptibility of Enterococcal Infections in Tertiary Care Hospital

Angadi¹,

Jadhav²,

Mirza³

et al. 2018

BIOP

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“…Selective pressures exerted by various antibiotics used in human and veterinary medicine, as well as in agriculture, have resulted in the emergence and dissemination of numerous mechanisms of resistance in GPB in Africa. Commonly reported mechanisms include blaZ, erm( B), mecA, tet (M), vanB and vanC 30-33 . These resistance genes have been found to be associated with mobile genetic elements (MGEs) such as transposons, conjugative plasmids, integrons, and insertion sequences, which are capable of mobilizing resistance genes across a wide spectrum of bacterial species 34,35 .…”

Section: Introductionmentioning

confidence: 99%

Molecular Epidemiology and Mechanisms of Antibiotic Resistance in Gram-positive Bacteria in Africa: A Systematic Review and Meta-Analysis from a One Health Perspective

Mensah

2018

Preprint

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15 16 17 18 19 [2]HIGHLIGHTS 20  There is substantial resistance to antibiotics among Gram-positive bacteria (GPB) in Africa 21  Multidrug-resistant (MDR) S. aureus, E. faecium, E. faecalis, S. pyogenes, and S. 22 haemolyticus of the same clones were common in humans, animals and the environment. 23  MDR clones such as S. aureus ST5 and E. faecium ST80 were found in humans, animals and 24 the environment. 25  mecA, ermB, ermC, tetM/K/L, and vanA/B/C were common in GPB, including in VRSA. 26 Meta-analysis confirmed a high mean rate of drug resistance in GPB from humans (35.68%), 27 animals (69.63%) and the environment (88.33%) (p-value= 0.0301) in Africa. 28 SCCmec, IS16, and Tn916 mobilized mecA, ermB and tetM respectively across various GPB 29 species in animals, humans, and the environment. 30  A One Health approach to studying resistance mechanisms and molecular epidemiology of 31 antibiotic-resistant GPB is warranted. 32ABSTRACT 33 The emergence and dissemination of antibiotic resistance (ABR) in bacteria are being driven by 34 antibiotics use in humans, animals and the environment, threatening global health and 35 strengthening calls for a One Health approach to contain ABR. 36 A systematic search in PubMed for English research articles reporting on ABR in Gram-positive 37 bacteria in Africa within the last ten years from 2007 to 2017 was undertaken. This finally yielded 38 76 articles that were included in this review and all statistical analysis. [3]The same ABR Gram-positive bacterial clones, resistance genes, and mobile genetic elements 40 (MGEs) were found in humans, animals and the environment. IS16 and Tn916 were highly 41 associated with erm (B) and tet(M) in E. faecium (ST18, ST80 and ST910), S. agalactiae (ST612, 42 ST616 and ST617), E. faecalis and S. pyogenes (emm18, emm42, emm76 and emm118) whilst 43 SCCmec was associated with mecA in S. aureus (ST5, ST80, ST8, and ST88) and S. haemolyticus. 44 The resistance genes, mecA, erm (B), erm(C), tet(M), tet(K), tet(L), van(B), van(A), van(C), and 45 tet(O), were found in isolates from humans, animals and the environment. An ABR rate of 39.55% 46 in Gram-positive bacteria is estimated in Africa. Meta-analysis reveal that isolates were most 47 resistant to erythromycin (≥ 2 482) (37.37%), rifampicin (≥ 2 323) (33.42%), tetracycline (≥ 2 181) 48 (40.72%), penicillin (≥ 2 127) (73.47%), sulfamethoxazole/trimethoprim (≥1 377) (45.97%), 49 ciprofloxacin (≥846) (35.37%), gentamicin (≥805) (23.87%), vancomycin (≥712) (42.24%), 50 ampicillin (≥691) (48.25%), streptomycin (≥551) (32.03%) and chloramphenicol (≥376) (11.50%) 51 (p-value <0.0001). 52There is substantial resistance to antibiotics among Gram-positive bacteria in clinical and 53 environmental settings in Africa, mediated by clonal and polyclonal expansion as well as 54 horizontal transmission of resistance genes. A One Health approach to research, surveillance, and 55 molecular epidemiology, as well as antibiotic stewardship to contain ABR in humans, animals and ...

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Emergence of vancomycin-resistant Enterococcus at a tertiary paediatric hospital in South Africa

Cited by 15 publications

References 11 publications

Molecular epidemiology and mechanisms of antibiotic resistance inEnterococcusspp.,Staphylococcusspp., andStreptococcusspp. in Africa: a systematic review from a One Health perspective

Molecular epidemiology and mechanisms of antibiotic resistance inEnterococcusspp.,Staphylococcusspp., andStreptococcusspp. in Africa: a systematic review from a One Health perspective

Incidence and Antimicrobial Susceptibility of Enterococcal Infections in Tertiary Care Hospital

Molecular Epidemiology and Mechanisms of Antibiotic Resistance in Gram-positive Bacteria in Africa: A Systematic Review and Meta-Analysis from a One Health Perspective

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