Extended Spectrum Beta-Lactamase Escherichia coli in River Waters Collected from Two Cities in Ghana, 2018–2020

Banu, R. A.; Alvarez, Jorge Matheu; Reid, Anthony; Enbiale, Wendemagegn; Ansa, E.D.O.; Annan, Edith Andrews; Akrong, M. O.; Borbor, Selorm; Adomako, Lady Asantewah Boamah; Ahmed, Hawa; Mustapha, Mohammed Bello; Davtyan, Hayk; Owiti, P.; Hedidor, George Kwesi; Quarcoo, Gerard; Opare, David; Kikimoto, Boi; Osei-Atweneboana, Mike Y.; Schmitt, Heike

doi:10.3390/tropicalmed6020105

Cited by 16 publications

(20 citation statements)

References 46 publications

(53 reference statements)

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“…The site with the highest prevalence of ESBL-producing E. coli was located downstream of a treated effluent outlet (site F). This is not surprising as it has previously been shown that wastewater treatment is not completely effective at removing antimicrobial resistant bacteria [59][60][61][62], and studies have found a higher prevalence of ESBL-producing E. coli and other types of resistant E. coli immediately downstream of effluent outlets [32,[63][64][65]. A higher prevalence of antimicrobial resistant bacteria and their genes has also been detected during periods associated with higher rainfall [66][67][68].…”

Section: Discussionmentioning

confidence: 93%

Genomic epidemiology of ESBL-producingEscherichia colifrom humans and an Aotearoa New Zealand river

Gray,

Biggs,

Midwinter

et al. 2024

Preprint

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In Aotearoa New Zealand, urinary tract infections in humans are commonly caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. This group of antimicrobial resistant bacteria are often multidrug resistant. However, there is limited information on ESBL-producing E. coli found in the environment and their link with human clinical isolates. In this study, we examined the genetic relationship of environmental and human clinical ESBL-producing E. coli and isolates collected in parallel within the same area over 14 months. Environmental samples were collected from treated effluent, stormwater and multiple locations along an Aotearoa New Zealand river. Treated effluent, stormwater and river water sourced downstream of the treated outflow point were the main sources of ESBL-producing E. coli (7/14 samples, 50.0%; 3/6 samples, 50%; and 15/28 samples, 54% respectively). Whole genome sequence comparison was carried out on 307 human clinical and 45 environmental ESBL-producing E. coli isolates. Sequence type 131 was dominant for both clinical (147/307, 47.9%) and environmental isolates (11/45, 24.4%). The most prevalent ESBL genes were both blaCTX-M-27 and blaCTX-M-15 for the clinical isolates (134/307, 43.6%) and blaCTX-M-15 for the environmental isolates (28/45, 62.2%). A core single nucleotide polymorphism analysis of these isolates suggested that some strains were shared between humans and the local river. These results highlight the importance of understanding different transmission pathways for the spread of ESBL-producing E. coli.

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Section: Discussionmentioning

confidence: 93%

Genomic epidemiology of ESBL-producingEscherichia colifrom humans and an Aotearoa New Zealand river

Gray,

Biggs,

Midwinter

et al. 2024

Preprint

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“…Such a monitoring system would provide early signals of emergent AMR threats, and background data against which the impact of MDA programs and AMR mitigation efforts can be assessed. Existing wastewater surveillance systems for polio or COVID-19 can provide a starting point [ 127 , 128 ] possibly building on the World Health Organization Tricycle Protocol [ 129 ] that focuses on ESBL E. coli monitoring in environmental matrices [ 130 ]. This protocol has been designed specifically for cost-effective, at-scale AMR monitoring in LMICs.…”

Section: Strategies For Mitigation Of Amr Following Mdamentioning

confidence: 99%

Environmental impacts of mass drug administration programs: exposures, risks, and mitigation of antimicrobial resistance

et al. 2022

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Mass drug administration (MDA) of antimicrobials has shown promise in the reduction and potential elimination of a variety of neglected tropical diseases (NTDs). However, with antimicrobial resistance (AMR) becoming a global crisis, the risks posed by widespread antimicrobial use need to be evaluated. As the role of the environment in AMR emergence and dissemination has become increasingly recognized, it is likewise crucial to establish the role of MDA in environmental AMR pollution, along with the potential impacts of such pollution. This review presents the current state of knowledge on the antimicrobial compounds, resistant organisms, and antimicrobial resistance genes in MDA trials, routes of these determinants into the environment, and their persistence and ecological impacts, particularly in low and middle-income countries where these trials are most common. From the few studies directly evaluating AMR outcomes in azithromycin MDA trials, it is becoming apparent that MDA efforts can increase carriage and excretion of resistant pathogens in a lasting way. However, research on these outcomes for other antimicrobials used in MDA trials is sorely needed. Furthermore, while paths of AMR determinants from human waste to the environment and their persistence thereafter are supported by the literature, quantitative information on the scope and likelihood of this is largely absent. We recommend some mitigative approaches that would be valuable to consider in future MDA efforts. This review stands to be a valuable resource for researchers and policymakers seeking to evaluate the impacts of MDA. Graphical Abstract

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“…Several reports from Ghana show increasing AMR, with a high prevalence of resistance phenotypes such as extended-spectrum beta-lactamases and increasing reports of carbapenemase-producing bacteria. 4–7 The Ghana national policy and action plan on AMR that is aligned with the global action plan on AMR highlight the need to strengthen surveillance and research as well as optimize the use of antimicrobials. 8 Optimizing antimicrobial use and consumption through antimicrobial stewardship hinges on the availability of antimicrobial use and consumption data.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic consumption trends in Ghana: analysis of six-years pharmacy issue data from a secondary healthcare facility

Kartey¹,

Hedidor²,

Nuertey³

et al. 2023

JAC-Antimicrobial Resistance

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Background Surveillance of hospital antibiotic consumption provides data to inform corrective action and for monitoring antimicrobial stewardship activities. This study described antibiotic consumption patterns from 2016 through 2021 at a secondary healthcare facility in Ghana. Methods Using the WHO methodology for surveillance of antimicrobial consumption in hospitals, we analysed a 6-year pharmacy issue data at the Eastern Regional Hospital. We report on the defined daily dose (DDD) per 100 patients, types of antibiotics consumed according to Anatomic Therapeutic Classification (ATC), WHO AWaRe classification; trends in antibiotic consumption and expenditure per DDD of antibiotics consumed. Results Over the period, the mean (±standard deviation) antibiotic consumption rate was 256.7 ± 33 DDD/100 patients per year. A linear regression model showed an insignificant decreasing trend in antibiotic consumption (coefficient for time –0.561; P = 0.247). The top three consumed antibiotics in DDD/100 patients at ATC level 5 were amoxicillin-clavulanate (n = 372.6), cefuroxime (n = 287.4) and sulfamethoxazole-trimethoprim (n = 145.8). The yearly Access-to-Watch ratio decreased from 2.4 in 2016 to 1.2 in 2021. The mean yearly cost of antibiotics was $394 206 ± 57 618 US dollars. The top three antibiotics consumed in terms of cost were clindamycin $718 366.3, amoxicillin-clavulanate $650 928.3 and ceftriaxone $283 648.5. Conclusion This study showed a sturdy rate of antibiotic consumption over the 6-year period with a year-on-year decrease in the Access-to-Watch antibiotic ratio. Data from pharmacy drug issues offer an opportunity to conduct antibiotic consumption surveillance at the hospital and national level in Ghana.

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Extended Spectrum Beta-Lactamase Escherichia coli in River Waters Collected from Two Cities in Ghana, 2018–2020

Cited by 16 publications

References 46 publications

Genomic epidemiology of ESBL-producingEscherichia colifrom humans and an Aotearoa New Zealand river

Genomic epidemiology of ESBL-producingEscherichia colifrom humans and an Aotearoa New Zealand river

Environmental impacts of mass drug administration programs: exposures, risks, and mitigation of antimicrobial resistance

Antibiotic consumption trends in Ghana: analysis of six-years pharmacy issue data from a secondary healthcare facility

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