Point Prevalence survey of antimicrobial use in three hospitals in North-eastern Tanzania

Horumpende, Pius Gerald; Mshana, Stephen E.; Mouw, Elise F; Mmbaga, Blandina T.; Chilongola, Jaffu; Mast, Quirijn de

doi:10.21203/rs.3.rs-28855/v1

“…In low-and middle-income countries (LMIC) such as the nations of sub-Saharan Africa, multidrug-resistant K. pneumoniae, especially strains producing extended-spectrum beta lactamase (ESBL) enzymes present a significant therapeutic challenge. In many countries in sub-Saharan Africa, third-generation cephalosporin (3GC) antimicrobials are the mainstay of management of severe febrile illness [5][6][7], but ESBL production renders these antimicrobials ineffective. For example, in Malawi, a low-income country in South-East Africa, 91 % of K. pneumoniae infections are now resistant to third-generation cephalosporins at one major centre [8]; the BARNARDS study in seven LMIC found K. pneumoniae to be the commonest cause of neonatal sepsis, with all isolates resistant to 3GC [9].…”

Section: Introductionmentioning

confidence: 99%

Genomic and antigenic diversity of colonizing Klebsiella pneumoniae isolates mirrors that of invasive isolates in Blantyre, Malawi

Lewis

¹

,

Mphasa

²

,

Banda

³

et al. 2022

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Members of the Klebsiella pneumoniae species complex, particularly K. pneumoniae subsp. pneumoniae are antimicrobial resistance (AMR) associated pathogens of global importance, and polyvalent vaccines targeting Klebsiella O-antigens are in development. Whole-genome sequencing has provided insight into O-antigen distribution in the K. pneumoniae species complex, as well as population structure and virulence determinants, but genomes from sub-Saharan Africa are underrepresented in global sequencing efforts. We therefore carried out a genomic analysis of extended-spectrum beta-lactamase (ESBL)-producing K. pneumoniae species complex isolates colonizing adults in Blantyre, Malawi. We placed these isolates in a global genomic context, and compared colonizing to invasive isolates from the main public hospital in Blantyre. In total, 203 isolates from stool and rectal swabs from adults were whole-genome sequenced and compared to a publicly available multicounty collection and previously sequenced Malawian and Kenyan isolates from blood or sterile sites. We inferred phylogenetic relationships and analysed the diversity of genetic loci linked to AMR, virulence, capsule and LPS O-antigen (O-types). We find that the diversity of Malawian K. pneumoniae subsp. pneumoniae isolates represents the species’ population structure, but shows distinct local signatures concerning clonal expansions. Siderophore and hypermucoidy genes were more frequent in invasive versus colonizing isolates (present in 13 % vs 1 %) but still generally lacking in most invasive isolates. O-antigen population structure and distribution was similar in invasive and colonizing isolates, with O4 more common (14%) than in previously published studies (2–5 %). We conclude that host factors, pathogen opportunity or alternate virulence loci not linked to invasive disease elsewhere are likely to be the major determinants of invasive disease in Malawi. Distinct ST and O-type distributions in Malawi highlight the need to sample locations where the burden of invasive Klebsiella disease is greatest to robustly define secular trends in Klebsiella diversity to assist in the development of a useful vaccine. Colonizing and invasive isolates in Blantyre are similar, hence O-typing of colonizing Klebsiella isolates may be a rapid and cost-effective approach to describe global diversity and guide vaccine development.

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“…The finding of carbapenem resistance conferred by the bla NDM-5 gene in Tanzania is of the great concern, since these isolates also were resistant to virtually all other antibiotics commonly used in Tanzania. Carbapenems have been used as the last alternative for treatment of severe infections caused by multi-drug resistant Gram-negative bacteria infection, the emergence of carbapenem resistance severely limits treatment options for these Lately, the use of carbapenems in Tanzania has been frequent [35], and increased use is anticipated in the future due to increased extended spectrum beta-lactamase (ESBL) producing bacterial infections [36]. Increasing carbapenem use will increase selection for horizontal gene transfer events and, therefore, the movement of the gene and human movement will increase dissemination of carbapenem resistant bacteria around the country.…”

Section: Discussionmentioning

confidence: 99%

First identification of bla NDM-5 producing Escherichia coli from neonates and a HIV infected adult in Tanzania

Manyahi

¹

,

Moyo

²

,

Kibwana

³

et al. 2022

Journal of Medical Microbiology

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Introduction. Carbapenem-resistant members of the family Enterobacteriaceae are emerging as a global public-health threat and cause substantial challenges in clinical practice. Gap Statement. There is a need for increased and continued genomic surveillance of antimicrobial resistance genes globally in order to detect outbreaks and dissemination of clinically important resistance genes and their associated mobile genetic elements in human pathogens. Aim. To describe the resistance mechanisms of carbapenem-resistant Escherichia coli . Methods. Rectal swabs from neonates and newly diagnosed human immunodeficiency virus (HIV) infected adults were collected between April 2017 and May 2018 and screened for faecal carriage of carbapenamases and OXA-48 producing members of the family Enterobacteriaceae. Bacterial isolates were identified using matrix assisted laser desorption ionization time of flight mass spectrometry. Antimicrobial susceptibility testing was performed by E-test. Whole genomes of carbapenem-resistant E. coli were investigated using a hybrid assembly of Illumina and Oxford Nanopore Technologies sequencing reads. Results. Three carbapenem-resistant E. coli were detected, two from neonates and one from an HIV infected adult. All three isolates carried bla NDM-5. Two E. coli from neonates belonged to ST167 and bla NDM-5 co-existed with bla CTX-M-15 and bla OXA-01, and all were carried on IncFIA type plasmids. The E. coli from the HIV infected adult belonged to ST2083, and carried bla NDM-5 on an IncX3 type plasmid and bla CMY-42 on an IncI type plasmid. All bla NDM-5 carrying plasmids contained conjugation related genes. In addition, E. coli from the HIV infected adult carried three more plasmid types; IncFIA, IncFIB and Col(BS512). One E. coli from a neonate also carried one extra plasmid Col(BS512). All three E. coli harboured resistance genes to fluoroquinolone, aminoglycosides, sulfamethoxazole, trimethoprim, macrolides and tetracycline, carried on the IncFIA type plasmid. Furthermore, E. coli from the neonates carried a chloramphenicol resistance gene (catB3), also on the IncFIA plasmid. All three isolates were susceptible to colistin. Conclusion. This is the first report, to our knowledge, from Tanzania detecting bla NDM-5 producing E. coli. The carbapenemase gene was carried on an IncFIA and IncX3 type plasmids. Our findings highlight the urgent need for a robust antimicrobial resistance (AMR) surveillance system to monitor and rapidly report on the incidence and spread of emerging resistant bacteria in Tanzania.

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“…Em outro estudo conduzido em três hospitais localizados no município de Mosh, no nordeste da Tanzânia a ceftriaxona e o metronidazol foram os antibióticos mais comumente prescritos. (Horumpende et al, 2020). A prevalência do uso da ceftriaxona pode ser justificada por ser um medicamento de amplo espectro que pode ser utilizada na terapia de uma gama de infecções, sendo utilizada como primeira escolha para casos como: meningite bacteriana aguda, pneumonia adquirida pela comunidade, infecções intra-abdominais complicadas, infecções intra-abdominais complicadas, pneumonia hospitalar adquirida; pielonefrite, entre outros (Sonda et al, 2019).…”

Section: Discussionunclassified

Avaliação de potenciais interações medicamentosas em prescrições de antimicrobianos em um hospital no Estado do Pará

Vilaça

¹

,

Santana

²

,

Alves

³

et al. 2021

RSD

1

0

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Objetivo: avaliar as potenciais interações medicamentosas de antimicrobianos em prescrições de pacientes internados em um hospital no Estado do Pará, no ano de 2019. Metodologia: Trata-se de estudo quali-quantitativo, retrospectivo e transversal, realizado através da coleta de dados de prontuários de pacientes que fizeram uso de antibióticos e estavam internados no ano de 2019 em um hospital no Pará. As interações medicamentosas foram avaliadas através da base de dados do Micromedex. Resultados: No período em estudo, 83% (n=762) dos pacientes que foram internados na instituição fizeram uso de antibiótico. Houve prevalência do sexo masculino com 54% (n=409), a idade média foi de 56 anos. Foram prescritos 6870 medicamentos, sendo que 1727 (25%) eram antimicrobianos, média de dois antibióticos prescritos por paciente. Obteve-se uma taxa de 52% (n=395) de interações medicamentosas entre os medicamentos antimicrobianos e de outras classes. O fármaco ciprofloxacino apresentou o maior número de interações, 42% (n=165), interagindo com 12 fármacos diferentes. Conclusão: as prescrições analisadas apresentaram um alto índice de potenciais interações medicamentosas. Dessa maneira, afirma-se que a presença do profissional farmacêutico inseridos nas equipes multiprofissionais e no processo de avaliação de prescrições no setor hospitalar, é de extrema importância e necessidade para diminuição dos riscos e aumento na segurança do paciente no uso de medicamentos.

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Point Prevalence survey of antimicrobial use in three hospitals in North-eastern Tanzania

Cited by 3 publications

References 9 publications

Genomic and antigenic diversity of colonizing Klebsiella pneumoniae isolates mirrors that of invasive isolates in Blantyre, Malawi

Genomic and antigenic diversity of colonizing Klebsiella pneumoniae isolates mirrors that of invasive isolates in Blantyre, Malawi

First identification of bla NDM-5 producing Escherichia coli from neonates and a HIV infected adult in Tanzania

Avaliação de potenciais interações medicamentosas em prescrições de antimicrobianos em um hospital no Estado do Pará

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