Serotype Distribution and Antimicrobial Resistance of Shigella Species in Bangui, Central African Republic, from 2002 to 2013

Breurec, Sébastien; Rafaï, Clotaire; Onambele, Manuella; Frank, Thierry; Farra, Alain; Legrand, Arnaud; Weill, François‐Xavier

doi:10.4269/ajtmh.17-0917

Cited by 12 publications

(13 citation statements)

References 20 publications

(24 reference statements)

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“…ree Shigella serogroups, serogroup A (Shigella dysenteriae type 1), B (S. flexneri), and C (S. sonnei), caused bacillary dysentery among children under five years at Banadir Hospital, Somalia. Serogroup D (Shigella boydii) was absent, an unsurprising finding since this bacterium is more prevalent in Southeast Asia (Nepal and Bangladesh) Canadian Journal of Infectious Diseases and Medical Microbiology [17] but rarely reported elsewhere in the Central African Republic [18], Ethiopia, and Egypt [19]. In our study, the most prevalent serogroup was Shigella flexneri (70%), a finding consistent with other reports from Nigeria [20], Central Africa Republic [18], Nepal [21], Iran, India, and Eritrea [22,23]-(4).…”

Section: Discussionmentioning

confidence: 99%

“…Serogroup D (Shigella boydii) was absent, an unsurprising finding since this bacterium is more prevalent in Southeast Asia (Nepal and Bangladesh) Canadian Journal of Infectious Diseases and Medical Microbiology [17] but rarely reported elsewhere in the Central African Republic [18], Ethiopia, and Egypt [19]. In our study, the most prevalent serogroup was Shigella flexneri (70%), a finding consistent with other reports from Nigeria [20], Central Africa Republic [18], Nepal [21], Iran, India, and Eritrea [22,23]-(4). Epidemiologically, Shigella serogroups show geographical stratification based on the economic and development status of a country, as well as the virulence of a given serogroup.…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, this was the highest Shigella resistance level to these three antibiotics, not only in Somalia but also in the neighboring countries. Resistance ranging from 80% to 100% has been reported in Kenya [ 26 ], Central Africa Republic [ 18 ], and Iran [ 27 , 28 ]. AMP, SXT, and TE are low-cost antibiotics available over-the-counter and often used as empiric therapy for diarrheal cases in many developing countries and, therefore, the observed high-level resistance may have arisen due to overuse or misuse of these drugs.…”

Section: Discussionmentioning

confidence: 99%

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Multidrug-Resistant Shigellosis among Children Aged below Five Years with Diarrhea at Banadir Hospital in Mogadishu, Somalia

Nor

Menza

Musyoki

2021

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Globally, shigellosis remains the second leading cause of diarrhea-associated deaths among children under five years of age, and the infections are disproportionately higher in resource-limited settings due to overcrowding, poor sanitation, and inadequate safe drinking water. The emergence and global spread of multidrug-resistant (MDR) Shigella are exacerbating the shigellosis burden. We adopted a cross-sectional study design to determine the distribution and antimicrobial susceptibility (AST) patterns of Shigella serogroups among children aged below five years presenting with diarrhea at Banadir Hospital in Mogadishu, Somalia, from August to October 2019. Stool and rectal swab samples were collected from 180 children consecutively enrolled using a convenient sampling technique and processed following standard bacteriological methods. AST was determined using the Kirby–Bauer disc diffusion method and interpreted as per the Clinical Laboratory Standard Institute (2018) guidelines. Shigellosis prevalence was 20.6% (37/180), and S. flexneri (26/37 (70.3%)) was the predominant serogroup. All the serogroups were 100% resistant to ampicillin (AMP), trimethoprim-sulfamethoxazole (SXT), and tetracycline (TE). Ceftriaxone (CRO) resistance was the highest among S. sonnei (66.7%) isolates. 19.2% of S. flexneri and S. sonnei (50%) serogroups were resistant to ciprofloxacin (CIP), but all S. dysenteriae type 1 isolates remained (100%) susceptible. Forty percent of CIP-susceptible S. dysenteriae type 1 were resistant to CRO. Seven MDR Shigella phenotypes were identified, dominated by those involving resistance to AMP, SXT, and TE (100%). Our findings showed a high prevalence of shigellosis with S. flexneri as the most predominant serogroup among children under five years of age in Banadir Hospital, Somalia. AMP and SXT are no longer appropriate treatments for shigellosis in children under five years in Banadir Hospital. MDR Shigella strains, including those resistant to CIP and CRO, have emerged in Somalia, posing a public health challenge. Therefore, there is an urgent need for AMR surveillance and continuous monitoring to mitigate the further spread of the MDR Shigella strains in Banadir Hospital and beyond.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Multidrug-Resistant Shigellosis among Children Aged below Five Years with Diarrhea at Banadir Hospital in Mogadishu, Somalia

Nor

Menza

Musyoki

2021

Canadian Journal of Infectious Diseases and Medical Microbiolog

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“…Five studies [23,34,36,37,57] were found in our search. Two-thirds reported on outbreak investigations, and Shigella dysenteriae type 1 was the predominant serotype.…”

Section: Shigella Spp Resistancementioning

confidence: 99%

Antimicrobial Resistance in the Central African Region: A Review

Njukeng¹,

Ako-Arrey²,

Amin³

et al. 2019

J Environ Sci Public Health

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Background:The impact of antimicrobial resistance (AMR) has placed it among one of the top public health problems worldwide. AMR has increased the global infectious disease burden and put a greater strain on health systems. This review sought to contribute more evidence on this issue of AMR in the Central African Region, by determining the overall bacterial pathogens resistance rate and pathogen specific resistance rate with respect to antimicrobial agents common in the region.Methods: Pubmed and other relevant databases were searched using the Boolean strategy. We reviewed articles from 2008 to 2018 and in accordance with an adapted PRISMA guideline. Article retrieval and screening were done using a structured search inclusion/exclusion criteria. Median and interquartile ranges of percentage resistance were calculated for each antibiotic-bacterium combination.Results: Limited AMR data was available for Central African countries with no reported data for Burundi. A total of 30 articles were included in the final analysis. The most commonly reported bacterium was Salmonella spp that has been reported from 16 studies with median resistance rate of 45.5 (IQR 9.1-81.0). It was also observed that bacterium Staphylococcus aureus had the highest resistance rate with a median resistance of 90 (IQR 86.4-95.2). In general, median resistance rate higher above 50% were observed for the following bacteria; Staphylococcus aureus, Shigella spp, Klebsiella spp, Enterococci, E. Coli and Acinetobacter spp. Conclusion:The review highlights two important findings: first, there is a huge gap of data regarding Antimicrobial resistance in the Central African Region. Second, a high level of drug resistance exists for commonly prescribed Antimicrobial drugs in the Central African region. We recommend the standardization and quality of microbiological identification and susceptibility/resistance testing methods as well as surveillance of AMR to be

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“…Many reproductive health needs of the population are not met as there is only 0.3 nurses/midwives per 1000 population and only 40% of births are attended by skilled healthcare personnel [ 12 ]. Data on microbiology and ABR in the CAR are sporadic, with most data focusing on the ABR of the Enterobacteriaceae, and are rarely specific to the paediatric population [ 13 – 17 ]. To our knowledge, no studies have been published on neonatal infections and their ABR in CAR.…”

Section: Introductionmentioning

confidence: 99%

When first line treatment of neonatal infection is not enough: blood culture and resistance patterns in neonates requiring second line antibiotic therapy in Bangui, Central African Republic

et al. 2021

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Background Infectious diseases account for the third most common cause of neonatal deaths. Globally, antibiotic resistance (ABR) has been increasingly challenging neonatal sepsis treatment, with 26 to 84% of gram-negative bacteria resistant to third-generation cephalosporins. In sub-Saharan Africa, limited evidence is available regarding the neonatal microbiology and ABR. To our knowledge, no studies have assessed neonatal bacterial infections and ABR in Central-African Republic (CAR). Therefore, this study aimed to describe the pathogens isolated and their specific ABR among patients with suspected antibiotic-resistant neonatal infection admitted in a CAR neonatal unit. Methods This retrospective cohort study included neonates admitted in the neonatal unit in Bangui, CAR, from December 2018 to March 2020, with suspected antibiotic-resistant neonatal infection and subsequent blood culture. We described the frequency of pathogens isolated from blood cultures, their ABR prevalence, and factors associated with fatal outcome. Results Blood cultures were positive in 33 (26.6%) of 124 patients tested (17.9% for early-onset and 46.3% for late-onset infection; p = 0.002). Gram-negative bacteria were isolated in 87.9% of positive samples; with most frequently isolated bacteria being Klebsiella pneumoniae (39.4%), Escherichia coli (21.2%) and Klebsiella oxytoca (18.2%). All tested bacteria were resistant to ampicillin. Resistance to third-generation cephalosporins was observed in 100% of tested Klebsiella pneumoniae, 83.3% of isolated Klebsiella oxytoca and 50.0% of tested Escherichia coli. None of the tested bacteria were resistant to carbapenems. Approximately 85.7 and 77.8% of gram-negative tested bacteria were resistant to first-line (ampicillin-gentamicin) and second-line (third-generation cephalosporins) treatments, respectively. In hospital mortality, adjusted for blood culture result, presence of asphyxia, birth weight and sex was higher among neonates with positive blood culture (adjusted relative risk [aRR] = 2.32; 95% confidence interval [CI] = 1.17–4.60), male sex (aRR = 2.07; 95% CI = 1.01–4.26), asphyxia (aRR = 2.42; 95% CI = 1.07–5.47) and very low birth weight (1000–1499 g) (aRR = 2.74; 95% CI = 1.3–5.79). Conclusion Overall, 77.8% of confirmed gram-negative neonatal infections could no longer effectively be treated without broad-spectrum antibiotics that are not routinely used in sub-Saharan Africa referral hospitals. Carbapenems should be considered an option in hospitals with surveillance and antibiotic stewardship.

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Serotype Distribution and Antimicrobial Resistance of Shigella Species in Bangui, Central African Republic, from 2002 to 2013

Cited by 12 publications

References 20 publications

Multidrug-Resistant Shigellosis among Children Aged below Five Years with Diarrhea at Banadir Hospital in Mogadishu, Somalia

Multidrug-Resistant Shigellosis among Children Aged below Five Years with Diarrhea at Banadir Hospital in Mogadishu, Somalia

Antimicrobial Resistance in the Central African Region: A Review

When first line treatment of neonatal infection is not enough: blood culture and resistance patterns in neonates requiring second line antibiotic therapy in Bangui, Central African Republic

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