The prevalence of antimicrobial resistance in human faecal flora in South Africa

Shanahan, P. M. A.; Wylie, B. A.; Adrian, Peter V.; Koornhof, H. J.; Thomson, C. J.; Amyes, S. G. B.

doi:10.1017/s0950268800056922

Cited by 34 publications

(34 citation statements)

References 24 publications

(43 reference statements)

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“…This history of CTX-M enzyme dissemination shows parallels with the emergence of TEM-1, a well-known wild-type narrowspectrum penicillinase which was first isolated in 1965 in Greece (133) and later spread through healthy populations worldwide (134)(135)(136)(137). The rapid and wide dissemination of this gene in cattle as well as in food, pets, and environments (138)(139)(140)(141)(142) is also paralleled by recent observations made for CTX-M (143).…”

Section: Discussionmentioning

confidence: 65%

Trends in Human Fecal Carriage of Extended-Spectrum β-Lactamases in the Community: Toward the Globalization of CTX-M

et al. 2013

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SUMMARY In the last 10 years, extended-spectrum β-lactamase-producing enterobacteria (ESBL-E) have become one of the main challenges for antibiotic treatment of enterobacterial infections, largely because of the current CTX-M enzyme pandemic. However, most studies have focused on hospitalized patients, though today it appears that the community is strongly affected as well. We therefore decided to devote our investigation to trends in ESBL-E fecal carriage rates and comprehensively reviewed data from studies conducted on healthy populations in various parts of the world. We show that (i) community ESBL-E fecal carriage, which was unknown before the turn of the millennium, has since increased significantly everywhere, with developing countries being the most affected; (ii) intercontinental travel may have emphasized and globalized the issue; and (iii) CTX-M enzymes, especially CTX-M-15, are the dominant type of ESBL. Altogether, these results suggest that CTX-M carriage is evolving toward a global pandemic but is still insufficiently described. Only a better knowledge of its dynamics and biology will lead to further development of appropriate control measures.

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Section: Discussionmentioning

confidence: 65%

Trends in Human Fecal Carriage of Extended-Spectrum β-Lactamases in the Community: Toward the Globalization of CTX-M

et al. 2013

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“…While these guidelines were developed within the context of high-income countries, there are few data on the validity of this method in low-to middle-income countries where there are differences in the distributions of saprophytic organisms and antimicrobial resistance is common (23)(24)(25)(26). In this study, we compared the recovery rates of GBS by standard methods with direct plating onto either CNA or CA from either the vaginal or rectal swabs from pregnant South African women to determine whether these alternatives would provide better recovery rates.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Trans-Vag Broth, Colistin-Nalidixic Agar, and CHROMagar StrepB for Detection of Group B Streptococcus in Vaginal and Rectal Swabs from Pregnant Women in South Africa

et al. 2013

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d Maternal vaginal colonization with group B streptococcus (GBS) is a major risk factor for invasive GBS infection in newborns.The CDC-recommended method for detecting GBS colonization is to culture vaginal and rectal swabs in a selective broth followed by subculture on blood agar or a selective medium. A high incidence of antimicrobial resistance in the fecal microflora can compromise the recovery of GBS from the selective broth. Here, we compared CHROMagar StrepB (CA), Columbia colistinnalidixic agar (CNA), and Trans-Vag selective broth enrichment for the isolation of GBS from 130 vaginal and 130 rectal swabs from pregnant women. The swabs were randomized for plating first on either CA or CNA, and they then were inoculated in Trans-Vag broth. GBS was cultured from 37.7% of the vaginal swabs and 33.1% of the rectal swabs. There were no differences in the detection rates for the vaginal swabs between CA (31.5%), CNA (26.2%), and the selective broth (30.0%). The sensitivities in relation to a composite score were 83.7%, 69.4%, and 79.6%, respectively. However, recovery of GBS from the rectal swabs was significantly higher from CA (29.2%; P < 0.0001) and CNA (23.8%; P ‫؍‬ 0.002) than from the selective broth (9.2%). The sensitivities were 88.4%, 72.1%, and 27.9%, respectively. The order of plating on the solid medium was significant (P ‫؍‬ 0.003), with GBS detection rates of 30.8% and 24.6% when swabs were plated first and second, respectively. These findings show that a selective broth is not suitable for the recovery of GBS from rectal swabs in settings such as ours, due to masking of the GBS colonies by persistent microflora. Infection by group B streptococcus (GBS) is one of the most common infections in newborns (1). Maternal colonization has been found to be a major risk factor for invasive GBS disease within 6 days of birth. Approximately 10 to 40% of pregnant women are colonized with GBS in either the vagina, the rectum, or both areas (2). The rate of peripartum transmission of GBS to newborns of colonized women is approximately 50%, after which 1 to 2% of these newborns develop invasive GBS infection in the first week of life (3, 4). The Centers for Disease Control and Prevention (CDC) has recommended that all pregnant women be screened for rectovaginal carriage of GBS at 35 to 37 weeks' gestation to identify women who should receive intrapartum antimicrobial prophylaxis (IAP). When successfully implemented, IAP targeted at GBS-colonized pregnant women has reduced the incidence of invasive GBS disease by 86 to 89% (5-7). The sensitivities of screening methods for the identification of maternal carriage of GBS depends on the timing of specimen collection, the source of the specimen, and the culture technique used. Optimally, specimens should be collected as close to delivery as possible. The use of vaginal and rectal swab specimens has been shown to yield higher GBS culture-positivity rates than vaginal swabs alone or cervical specimens (8-10). The current CDC recommendation for the isolation of GBS from v...

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“…[10][11][12]. High levels of resistance have also been reported in the normal faecal flora from populations in Africa and Asia [13][14][15][16] and in the Netherlands [17,18].…”

Section: Introductionmentioning

confidence: 93%

Trimethoprim resistant dihydrofolate reductases in normal faecal flora isolated in India

Tait

Amyes

1994

Epidemiol. Infect.

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SUMMARYA high incidence of resistance to trimethoprim has been shown in the normal faecal flora in a population in south India. The dihydrofolate reductase (dhfr) genes mediating transferable resistance to trimethoprim have been identified.Unusually, in this study, the dhfrV was shown to be the predominant resistance gene (dhfrV 50 % of transconjugants, dhfrla 30%), the dhfrlb was also detected being distinguished from the dhfrV by an oligo-probe. However, when nontransferable resistance was considered, the dhfrIa was the most prevalent of the dhfrs identified. All those plasmids harbouring the dhfrla were shown to possess Tn7. All the plasmids that probed positive for the dhfrV and the dhfrlb were shown to be associated with the integrase of the Tn2l-like transposons, but 8 of the dhfrV genes were not associated with the Tn2l resolvase. The dhfrIV was shown to be present in all seven plasmids that produced low level trimethoprimresistance. The dhfrV, first characterized in Sri Lanka, would seem to have a local distribution in this region of Asia but is distinguishable from the dhfrlb only by the use of an oligo-probe.

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The prevalence of antimicrobial resistance in human faecal flora in South Africa

Cited by 34 publications

References 24 publications

Trends in Human Fecal Carriage of Extended-Spectrum β-Lactamases in the Community: Toward the Globalization of CTX-M

Trends in Human Fecal Carriage of Extended-Spectrum β-Lactamases in the Community: Toward the Globalization of CTX-M

Evaluation of Trans-Vag Broth, Colistin-Nalidixic Agar, and CHROMagar StrepB for Detection of Group B Streptococcus in Vaginal and Rectal Swabs from Pregnant Women in South Africa

Trimethoprim resistant dihydrofolate reductases in normal faecal flora isolated in India

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