Multicountry Distribution and Characterization of Extended-spectrum β-Lactamase-associated Gram-negative Bacteria from Bloodstream Infections in Sub-Saharan Africa

Trevor Toy, Gi Deok Pak, Trung Pham Duc, James I. Campbell, Muna Ahmed El Tayeb, Vera Von Kalckreuth, Justin Im, Ursula Panzner, Ligia Maria Cruz Espinoza, Daniel Eibach, Denise Myriam Dekker, Se Eun Park, Hyon Jin Jeon, Frank Konings, Ondari D. Mogeni, Leonard Cosmas, Morten Bjerregaard-Andersen, Nagla Gasmelseed, Julian T. Hertz, Anna JaegerRalf Krumkamp, Benedikt Ley, Kamala Thriemer, Leon Parfait Kabore, Aissatou Niang, Tiana Mirana Raminosoa, Emmanuel Sampo, Nimako Sarpong, Abdramane Soura, Ellis Owusu-Dabo, Mekonnen Teferi, Biruk Yeshitela, Sven Poppert, Jürgen May, Jerome H. Kim, Yun Chon, Jin Kyung Park, Abroaham Aseffa, Robert F. Breiman, Heidi Schütt-Gerowitt, Peter Aaby, Yaw Adu-Sarkodie, John A. Crump, Raphaël Rakotozandrindrainy, Christian G. Meyer, Amy Gassama Sow, John D. Clemens, Thomas F. Wierzba, Stephen Baker, Florian Marks

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Background: Antimicrobial resistance (AMR) is a major global health concern, yet, there are noticeable gaps in AMR surveillance data in regions such as sub-Saharan Africa. We aimed to measure the prevalence of extended-spectrum β-lactamase (ESBL) producing Gram-negative bacteria in bloodstream infections from 12 sentinel sites in sub-Saharan Africa. 

Methods: Data were generated during the Typhoid Fever Surveillance in Africa Program (TSAP), in which standardized blood cultures were performed on febrile patients attending 12 health facilities in 9 sub-Saharan African countries between 2010 and 2014. Pathogenic bloodstream isolates were identified at the sites and then subsequently confirmed at a central reference laboratory. Antimicrobial susceptibility testing, detection of ESBL production, and conventional multiplex polymerase chain reaction (PCR) testing for genes encoding for β-lactamase were performed on all pathogens. 

Results: Five hundred and five pathogenic Gram-negative bloodstream isolates were isolated during the study period and available for further characterization. This included 423 Enterobacteriaceae. Phenotypically, 61 (12.1%) isolates exhibited ESBL activity, and genotypically, 47 (9.3%) yielded a PCR amplicon for at least one of the screened ESBL genes. Among specific Gram-negative isolates, 40 (45.5%) of 88 Klebsiella spp., 7 (5.7%) of 122 Escherichia coli, 6 (16.2%) of 37 Acinetobacter spp., and 2 (1.3%) of 159 of nontyphoidal Salmonella (NTS) showed phenotypic ESBL activity. 

Conclusions: Our findings confirm the presence of ESBL production among pathogens causing bloodstream infections in sub-Saharan Africa. With few alternatives for managing ESBL-producing pathogens in the African setting, measures to control the development and proliferation of AMR organisms are urgently needed.

Original languageEnglish
Pages (from-to)S449-S458
Number of pages10
JournalClinical Infectious Diseases
Issue numberSupplement_6
Publication statusPublished - 30 Oct 2019


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