Calvina E L Estaleva1,2,3, Tomas F Zimba1,2, John Osei Sekyere3, Usha Govinden3, Hafizah Y Chenia4, Gunnar S Simonsen3,5,6, Bjørg Haldorsen5, Sabiha Y Essack3, Arnfinn Sundsfjord7,8,9. 1. Microbiology Laboratory, Maputo Central Hospital, Maputo, Mozambique. 2. High Institute of Health Sciences (ISCISA), Maputo, Mozambique. 3. Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. 4. Discipline of Microbiology, School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa. 5. Department of Microbiology and Infection Control, Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, University Hospital of North Norway, Tromsø, Norway. 6. Research Group for Host-Microbe Interaction, Department of Medical Biology, Faculty of Health Sciences, UiT Arctic University of Norway, NO-9037, Tromsø, Norway. 7. Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. arnfinn.sundsfjord@uit.no. 8. Department of Microbiology and Infection Control, Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, University Hospital of North Norway, Tromsø, Norway. arnfinn.sundsfjord@uit.no. 9. Research Group for Host-Microbe Interaction, Department of Medical Biology, Faculty of Health Sciences, UiT Arctic University of Norway, NO-9037, Tromsø, Norway. arnfinn.sundsfjord@uit.no.
Abstract
BACKGROUND: Epidemiological data of cephalosporin-resistant Enterobacterales in Sub-Saharan Africa is still restricted, and in particular in Mozambique. The aim of this study was to detect and characterize extended-spectrum β-lactamase (ESBL) - and plasmid-mediated AmpC (pAmpC)-producing clinical strains of Escherichia coli at Maputo Central Hospital (MCH), a 1000-bed reference hospital in Maputo, Mozambique. METHODS: A total of 230 clinical isolates of E. coli from urine (n = 199) and blood cultures (n = 31) were collected at MCH during August-November 2015. Antimicrobial susceptibility testing was performed by the disc diffusion method and interpreted according to EUCAST guidelines. Isolates with reduced susceptibility to 3rd generation cephalosporins were examined further; phenotypically for an ESBL-/AmpC-phenotype by combined disc methods and genetically for ESBL- and pAmpC-encoding genes by PCR and partial amplicon sequencing as well as genetic relatedness by ERIC-PCR. RESULTS: A total of 75 isolates with reduced susceptibility to cefotaxime and/or ceftazidime (n = 75) from urine (n = 58/199; 29%) and blood (n = 17/31; 55%) were detected. All 75 isolates were phenotypically ESBL-positive and 25/75 (33%) of those also expressed an AmpC-phenotype. ESBL-PCR and amplicon sequencing revealed a majority of blaCTX-M (n = 58/75; 77%) dominated by blaCTX-M-15. All AmpC-phenotype positive isolates (n = 25/75; 33%) scored positive for one or more pAmpC-genes dominated by blaMOX/FOX. Multidrug resistance (resistance ≥ three antibiotic classes) was observed in all the 75 ESBL-positive isolates dominated by resistance to trimethoprim-sulfamethoxazole, ciprofloxacin and gentamicin. ERIC-PCR revealed genetic diversity among strains with minor clusters indicating intra-hospital spread. CONCLUSION: We have observed a high prevalence of MDR pAmpC- and/or ESBL-producing clinical E. coli isolates with FOX/MOX and CTX-Ms as the major β-lactamase types, respectively. ERIC-PCR analyses revealed genetic diversity and some clusters indicating within-hospital spread. The overall findings strongly support the urgent need for accurate and rapid diagnostic services to guide antibiotic treatment and improved infection control measures.
BACKGROUND: Epidemiological data of cephalosporin-resistant Enterobacterales in Sub-Saharan Africa is still restricted, and in particular in Mozambique. The aim of this study was to detect and characterize extended-spectrum β-lactamase (ESBL) - and plasmid-mediated AmpC (pAmpC)-producing clinical strains of Escherichia coli at Maputo Central Hospital (MCH), a 1000-bed reference hospital in Maputo, Mozambique. METHODS: A total of 230 clinical isolates of E. coli from urine (n = 199) and blood cultures (n = 31) were collected at MCH during August-November 2015. Antimicrobial susceptibility testing was performed by the disc diffusion method and interpreted according to EUCAST guidelines. Isolates with reduced susceptibility to 3rd generation cephalosporins were examined further; phenotypically for an ESBL-/AmpC-phenotype by combined disc methods and genetically for ESBL- and pAmpC-encoding genes by PCR and partial amplicon sequencing as well as genetic relatedness by ERIC-PCR. RESULTS: A total of 75 isolates with reduced susceptibility to cefotaxime and/or ceftazidime (n = 75) from urine (n = 58/199; 29%) and blood (n = 17/31; 55%) were detected. All 75 isolates were phenotypically ESBL-positive and 25/75 (33%) of those also expressed an AmpC-phenotype. ESBL-PCR and amplicon sequencing revealed a majority of blaCTX-M (n = 58/75; 77%) dominated by blaCTX-M-15. All AmpC-phenotype positive isolates (n = 25/75; 33%) scored positive for one or more pAmpC-genes dominated by blaMOX/FOX. Multidrug resistance (resistance ≥ three antibiotic classes) was observed in all the 75 ESBL-positive isolates dominated by resistance to trimethoprim-sulfamethoxazole, ciprofloxacin and gentamicin. ERIC-PCR revealed genetic diversity among strains with minor clusters indicating intra-hospital spread. CONCLUSION: We have observed a high prevalence of MDR pAmpC- and/or ESBL-producing clinical E. coli isolates with FOX/MOX and CTX-Ms as the major β-lactamase types, respectively. ERIC-PCR analyses revealed genetic diversity and some clusters indicating within-hospital spread. The overall findings strongly support the urgent need for accurate and rapid diagnostic services to guide antibiotic treatment and improved infection control measures.
Authors: A Russo; M Falcone; B Gutiérrez-Gutiérrez; E Calbo; B Almirante; P L Viale; A Oliver; P Ruiz-Garbajosa; O Gasch; M Gozalo; J Pitout; M Akova; C Peña; J M Cisneros; A Hernández-Torres; A Farcomeni; N Prim; J Origüen; G Bou; E Tacconelli; M Tumbarello; A Hamprecht; I Karaiskos; C de la Calle; F Pérez; M J Schwaber; J Bermejo; W Lowman; P-R Hsueh; M Mora-Rillo; J Rodriguez-Gomez; M Souli; R A Bonomo; D L Paterson; Y Carmeli; A Pascual; J Rodríguez-Baño; M Venditti Journal: Int J Antimicrob Agents Date: 2018-06-30 Impact factor: 5.283
Authors: Enrique Rodríguez-Guerrero; Juan Carlos Callejas-Rodelas; José María Navarro-Marí; José Gutiérrez-Fernández Journal: Microorganisms Date: 2022-03-14