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Extended spectrum beta-lactamase producing Enterobacteriaceae causing bloodstream infections in rural Ghana, 2007-2012.
Int J Med Microbiol. 2016 06; 306(4):249-54.IJ

Abstract

BACKGROUND

High prevalence of Extended Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae threatens treatment options for invasive bloodstream infections in sub-Saharan Africa.

OBJECTIVES

To explore the frequency and genotype distribution of ESBL producing Enterobacteriaceae causing bloodstream infections in a primary health care setting in rural Ghana.

METHODS

Blood cultures from all patients with fever ≥38°C within 24h after admission (community-acquired) and from all neonates with suspected neonatal sepsis (hospital-acquired) were obtained. ESBL-producing isolates were characterized by combined disc test and by amplifying the blaCTX-M, blaTEM and blaSHV genes. Multilocus sequence typing (MLST) was performed for all ESBL-producing Klebsiella pneumoniae and Escherichia coli isolates, and all K. pneumoniae isolates were differentiated by pulsed-field gel electrophoresis (PFGE).

RESULTS

Among 426 Enterobacteriaceae isolated from blood cultures, non-typhoid Salmonella (n=215, 50.8%), S. Typhi (n=110, 26.0%), E. coli (n=50, 11.8%) and K. pneumoniae (n=41, 9.7%) were the most frequent. ESBL-producing isolates were restricted to the CTX-M-15 genotype and the species K. pneumoniae (n=34, 82.9%), Enterobacter cloacae complex (n=2, 66.7%) and E. coli (n=5, 10.0%). The rates of ESBL-producers in K. pneumoniae were 55.6% and 90.6% in community-acquired and neonatal bloodstream infections, respectively. MLST and PFGE analysis identified four outbreak clusters among neonates.

CONCLUSIONS

Considering the rural primary health care study setting, the high proportion of ESBL-producing Klebsiella pneumoniae is worrisome and might be devastating in the absence of second line antibiotics. Therefore, enhanced diagnostic laboratories for surveillance purposes and sustainable hospital hygiene measures must be considered to prevent further spread of multidrug resistant bacteria within rural communities.

Authors+Show Affiliations

Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str.74, 20359 Hamburg, Germany. Electronic address: eibach@bnitm.de.University Medical Centre Hamburg-Eppendorf (UKE), Martinist. 52, 20246 Hamburg, Germany. Electronic address: c.belmar-campos@uke.de.Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str.74, 20359 Hamburg, Germany; German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Germany. Electronic address: krumkamp@bnitm.de.Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str.74, 20359 Hamburg, Germany. Electronic address: al-emran@bnitm.de.Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str.74, 20359 Hamburg, Germany; German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Germany. Electronic address: dekker@bnitm.de.Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana. Electronic address: gyaukennedy@yahoo.com.Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str.74, 20359 Hamburg, Germany; University Medical Centre Hamburg-Eppendorf (UKE), Martinist. 52, 20246 Hamburg, Germany; German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Germany. Electronic address: b.kreuels@uke.de.Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. Electronic address: sax@ghanatel.com.gh.University Medical Centre Hamburg-Eppendorf (UKE), Martinist. 52, 20246 Hamburg, Germany. Electronic address: maepfelbacher@uke.de.International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742 Republic of Korea. Electronic address: seeun.park@ivi.int.International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742 Republic of Korea. Electronic address: upanzner@ivi.int.International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742 Republic of Korea. Electronic address: fmarks@ivi.int.Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str.74, 20359 Hamburg, Germany; German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Germany. Electronic address: may@bnitm.de.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27222489

Citation

Eibach, Daniel, et al. "Extended Spectrum Beta-lactamase Producing Enterobacteriaceae Causing Bloodstream Infections in Rural Ghana, 2007-2012." International Journal of Medical Microbiology : IJMM, vol. 306, no. 4, 2016, pp. 249-54.
Eibach D, Belmar Campos C, Krumkamp R, et al. Extended spectrum beta-lactamase producing Enterobacteriaceae causing bloodstream infections in rural Ghana, 2007-2012. Int J Med Microbiol. 2016;306(4):249-54.
Eibach, D., Belmar Campos, C., Krumkamp, R., Al-Emran, H. M., Dekker, D., Boahen, K. G., Kreuels, B., Adu-Sarkodie, Y., Aepfelbacher, M., Park, S. E., Panzner, U., Marks, F., & May, J. (2016). Extended spectrum beta-lactamase producing Enterobacteriaceae causing bloodstream infections in rural Ghana, 2007-2012. International Journal of Medical Microbiology : IJMM, 306(4), 249-54. https://doi.org/10.1016/j.ijmm.2016.05.006
Eibach D, et al. Extended Spectrum Beta-lactamase Producing Enterobacteriaceae Causing Bloodstream Infections in Rural Ghana, 2007-2012. Int J Med Microbiol. 2016;306(4):249-54. PubMed PMID: 27222489.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extended spectrum beta-lactamase producing Enterobacteriaceae causing bloodstream infections in rural Ghana, 2007-2012. AU - Eibach,Daniel, AU - Belmar Campos,Cristina, AU - Krumkamp,Ralf, AU - Al-Emran,Hassan M, AU - Dekker,Denise, AU - Boahen,Kennedy Gyau, AU - Kreuels,Benno, AU - Adu-Sarkodie,Yaw, AU - Aepfelbacher,Martin, AU - Park,Se Eun, AU - Panzner,Ursula, AU - Marks,Florian, AU - May,Jürgen, Y1 - 2016/05/10/ PY - 2016/02/24/received PY - 2016/04/04/revised PY - 2016/05/09/accepted PY - 2016/5/26/entrez PY - 2016/5/26/pubmed PY - 2017/2/15/medline KW - Bloodstream infection KW - Extended spectrum β-lactamase KW - Ghana KW - Klebsiella pneumoniae KW - Molecular epidemiology SP - 249 EP - 54 JF - International journal of medical microbiology : IJMM JO - Int. J. Med. Microbiol. VL - 306 IS - 4 N2 - BACKGROUND: High prevalence of Extended Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae threatens treatment options for invasive bloodstream infections in sub-Saharan Africa. OBJECTIVES: To explore the frequency and genotype distribution of ESBL producing Enterobacteriaceae causing bloodstream infections in a primary health care setting in rural Ghana. METHODS: Blood cultures from all patients with fever ≥38°C within 24h after admission (community-acquired) and from all neonates with suspected neonatal sepsis (hospital-acquired) were obtained. ESBL-producing isolates were characterized by combined disc test and by amplifying the blaCTX-M, blaTEM and blaSHV genes. Multilocus sequence typing (MLST) was performed for all ESBL-producing Klebsiella pneumoniae and Escherichia coli isolates, and all K. pneumoniae isolates were differentiated by pulsed-field gel electrophoresis (PFGE). RESULTS: Among 426 Enterobacteriaceae isolated from blood cultures, non-typhoid Salmonella (n=215, 50.8%), S. Typhi (n=110, 26.0%), E. coli (n=50, 11.8%) and K. pneumoniae (n=41, 9.7%) were the most frequent. ESBL-producing isolates were restricted to the CTX-M-15 genotype and the species K. pneumoniae (n=34, 82.9%), Enterobacter cloacae complex (n=2, 66.7%) and E. coli (n=5, 10.0%). The rates of ESBL-producers in K. pneumoniae were 55.6% and 90.6% in community-acquired and neonatal bloodstream infections, respectively. MLST and PFGE analysis identified four outbreak clusters among neonates. CONCLUSIONS: Considering the rural primary health care study setting, the high proportion of ESBL-producing Klebsiella pneumoniae is worrisome and might be devastating in the absence of second line antibiotics. Therefore, enhanced diagnostic laboratories for surveillance purposes and sustainable hospital hygiene measures must be considered to prevent further spread of multidrug resistant bacteria within rural communities. SN - 1618-0607 UR - https://www.unboundmedicine.com/medline/citation/27222489/Extended_spectrum_beta_lactamase_producing_Enterobacteriaceae_causing_bloodstream_infections_in_rural_Ghana_2007_2012_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1438-4221(16)30061-3 DB - PRIME DP - Unbound Medicine ER -