Raspail CarrelFounou1, Luria Leslie FOUNOU1, ESSACK SABIHA2
1Centre of Expertise and Biological Diagnostic of Cameroon ; 2University of KwaZulu-Natal South Africa
CaHReF 2018, Yaoundé Congres hall, 08 – 11 January 2019 , OSEP005
Background: Gram-negative ESKAPE bacteria are increasingly implicated in several difficult-to-treat infections in developed and developing countries. They are listed by the World Health Organization as resistant bacteria of critical priority in research.
Objectif : To determine risk factors, prevalence, phenotypic profiles, genetic diversity and clonal relatedness of extended-spectrum β-lactamase-producing multi-drug resistant Gram-negative ESKAPE bacteria in carriage and clinical samples.
Methodolody: This study took place in a district and tertiary hospital during two-months from May to June 2017 in uMgungundlovu district, South Africa. Rectal swabs were collected from hospitalized patients, at admission, after 48h and at discharge and clinical isolates routinely processed in the microbiological laboratory during the sampling period were also collected. Gram-negative ESKAPE bacteria were screened for ESBL production on selective MacConkey agar. Minimum inhibitory concentrations were determined, and real-time and multiplex PCR were used to ascertain the presence of blaCTX-M group-1-2-9, blaCTX-M group 8/25, blaSHV, blaTEM, blaOXA-1-like, and AmpC genes. Genomic fingerprinting was performed using ERIC-PCR.
Results: Overall prevalence of carriage of ESBL-mediating MDR Gram-negative ESKAPE was 37.21% (16/43), 42.31% (11/26) and 57.14% (4/7) at admission, after 48 h and at discharge respectively. The prevalence of ESBL-mediating MDR Gram-negative ESKAPE bacteria in faecal carriage (46%) was higher than clinical samples (28%). Colonization was mainly associated with the referral from district to tertiary hospital with high statistical significance (OR: 14.40, 95% CI 0.98-210.84). blaCTX-M-group-9, blaCTX-M-group-1 and blaSHV were the main resistance genes identified. Several patients carried more than two different isolates. A Klebsiella pneumoniae (K1) clone was circulating within wards and between hospitals.
Conclusion/Recommandation: The study highlights the high prevalence of ESBL-mediating MDR Gram-negative ESKAPE bacteria in carriage and clinical samples among hospitalized patients in uMgungundlovu, South Africa. The wide dissemination of these resistant ESKAPE bacteria in hospitals necessitates improvements in routine screening and reinforcement of infection, prevention and control measures.
Key Words:Antibiotic resistance, ESKAPE bacteria, ESBLs, Carriage,