Extended spectrum beta-lactamase producing Enterobacteriaceae causing bloodstream infections in rural Ghana, 2007-2012

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• 作者：Daniel Eibach^a ; ¹ ; ^{eibach@bnitm.de" class="auth_mail" title="E-mail the corresponding author} ; Cristina Belmar Campos^b ; ¹ ; ^{c.belmar-campos@uke.de" class="auth_mail" title="E-mail the corresponding author} ; Ralf Krumkamp^a ; ^c ; ^{krumkamp@bnitm.de" class="auth_mail" title="E-mail the corresponding author} ; Hassan M. Al-Emran^a ; ^{al-emran@bnitm.de" class="auth_mail" title="E-mail the corresponding author} ; Denise Dekker^a ; ^c ; ^{dekker@bnitm.de" class="auth_mail" title="E-mail the corresponding author} ; Kennedy Gyau Boahen^d ; ^{gyaukennedy@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; Benno Kreuels^a ; ^b ; ^c ; ^{b.kreuels@uke.de" class="auth_mail" title="E-mail the corresponding author} ; Yaw Adu-Sarkodie^e ; ^{sax@ghanatel.com.gh" class="auth_mail" title="E-mail the corresponding author} ; Martin Aepfelbacher^b ; ^{maepfelbacher@uke.de" class="auth_mail" title="E-mail the corresponding author} ; Se Eun Park^f ; ^{seeun.park@ivi.int" class="auth_mail" title="E-mail the corresponding author} ; Ursula Panzner^f ; ^{upanzner@ivi.int" class="auth_mail" title="E-mail the corresponding author} ; Florian Marks^f ; ^{fmarks@ivi.int" class="auth_mail" title="E-mail the corresponding author} ; Jü ; rgen May^a ; ^c ; ^{may@bnitm.de" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Ghana ; Molecular epidemiology ; Extended spectrum β-lactamase ; Klebsiella pneumoniae ; Bloodstream infection
• 刊名：International Journal of Medical Microbiology
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：306
• 期：4
• 页码：249-254
• 全文大小：1023 K

文摘

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 24 h 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.