Laboratory-based nationwide surveillance of antimicrobial resistance in Ghana
Laboratory-based nationwide surveillance of antimicrobial resistance in Ghana
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DOI：
10.2147/idr.s88725
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发表时间：
2015-01-01
影响因子：
3.9
通讯作者：
Mills-Pappoe, William
中科院分区：
文献类型：
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作者：
Opintan, Japheth A.;Newman, Mercy J.;Mills-Pappoe, William
全球正在努力对抗抗菌素耐药性（AMR）。这一干预措施的一个关键目标是监测地方和国家行动。加纳关于抗生素耐药性的数据有限，也不存在对抗生素耐药性的监测。我们试图生成AMR的基线数据，并评估加纳在实验室监测方面的准备情况。在加纳各地的实验室挑选和培训了有能力进行细菌培养的生物医学科学家。使用内部标准操作方案对临床标本进行微生物研究。在中心实验室进行额外的微生物检测和数据分析。使用WHONET程序文件存储和分析监测数据。共有24个实验室参加了培训，1 598个数据集被纳入最终分析。大多数细菌菌种分离自门诊患者（963株; 60.3%）。与血液（100株分离株; 6.3%）相比，尿液（617株分离株; 38.6%）是最常见的临床标本培养物。18个实验室中有10个进行了血培养。分离出的细菌主要为大肠埃希菌（27.5%）、假单胞菌属（27.5%）。(14.0%）、金黄色葡萄球菌（11.5%）、链球菌属（11.5%）、(2.3伤寒沙门氏菌（0.6%）。大多数菌株为多重耐药菌，其中80%以上为产超广谱β-内酰胺酶菌。环丙沙星、头孢曲松和阿米卡星在50%和90%时对选定多药耐药细菌物种的最低抑制浓度水平范围为2 μ g/mL至>256 μ g/mL。一系列临床细菌分离株对该国常用的重要抗菌药物具有耐药性，因此需要进行有效监测，以持续监测加纳的AMR。在当地和国际支持下，加纳可以参与全球AMR监测。
Global efforts are underway to combat antimicrobial resistance (AMR). A key target in this intervention is surveillance for local and national action. Data on AMR in Ghana are limited, and monitoring of AMR is nonexistent. We sought to generate baseline data on AMR, and to assess the readiness of Ghana in laboratory-based surveillance. Biomedical scientists in laboratories across Ghana with capacity to perform bacteriological culture were selected and trained. In-house standard operating protocols were used to perform microbiological investigations on clinical specimens. Additional microbiological tests and data analyses were performed at a centralized laboratory. Surveillance data were stored and analyzed using WHONET program files. A total of 24 laboratories participated in the training, and 1,598 data sets were included in the final analysis. A majority of the bacterial species were isolated from outpatients (963 isolates; 60.3%). Urine (617 isolates; 38.6%) was the most common clinical specimen cultured, compared to blood (100 isolates; 6.3%). Ten of 18 laboratories performed blood culture. Bacteria isolated included Escherichia coli (27.5%), Pseudomonas spp. (14.0%), Staphylococcus aureus (11.5%), Streptococcus spp. (2.3%), and Salmonella enterica serovar Typhi (0.6%). Most of the isolates were multidrug-resistant, and over 80% of them were extended-spectrum beta-lactamases-producing. Minimum inhibitory concentration levels at 50% and at 90% for ciprofloxacin, ceftriaxone, and amikacin on selected multidrug-resistant bacteria species ranged between 2 mu g/mL and >256 mu g/mL. A range of clinical bacterial isolates were resistant to important commonly used antimicrobials in the country, necessitating an effective surveillance to continuously monitor AMR in Ghana. With local and international support, Ghana can participate in global AMR surveillance.