High prevalence of multidrug resistant Enterobacteriaceae isolated from outpatient urine samples but not the hospital environment in Bo, Sierra Leone.
High prevalence of multidrug resistant Enterobacteriaceae isolated from outpatient urine samples but not the hospital environment in Bo, Sierra Leone.
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DOI：
10.1186/s12879-016-1495-1
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发表时间：
2016-04-18
影响因子：
3.7
通讯作者：
Vora, Gary J
中科院分区：
文献类型：
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作者：
Leski, Tomasz A;Taitt, Chris R;Vora, Gary J
背景：细菌病原体中抗生素耐药性水平的上升是全球最重要的公共卫生问题之一。虽然在许多发达国家密切跟踪临床重要细菌的抗生素耐药性，但目前在撒哈拉以南非洲大多数国家流行的病原体中的耐药性和多药耐药性（MDR）的类型和水平几乎是未知的。2013年12月至2014年4月，我们收集了93份来自所有显示尿路感染（UTI）症状的门诊患者的尿液样本和189份来自塞拉利昂博城的一家小医院的污染物拭子。采用显色琼脂培养结合生化和DNA序列分析的方法对分离菌株进行检测和鉴定。结果：70株肠杆菌科细菌经鉴定分别为弗氏柠檬酸杆菌（n=22）、肺炎克雷伯菌（n = 15）、阴沟肠杆菌（n=15）、大肠埃希菌（n = 13）、肠杆菌属/肺炎克雷伯菌（n = 15）、铜绿假单胞菌（n=13）、铜绿假单胞菌（n = 1 Leclercia sp.（n=4）和Escherichia hermannii（n=1）。药敏试验显示85.7%的菌株为MDR，64.3%的菌株产超广谱β-内酰胺酶（ESBL）。最显著的结果包括广泛耐药磺胺类（91.4%）、氯霉素（72.9%）、庆大霉素（72.9%）、氨苄西林+舒巴坦（51.4%）和环丙沙星（47.1%）。freundii表现最好，E.大肠杆菌的多药耐药率最低。环境培养结果显示，在189株肠杆菌科细菌中，仅有5株具有较低的总体耐药性。在疑似UTI患者的尿液中发现的弗氏杆菌支持了早期的发现，即这种病原体在低资源国家的UTI中的作用越来越大。所有分析物种的分离株对一线和二线抗生素都表现出令人担忧的高水平耐药性，以及MDR和ESBL表型的高频率，这可能是由于塞拉利昂缺乏一致的抗生素管理政策。然而，对医院环境分离株的分析表明，在这个自然通风的医院中，污染物不是肠杆菌科或抗生素耐药决定因素的主要储存库。
BACKGROUND: The rising level of antimicrobial resistance among bacterial pathogens is one of the most significant public health problems globally. While the antibiotic resistance of clinically important bacteria is closely tracked in many developed countries, the types and levels of resistance and multidrug resistance (MDR) among pathogens currently circulating in most countries of sub-Saharan Africa are virtually unknown.METHODS: From December 2013 to April 2014, we collected 93 urine specimens from all outpatients showing symptoms of urinary tract infection(UTI) and 189 fomite swabs from a small hospital in Bo, Sierra Leone. Culture on chromogenic agar combined with biochemical and DNA sequence-based assays was used to detect and identify the bacterial isolates. Their antimicrobial susceptibilities were determined using a panel of 11 antibiotics or antibiotic combinations.RESULTS: The 70 Enterobacteriaceae urine isolates were identified as Citrobacter freundii (n=22), Klebsiella pneumoniae (n=15), Enterobacter cloacae (n=15), Escherichia coli (n=13), Enterobacter sp./Leclercia sp. (n=4) and Escherichia hermannii (n=1). Antimicrobial susceptibility testing demonstrated that 85.7% of these isolates were MDR while 64.3% produced an extended-spectrumSS-lactamase (ESBL). The most notable observations included widespread resistance to sulphonamides (91.4%), chloramphenicol (72.9%), gentamycin (72.9%), ampicillin with sulbactam (51.4%) and ciprofloxacin (47.1%) with C. freundii exhibiting the highest and E. coli the lowest prevalence of multidrug resistance. The environmental cultures resulted in only five Enterobacteriaceae isolates out of 189 collected withlower overall antibiotic resistance.CONCLUSIONS: The surprisingly high proportion of C. freundii found in urine of patients with suspected UTI supports earlier findings of the growing role of this pathogen in UTIs in low-resource countries. The isolates of all analyzed species showed worryingly high levels of resistance to both first- and second-line antibiotics as well as ahigh frequency of MDR and ESBL phenotypes, which likely resulted from the lack of consistent antibiotic stewardship policies in Sierra Leone. Analysis of hospital environmental isolates however suggested that fomites in this naturally ventilated hospital were not a major reservoir for Enterobacteriaceae or antibiotic resistance determinants.