Molecular surveillance reveals widespread colonisation by carbapenemase and extended spectrum beta-lactamase producing organisms in neonatal units in Kenya and Nigeria.
Molecular surveillance reveals widespread colonisation by carbapenemase and extended spectrum beta-lactamase producing organisms in neonatal units in Kenya and Nigeria.
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DOI：
10.1186/s13756-023-01216-0
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发表时间：
2023-02-22
影响因子：
5.5
通讯作者：
Allen, Stephen
中科院分区：
文献类型：
--
作者：
Edwards, Thomas;Williams, Christopher T.;Olwala, Macrine;Andang'o, Pauline;Otieno, Walter;Nalwa, Grace N.;Akindolire, Abimbola;Cubas-Atienzar, Ana I.;Ross, Toby;Tongo, Olukemi O.;Adams, Emily R.;Nabwera, Helen;Allen, Stephen
新生儿败血症是撒哈拉以南非洲婴儿死亡的主要原因，通常是肠道源性的。产超广谱β-内酰胺酶（ESBL）或碳青霉烯酶的肠杆菌科细菌的肠道定植可导致抗生素耐药（AMR）或无法治疗的感染。我们试图探索产ESBL菌或产碳青霉烯酶菌在西非和东非两个新生儿单位（NNUs）的定植率。在多个时间点从尼日利亚伊巴丹大学学院医院和肯尼亚西部基苏穆Jaramogi Oginga Odinga教学和转诊医院的NNUs住院新生儿中采集粪便和直肠拭子样本。使用先前验证的qPCR检测试剂盒检测样本的ESBL和碳青霉烯酶基因。Kaplan-Meier生存分析用于检查两个研究中心的定殖率。总共从两个NNU收治的42名婴儿中采集了119份粪便和直肠拭子样本。ESBL定植（37例婴儿，89%）比碳青霉烯酶产生者（26例，62.4%; P = 0.093）更常见。产ESBL微生物定植前的中位生存时间为7天，产碳青霉烯酶微生物定植前的中位生存时间为16天（P = 0.035）。检出的ESBL基因大多属于CTX-M-1（36/38; 95%）和CTX-M-9（2/36; 5%）组，最常见的碳青霉烯酶为blaNDM（27/29，93%）。在肯尼亚和尼日利亚的NNUs中，AMR微生物在新生儿肠道定植很常见，并迅速发生。对定植的积极监测将提高对这些环境中AMR的理解，并指导感染控制和抗生素处方实践，以改善临床结局。在线版本包含补充材料，可通过10.1186/s13756-023-01216-0获得。
Neonatal sepsis, a major cause of death amongst infants in sub-Saharan Africa, is often gut derived. Gut colonisation by Enterobacteriaceae producing extended spectrum beta-lactamase (ESBL) or carbapenemase enzymes can lead to antimicrobial-resistant (AMR) or untreatable infections. We sought to explore the rates of colonisation by ESBL or carbapenemase producers in two neonatal units (NNUs) in West and East Africa. Stool and rectal swab samples were taken at multiple timepoints from newborns admitted to the NNUs at the University College Hospital, Ibadan, Nigeria and the Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, western Kenya. Samples were tested for ESBL and carbapenemase genes using a previously validated qPCR assay. Kaplan–Meier survival analysis was used to examine colonisation rates at both sites. In total 119 stool and rectal swab samples were taken from 42 infants admitted to the two NNUs. Colonisation with ESBL (37 infants, 89%) was more common than with carbapenemase producers (26, 62.4%; P = 0.093). Median survival time before colonisation with ESBL organisms was 7 days and with carbapenemase producers 16 days (P = 0.035). The majority of ESBL genes detected belonged to the CTX-M-1 (36/38; 95%), and CTX-M-9 (2/36; 5%) groups, and the most prevalent carbapenemase was blaNDM (27/29, 93%). Gut colonisation of neonates by AMR organisms was common and occurred rapidly in NNUs in Kenya and Nigeria. Active surveillance of colonisation will improve the understanding of AMR in these settings and guide infection control and antibiotic prescribing practice to improve clinical outcomes. The online version contains supplementary material available at 10.1186/s13756-023-01216-0.
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DOI：
10.1097/mpg.0000000000000597
发表时间：
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影响因子：
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作者：
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