Transmission Networks of Extended-spectrum beta-lactamase producing-Enterobacteriaceae in communities and hospitals in rural sub-Sahara Africa

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Current models predict a tremendous increase of antimicrobial resistance (AMR) for the African continent. An annual 4.1 million deaths and a mortality rate of >10/100,000 related to AMR are estimated for the year 2050. In 2016 the Bernhard-Nocht-Institute for Tropical Medicine and the University Medical Center Hamburg-Eppendorf (both Hamburg, Germany) in collaboration with the Kumasi Centre for Collaborative Research in Tropical Medicine (Kumasi, Ghana) initiated a screening for Extended-spectrum beta-lactamase (ESBL)-producing bacteria at hospital admission and discharge in a rural Ghanaian hospital. This study will be able to provide reliable data on the prevalence and the frequency of nosocomial transmission events of these multidrug resistant bacteria. At the same time, families, their neighbours and animal contacts within the hospital catchment area were screened for ESBL carriage with the aim to collect data on the prevalence outside the hospital boundaries. Building on this surveillance project (already financed), we are now proposing to sequence the genomes and relevant plasmids of all ESBL-producing isolates collected from the hospital (n=749) and the community (n=251). By comparing genomes and plasmids transmission networks within and outside of the hospital will be established, and the potential spread of nosocomial pathogens into the community can be demonstrated. The results will be used to model the dissemination of AMR pathogens in rural sub-Sahara Africa. Further, the impact of public health interventions can be modelled in order to choose effective measure to tackle the spread of AMR.