Molecular epidemiology and antimicrobial resistance mechanisms in staphylococci from various geographic regions in Africa

细菌病原体的抗菌素耐药性（AMR）是一个持续且日益严重的问题，其被世界卫生组织（WHO）确定为具有威胁现代医学成就的潜力。AMR袭击全球所有地区，包括非洲大陆;国际旅行，贸易和交流有利于多药耐药分离株的快速全球传播。为了应对这一事态发展，需要采取综合办法，既要考虑到当地的抵抗情况，又要认识到这一问题的全球性。在该项目中，来自埃及、肯尼亚和南非的医学微生物学家与来自德国的分子感染生物学家合作，解决葡萄球菌中的AMR，葡萄球菌是一组代表常见人类和兽医病原体的革兰氏阳性菌，其中AMR特别明显。葡萄球菌容易获得许多不同的耐药基因，耐甲氧西林金黄色葡萄球菌（MRSA）和凝固酶阴性葡萄球菌（MR-CoNS）是参与国家和全球医疗保健相关感染的最常见原因。然而，MRSA和MR-CoNS也发生在医疗设施之外，并且在社区，动物养殖场以及环境中均可检测到。通过采用“一个健康”方法（除了考虑人类医学外，还考虑兽医部门和环境），我们以前能够通过全面了解目前在三个参与非洲地区流行的葡萄球菌的AMR情况，填补非洲葡萄球菌流行病学的知识空白。我们将以这些信息为基础，进行详细的研究，以支持流行病学数据，分子标记物与各非洲中心的CoNS致病性和不同的AMR表型相关。确切地说，我们将重点关注β-内酰胺耐药性和对以前的最后手段抗生素（如利奈唑胺和达托霉素）产生耐药性的早期迹象。我们工作的一个关键方面是通过提供合理决策的分子数据来支持当地抗生素管理计划，以减少非关键性使用，特别是广谱抗生素。这不仅有助于提高公共卫生部门的成本效益，而且还可以减少对其他主要关注的AMR细菌的选择性压力，从而（从长远来看）减少AMR病原体的总体负担。我们认为，通过这一项目，我们可以为改善三个非洲地点的诊断和病人治疗作出重大贡献。

Antimicrobial resistance (AMR) of bacterial pathogens is an ongoing and increasing issue which was identified by the World Health Organization (WHO) to have the potential to threaten the achievements of modern medicine. AMR strikes all regions worldwide, including the African continent; and international travel, trade and exchange favor the rapid global spread of multidrug-resistant isolates. To counteract this development, a holistic approach is needed that takes into account the local resistance situation while being aware of the global dimension of the problem. In this project, medical microbiologists from Egypt, Kenya and South Africa work together with molecular infection biologists from Germany to address AMR in staphylococci, a group of Gram-positive bacteria that represent common human and veterinary pathogens and in which AMR is particularly pronounced. Staphylococci readily acquire many different resistance genes, and methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococci (MR-CoNS) are among the most common causes of healthcare-associated infections in the participating countries and worldwide. However, MRSA and MR-CoNS also occur outside of medical facilities and are detectable in the community, in animal husbandries as well as in the environment. By adopting the One Health approach (which considers in addition to human medicine also the veterinary sector and the environment) we were previously able to fill the knowledge gap on staphylococcal epidemiology in Africa by generating comprehensive insight into the AMR situation in staphylococci currently circulating in the three participating African regions. We will take this information as a basis for detailed studies to underpin the epidemiological data with molecular markers being associated with CoNS pathogenicity and distinct AMR phenotypes in the respective African centers. Precisely, we will focus on beta-lactam resistance and early signs of resistance development to formerly last resort antibiotics such as linezolid and daptomycin. A key aspect of our work is to support local antibiotic stewardship programmes by providing molecular data for rational decision making in order to reduce the uncritical use particularly of broad spectrum antibiotics. This will not only contribute to cost effectiveness in the public health sector, but also diminish the selective pressure on other AMR bacteria of major concern, thereby (in the long run) decreasing the overall burden of AMR pathogens. We feel that with this project we can make a major contribution to improve both diagnostics and treatment of patients at the three African sites.