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

目前的模型预测，非洲大陆的抗菌素耐药性（AMR）将大幅增加。据估计，到2050年，每年有410万例死亡和>10/100，000的死亡率与AMR有关。2016年，Bernhard-Nocht热带医学研究所和汉堡-埃彭多夫大学医学中心（均位于德国汉堡）与库马西热带医学合作研究中心（库马西，加纳）合作，在加纳农村医院的入院和出院时开始筛查产超广谱β-内酰胺酶（ESBL）的细菌。这项研究将能够提供关于这些多重耐药细菌的医院传播事件的患病率和频率的可靠数据。与此同时，对医院服务范围内的家庭、邻居和动物接触者进行了ESBL携带筛查，目的是收集医院范围外流行率的数据。在这个监测项目（已经资助）的基础上，我们现在建议对从医院（n=749）和社区（n=251）收集的所有产ESBL分离株的基因组和相关质粒进行测序。通过比较基因组和质粒，将建立医院内外的传播网络，并可以证明医院病原体向社区传播的潜力。研究结果将用于模拟AMR病原体在撒哈拉以南非洲农村地区的传播。此外，可以模拟公共卫生干预措施的影响，以选择有效的措施来应对AMR的传播。

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.