High prevalence of multidrug resistant ESBL- and plasmid mediated AmpC-producing clinical isolates of Escherichia coli at Maputo Central Hospital, Mozambique.

BACKGROUND: Epidemiological data of cephalosporin-resistant Enterobacterales in Sub-Saharan Africa is still restricted, and in particular in Mozambique. The aim of this study was to detect and characterize extended-spectrum ß-lactamase (ESBL) - and plasmid-mediated AmpC (pAmpC)-producing clinical strains of Escherichia coli at Maputo Central Hospital (MCH), a 1000-bed reference hospital in Maputo, Mozambique. METHODS: A total of 230 clinical isolates of E. coli from urine (n = 199) and blood cultures (n = 31) were collected at MCH during August-November 2015. Antimicrobial susceptibility testing was performed by the disc diffusion method and interpreted according to EUCAST guidelines. Isolates with reduced susceptibility to 3rd generation cephalosporins were examined further; phenotypically for an ESBL-/AmpC-phenotype by combined disc methods and genetically for ESBL- and pAmpC-encoding genes by PCR and partial amplicon sequencing as well as genetic relatedness by ERIC-PCR. RESULTS: A total of 75 isolates with reduced susceptibility to cefotaxime and/or ceftazidime (n = 75) from urine (n = 58/199; 29%) and blood (n = 17/31; 55%) were detected. All 75 isolates were phenotypically ESBL-positive and 25/75 (33%) of those also expressed an AmpC-phenotype. ESBL-PCR and amplicon sequencing revealed a majority of blaCTX-M (n = 58/75; 77%) dominated by blaCTX-M-15. All AmpC-phenotype positive isolates (n = 25/75; 33%) scored positive for one or more pAmpC-genes dominated by blaMOX/FOX. Multidrug resistance (resistance ≥ three antibiotic classes) was observed in all the 75 ESBL-positive isolates dominated by resistance to trimethoprim-sulfamethoxazole, ciprofloxacin and gentamicin. ERIC-PCR revealed genetic diversity among strains with minor clusters indicating intra-hospital spread. CONCLUSION: We have observed a high prevalence of MDR pAmpC- and/or ESBL-producing clinical E. coli isolates with FOX/MOX and CTX-Ms as the major ß-lactamase types, respectively. ERIC-PCR analyses revealed genetic diversity and some clusters indicating within-hospital spread. The overall findings strongly support the urgent need for accurate and rapid diagnostic services to guide antibiotic treatment and improved infection control measures.

[Broad-spectrum beta-lactamases in Gram-negative bacteria]. / Bredspektrede betalaktamaser hos gramnegative stavbakterier.

BACKGROUND: beta-lactams are our most valuable and frequently used antibiotics. Resistance towards them, in both Gram-positive and Gram-negative bacteria, challenges their antimicrobial effect. beta-lactamases are the most important resistance mechanism against beta-lactams in Gram-negative bacteria. MATERIAL AND METHODS: This review is based on literature retrieved through a non-systematic search of Pubmed (with the terms "ESBL", "AmpC", and "carbapenemases"), as well as the authors' own research experience. RESULTS AND INTERPRETATION: We now observe a global dissemination of particularly broad spectrum beta-lactamases; extended-spectrum beta-lactamases (ESBLs), plasmid-mediated AmpC, and carbapenemases. These beta-lactamases are hosted by multidrug-resistant clones of Enterobacteriaceae, Pseudomonas aeruginosa with few, if any, therapeutic alternatives. We have observed that this pandemic has reached Norway with an increase in ESBL-producing Escherichia coli in particular, but also pan-resistant carbapenemase-producing K. pneumoniae, P. aeruginosa OG A. baumannii during the last years. The latter ones have been associated with import after hospitalization abroad, but this situation may change due to the epidemic potential of these resistant clones. Rapid diagnostic service and targeted infection control measures are important to prevent them from spreading.

Antibiotic susceptibility of Neisseria gonorrhoeae in Arkhangelsk, Russia.

OBJECTIVES: To characterise comprehensively the antibiotic susceptibility of Neisseria gonorrhoeae in Arkhangelsk, Russia, and to investigate whether the recommended treatment guidelines are updated and effective. METHODS: The susceptibility of N gonorrhoeae isolates, cultured during June-November 2004 mainly from consecutive patients with gonorrhoea (n = 76) in Arkhangelsk, to penicillin G, ampicillin, cefixime, ceftriaxone, ciprofloxacin, erythromycin, azithromycin, kanamycin, spectinomycin and tetracycline was analysed using Etest. Nitrocefin discs were used for beta-lactamase detection. RESULTS: The levels of intermediate susceptibility and resistance to the different antibiotics were as follows: penicillin G 76%, ampicillin 71%, cefixime 0%, ceftriaxone 3%, ciprofloxacin 17%, erythromycin 54%, azithromycin 14%, kanamycin 49%, spectinomycin 0% and tetracycline 92%. Of the isolates 55 (72%) were determined as multiresistant--that is, they showed intermediate susceptibility or resistance to three or more classes of antibiotics. However, none of the isolates were beta-lactamase producing. CONCLUSIONS: In Arkhangelsk, and presumably in many other areas of Russia, penicillins, ciprofloxacin, erythromycin, azithromycin, kanamycin and tetracycline should not be used in the treatment of gonorrhoea if the results of antibiotic susceptibility testing are not available. In Russia, optimised, standardised and quality-assured antibiotic susceptibility testing needs to be established in many laboratories. Subsequently, continuous local, regional and national surveillance of antibiotic susceptibility is crucial to detect the emergence of new resistance, monitor changing patterns of susceptibility and be able to update treatment recommendations on a regular basis.