Spectrum and Trends of Cancer in Southwestern Uganda from 2012 to 2021.

Background: Cancer has become a global public health challenge and the number one cause of premature death. The incidence is increasing globally and more rapidly in low and middle-income countries despite the gross under-registration and challenges in diagnosis. Data about Uganda is mostly from the Mulago cancer registry which may not entirely represent other parts of the country. This study presents the trends of cancer incidence for Southwestern Uganda in a decade (2012 to 2021). Method: We did a review of records at the Mbarara University histopathology laboratory and Mbarara Regional Referral Oncology Clinics from January 2012 to December 2021 for cancer diagnoses. Records missing patients' age or sex were excluded. Results: We registered 4197 incident cancers, 51.8% were among males, and 10.7% were among children (0-18 years). The median age was 52 years and the interquartile range was 35-67 years. The most commonly diagnosed cancers were prostate cancer (13.46%), ocular surface carcinoma (11.03%), cervical cancer (10.55%), head and neck cancers (7.31%), esophageal carcinoma (6.79%), lymphomas (5.36%), retinoblastoma (5.31%), and breast cancer (5.00%) in descending order. Retinoblastoma was the most common cancer among children. Conclusion: The cancer pattern in Southwestern Uganda has changed and the numbers diagnosed each year are increasing. Prostate cancer is the most common diagnosed cancer overall, and the commonest cancer among men. Among women, cervical cancer is the most common cancer, followed by ocular surface carcinoma, and breast cancer. Retinoblastoma is the most common cancer among children. The trend of Kaposi sarcoma has plummeted together with ocular surface carcinomas. The cancer trends seem to be influenced by the presence of diagnostic and treatment expertise in the region.

Carbapenem-resistant Enterobacteriaceae in the livestock, humans and environmental samples around the globe: a systematic review and meta-analysis.

Carbapenem-resistant Enterobacteriaceae (CRE) have diminished treatment options causing serious morbidities and mortalities. This systematic review and meta-analysis assessed the prevalence and associated factors of Enterobacteriaceae infections in clinical, livestock and environmental settings globally. The population intervention comparison and outcome strategy was used to enroll studies using the preferred reporting system for systematic review and meta-analysis to include only cross-sectional studies. Search engines used to retrieve articles included journal author name estimator, PubMed, Google Scholar and African Journals Online (AJOL). The Newcastle-Ottawa scale was used to assess the quality of studies. Sixteen articles from 2013 to 2023 in Africa, Asia, Europe and South America were studied. The pooled prevalence of CRE was 43.06% (95% CI 21.57-66.03). Klebsiella pneumoniae (49.40%), Escherichia coli (26.42%), and Enterobacter cloacae (14.24%) were predominant. Klebsiella pneumoniae had the highest resistance with the blaKPC-2 in addition to blaNDM, blaOXA-48, blaIMP and blaVIM. The blaKPC-2 genes occurrence was associated with environmental (P-value < 0.0001) and South American studies (P-value < 0.0001), but there was no difference in the trends over time (P-value = 0.745). This study highlights the high rates of CRE infections, particularly within blaKPC production. Monitoring and surveillance programs, research and infection control measures should be strengthened. Additionally, further studies are needed to explore the mechanisms driving the predominance of specific bacterial species and the distribution of resistance genes within this bacterial family.

Klebsiella pneumoniae carbapenamases in Escherichia coli isolated from humans and livestock in rural south-western Uganda.

BACKGROUND: The accumulation of resistance genes in Escherichia coli (E. coli) strains imposes limitations in the therapeutic options available for the treatment of infections caused by E.coli. Production of Klebsiella pneumoniae carbapenemase (KPC) by E. coli renders it resistant to broad-spectrum ß-lactam antibiotics. Globally there is existing evidence of spread of carbapenem-resistant E. coli in both humans and livestock driven by acquisition of the several other carbapenemase genes. Overall, there is little information regarding the extent of KPC gene distribution in E. coli. We set out to determine the prevalence, and evaluate the phenotypic and genotypic patterns of KPC in E. coli isolated from humans and their livestock in rural south western Uganda. METHODS: A laboratory-based, descriptive cross-sectional study was conducted involving 96 human and 96 livestock isolates collected from agro-pastoralist communities in Mbarara district in south western Uganda. Phenotypic and molecular methods (PCR) were used for presence and identification of KPC genes in the E. coli isolates. A chi-square test of independence was used to evaluate the differences in resistant patterns between carbapenems and isolates. RESULTS: The overall prevalence of carbapenem resistance by disk diffusion susceptibility testing (DST) for both humans and livestock isolates were 41.7% (80/192). DST-based resistance was identical in both human and livestock isolates (41.7%). The prevalence of carbapenem resistance based on Modified Hodge Test (MHT) was 5% (2/40) and 10% (4/40) for humans and livestock isolates respectively. Both human and livestock isolates, 48.7% (95/192) had the KPC gene, higher than phenotypic expression; 41.7% (80/192). blaKPC gene prevalence was overall similar in human isolates (51%; 49/96) vs livestock isolates (47.9%; 46/96). Approximately, 19% (15/80) of the isolates were phenotypically resistant to carbapenems and over 70% (79/112) of the phenotypically sensitive strains harbored the blaKPC gene. CONCLUSION: Our results suggest that both human and livestock isolates of E. coli in our setting carry the blaKPC gene with a high percentage of strains not actively expressing the blaKPC gene. The finding of fewer isolates carrying the KPC gene than those phenotypically resistant to carbapenems suggests that other mechanisms are playing a role in this phenomenon, calling for further researcher into this phenomenon.