Antimicrobial Resistance in Enterobacterales and Its Contribution to Sepsis in Sub-saharan Africa.

Kathleen Tompkins,Jonathan J Juliano,David Van Duin

doi:10.3389/fmed.2021.615649

Kathleen Tompkins, Jonathan J Juliano + Show 1 more

Open Access

https://doi.org/10.3389/fmed.2021.615649

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Abstract

Antibiotic resistant Enterobacterales (formerly Enterobactereaceae) are a growing threat to Sub-Saharan Africa. Genes causing antibiotic resistance are easily spread between the environment and humans and infections due to drug resistant organisms contribute to sepsis mortality via delayed time to appropriate antimicrobial therapy. Additionally, second or third-line antibiotics are often not available or are prohibitively expensive in resource-constrained settings leading to limited treatment options. Lack of access to water and sanitation facilities, unregulated use of antibiotics, and malnutrition are contributors to high rates of antibiotic resistance in the region. Improvements in the monitoring of drug resistant infections and antibiotic stewardship are needed to preserve the efficacy of antibiotics for the future.

Highlights

Sepsis is estimated to cause an excess of 5 million deaths annually with low and middle income countries disproportionately affected [1]
A study in pediatric patients at a hospital in Senegal showed that Antimicrobial resistance (AMR) carriage is associated with delayed time to appropriate antibiotics and a substantial increase in mortality from 15.4 to 54.8% in patients with ESBL-producing Enterobacterales bloodstream infections (BSI) compared to susceptible strains [77]
This review focuses on AMR and its contribution to sepsis in Sub-Saharan Africa (SSA), drug resistance is a global problem that extends beyond national borders

Summary

Introduction

Sepsis is estimated to cause an excess of 5 million deaths annually with low and middle income countries disproportionately affected [1]. This review will focus on the rates and causes of AMR in Enterobacterales in SSA and the subsequent contribution to sepsis and mortality in the region. A recent meta-analysis of bloodstream infections in SSA found an overall prevalence rate of third generation cephalosporin resistance of 18.4% for Escherichia coli isolates and Percent with ESBL intestinal carriage (%)

Results

Conclusion