Abstract
BackgroundAlthough global surveillance of antimicrobial resistance (AMR) is considered key in the containment of AMR, data from low- and middle-income countries, especially from sub-Saharan Africa, are scarce. This study describes epidemiology of bloodstream infections and antimicrobial resistance rates in a secondary care hospital in Benin.MethodsBlood cultures were sampled, according to predefined indications, in BacT/ALERT FA Plus and PF Plus (bioMérieux, Marcy-l’Etoile, France) blood culture bottles (BCB) in a district hospital (Boko hospital) and to a lesser extent in the University hospital of Parakou. These BCB were incubated for 7 days in a standard incubator and twice daily inspected for visual signs of growth. Isolates retrieved from the BCB were processed locally and later shipped to Belgium for reference identification [matrix-assisted laser desorption/ionization time-of-flight spectrometry (MALDI-TOF)] and antibiotic susceptibility testing (disk diffusion and E-tests).ResultsFrom October 2017 to February 2020, 3353 BCB were sampled, corresponding to 3140 blood cultures (212 cultures consisting of > 1 BCB) and 3082 suspected bloodstream infection (BSI) episodes. Most of these cultures (n = 2471; 78.7%) were sampled in children < 15 years of age. Pathogens were recovered from 383 (12.4%) cultures, corresponding to 381 confirmed BSI. 340 of these pathogens were available and confirmed by reference identification. The most common pathogens were Klebsiella pneumoniae (n = 53; 15.6%), Salmonella Typhi (n = 52; 15.3%) and Staphylococcus aureus (n = 46; 13.5%). AMR rates were high among Enterobacterales, with resistance to third-generation cephalosporins in 77.6% of K. pneumoniae isolates (n = 58), 12.8% of Escherichia coli isolates (n = 49) and 70.5% of Enterobacter cloacae isolates (n = 44). Carbapenemase production was detected in 2 Escherichia coli and 2 Enterobacter cloacae isolates, all of which were of the New Delhi metallo-beta lactamase type. Methicillin resistance was present in 22.4% of S. aureus isolates (n = 49).ConclusionBlood cultures were successfully implemented in a district hospital in Benin, especially among the pediatric patient population. Unexpectedly high rates of AMR among Gram-negative bacteria against commonly used antibiotics were found, demonstrating the clinical and scientific importance of clinical bacteriology laboratories at this level of care.
Highlights
Global surveillance of antimicrobial resistance (AMR) is considered key in the containment of AMR, data from low- and middle-income countries, especially from sub-Saharan Africa, are scarce
Antibiotic resistance patterns & mechanisms Multidrug resistance (MDR) Methicillin-resistance Staphylococcus aureus (MRSA) Co-resistance oxacillin-ciprofloxacin Co-resistance oxacillin-gentamicin Co-resistance oxacillin-ciprofloxacin-gentamicin Co-resistance oxacillin-doxycycline Co-resistance oxacillin-ciprofloxacin-doxycycline Co-resistance oxacillin-trimethoprim-sulfamethoxazole Co-resistance oxacillin-erythromycin most important bacterial pathogen, making up almost half of all isolates. This is in sharp contrast to other, similar settings in sub-Saharan Africa, where nontyphoid Salmonella are the main culprit of bloodstream infection (BSI) in children, and much more common than Salmonella Typhi [27, 30,31,32]
It has been shown that many African countries provide the right ecological conditions for this environmental species to thrive, and Benin is among the countries where Burkholderia pseudomallei is predicted to be endemic but so far not reported [37]
Summary
Global surveillance of antimicrobial resistance (AMR) is considered key in the containment of AMR, data from low- and middle-income countries, especially from sub-Saharan Africa, are scarce. Access to clinical bacteriology services in low- and middle-income countries (LMIC) is increasingly recognized as a crucial component in the adequate management of severe bacterial infections and in the prevention of antimicrobial resistance (AMR) [1,2,3,4]. Sub-Saharan Africa is still underserved in terms of quality-assured clinical bacteriology services [6]. Meta-analyses describing antimicrobial resistance rates in Africa describe high rates of resistance but emphasize the scarcity of data, the bias towards tertiary centres in urban areas and the lack of microbiological quality control in most studies [7, 8]. Antimicrobial stewardship, defined as the effort to promote appropriate use of antimicrobials to improve patient outcomes, reduce antibiotic resistance and decrease spread of multi-drug resistance [15], relies on knowledge of local AMR epidemiology to effectively guide clinicians towards appropriate treatments
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