Characterisation of extended-spectrum β-lactamases among Klebsiella pneumoniae isolates causing bacteraemia and urinary tract infection in Mozambique.

Maria J Pons,Delfino Vubil,Joaquim Ruiz,Elisabet Guiral,Inacio Mandomando,Sara M Soto,Jordi Vila,Pedro Aide,Betuel Sigaúque,Tacilta Nhampossa,Dinis Jaintilal,Oscar Fraile,Pedro L Alonso

doi:10.1016/j.jgar.2015.01.004

Abstract

The aim of this study was to determine the prevalence of extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae isolated from urinary tract and bloodstream infections in a rural hospital in Manhiça, Mozambique. ESBLs were investigated among ceftriaxone-non-susceptible K. pneumoniae clinical isolates recovered between 2004 and 2009. Characterisation of blaCTX-M, blaSHV, blaOXA and blaTEM genes was performed by PCR and sequencing. Epidemiological relationships were established by phylogenetic analysis, repetitive extragenic palindromic PCR (REP-PCR), pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST), whilst plasmid transferability was evaluated by conjugation. In addition, the presence of class 1 and 2 integrons was studied. A total of 19 K. pneumoniae were analysed. The blaCTX-M-15 gene was found in all strains. Other ESBL genes were found concomitantly, including blaSHV-5, blaSHV-2, blaSHV-2A, blaSHV-12 and blaSHV-38. In addition, other β-lactamases such as blaTEM-1 and blaOXA-30 were also detected. REP-PCR identified 15 different epidemiological profiles. MLST analysis also showed great variability of sequence types. The blaCTX-M-15 gene showed a high transfer capacity. The presence of class 1 integrons was high. High levels of multidrug resistance were also found. In conclusion, these data show the dominance of the CTX-M-type ESBL, particularly CTX-M-15, supporting its worldwide dissemination, including in areas with limited access to third-generation cephalosporins. This finding is a matter of concern for clinical management as third-generation cephalosporins are an alternative for treating severe cases of multidrug-resistant infections in this community.

Highlights

Childhood abuse has been associated with age of menarche in some studies, but not all, and few have assessed the independent associations of sexual and physical abuse with early menarche
14.3% reported that it was very hard to access basic foods and this proportion was higher for women who reported experiencing sexual abuse only or both sexual and physical abuse in childhood (21.6% and 21.9%, respectively)
We found that a history of any childhood physical or sexual abuse was associated with 1.40-fold increased odds of reporting early age at menarche among pregnant Peruvian women

Summary

Introduction

Childhood abuse has been associated with age of menarche in some studies, but not all, and few have assessed the independent associations of sexual and physical abuse with early menarche. We examined the association between childhood abuse and early menarche among pregnant women in Lima, Peru. The odds of early menarche was 1.60-fold among women with childhood sexual abuse only (OR, 1.60; 95% CI, .93e2.74) and 1.56-fold for those with both physical and sexual abuse (OR, 1.56; 95% CI, 1.07e2.25) during childhood. Isolated physical abuse was weakly associated with early menarche (OR, 1.23; 95% CI, .87e1.74). Conclusions: Childhood abuse, joint physical and sexual abuse, is associated with early menarche. This study documents the association of childhood abuse with early menarche among lowincome Peruvian women. Health care providers should screen women for the past and current abuse

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