Abstract
BackgroundAntimicrobial resistance (AMR) poses a complex threat to global health security and universal health coverage. Recently, nosocomial infections with carbapenemase-producing Gram-negative bacilli (GNB) is increasing worldwide. We report the molecular characterization and detection of genes associated with carbapenemase producing Gram negative bacteria isolated from hospitalized patients at Soba University Hospital (SUH) in Khartoum State, Sudan.ResultsBetween October 2016 and February 2017, a total of 206 GNB clinical specimens were collected from hospitalized patients in SUH. Of 206 carbapenem resistance isolates, 171 (83 %) were confirmed as phenotypically resistant and 121 (58.7 %) isolates harboured one or more carbapenemase genes. New Delhi metallo-β-lactamase (NDM) types were the most predominant genes, blaNDM 107(52 %), followed by blaIMP 7 (3.4 %), blaOXA-48 5(2.4 %) and blaVIM 2 (0.9 %). Co-resistance genes with NDM producing GNB were detected in 87 (81.3 %) of all blaNDM producing isolates. NDM-1 was the most frequent subtype observed in 75 (70 %) blaNDM producing isolates. The highest percentage of resistance was recorded in ampicillin (98 %), cephalexin (93.5 %) amoxicillin clavulanic acid (90 %), cefotaxime (89.7 %), ceftriaxone (88.4 %), ceftazidime (84.2 %), sulfamethoxazole-trimethoprim (78.4 %) and nitrofurantoin (75.2 %), aztreonam (66 %) and temocillin (64 %). A close correlation between phenotypic and carbapenemase genes detection in all GNB was observed.ConclusionsThe frequency of carbapenemase producing bacilli was found to be high in SUH. NDM was found to be the most prevalent carbapenemase gene among clinical isolates. Close surveillance across all hospitals in Sudan is required. The relative distribution of carbapenemase genes among GNB in nosocomial infections in Africa needs to be defined.
Highlights
Antimicrobial resistance (AMR) poses a complex threat to global health security and universal health coverage
Surveys of the molecular epidemiology of carbapenemases revealed that the dissemination of carbapenemases, including New Delhi metallo-β-lactamase (NDM), Verona integron-encoded Metallo-β-lactamase (VIM), Imipenemase Metallo-β-lactamase (IMP), OXA-48 and Klebsiella pneumoniae carbapenemase-producer (KPC) producers, are rapid and widespread among healthcare facilities [9, 10]
With regard to the distribution of carbapenemase producers by hospital location, the most carbapenemase producing isolates were found in the Neonatal Intensive Care Unit 32(26 %), followed by Medicine wards 26(22 %), Pediatric wards 22 (18 %), Surgery 18(15 %), Intensive care unit (ICU) 15(12 %) and the Renal Unit 8(7 %)
Summary
Antimicrobial resistance (AMR) poses a complex threat to global health security and universal health coverage. Carbapenems have been considered as a robust group of antibiotics to treat extended spectrum β-lactamase (ESBL)- producing bacteria in the past ten years and are widely prescribed for treatment of multidrug-resistant Gram-negative bacilli in systemic infections [3]. Overuse of these drugs can favor the selection and spread of multidrug resistant bacteria as well as Carbapenem resistant Enterobacteriales (CRE) [4] CRE, carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii were ranked as ‘critical’ and ‘high’ priority pathogens by the World Health Organization (WHO) in 2017 [5]. Surveys of the molecular epidemiology of carbapenemases revealed that the dissemination of carbapenemases, including NDM, VIM, IMP, OXA-48 and KPC producers, are rapid and widespread among healthcare facilities [9, 10]
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