Polyclonal gut colonization with extended-spectrum cephalosporin- and/or colistin-resistant Enterobacteriaceae: a normal status for hotel employees on the island of Zanzibar, Tanzania

2019 ◽  
Vol 74 (10) ◽  
pp. 2880-2890 ◽  
Author(s):  
Thomas Büdel ◽  
Esther Kuenzli ◽  
Mathieu Clément ◽  
Odette J Bernasconi ◽  
Jan Fehr ◽  
...  
Keyword(s):  
Low Income ◽  
Local Environment ◽  
Low Income Countries ◽  
E Coli ◽  
Hotel Employees ◽  
Gut Colonization ◽  
Extended Spectrum ◽  
Life Threatening ◽  
Low Prevalence ◽  
Repetitive Extragenic Palindromic Pcr

Abstract Objectives For low-income countries, data regarding the intestinal colonization with extended-spectrum cephalosporin-resistant (ESC-R) and colistin-resistant (CST-R) Enterobacteriaceae in the community are still scarce. Here, we investigated this phenomenon by analysing hotel employees in Zanzibar. Methods During June to July 2018, rectal swabs from 59 volunteers were screened implementing selective enrichments and agar plates. Species identification was achieved using MALDI-TOF MS. Strains were characterized using microdilution panels (MICs), microarray, PCRs for mcr-1/-8, repetitive extragenic palindromic-PCR (rep-PCR) and WGS. Results Colonization prevalence with ESC-R-, CST-R- and mcr-1-positive Enterobacteriaceae were 91.5%, 66.1% and 18.6%, respectively (average: 2.2 strains per volunteer). Overall, 55 ESC-R Escherichia coli (3 also CST-R), 33 ESC-R Klebsiella pneumoniae (1 also CST-R), 17 CST-R E. coli and 21 CST-R K. pneumoniae were collected. The following main resistance genes were found: ESC-R E. coli (blaCTX-M-15-like, 51.0%), ESC-R K. pneumoniae (blaCTX-M-9-like, 42.9%), CST-R E. coli (mcr-1, 55%) and CST-R K. pneumoniae (D150G substitution in PhoQ). ESBL-producing E. coli mainly belonged to ST361, ST636 and ST131, whereas all those that were mcr-1 positive belonged to ST46 that carried mcr-1 in a 33 kb IncX4 plasmid. ESBL-producing K. pneumoniae mainly belonged to ST17, ST1741 and ST101, whereas CST-R strains belonged to ST11. Conclusions We recorded remarkably high colonization prevalence with ESC-R and/or CST-R Enterobacteriaceae in hotel staff. Further research in the local environment, livestock and food chain is warranted to understand this phenomenon. Moreover, as Zanzibar is a frequent holiday destination, attention should be paid to the risk of international travellers becoming colonized and thereby importing life-threatening pathogens into their low-prevalence countries.

scholarly journals Travel-Related Typhoid Fever: Narrative Review of the Scientific Literature

2020 ◽  
Vol 17 (2) ◽  
pp. 615 ◽  
Author(s):  
Narcisa Muresu ◽  
Giovanni Sotgiu ◽  
Bianca Maria Are ◽  
Andrea Cossu ◽  
Clementina Cocuzza ◽  
...  
Keyword(s):  
Low Income ◽  
Delayed Diagnosis ◽  
Low Income Countries ◽  
Travel Health ◽  
High Incidence ◽  
Health Advice ◽  
Life Threatening ◽  
Risk Of Disease ◽  
Resistant Strains ◽  
Drug Resistant Strains

Enteric fever is a foodborne infectious disease caused by Salmonella enterica serotypes Typhi and Paratyphi A, B and C. The high incidence in low income countries can increase the risk of disease in travelers coming from high income countries. Pre-travel health advice on hygiene and sanitation practices and vaccines can significantly reduce the risk of acquiring infections. Although the majority of the cases are self-limiting, life-threatening complications can occur. Delayed diagnosis and cases of infections caused by multi-drug resistant strains can complicate the clinical management and affect the prognosis. More international efforts are needed to reduce the burden of disease in low income countries, indirectly reducing the risk of travelers in endemic settings. Surveillance activities can help monitor the epidemiology of cases caused by drug-susceptible and resistant strains.

scholarly journals 441: The burden of preeclampsia and potentially life threatening complications (PLTC) in high versus low- income countries

2019 ◽  
Vol 220 (1) ◽  
pp. S297-S298
Author(s):  
Irina A. Buhimschi ◽  
Jennifer Makin ◽  
Kara M. Rood ◽  
Hillary Bracken ◽  
Catalin S. Buhimschi ◽  
...  
Keyword(s):  
Low Income ◽  
Low Income Countries ◽  
Life Threatening

scholarly journals Implementing Antimicrobial Stewardship in Two Community Nepali Hospitals

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S20-S20
Author(s):  
Michael P Veve ◽  
Linda M Kaljee ◽  
Tyler Prentiss ◽  
Rajesh Dhoj Joshi ◽  
Shankar Man Rai ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Antimicrobial Stewardship ◽  
Low Income ◽  
Effective Means ◽  
Low Income Countries ◽  
Successful Implementation ◽  
E Coli ◽  
Grant Recipient ◽  
Post Test ◽  
Research Grant

Abstract Background Antimicrobial stewardship programs (ASP) are crucial to improving patient outcomes and decreasing resistance, but the effectiveness and the presence of ASP in low-income countries, like Nepal, are unknown. Nepal has no formal ASP efforts or antimicrobial regulations, which has lead to an increased prevalence of resistance in the community. We developed and implemented an educational ASP training program to identify areas for ASP in two community hospitals in Kathmandu. With a multidisciplinary team of clinicians and Nepal stakeholders, we developed an ASP toolkit aimed to improve patient outcomes through antimicrobial optimization. Methods A 1-day conference on ASP and resistance was held at a community hospital in Kathmandu, with subsequent field observations, microbiologic hospital surveillance, and 2,016 antibiogram review. Eleven physician champions (PC) from the two hospitals were selected for formal ASP instruction. ASP protocols were developed with stakeholders and included (i) empiric and definitive antibiotic selection recommendations, (ii) renal dose-adjustment guidelines, (iii) evidence-based duration of therapy recommendations, and (iv) an intravenous-to-oral antimicrobial conversion policy. Two days of fieldwork and stakeholder feedback occurred. A post-test PC evaluation was performed with the intent to gather feedback for implementation of a post-prescription review and feedback (PPRF) system incorporating AMS protocols related to antimicrobial optimization. Results The most prevalent infectious organism isolated was Escherichia coli (51%). Most E. coli isolates were commonly resistant to first-line or broad-spectrum antibiotics: 49% ceftriaxone, 46% ciprofloxacin, 22% piperacillin/tazobactam, and 32% meropenem. The overall PC response to ASP toolkit was positive: 73% of PC felt the guidelines would be useful in making decisions about antimicrobials. Cost and availability of antimicrobials were identified as barriers to successful implementation. Conclusion Development of a simple ASP toolkit can be an effective means to bring awareness appropriate antimicrobial use, and may be extrapolated to other low-income countries. Stakeholder buy-in is necessary for a successful international interventional program. Disclosures L. M. Kaljee, Merck: Grant Investigator, Grant recipient; T. Prentiss, Merck, Inc.: Investigator, Research grant; R. D. Joshi, Merck: Grant Investigator, Grant recipient; B. Shrestha, Merck: Grant Investigator, Research grant; D. C. Bajracharya, Merck: Grant Investigator, Grant recipient; M. J. Zervos, Merck: Grant Investigator, Grant recipient; Genentech: Grant Investigator, Grant recipient; Cempra: Grant Investigator, Grant recipient; Medicines Company: Consultant, Consulting fee

scholarly journals Colonization of Extended-Spectrum-β-Lactamase- and NDM-1-Producing Enterobacteriaceae among Pregnant Women in the Community in a Low-Income Country: a Potential Reservoir for Transmission of Multiresistant Enterobacteriaceae to Neonates

2015 ◽  
Vol 59 (6) ◽  
pp. 3652-3655 ◽  
Author(s):  
Fanny Chereau ◽  
Perlinot Herindrainy ◽  
Benoit Garin ◽  
Bich-Tram Huynh ◽  
Frederique Randrianirina ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Low Income ◽  
Low Income Countries ◽  
New Delhi ◽  
Content Type ◽  
Low Income Country ◽  
Extended Spectrum ◽  
Multiresistant Bacteria ◽  
Potential Reservoir ◽  
Rectal Colonization

ABSTRACTThe spread of extended-spectrum-β-lactamase-producingEnterobacteriaceae(ESBL-PE) in low-income countries, where the burden of neonatal sepsis is high, may have a serious impact on neonatal mortality rates. Given the potential for mother-to-child transmission of multiresistant bacteria, this study investigated the ESBL-PE rectal colonization among pregnant women at delivery in the community in Madagascar and estimated a prevalence of 18.5% (95% confidence interval, 14.5% to 22.6%). One strain ofKlebsiella pneumoniaeisolated was also a New Delhi metallo-β-lactamase-1 (NDM-1) producer.

scholarly journals Single domain antibodies against enteric pathogen virulence factors are active as curli fiber fusions on probiotic E. coli Nissle 1917

2021 ◽  
Author(s):  
Ilia Gelfat ◽  
Yousuf Aqeel ◽  
Jacquiline M Tremblay ◽  
Justyna Jaskiewicz ◽  
Anishma Shrestha ◽  
...  
Keyword(s):  
Virulence Factors ◽  
Low Income ◽  
Shiga Toxin ◽  
Microbial Pathogens ◽  
Low Income Countries ◽  
Bacterial Toxin ◽  
Scanning Electron Micrographs ◽  
E Coli ◽  
Curli Fiber

Enteric microbial pathogens, including Escherichia coli, Shigella and Cryptosporidium species, take a particularly heavy toll in low-income countries and are highly associated with infant mortality. We describe here a means to display anti-infective agents on the surface of a probiotic bacterium. Because of their stability and versatility, VHHs, the variable domains of camelid heavy-chain-only antibodies, have potential as components of novel agents to treat or prevent enteric infectious disease. We isolated and characterized VHHs targeting several enteropathogenic Escherichia.coli (EPEC) virulence factors: flagellin (Fla), which is required for bacterial motility and promotes colonization; both intimin and the translocated intimin receptor (Tir), which together play key roles in attachment to enterocytes; and E. coli secreted protein A (EspA), an essential component of the type III secretion system (T3SS) that is required for virulence. Several VHHs that recognize Fla, intimin, or Tir blocked function in vitro. The probiotic strain E. coli Nissle 1917 (EcN) produces on the bacterial surface curli fibers, which are the major proteinaceous component of E. coli biofilms. A subset of Fla-, intimin-, or Tir-binding VHHs, as well as VHHs that recognize either a T3SS of another important bacterial pathogen (Shigella flexneri), a soluble bacterial toxin (Shiga toxin or Clostridioides difficile toxin TcdA), or a major surface antigen of an important eucaryotic pathogen (Cryptosporidium parvum) were fused to CsgA, the major curli fiber subunit. Scanning electron micrographs indicated CsgA-VHH fusions were assembled into curli fibers on the EcN surface, and Congo Red binding indicated that these recombinant curli fibers were produced at high levels. Ectopic production of these VHHs conferred on EcN the cognate binding activity and, in the case of anti-Shiga toxin, was neutralizing. Taken together, these results demonstrate the potential of the curli-based pathogen sequestration strategy described herein and contribute to the development of novel VHH-based gut therapeutics.

scholarly journals Mucosal immune responses against an oral ETEC vaccine evaluated in clinical trials

2021 ◽  
Author(s):  
Ann-Mari Svennerholm ◽  
Anna Lundgren ◽  
Susannah Leach ◽  
Marjahan Akhtar ◽  
Firdausi Qadri
Keyword(s):  
Immune Responses ◽  
Low Income ◽  
Age Groups ◽  
Enterotoxigenic Escherichia Coli ◽  
Low Income Countries ◽  
Mortality And Morbidity ◽  
E Coli ◽  
Vaccine Antigens ◽  
Colonization Factors ◽  
Mucosal Immune Responses

Abstract Enterotoxigenic Escherichia coli, ETEC, is a leading cause of mortality and morbidity in children in low-income countries. We have tested an oral ETEC vaccine, ETVAX, consisting of inactivated E. coli over-expressing the most prevalent colonization factors and a toxoid, LCTBA, administered together with a mucosal adjuvant, dmLT, for capacity to induce mucosal immune responses and immunological memory against the primary vaccine antigens, i.e. colonization factors, LTB and O antigen. The studies show that ETVAX could induce strong intestine-derived and/or fecal immune responses in a majority of vaccinated Swedish adults and in different age groups, including infants, in Bangladesh.

scholarly journals Nomogram to Early Screen Multiparous Women for Preterm Birth in a Cohort Study

2021 ◽  
Vol 15 ◽  
pp. 135-141
Author(s):  
Mayssa A. Traboulsi ◽  
Zainab. El Alaoui Talibi ◽  
Abdellatif Boussaid
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
Low Income ◽  
Health Indicators ◽  
Penalized Regression ◽  
Low Income Countries ◽  
Medical Surveillance ◽  
Spontaneous Preterm Birth ◽  
Multiparous Women ◽  
Low Prevalence

Preterm Birth (PTB) can negatively affect the health of mothers as well as infants. Prediction of this gynecological complication remains difficult especially in Middle and Low-Income countries because of limited access to specific tests and data collection scarcity. Machine learning methods have been used to predict PTB but the low prevalence of this pregnancy complication led to rather low prediction values. The objective of this study was to produce a nomogram based on improved prediction for low prevalence PTB using up sampling and lasso penalized regression. We used data from a cohort study in Northern Lebanon of 922 multiparous presenting a PTB prevalence of 8%. We analyzed the personal, demographic, and health indicators available for this group of women. The improved Positive Predictive Value for PTB reached around 88%. The regression coefficients of the 6 selected variables (Pre-hemorrhage, Social status, Residence, Age, BMI, and Weight gain) were used to create a nomogram to screen multiparous women for PTB risk. The nomogram based on readily available indicators for multiparous women reasonably predicted most of the at PTB risk women. The physicians can use this tool to screen for women at high risk for spontaneous preterm birth to improve medical surveillance that can reduce PTB incidence.

scholarly journals Diversity of Extended-Spectrum β-Lactamases and Class C β-Lactamases among Cloacal Escherichia coli Isolates in Belgian Broiler Farms

2008 ◽  
Vol 52 (4) ◽  
pp. 1238-1243 ◽  
Author(s):  
Annemieke Smet ◽  
An Martel ◽  
Davy Persoons ◽  
Jeroen Dewulf ◽  
Marc Heyndrickx ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Broad Spectrum ◽  
Antimicrobial Agents ◽  
Acquired Resistance ◽  
Farm Level ◽  
E Coli ◽  
Extended Spectrum ◽  
Genes Encoding ◽  
Class C ◽  
Repetitive Extragenic Palindromic Pcr

ABSTRACT A total of 295 ceftiofur-resistant Escherichia coli isolates were obtained from 489 cloacal samples collected at five different Belgian broiler farms with the aim to evaluate the diversity of this resistance at the farm level. Strains were examined for resistance against β-lactam antibiotics and other antimicrobial agents by using disk diffusion tests. Three different β-lactam resistance phenotypes suggested the presence of an extended-spectrum β-lactamase (ESBL), a class C β-lactamase, or the combination of an ESBL with a class C β-lactamase. Seventy-six percent of these isolates also showed acquired resistance to other antimicrobial agents. After genotyping by repetitive extragenic palindromic-PCR, 51 unrelated E. coli strains were selected for further analyses. Isoelectric focusing and sequencing of the amplicons obtained in PCRs for the detection of genes encoding broad-spectrum β-lactamase enzymes revealed the following ESBLs: TEM-52 (13.2%), TEM-106 (2%), CTX-M-1 (27.4%), CTX-M-2 (7.8%), CTX-M-14 (5.9%), and CTX-M-15 (2%). The only plasmidic AmpC β-lactamase found in this study was the CMY-2 enzyme (49%). Mutations in the promoter and attenuator regions of the chromosomal ampC gene were found only in association with bla CMY-2 genes and ESBL genes. The combination of an ESBL (CTX-M-1) with a plasmidic AmpC β-lactamase (CMY-2) was found in 7.8% of the isolates. These data show that ceftiofur-resistant E. coli strains are often present in cloacal samples of broilers at the farm level in Belgium. The diversity of broad-spectrum β-lactamases among these isolates is high, and they may act as a reservoir of ESBL and ampC genes.

scholarly journals Ethiopian pre-school children consuming a predominantly unrefined plant-based diet have low prevalence of iron-deficiency anaemia

2016 ◽  
Vol 19 (10) ◽  
pp. 1834-1841 ◽  
Author(s):  
Dawd Gashu ◽  
Barbara J Stoecker ◽  
Abdulaziz Adish ◽  
Gulelat D Haki ◽  
Karim Bougma ◽  
...  
Keyword(s):  
Low Income ◽  
Dietary Diversity ◽  
Total Sample ◽  
High Rate ◽  
Low Income Countries ◽  
Fe Deficiency ◽  
Food Groups ◽  
Cross Sectional ◽  
Deficiency Anaemia ◽  
Low Prevalence

AbstractObjectiveChildren from low-income countries consuming predominantly plant-based diets but little animal products are considered to be at risk of Fe deficiency. The present study determined the Fe status of children from resource-limited rural households.DesignA cross-sectional study.SettingTwenty six kebeles (the smallest administrative unit) from six zones of the Amhara region, Ethiopia.SubjectsChildren aged 54–60 months (n 628).ResultsGrain, roots or tubers were the main dietary components consumed by 100 % of the study participants, followed by pulses, legumes or nuts (66·6 %). Consumption of fruit and vegetables (19·3 %) and meat, poultry and fish (2·2 %) was low. Children had a mean dietary diversity score of 2·1 (sd 0·8). Most children (74·8 %, n 470) were in the lowest dietary diversity group (1–2 food groups). Rate of any morbidity in the preceding 14 d was 22·9 % (n 114). Infection or inflammation (α1-acid glycoprotein >1·2 g/l) was present in 30·2 % (n 184) of children. Children had a high rate of stunting (43·2 %). Of the total sample, 13·6 % (n 82) of children were anaemic, 9·1 % (n 57) were Fe deficient and 5·3 % (n 32) had Fe-deficiency anaemia. Fe-deficiency erythropoiesis was present in 14·2 % (n 60) of children.ConclusionsDespite consuming a predominantly plant-based diet and little animal-source foods, there was a low prevalence of Fe-deficiency anaemia. This illustrates that dietary patterns can be inharmonious with Fe biochemical status; thus, Fe-related interventions require biochemical screening.

scholarly journals Carriage Prevalence of Extended-Spectrum β-Lactamase Producing Enterobacterales in Outpatients Attending Community Health Centers in Blantyre, Malawi

2021 ◽  
Vol 6 (4) ◽  
pp. 179
Author(s):  
Onduru Gervas Onduru ◽  
Rajhab Sawasawa Mkakosya ◽  
Susan Fred Rumisha ◽  
Said Aboud
Keyword(s):  
Community Health Centers ◽  
Control Strategies ◽  
Clinical Samples ◽  
Community Settings ◽  
Esbl Production ◽  
E Coli ◽  
Extended Spectrum ◽  
History Of ◽  
Low Prevalence ◽  
Community Patients

Antimicrobial resistance due to extended-spectrum β-lactamase (ESBL) production by Enterobacterales is a global health problem contributing to increased morbidity and mortality, particularly in resource-constrained countries. We aimed to determine the prevalence of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) in community patients in Blantyre, Malawi. Clinical samples were collected from 300 patients and screened for ESBL-E using a CHROMagarTM ESBL medium. Confirmation of ESBL production was done by a combination disk test (CDT). The prevalence of community-acquired ESBL-E was 16.67% (50/300, 95% CI = 12.43–20.91%). The most common ESBL-E species isolated was Escherichia coli (66%). All ESBL-E isolates were resistant to Trimethoprim-Sulfamethoxazole except for 2% of E. coli. Besides this, all ESBL-E were susceptible to Imipenem and only 4% were resistant to Meropenem. No patients with a positive ESBL-E phenotype had a history of hospital admission in the last three months, and the carriage of ESBL-E was neither associated with the demographic nor the clinical characteristics of participants. Our findings reveal a low presence of ESBL-E phenotypes in community patients. The low prevalence of ESBL-E in the community settings of Blantyre can be maintained if strong infection and antimicrobial use-control strategies are implemented.

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