High prevalence of multidrug resistant ESBL- and plasmid mediated AmpC-producing clinical isolates of Escherichia coli at Maputo Central Hospital, Mozambique
Background: Epidemiological data of cephalosporin-resistant Enterobacterales in Sub-Saharan Africa is still restricted, and in particular in Mozambique. The aim of this study was to detect and characterize extended-spectrum β-lactamase (ESBL) - and plasmid-mediated AmpC (pAmpC)-producing clinical strains of Escherichia coli at Maputo Central Hospital (MCH), a 1,000-bed reference hospital in Maputo, Mozambique.
Methods: A total of 230 clinical isolates of E. coli from urine (n=199) and blood cultures (n=31) were collected at MCH during August-November 2015. Antimicrobial susceptibility testing was performed by the disc diffusion method and interpreted according to EUCAST guidelines. Isolates with reduced susceptibility to 3rd generation cephalosporins were examined further; phenotypically for an ESBL-/AmpC-phenotype by combined disc methods and genetically for ESBL- and pAmpC-encoding genes by PCR and partial amplicon sequencing as well as genetic relatedness by ERIC-PCR.
Results: A total of 75 isolates with reduced susceptibility to cefotaxime and/or ceftazidime (n=75) from urine (n=58/199; 29%) and blood (n=17/31; 55%) were detected. All 75 isolates were phenotypically ESBL-positive and 25/75 (33%) of those also expressed an AmpC-phenotype. ESBL-PCR and amplicon sequencing revealed a majority of blaCTX-M (n=58/75; 77%) dominated by blaCTX-M-15. All AmpC-phenotype positive isolates (n=25/75; 33 %) scored positive for one or more pAmpC-genes dominated by blaMOX/FOX. Multidrug resistance (resistance ≥ three antibiotic classes) was observed in all the 75 ESBL-positive isolates dominated by resistance to trimethoprim-sulfamethoxazole, ciprofloxacin and gentamicin. ERIC-PCR revealed genetic diversity among strains with minor clusters indicating intra-hospital spread.
Conclusion: We have observed a high prevalence of MDR pAmpC- and/or ESBL-producing clinical E. coli isolates with FOX/MOX and CTX-Ms as the major β-lactamase types, respectively. ERIC-PCR analyses revealed genetic diversity and some clusters indicating within-hospital spread. The overall findings strongly support the urgent need for accurate and rapid diagnostic services to guide antibiotic treatment and improved infection control measures.
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
Posted 24 Jun, 2020
On 19 Jun, 2020
Received 09 Jun, 2020
On 04 Jun, 2020
Invitations sent on 22 Apr, 2020
On 20 Apr, 2020
On 19 Apr, 2020
On 06 Apr, 2020
On 26 Mar, 2020
Received 17 Mar, 2020
On 03 Mar, 2020
Received 10 Feb, 2020
On 28 Jan, 2020
Received 11 Nov, 2019
On 31 Oct, 2019
Invitations sent on 31 Oct, 2019
On 31 Oct, 2019
On 30 Oct, 2019
On 30 Oct, 2019
On 01 Oct, 2019
Received 23 Sep, 2019
Received 20 Sep, 2019
On 09 Sep, 2019
Invitations sent on 04 Sep, 2019
On 04 Sep, 2019
On 21 Jul, 2019
On 16 Jul, 2019
On 16 Jul, 2019
On 09 Jul, 2019
High prevalence of multidrug resistant ESBL- and plasmid mediated AmpC-producing clinical isolates of Escherichia coli at Maputo Central Hospital, Mozambique
Posted 24 Jun, 2020
On 19 Jun, 2020
Received 09 Jun, 2020
On 04 Jun, 2020
Invitations sent on 22 Apr, 2020
On 20 Apr, 2020
On 19 Apr, 2020
On 06 Apr, 2020
On 26 Mar, 2020
Received 17 Mar, 2020
On 03 Mar, 2020
Received 10 Feb, 2020
On 28 Jan, 2020
Received 11 Nov, 2019
On 31 Oct, 2019
Invitations sent on 31 Oct, 2019
On 31 Oct, 2019
On 30 Oct, 2019
On 30 Oct, 2019
On 01 Oct, 2019
Received 23 Sep, 2019
Received 20 Sep, 2019
On 09 Sep, 2019
Invitations sent on 04 Sep, 2019
On 04 Sep, 2019
On 21 Jul, 2019
On 16 Jul, 2019
On 16 Jul, 2019
On 09 Jul, 2019
Background: Epidemiological data of cephalosporin-resistant Enterobacterales in Sub-Saharan Africa is still restricted, and in particular in Mozambique. The aim of this study was to detect and characterize extended-spectrum β-lactamase (ESBL) - and plasmid-mediated AmpC (pAmpC)-producing clinical strains of Escherichia coli at Maputo Central Hospital (MCH), a 1,000-bed reference hospital in Maputo, Mozambique.
Methods: A total of 230 clinical isolates of E. coli from urine (n=199) and blood cultures (n=31) were collected at MCH during August-November 2015. Antimicrobial susceptibility testing was performed by the disc diffusion method and interpreted according to EUCAST guidelines. Isolates with reduced susceptibility to 3rd generation cephalosporins were examined further; phenotypically for an ESBL-/AmpC-phenotype by combined disc methods and genetically for ESBL- and pAmpC-encoding genes by PCR and partial amplicon sequencing as well as genetic relatedness by ERIC-PCR.
Results: A total of 75 isolates with reduced susceptibility to cefotaxime and/or ceftazidime (n=75) from urine (n=58/199; 29%) and blood (n=17/31; 55%) were detected. All 75 isolates were phenotypically ESBL-positive and 25/75 (33%) of those also expressed an AmpC-phenotype. ESBL-PCR and amplicon sequencing revealed a majority of blaCTX-M (n=58/75; 77%) dominated by blaCTX-M-15. All AmpC-phenotype positive isolates (n=25/75; 33 %) scored positive for one or more pAmpC-genes dominated by blaMOX/FOX. Multidrug resistance (resistance ≥ three antibiotic classes) was observed in all the 75 ESBL-positive isolates dominated by resistance to trimethoprim-sulfamethoxazole, ciprofloxacin and gentamicin. ERIC-PCR revealed genetic diversity among strains with minor clusters indicating intra-hospital spread.
Conclusion: We have observed a high prevalence of MDR pAmpC- and/or ESBL-producing clinical E. coli isolates with FOX/MOX and CTX-Ms as the major β-lactamase types, respectively. ERIC-PCR analyses revealed genetic diversity and some clusters indicating within-hospital spread. The overall findings strongly support the urgent need for accurate and rapid diagnostic services to guide antibiotic treatment and improved infection control measures.
Figure 1