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High prevalence of multidrug resistant ESBL- and plasmid mediated AmpC-producing clinical isolates of Escherichia coli at Maputo Central Hospital, Mozambique
Arnfinn Sundsfjord
UiT Norges arktiske universitet
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3728-2270
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Infectious Diseases.
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.
Keywords
Escherichia coli, multidrug resistance, extended-spectrum β-lactamase, plasmid-mediated AmpC β-lactamase.
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Received 10 Feb, 2020
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On 28 Jan, 2020
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Reviewer #1 agreed
On 31 Oct, 2019
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On 30 Oct, 2019
Editor invited
On 30 Oct, 2019
No comments provided
Editorial decision: Major revision
On 01 Oct, 2019
Review #2 received
Received 23 Sep, 2019
Review #1 received
Received 20 Sep, 2019
Reviewer #2 agreed
On 09 Sep, 2019
Reviewers invited
Invitations sent on 04 Sep, 2019
Reviewer #1 agreed
On 04 Sep, 2019
Editor assigned
On 21 Jul, 2019
Submission checks complete
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This preprint is under consideration at BMC Infectious Diseases. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
High prevalence of multidrug resistant ESBL- and plasmid mediated AmpC-producing clinical isolates of Escherichia coli at Maputo Central Hospital, Mozambique
Arnfinn Sundsfjord
UiT Norges arktiske universitet
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3728-2270
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 4
Posted 24 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 19 Jun, 2020
Review #1 received
Received 09 Jun, 2020
Reviewer #1 agreed
On 04 Jun, 2020
Reviewers invited
Invitations sent on 22 Apr, 2020
Editor assigned
On 20 Apr, 2020
Editor invited
On 19 Apr, 2020
Submission checks complete
On 06 Apr, 2020
No comments provided
Editorial decision: Major revision
On 26 Mar, 2020
Review #3 received
Received 17 Mar, 2020
Reviewer #3 agreed
On 03 Mar, 2020
Review #2 received
Received 10 Feb, 2020
Reviewer #2 agreed
On 28 Jan, 2020
Review #1 received
Received 11 Nov, 2019
Editor assigned
On 31 Oct, 2019
Reviewers invited
Invitations sent on 31 Oct, 2019
Reviewer #1 agreed
On 31 Oct, 2019
Submission checks complete
On 30 Oct, 2019
Editor invited
On 30 Oct, 2019
No comments provided
Editorial decision: Major revision
On 01 Oct, 2019
Review #2 received
Received 23 Sep, 2019
Review #1 received
Received 20 Sep, 2019
Reviewer #2 agreed
On 09 Sep, 2019
Reviewers invited
Invitations sent on 04 Sep, 2019
Reviewer #1 agreed
On 04 Sep, 2019
Editor assigned
On 21 Jul, 2019
Submission checks complete
On 16 Jul, 2019
Editor invited
On 16 Jul, 2019
First submitted
On 09 Jul, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Infectious Diseases.
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