Changing epidemiology and antimicrobial resistance in Vibrio cholerae: AMR surveillance findings (2006–2016) from Nepal

Abstract

Background In Nepal, cases of Cholera occur annually either as sporadic or as outbreaks claiming the lives of many in rural areas. The present study is a laboratory based surveillance which aims to analyze the changing epidemiology and antimicrobial susceptibility trend of V. cholerae strains isolated or referred to National Public Health Laboratory (NPHL) over a period of 11 years (2006–2016). Methods Specimens of fresh stool /rectal swab either received at sentinel sites or NPHL were processed following standard microbiological techniques. Suspected colonies on selective medium were identified using routine biochemical tests and confirmed by serotyping. Antimicrobial susceptibility testing was performed following Kirby Baeur disc diffusion method. Results Of the 836 confirmed isolates, 87% (728/836) were V.cholerae O1 Ogawa,12% (103/836) were V.cholerae O1 Inaba and only 6 isolates were V.cholerae O1 Hikojima. In 2006 all the Vibrio isolates were of Inaba serotype, followed by all 3 serotypes during 2007.During 2008–2014 only Ogawa serotype was isolated while few cases of Inaba again surfaced in 2015. Resistance to ampicillin decreased from 93% in 2006 to 18% by 2010 and again raised to 100% by 2016.Cotrimoxazole resistance remained at constant range (77–100%).Nalidixic acid resistance was 100% since 2006.Ciprofloxacin and tetracycline resistance emerged in 2007, reached a peak during 2010–2012 and declined to 0 by 2016.Susceptibility to Furazolidone has re-emerged.63.6% of the isolates were Multi drug resistant. Conclusion With changing epidemiology and antibiogram of V.cholerae in Nepal, the present study reflects the importance of continuous monitoring, which could be used by policy makers and health professionals for better management of outbreaks. Decline in tetracycline and ciprofloxacin resistance along with emerging sensitivity to furazolidone shows that these drugs could make an effective comeback in future.

Clinical and socio-environmental determinants of multidrug-resistant vibrio cholerae 01 in older children and adults in Bangladesh

“…However, susceptibility to tetracycline and doxycycline was notably higher (>99% susceptibility) than previously reported at icddr,b, which found a reversal in susceptibility to 76% in 2018 after <6% susceptibility between 2012-2017 (Parvin et al, 2020). A reversal to complete susceptibility has also been shown in Nepal's recent national surveillance study (Rijal et al, 2019). AMR patterns have been shown to fluctuate rapidly in V. cholerae because it cannot stably carry resistance plasmids, and the organism naturally resides in aquatic environments without selective pressure from antibiotics (Rijal et al, 2019).…”

“…This rate is higher than the 18% MDR rate found in V. cholerae from a study in Dhaka in 2013, suggesting a potential increase of MDR in recent years (Das et al, 2013). This is a concerning finding given that 100% MDR V. cholera rates have been reported in two studies (2015 and 2019) in Nepal, as well as in a five-country study in sub-Saharan Africa in 2015 (Rijal et al, 2019;Smith et al, 2015;Thapa Shrestha et al, 2015).…”

<p>Pathogenic Characteristics of and Variation in <em>Vibrio parahaemolyticus</em> Isolated from Acute Diarrhoeal Patients in Southeastern China from 2013 to 2017</p>

“…Ciprofloxacin and tetracycline resistance emerged in 2007, reached a peak during 2010-2012 and declined to 0 by 2016. 38 In addition, Aeromonas spp., which is one of the main pathogens of infectious diarrhea, was uniformly resistant to penicillin, cephalosporins or carbapenems due to the production of various β-lactamases. From 2011 to 2017, Aeromonas demonstrated the high resistance rates to ceftriaxone (29.4%), ceftazidime (28.9%), cefepime (22.2%), ciprofloxacin (27.3%) and trimethoprimsulfamethoxazole (45%), respectively, in southwest China.…”

A Phage Therapy Guide for Clinicians and Basic Scientists: Background and Highlighting Applications for Developing Countries

“…Chemoprophylaxis within households may be effective but is not recommended by WHO because of the risk from AMR. Most V. cholerae in endemic areas are now resistant to the commonly used antibiotics ( Dengo-Baloi et al, 2017 ; Rijal et al, 2019 ; Verma et al, 2019 ; Chatterjee et al, 2020 ).…”