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

Abstract

Few studies have evaluated determinants of multidrug-resistant (MDR) Vibrio cholerae O1 in older children and adults. This study aimed to characterize the prevalence of MDR V. cholerae O1 and associated risk factors among patients over five years of age in Bangladesh. Methods: Stool culture and antimicrobial susceptibility testing were performed as a part of a larger study at Dhaka Hospital in Bangladesh from March 2019-March 2020. Univariate statistics and multiple logistic regression were used to assess the association between a range of variables and MDR V. cholerae O1. Results: MDR was found in 175 of 623 (28.1%) V. cholerae O1 isolates. High levels of resistance were found to erythromycin (99.2%), trimethoprim-sulfamethoxazole (99.7%), and ampicillin (88.9%), while susceptibility was high to tetracyclines (99.7%), azithromycin (99.2%), ciprofloxacin (99.8%), and cephalosporins (98.6%). MDR was associated with prior antibiotic use, longer transport time to hospital, higher income, non-flush toilet use, greater stool frequency, lower blood pressure, lower mid-upper arm circumference, and lower percent dehydration. Conclusions: MDR V. cholerae O1 was common among patients over five in an urban hospital in Bangladesh. Significant factors associated with MDR may be actionable in identifying patients with a high likelihood of MDR.

Vibrio cholerae O1 associated with recent endemic cholera shows temporal changes in serotype, genotype, and drug-resistance patterns in Bangladesh

“…For example, tetracycline (TE) was the priority drug widely used for the treatment of cholera, but its clinical use was reduced drastically because of the emergence of TE resistant V. cholerae strains in Asia and Africa (5). The recently isolated V. cholerae O1 strains in South Asia, including Bangladesh, were found to be susceptible against TE (35)(36)(37). In the present study all of the V. cholerae isolates tested were susceptible towards TE.…”

Vibrio cholerae O1 associated with recent endemic cholera shows temporal changes in serotype, genotype, and drug-resistance patterns in Bangladesh

“…For example, tetracycline (TE) was the priority drug widely used for the treatment of cholera, but its clinical use was reduced drastically because of the emergence of TE resistant V. cholerae strains in Asia and Africa [ 5 ]. The recently isolated V. cholerae O1 strains in South Asia, including Bangladesh, were found to be susceptible against TE [ 40 – 42 ]. In the present study all of the V. cholerae isolates tested were susceptible towards TE.…”

Antimicrobial Resistance in Cholera: A Need for Quick Intervention in Nigeria, West Africa

“…However, the resistance is due to mutation in the chromosome and/or acquisition of mobile genetic elements such as plasmids, transposons, and integrating conjugative elements. 26,27 AMR in cholera leads to an increase in healthcare costs, morbidities, mortalities, and prolonged hospitalization. 3 Antimicrobial multidrug resistance is most common among the atypical cholera strains, which is associated with the acquirement of genes and/or modification in the antibiotic target.…”

“…2 In Nigeria, high resistance in tetracycline and ampicillin 3 were reported, in contrast, to 3 Stephanie et al reported that the O1 cholera strain is highly sensitive to tetracycline in Bangladesh. 26 Resistance to antimicrobial among V. cholerae O1 varies considerably between regions and over time. 28 Garbati et al reported that amikacin, cefotaxime, and ciprofloxacin are sensitive, while tetracycline, trimethoprim/sulfamethoxazole are resistant.…”