Systematic review in South Africa reveals antibiotic resistance genes shared between clinical and environmental settings

Ekwanzala, Mutshiene Deogratias; Dewar, John Barr; Kamika, Ilunga; Momba, Maggy Ndombo Benteke

doi:10.2147/idr.s170715

Cited by 54 publications

(35 citation statements)

References 95 publications

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“…Therefore, beta-lactamases reported in this systematic review may not reflect the true picture of the beta-lactamases distributed in Nigeria geographically. However, of all the betalactamases detected in Nigeria, the majority of the articles were from human clinical settings compared to the animal and environmental settings which is consistent with what has been reported from a similar study in South Africa 68 i.e., blaTEM-10 and blaTEM-52 were not detected yet in Nigeria, narrow-spectrum blaTEM-1 coding for ampicillin resistance was however more common.…”

Section: Discussionsupporting

confidence: 86%

“…However, five different genotypic methods including PCR, DNA sequencing, WGS, isoelectric point, and RFLP were reported by the studies. PCR method was mostly reported from published articles reviewed; this may be due to ease of access and reduced cost associated with PCR compared to other advanced techniques such as DNA sequencing and WGS 68 . While WGS method is commonly used in the developed world both in research and surveillance programs, the use of WGS in beta-lactamase studies in Nigeria is still limited.…”

Section: Discussionmentioning

confidence: 99%

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Beta-Lactamase Resistance Genes in <em>Enterobacteriaceae</em> from Nigeria

Awosile¹,

Agbaje²,

Adebowale³

et al. 2020

Preprint

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This review was carried out to identify different beta-lactamase resistance genes reported in published literature from Nigeria and to determine the proportion estimates of the important beta-lactamase resistance genes in Nigeria. Sixty-three (63) articles were included in this review based on the eligibility criteria. All the beta-lactamases reported were detected from the Gram-negative bacteria, most especially from Enterobacteriaceae (n=53). Thirty-six different beta-lactamase genes have been reported from Nigeria. These genes belong to the narrow-spectrum, AmpC, extended-spectrum, and carbapenemase beta-lactamase resistance genes. Eight (8) genes (blaDHA, blaCTXM-1, blaCTXM-14, blaGES-1, blaVEB-1, blaOXA-1, blaOXA-2, and blaTEM-1) were shared between animals and humans, 5 genes (blaSHV-1, blaSHV-2, blaSHV-11, blaSHV-12, and blaNDM-1) were common to both humans and environment while none of the genes was unique to both animals and environment. Four genes including blaCMY, blaTEM-1, blaAmpC, and internationally pandemic blaCTXM-15 gene were unique to animals, humans, and the environment. No carbapenemase gene was reported from animals yet. The pooled proportion estimate of ESBL genes in Nigeria was 31% (95% CI: 26-36%, P<0.0001), while the estimate of blaCTXM-15 gene in Nigeria was 46% (95% CI: 36-57%, P<0.0001). The proportion estimate of AmpC genes was 32% (95% CI: 11-52%, P<0.001), while the estimate for carbapenemases was 8% (95% CI: 5-12%, P<0.001). This study has provided information on the beta-lactamases distribution in Nigeria. This is necessary for a better understanding of molecular epidemiology of clinically important beta-lactamases especially the extended-spectrum beta-lactamases and carbapenemases in Nigeria.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Beta-Lactamase Resistance Genes in <em>Enterobacteriaceae</em> from Nigeria

Awosile¹,

Agbaje²,

Adebowale³

et al. 2020

Preprint

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“…A few studies compared AMR genes in humans, animals and environment and detected bla CTX-M , bla TEM , bla SHV, bla OXA, aac(6′)-Ib-cr, tet(A), tet(B), sul1, sul2, and qnr in all the three compartments [64][65][66][67] This finding seems to suggest that these MDR pathogens have high propensity to spread widely and cause infections that are difficult treat [18,68,88]. Due to limited laboratory capacity in most of the countries the identified AMR genes could just be a tip of iceberg, representing only a fraction of transmitted genes.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial use and resistance in food-producing animals and the environment: an African perspective

Kimera

Mshana

Rweyemamu

et al. 2020

Antimicrob Resist Infect Control

152

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Background: The overuse of antimicrobials in food animals and the subsequent contamination of the environment have been associated with development and spread of antimicrobial resistance. This review presents information on antimicrobial use, resistance and status of surveillance systems in food animals and the environment in Africa. Methods: Information was searched through PubMed, Google Scholar, Web of Science, and African Journal Online databases. Full-length original research and review articles on antimicrobial use, prevalence of AMR from Africa covering a period from 2005 to 2018 were examined. The articles were scrutinized to extract information on the antimicrobial use, resistance and surveillance systems.Results: A total of 200 articles were recovered. Of these, 176 studies were included in the review while 24 articles were excluded because they were not relevant to antimicrobial use and/or resistance in food animals and the environment. The percentage of farms using antimicrobials in animal production ranged from 77.6% in Nigeria to 100% in Tanzania, Cameroon, Zambia, Ghana and Egypt. The most antibiotics used were tetracycline, aminoglycoside and penicillin groups. The percentage of multi drug resistant isolates ranged from 20% in Nigeria to 100% in South Africa, Zimbabwe and Tunisia. In the environment, percentage of multi drug resistant isolates ranged from 33.3% in South Africa to 100% in Algeria. None of the countries documented national antimicrobial use and resistance surveillance system in animals. Conclusion:There is high level of antimicrobial use, especially tetracycline, aminoglycoside and penicillin in animal production systems in Africa. This is likely to escalate the already high prevalence of antimicrobial resistance and multi drug resistance in the continent. This, coupled with weak antimicrobial resistance surveillance systems in the region is a great concern to the animals, environment and humans as well.

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“…In the framework documentation, reduced levels of resistance and antibiotic stewardship were linked to the need to strengthen the involvement of pharmacists to support appropriate medication in hospitals, and in communities, the need to increase the uptake of influenza and pneumonia vaccinations for people at high risk (for example, people with HIV and/or TB). There was expressed concern with the overuse of both veterinary and human medicines for food animals and companion animals, thus veterinarians were included on the MAC, contributing to a nascent and growing interest in a One Health approach globally (Ekwanzala et al, 2018;Essack, 2018;Mendelson et al, 2018;van den Honert et al, 2018). The framework in addition emphasised the need for infrastructural improvements to ensure water safety and optimum conditions for hygiene and sanitation.…”

Section: Introductionmentioning

confidence: 99%

Prescribing, care and resistance: antibiotic use in urban South Africa

Manderson

2020

Humanit Soc Sci Commun

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patients' and providers' expectations of transactions in health services converge in consultations for acute respiratory tract infections with the prescription of antibiotics. To explore this, a qualitative study was undertaken at community health centres and private general practice surgeries in four areas of metropolitan South Africa, selected purposively to allow for wide variability in terms of socioeconomic status and ethnicities/race of patient populations. With permission, clinic waiting rooms and patient/provider consultations were observed, and 65 in-depth interviews were undertaken with patients or parents or guardians presenting with children. These interviews were complemented by interviews with health providers (26) and key informants (12). All interviews were recorded, transcribed and imported into NVivo 12 for management. Data were open coded, with individual interviews and observational data compared and contrasted to highlight understandings and practices of care, antibiotic precription and use. In this article, I illustrate how the social context of patient and provider interactions in primary care settings influenced treatment. Community health centres and clinics were (and are) stretched for resources, and there were long wait times before patients can be seen; consultations were brief, with relatively little verbal exchange on the management of coughs and colds. Providers' decisions of treatment were informed by clinical assessment, concern about the risks of bacterial infection, and perceptions of patient ability to seek further care and advice-a mix of clinical and social considerations. While patients did not always request antibiotics and were willing to discuss how to manage acute conditions without them, doctors in private practice still often provided a prescription, sometimes postdated to discourage use but with the option for medication if needed. In the public sector, the provision of a prescription also reflected clinicans' appreciation of economic constraint and vulnerability. As described, patients understood principles of the appropriate use and storage of antibiotics, in contrast to other medications, and they were largely open to discussions with their providers about whether or not to use an antibiotic. However, their own and their prescribing providers had varied understandings of the mechanisms of resistance to antibiotics and so the need for antibiotic stewardship.

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Systematic review in South Africa reveals antibiotic resistance genes shared between clinical and environmental settings

Cited by 54 publications

References 95 publications

Beta-Lactamase Resistance Genes in <em>Enterobacteriaceae</em> from Nigeria

Beta-Lactamase Resistance Genes in <em>Enterobacteriaceae</em> from Nigeria

Antimicrobial use and resistance in food-producing animals and the environment: an African perspective

Prescribing, care and resistance: antibiotic use in urban South Africa

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