scholarly journals Control of multidrug-resistant Gram-negative bacteria in low- and middle-income countries—high impact interventions without much resources

2017 ◽  
Vol 23 (4) ◽  
pp. 216-218 ◽  
Author(s):  
N. Singh ◽  
V. Manchanda
Keyword(s):  
Multidrug Resistant ◽  
High Impact ◽  
Gram Negative Bacteria ◽  
Middle Income ◽  
Gram Negative ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Transferable Plasmid-Borne mcr-1 in a Colistin-Resistant Shigella flexneri Isolate

2018 ◽  
Vol 84 (8) ◽  
Author(s):  
Beibei Liang ◽  
Adam P. Roberts ◽  
Xuebin Xu ◽  
Chaojie Yang ◽  
Xiaoxia Yang ◽  
...  
Keyword(s):  
Shigella Flexneri ◽  
Multidrug Resistant ◽  
Inverted Repeats ◽  
Isolation And Identification ◽  
Middle Income ◽  
Content Type ◽  
Middle Income Countries ◽  
Pig Farm ◽  
Initial Discovery ◽  
Low And Middle Income

ABSTRACT Since the initial discovery of mcr-1 in an Escherichia coli isolate from China, the gene has also been detected in Klebsiella pneumoniae and Salmonella enterica but is rarely reported in other Enterobacteriaceae . Here, we report the isolation and identification of a Shigella flexneri strain harboring mcr-1 from stool samples in a pig farm in China from 2009. The MIC of colistin for the isolate is 4 μg/ml. Conjugation assays showed that the donor S. flexneri strain has functional and transferable colistin resistance. Sequencing revealed that mcr-1 was present on a putative composite transposon flanked by inverted repeats of IS Apl1 . IMPORTANCE There are four species of Shigella , and Shigella flexneri is the most frequently isolated species in low- and middle-income countries (LMICs). In this study, we report a functional, transferable, plasmid-mediated mcr-1 gene in S. flexneri . We have shown that mcr-1 is located on a novel composite transposon which is flanked by inverted repeats of IS Apl1 . The host strain is multidrug resistant, and this multidrug resistance is also transferable. The finding of a functional mcr-1 gene in S. flexneri , a human-associated Enterobacteriaceae family member, is a cause for concern as infections due to S. flexneri are the main Shigella infections in most low- and middle-income countries.

Intravenous colistin for the management of multidrug-resistant bacterial infections in Indian patients

2021 ◽  
pp. 004947552098777
Author(s):  
Premila M Wilfred ◽  
Sujith J Chandy ◽  
Grace Rebecca ◽  
Sowmya Satyendra ◽  
Sudha Jasmine
Keyword(s):  
Multivariate Analysis ◽  
Bacterial Infections ◽  
Therapeutic Agent ◽  
Multidrug Resistant ◽  
Middle Income ◽  
Gram Negative ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Global Concern ◽  
Elevated Lactate

Multidrug-resistant Gram-negative bacterial infection is a serious global concern and especially in low and middle-income countries (LMIC) such as India. Colistin, an antimicrobial once abandoned following reports of organ toxicity, has re-emerged as an essential therapeutic agent in the management of these infections. A retrospective review of 162 inpatients was done, focusing on culture-proven multidrug-resistant infections requiring colistin. The overall clinical outcome in 58% of patients was found to be good, with nephrotoxicity and neurotoxicity occurring only in 8 (5%) and 4 (2.5%) patients, respectively. Multivariate analysis revealed an elevated lactate and raised urea to be independent factors associated with poor clinical response. In conclusion, there appears to be strong evidence supporting the use of colistin in the management of multidrug-resistant Gram-negative bacterial infections.

scholarly journals High rates of multi-drug resistant gram-negative organisms associated with surgical site infections in a teaching hospital in Ghana

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Antoinette A. A. Bediako-Bowan ◽  
Jørgen A. L. Kurtzhals ◽  
Kåre Mølbak ◽  
Appiah-Korang Labi ◽  
Enid Owusu ◽  
...  
Keyword(s):  
Teaching Hospital ◽  
Surgical Site Infections ◽  
Multi Drug Resistance ◽  
Drug Resistant ◽  
Middle Income ◽  
Gram Negative ◽  
E Coli ◽  
Middle Income Countries ◽  
Gram Negative Organisms ◽  
Low And Middle Income

Abstract Background There is limited data to guide the prevention and management of surgical site infections (SSI) in low- and middle-income countries. We prospectively studied aetiological agents associated with SSI and their corresponding antibiotic susceptibility patterns in a tertiary hospital in Ghana. Methods As part of a cohort study carried out at the surgical department of the Korle Bu Teaching Hospital (KBTH) from July 2017 to April 2019, wound swabs were collected from patients diagnosed with SSI. Isolates cultured from the wound swabs were identified by MALDI TOF and susceptibility testing was conducted according to EUCAST 2020 guidelines. Clinical data were monitored prospectively. Results Of 4577 patients, 438 developed an SSI and 352 microbial isolates were cultured. Isolates were predominantly Gram negative (286, 81%), a pattern seen for all kinds of surgery and all wound classes. The most common species included Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Acinetobacter baumannii. The majority of organisms were multi-drug resistant including 86% of E. coli, 52% of A. baumannii and 86% of K. pneumoniae; and 65% (17/26) of the cefotaxime-resistant K. pneumoniae were extended spectrum β-lactamase producing. One of 139 E. coli, 15 of 49 P. aeruginosa, and 6 of 23 A. baumannii were meropenem resistant, but no clonal pattern was found. There was a 1% (5/428) prevalence of methicillin-resistant S. aureus. Conclusions The predominance of Gram-negative organisms and the high level of multi-drug resistance indicate a need to re-evaluate antibiotic prophylaxis and treatment protocols in surgical practice in low- and middle-income countries.

scholarly journals High rates of multi-drug resistant Gram-negative organisms associated with surgical site infections in a teaching hospital in Ghana

2020 ◽  
Author(s):  
Antoinette Afua Asiadua Bediako-Bowan ◽  
Jørgen Anders Lindholm Kurtzhals ◽  
Kåre Mølbak ◽  
Appiah-Korang Labi ◽  
Enid Owusu ◽  
...  
Keyword(s):  
Teaching Hospital ◽  
Surgical Site Infections ◽  
Multi Drug Resistance ◽  
Drug Resistant ◽  
Middle Income ◽  
Gram Negative ◽  
E Coli ◽  
Middle Income Countries ◽  
Gram Negative Organisms ◽  
Low And Middle Income

Abstract BackgroundThere is limited data to guide the prevention and management of surgical site infections (SSI) in low- and middle-income countries. We prospectively studied aetiological agents associated with SSI and their corresponding antibiotic susceptibility patterns in a tertiary hospital in Ghana.MethodsAs part of a cohort study carried out at the surgical department of the Korle Bu Teaching Hospital (KBTH) from July 2017 to April 2019, wound swabs were collected from patients diagnosed with SSI. Isolates cultured from the wound swabs were identified by MALDI TOF and susceptibility testing was conducted according to EUCAST 2020 guidelines. Clinical data were monitored prospectively.ResultsOf 4577 patients, 438 developed an SSI and 352 microbial isolates were cultured. Isolates were predominantly Gram negative (286, 81%), a pattern seen for all kinds of surgery and all wound classes. The most common species included Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Acinetobacter baumannii. The majority of organisms were multi-drug resistant including 86% of E. coli, 52% of A. baumannii and 86% of K. pneumoniae; and 65% (17/26) of the cefotaxime-resistant K. pneumoniae were extended spectrum β-lactamase producing. One of 139 E. coli, 15 of 49 P. aeruginosa, and 6 of 23 A. baumannii were meropenem resistant, but no clonal pattern was found. There was a 1% (5/428) prevalence of methicillin-resistant S. aureus.ConclusionsThe predominance of Gram-negative organisms and the high level of multi-drug resistance indicate a need to re-evaluate antibiotic prophylaxis and treatment protocols in surgical practice in low- and middle-income countries.

scholarly journals High Rates of Multi-Drug Resistant Gram-Negative Organisms Associated With Surgical Site Infections in a Teaching Hospital in Ghana

2020 ◽  
Author(s):  
Antoinette Afua Asiadua Bediako-Bowan ◽  
Jørgen Anders Lindholm Kurtzhals ◽  
Kåre Mølbak ◽  
Appiah-Korang Labi ◽  
Enid Owusu ◽  
...  
Keyword(s):  
Teaching Hospital ◽  
Surgical Site Infections ◽  
Multi Drug Resistance ◽  
Drug Resistant ◽  
Middle Income ◽  
Gram Negative ◽  
E Coli ◽  
Middle Income Countries ◽  
Gram Negative Organisms ◽  
Low And Middle Income

Abstract Background There is limited data to guide the prevention and management of surgical site infections (SSI) in low- and middle-income countries. We prospectively studied aetiological agents associated with SSI and their corresponding antibiotic susceptibility patterns in a tertiary hospital in Ghana. Methods As part of a cohort study carried out at the surgical department of the Korle Bu Teaching Hospital (KBTH) from July 2017 to April 2019, wound swabs were collected from patients diagnosed with SSI. Isolates cultured from the wound swabs were identified by MALDI TOF and susceptibility testing was conducted according to EUCAST 2020 guidelines. Clinical data were monitored prospectively. Results Of 4577 patients, 438 developed an SSI and 352 microbial isolates were cultured. Isolates were predominantly Gram negative (286, 81%), a pattern seen for all kinds of surgery and all wound classes. The most common species included Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Acinetobacter baumannii. The majority of organisms were multi-drug resistant including 86% of E. coli, 52% of A. baumannii and 86% of K. pneumoniae; and 65% (17/26) of the cefotaxime-resistant K. pneumoniae were extended spectrum β-lactamase producing. One of 139 E. coli, 15 of 49 P. aeruginosa, and 6 of 23 A. baumannii were meropenem resistant, but no clonal pattern was found. There was a 1% (5/428) prevalence of methicillin-resistant S. aureus. Conclusions The predominance of Gram-negative organisms and the high level of multi-drug resistance indicate a need to re-evaluate antibiotic prophylaxis and treatment protocols in surgical practice in low- and middle-income countries.

scholarly journals Gram-negative neonatal sepsis in low- and lower-middle-income countries and WHO empirical antibiotic recommendations: A systematic review and meta-analysis

PLoS Medicine ◽  
2021 ◽  
Vol 18 (9) ◽  
pp. e1003787
Author(s):  
Sophie C. H. Wen ◽  
Yukiko Ezure ◽  
Lauren Rolley ◽  
Geoff Spurling ◽  
Colleen L. Lau ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neonatal Sepsis ◽  
Regional Differences ◽  
Meta Analysis ◽  
Significant Heterogeneity ◽  
Gram Negative Bacteria ◽  
Middle Income ◽  
Gram Negative ◽  
Middle Income Countries ◽  
Gram Negative Organisms

Background Neonatal sepsis is a significant global health issue associated with marked regional disparities in mortality. Antimicrobial resistance (AMR) is a growing concern in Gram-negative organisms, which increasingly predominate in neonatal sepsis, and existing WHO empirical antibiotic recommendations may no longer be appropriate. Previous systematic reviews have been limited to specific low- and middle-income countries. We therefore completed a systematic review and meta-analysis of available data from all low- and lower-middle-income countries (LLMICs) since 2010, with a focus on regional differences in Gram-negative infections and AMR. Methods and findings All studies published from 1 January 2010 to 21 April 2021 about microbiologically confirmed bloodstream infections or meningitis in neonates and AMR in LLMICs were assessed for eligibility. Small case series, studies with a small number of Gram-negative isolates (<10), and studies with a majority of isolates prior to 2010 were excluded. Main outcomes were pooled proportions of Escherichia coli, Klebsiella, Enterobacter, Pseudomonas, Acinetobacter and AMR. We included 88 studies (4 cohort studies, 3 randomised controlled studies, and 81 cross-sectional studies) comprising 10,458 Gram-negative isolates from 19 LLMICs. No studies were identified outside of Africa and Asia. The estimated pooled proportion of neonatal sepsis caused by Gram-negative organisms was 60% (95% CI 55% to 65%). Klebsiella spp. was the most common, with a pooled proportion of 38% of Gram-negative sepsis (95% CI 33% to 43%). Regional differences were observed, with higher proportions of Acinetobacter spp. in Asia and Klebsiella spp. in Africa. Resistance to aminoglycosides and third-generation cephalosporins ranged from 42% to 69% and from 59% to 84%, respectively. Study limitations include significant heterogeneity among included studies, exclusion of upper-middle-income countries, and potential sampling bias, with the majority of studies from tertiary hospital settings, which may overestimate the burden caused by Gram-negative bacteria. Conclusions Gram-negative bacteria are an important cause of neonatal sepsis in LLMICs and are associated with significant rates of resistance to WHO-recommended first- and second-line empirical antibiotics. AMR surveillance should underpin region-specific empirical treatment recommendations. Meanwhile, a significant global commitment to accessible and effective antimicrobials for neonates is required.

Vaccines and global health: In search of a sustainable model for vaccine development and delivery

2019 ◽  
Vol 11 (497) ◽  
pp. eaaw2888 ◽  
Author(s):  
Rino Rappuoli ◽  
Steven Black ◽  
David E. Bloom
Keyword(s):  
Global Health ◽  
Vaccine Development ◽  
Multidrug Resistant ◽  
Public And Private ◽  
Middle Income ◽  
Market Incentives ◽  
Middle Income Countries ◽  
Multidrug Resistant Pathogens ◽  
Low And Middle Income

Most vaccines for diseases in low- and middle-income countries fail to be developed because of weak or absent market incentives. Conquering diseases such as tuberculosis, HIV, malaria, and Ebola, as well as illnesses caused by multidrug-resistant pathogens, requires considerable investment and a new sustainable model of vaccine development involving close collaborations between public and private sectors.

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