Antibiotic-Resistant Acinetobacter baumannii in Low-Income Countries (2000–2020): Twenty-One Years and Still below the Radar, Is It Not There or Can They Not Afford to Look for It?

Acinetobacter baumannii is an emerging pathogen, and over the last three decades it has proven to be particularly difficult to treat by healthcare services. It is now regarded as a formidable infectious agent with a genetic setup for prompt development of resistance to most of the available antimicrobial agents. Yet, it is noticed that there is a gap in the literature covering this pathogen especially in countries with limited resources. In this review, we provide a comprehensive updated overview of the available data about A. baumannii, the multi-drug resistant (MDR) phenotype spread, carbapenem-resistance, and the associated genetic resistance determinants in low-income countries (LIICs) since the beginning of the 21st century. The coverage included three major databases; PubMed, Scopus, and Web of Science. Only 52 studies were found to be relevant covering only 18 out of the 29 countries included in the LIC group. Studies about two countries, Syria and Ethiopia, contributed ~40% of the studies. Overall, the survey revealed a wide spread of MDR and alarming carbapenem-resistance profiles. Yet, the total number of studies is still very low compared to those reported about countries with larger economies. Accordingly, a discussion about possible reasons and recommendations to address the issue is presented. In conclusion, our analyses indicated that the reported studies of A. baumannii in the LICs is far below the expected numbers based on the prevailing circumstances in these countries. Lack of proper surveillance systems due to inadequate financial resources could be a major contributor to these findings.

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Molecular Characterization of Carbapenem-Resistant Acinetobacter baumannii Clinical Isolates from Egyptian Patients

10.1101/2020.08.24.264911 ◽

2020 ◽

Author(s):

Reem M Hassan ◽

Sherifa T Salem ◽

Saly Ismail Mostafa Hassan ◽

Asmaa Sayed Hegab ◽

Yasmine S Elkholy

Keyword(s):

Acinetobacter Baumannii ◽

Molecular Characterization ◽

Antimicrobial Agents ◽

Treatment Options ◽

Carbapenem Resistance ◽

Clinical Isolates ◽

Common Mechanism ◽

Carbapenem Resistant ◽

Egyptian Patients ◽

Global Threat

AbstractAcinetobacter baumannii (A. baumannii) represents a global threat owing to its ability to resist most of the currently available antimicrobial agents. Moreover, emergence of carbapenem resistant A. baumannii (CR-AB) isolates limits the available treatment options. Enzymatic degradation by variety of ß-lactamases, have been identified as the most common mechanism of carbapenem resistance in A. baumannii. The alarming increase in the prevalence of CR-AB necessitates continuous screening and molecular characterization to appreciate the problem. The present study was performed to assess the prevalence and characterize carbapenemases among 206 CR-AB isolated from various clinical specimens collected from different intensive care units at Kasr Al-Aini Hospital.All isolates were confirmed to be A. baumannii by detection of the blaOXA-51-like gene. Molecular screening of 13 common Ambler class bla carbapenemases genes in addition to insertion sequence (IS-1) upstream OXA-23 was performed by using four sets of multiplex PCR, followed by identification using gene sequencing technology. Among the investigated genes, the prevalence of blaOXA-23, and blaOXA-58 were 77.7%, and 1.9%, respectively. The ISAba1 was detected in 10% of the blaOXA-23 positive isolates. The prevalence of metallo-β-lactamases (MBLs) studied; blaNDM-1, blaSPM, blaVIM, blaSIM-1 were 11.7%, 6.3%, 0.5%, and 0.5% respectively. One of class A; bla KPC was detected in 10.7% of the investigated isolates. blaOXA-24/40, blaIMP, blaGES, blaVEB and blaGIM were not detected in any of the studied isolates. Moreover, 18.4% of the isolates have shown to harbor two or more of the screened bla genes. We concluded that the most prevalent type of ß-lactamases genes among CR-AB isolates collected from Egyptian patients were blaOXA-23 followed by blaNDM-1 and blaKPC.Author summaryCarbapenem-resistant A. baumannii has become a real global health threat. The aim of the present study was to characterize and to assess the prevalence of carbapenemases among 206 CR-AB clinical isolates from Egyptian patients. We concluded that the most prevalent type of ß-lactamases genes among CR-AB isolates collected from Egyptian patients were blaOXA-23 followed by blaNDM-1 and blaKPC. In this study, ISAba1 was detected upstream 10% of blaOXA-23 positive isolates only which indicates that the spread of resistance among Acinetobacter isolates could be either chromosomal or plamid-mediated.

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Geographical and socioeconomic inequalities in the utilization of maternal healthcare services in Nigeria: 2003–2017

BMC Health Services Research ◽

10.1186/s12913-020-05700-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Chijioke Okoli ◽

Mohammad Hajizadeh ◽

Mohammad Mafizur Rahman ◽

Rasheda Khanam

Keyword(s):

Low Income ◽

Rural Areas ◽

Healthcare Services ◽

Socioeconomic Inequalities ◽

Low Income Countries ◽

Theil Index ◽

Maternal Healthcare ◽

North East ◽

Birth Attendance ◽

Urban And Rural Areas

Abstract Background Maternal mortality has remained a challenge in many low-income countries, especially in Africa and in Nigeria in particular. This study examines the geographical and socioeconomic inequalities in maternal healthcare utilization in Nigeria over the period between 2003 and 2017. Methods The study used four rounds of Nigeria Demographic Health Surveys (DHS, 2003, 2008, 2013, and 2018) for women aged 15–49 years old. The rate ratios and differences (RR and RD) were used to measure differences between urban and rural areas in terms of the utilization of the three maternal healthcare services including antenatal care (ANC), facility-based delivery (FBD), and skilled-birth attendance (SBA). The Theil index (T), between-group variance (BGV) were used to measure relative and absolute inequalities in the utilization of maternal healthcare across the six geopolitical zones in Nigeria. The relative and absolute concentration index (RC and AC) were used to measure education-and wealth-related inequalities in the utilization of maternal healthcare services. Results The RD shows that the gap in the utilization of FBD between urban and rural areas significantly increased by 0.3% per year over the study period. The Theil index suggests a decline in relative inequalities in ANC and FBD across the six geopolitical zones by 7, and 1.8% per year, respectively. The BGV results do not suggest any changes in absolute inequalities in ANC, FBD, and SBA utilization across the geopolitical zones over time. The results of the RC and the AC suggest a persistently higher concentration of maternal healthcare use among well-educated and wealthier mothers in Nigeria over the study period. Conclusion We found that the utilization of maternal healthcare is lower among poorer and less-educated women, as well as those living in rural areas and North West and North East geopolitical zones. Thus, the focus should be on implementing strategies that increase the uptake of maternal healthcare services among these groups.

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Towards a research agenda for water, sanitation and antimicrobial resistance

Journal of Water and Health ◽

10.2166/wh.2017.124 ◽

2017 ◽

Vol 15 (2) ◽

pp. 175-184 ◽

Cited By ~ 23

Author(s):

Susanne Wuijts ◽

Harold H. J. L. van den Berg ◽

Jennifer Miller ◽

Lydia Abebe ◽

Mark Sobsey ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Low Income ◽

Research Agenda ◽

Human Exposure ◽

Action Plan ◽

Genetic Resistance ◽

World Health ◽

Low Income Countries ◽

Resistant Bacteria ◽

Surveillance Strategy

Clinically relevant antimicrobial resistant bacteria, genetic resistance elements, and antibiotic residues (so-called AMR) from human and animal waste are abundantly present in environmental samples. This presence could lead to human exposure to AMR. In 2015, the World Health Organization (WHO) developed a Global Action Plan for Antimicrobial Resistance with one of its strategic objectives being to strengthen knowledge through surveillance and research. With respect to a strategic research agenda on water, sanitation and hygiene and AMR, WHO organized a workshop to solicit input by scientists and other stakeholders. The workshop resulted in three main conclusions. The first conclusion was that guidance is needed on how to reduce the spread of AMR to humans via the environment and to introduce effective intervention measures. Second, human exposure to AMR via water and its health impact should be investigated and quantified, in order to compare with other human exposure routes, such as direct transmission or via food consumption. Finally, a uniform and global surveillance strategy that complements existing strategies and includes analytical methods that can be used in low-income countries too, is needed to monitor the magnitude and dissemination of AMR.

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Antiretroviral Therapy for HIV-2 Infection: Recommendations for Management in Low-Resource Settings

AIDS Research and Treatment ◽

10.1155/2011/463704 ◽

2011 ◽

Vol 2011 ◽

pp. 1-11 ◽

Cited By ~ 12

Author(s):

Kevin Peterson ◽

Sabelle Jallow ◽

Sarah L. Rowland-Jones ◽

Thushan I. de Silva

Keyword(s):

Antiretroviral Therapy ◽

West Africa ◽

Low Income ◽

Low Income Countries ◽

Hiv Diagnosis ◽

Nonnucleoside Reverse Transcriptase Inhibitors ◽

Development Of Resistance ◽

Virologic Control ◽

Testing Algorithms ◽

Hiv 1

HIV-2 contributes approximately a third to the prevalence of HIV in West Africa and is present in significant amounts in several low-income countries outside of West Africa with historical ties to Portugal. It complicates HIV diagnosis, requiring more expensive and technically demanding testing algorithms. Natural polymorphisms and patterns in the development of resistance to antiretrovirals are reviewed, along with their implications for antiretroviral therapy. Nonnucleoside reverse transcriptase inhibitors, crucial in standard first-line regimens for HIV-1 in many low-income settings, have no effect on HIV-2. Nucleoside analogues alone are not sufficiently potent enough to achieve durable virologic control. Some protease inhibitors, in particular those without ritonavir boosting, are not sufficiently effective against HIV-2. Following review of the available evidence and taking the structure and challenges of antiretroviral care in West Africa into consideration, the authors make recommendations and highlight the needs of special populations.

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β-lactamase genes in carbapenem resistance Acinetobacter baumannii isolates from a Turkish university hospital

The Journal of Infection in Developing Countries ◽

10.3855/jidc.10556 ◽

2019 ◽

Vol 13 (01) ◽

pp. 50-55

Author(s):

Umut Safiye Say Coskun ◽

Emel Caliskan ◽

Asegul Copur Cicek ◽

Halbay Turumtay ◽

Cemal Sandalli

Keyword(s):

Acinetobacter Baumannii ◽

Resistance Genes ◽

Antimicrobial Agents ◽

Low Frequency ◽

Carbapenem Resistance ◽

University Hospital ◽

High Rate ◽

Automated System ◽

Diffusion Method ◽

Disk Diffusion Method

Introduction: The spread of Acinetobacter baumannii, resistant to most of the available antimicrobial agents, is a serious health problem. The high rate of carbapenem resistance among Acinetobacter baumannii isolates is considered as a threat to public health. In this study, we aimed to determine the antibiotic resistance and related genes in carbapenem-resistant Acinetobacter baumannii isolates. Methodology: Ninety six isolates of A. baumannii were included. Antimicrobial susceptibility was performed by Phoenix Automated System and disk diffusion method. Carbapenem resistane was characterized by scrneeing of resistance genes such as blaTEM, blaSHV, blaCTX-M1-2, blaPER, blaVEB, blaKPC, blaGES, blaNDM, blaVIM, blaIMP and blaOXA23-24-51-58 using multiplex polymerase chain reaction. Results: Resistance for the levofloxacin, gentamicin, amikacin, and tigecycline were determined as 96.9%, 93.7%, 72.9% and 45.8% respectively. Colistin was the only susceptible antibiotic against all clinical isolates. All isolates were defined as multidrug resistance and of these, 31.2% were extensively drug-resistant (sensitive only to colistin). BlaOXA-51 and blaOXA-23 genes were detected in 100% strains while blaTEM was found in only 2% strains. There was no amplification for the blaSHV, blaCTX-M1-2, blaPER, blaVEB, blaKPC, blaGES blaNDM, blaVIM, blaIMP and blaOXA24-58 genes. Conclusions: The high frequency of blaOXA-23 and low frequency of blaTEM gene was observed that indicate prevalence of a variety of A. baumannii strains. The rates of resistance genes vary from region to region. Studies are required for the prevention and control of A. baumannii infection and to formulate the strategies of antibiotic usage.

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Allogenous Selection of Mutational Collateral Resistance: Old Drugs Select for New Resistances Within Antibiotic Families

10.32942/osf.io/6an72 ◽

2021 ◽

Author(s):

Fernando Baquero ◽

Jose-Luis martínez ◽

Angela Silva-Novais ◽

Jerónimo Rodríguez-Beltrán ◽

Laura Martínez-García ◽

...

Keyword(s):

Low Income ◽

Antimicrobial Agents ◽

Low Income Countries ◽

Future Research ◽

The Novel ◽

Bacterial Populations ◽

Minimal Inhibitory Concentrations ◽

The Family ◽

Old Drugs ◽

Selection Of

Allogeneous selection occurs when an antibiotic selects for resistance to more advanced members of the same family. The mechanisms of allogenous selection are (a) collateral expansion, when the antibiotic expands the gene and gene-containing bacterial populations favoring the emergence of other mutations, inactivating the more advanced antibiotics; (b) collateral selection, when the old antibiotic selects its own resistance but also resistances to more modern drugs; (c) collateral hyper-resistance, when resistance to the old antibiotic selects in higher degree for populations resistant to other antibiotics of the family than to itself; and (d) collateral evolution, when the simultaneous or sequential use of antibiotics of the same family selects for new mutational combinations with novel phenotypes, generally with higher activity or broader spectrum. Note that in some cases, collateral selection derives from collateral evolution. In this study, examples of allogenous selection are provided for the major families of antibiotics. Improvements in minimal inhibitory concentrations with the newest drugs do not necessarily exclude “old” antibiotics of the same family of retaining some selective power for resistance to the newest agents. If this were true, the use of older members of the same drug family would facilitate the emergence of mutational resistance to the younger drugs of the family, which is frequently based on previously established resistance traits. The extensive use of old drugs (particularly in low-income countries and in farming) might be significant for the emergence and selection of resistances to the novel members of the family, becoming a growing source of variation and selection of resistance to the whole family. In terms of future research, it could be advisable to focus antimicrobial drug discovery more on the identification of new targets and new (unique) classes of antimicrobial agents, than on the perpetual chemical exploitation of classic existing ones.

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A review on Development and Characterization of a Cost-Effective Targeted Quality-Driven Antimalarial Product with an Emphasis on Phytosomes

Current Drug Targets ◽

10.2174/1389450122666210204203132 ◽

2021 ◽

Vol 22 ◽

Author(s):

E. Bhargav ◽

Y. Padmanabha Reddy ◽

K.B. Koteshwara

Keyword(s):

Low Income ◽

Cost Effective ◽

Low Income Countries ◽

Development Of Resistance ◽

Infected Rbcs ◽

Resistant Strains ◽

The One ◽

The Cost ◽

Neural Network Technology

Abstract : Malaria, a protozoan disease led to numerous deaths and several new million cases raised due to the development of resistance as per the WHO malaria report 2019. This can be overcome by the development of an effective targeted plant-based delivery system through phytosomes that are effective in permeation and bioavailability to treat infected RBCs (parasitic cells). This review article explained the development of targeted Nanophytosomes to overcome resistance, to improve efficacy. This review paper also emphasized various quality-driven developmental approaches in developing an antimalarial product at a reasonable cost. By implementing molecular modeling techniques in development, a significant phytoconstituent with the capability of acting at the target (receptor or enzymes) of the parasite and the one with the capability to overcome drug resistance against resistant strains of parasites can be identified. Absorption Distribution Metabolism Excretion and Toxicity (ADMET) studies information provide a route to the design and formulation of a potent antimalarial agent. Efficient targeted Nanophytosomal formulations can be formulated by functionalizing or conjugating with suitable targets to direct the phytoconstituent to the infected RBCs thereby achieving complete parasitic eradication. Artificial Neural Network technology (ANN), Quality by Design (QbD), molecular dynamics, and simulation studies implementation improves quality and reduces the cost of the product, as these malarial products are much utilized in low-income countries. Hence it can be concluded that targeted developmental quality-driven approaches implementation is essential for effective malarial treatment.

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Increasing carbapenem resistance due to the clonal dissemination of oxacillinase (OXA-23 and OXA-58)-producing Acinetobacter baumannii: report from the Turkish SENTRY Program sites

Journal of Medical Microbiology ◽

10.1099/jmm.0.2008/002469-0 ◽

2008 ◽

Vol 57 (12) ◽

pp. 1529-1532 ◽

Cited By ~ 29

Author(s):

Deniz Gur ◽

Volken Korten ◽

Serhat Unal ◽

Lalitagauri M. Deshpande ◽

Mariana Castanheira

Keyword(s):

Acinetobacter Baumannii ◽

Antimicrobial Agents ◽

Carbapenem Resistance ◽

Surveillance Program ◽

Carbapenem Resistant ◽

Medical Institutions ◽

Antimicrobial Surveillance ◽

Resistant Strains ◽

Resistance Rates ◽

Encoding Genes

A significant increase in carbapenem-resistance rates among Acinetobacter baumannii isolates collected in two Turkish medical centres was detected in the 2000–2006 period (20–60 %) by the SENTRY Antimicrobial Surveillance Program. Carbapenem-resistant strains from 2006 were evaluated for the presence of encoding genes and epidemic clonality. OXA-58-like and OXA-23-like carbapenemase-producing strains were detected in both medical institutions. Seventeen out of 18 strains from Ankara were positive for bla OXA-58 primers and belonged to the same clone, whilst 26 isolates (25 from Istanbul and one from Ankara) harboured bla OXA-23-like genes and showed identical or similar PFGE patterns. Isolates producing OXA-23-like carbapenemases were more resistant than OXA-58-like carbapenemase producers to non-carbapenem antimicrobial agents. Carbapenem resistance in these institutions was observed to be largely driven by the dissemination of clones producing OXA-type carbapenemases.

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Molecular Characterization of Carbapenem-Resistant Acinetobacter baumannii Clinical Isolates from Egyptian Patients

10.21203/rs.3.rs-123397/v1 ◽

2020 ◽

Author(s):

Reem M Hassan ◽

Sherifa T Salem ◽

Saly Ismail Mostafa Hassan ◽

Asmaa Hegab ◽

Yasmine S Elkholy

Keyword(s):

Acinetobacter Baumannii ◽

Molecular Characterization ◽

Antimicrobial Agents ◽

Treatment Options ◽

Carbapenem Resistance ◽

Common Mechanism ◽

Carbapenem Resistant ◽

Egyptian Patients ◽

Global Threat

Abstract Acinetobacter baumannii (A. baumannii) represents a global threat owing to its ability to resist most of the currently available antimicrobial agents. Moreover, emergence of carbapenem resistant A. baumannii (CR-AB) isolates limits the available treatment options. Enzymatic degradation by variety of ß-lactamases, have been identified as the most common mechanism of carbapenem resistance in A. baumannii. The alarming increase in the prevalence of CR-AB necessitates continuous screening and molecular characterization to appreciate the problem. The present study was performed to assess the prevalence and characterize carbapenemases among 206 CR-AB isolated from various clinical specimens collected from different intensive care units at Kasr Al-Aini Hospital. All isolates were confirmed to be A. baumannii by detection of the blaOXA-51-like gene. Molecular screening of 13 common Ambler class bla carbapenemases genes in addition to insertion sequence (IS-1) upstream OXA-23 was performed by using four sets of multiplex PCR, followed by identification using gene sequencing technology. Among the investigated genes, the prevalence of blaOXA-23, and blaOXA-58 were 77.7%, and 1.9%, respectively. The ISAba1 was detected in 10% of the blaOXA-23 positive isolates. The prevalence of metallo-β-lactamases (MBLs) studied; blaNDM-1, blaSPM, blaVIM, blaSIM-1 were 11.7%, 6.3%, 0.5%, and 0.5% respectively. One of class A; bla KPC was detected in 10.7% of the investigated isolates. blaOXA-24/40, blaIMP, blaGES, blaVEB and blaGIM were not detected in any of the studied isolates. Moreover, 18.4% of the isolates have shown to harbor two or more of the screened bla genes. We concluded that the most prevalent type of ß-lactamases genes among CR-AB isolates collected from Egyptian patients were blaOXA-23 followed by blaNDM-1 and blaKPC.

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Breaking Barriers to Healthcare Access: A Multilevel Analysis of Individual- and Community-Level Factors Affecting Women’s Access to Healthcare Services in Benin

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020750 ◽

2021 ◽

Vol 18 (2) ◽

pp. 750

Author(s):

Betregiorgis Zegeye ◽

Ziad El-Khatib ◽

Edward Kwabena Ameyaw ◽

Abdul-Aziz Seidu ◽

Bright Opoku Ahinkorah ◽

...

Keyword(s):

Low Income ◽

Economic Status ◽

Healthcare Access ◽

Healthcare Services ◽

Access To Healthcare ◽

Community Level ◽

Low Income Countries ◽

Outcome Variable ◽

National Education ◽

Individual Level

Background: In low-income countries such as Benin, most people have poor access to healthcare services. There is scarcity of evidence about barriers to accessing healthcare services in Benin. Therefore, we examined the magnitude of the problem of access to healthcare services and its associated factors. Methods: We utilized data from the 2017–2018 Benin Demographic and Health Survey (n = 15,928). We examined the associations between the demographic and socioeconomic characteristics of women using multilevel logistic regression. The outcome variable for the study was problem of access to healthcare service. Adjusted odds ratios (AORs) with 95% confidence intervals (95% CI) were estimated. Results: Overall, 60.4% of surveyed women had problems in accessing healthcare services. Partner’s education (AOR = 0.70; 95% CI; 0.55–0.89), economic status (AOR = 0.59; 95% CI; 0.47–0.73), marital status (AOR = 0.44; 95% CI; 0.39–0.51), and parity (AOR = 1.85; 95% CI; 1.45–2.35) were significant individual-level factors associated with problem of access to healthcare. Region (AOR = 5.24; 95% CI; 3.18–8.64) and community literacy level (AOR = 0.69; 95% CI; 0.51–0.94) were the main community-level risk factors. Conclusions: Enhancing husband education through adult education programs, economic empowerment of women, enhancing national education coverage, and providing priority for unmarried and multipara women need to be considered. Additionally, there is the need to ensure equity-based access to healthcare services across regions.

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