High prevalence of multidrug resistant ESBL- and plasmid mediated AmpC-producing clinical isolates of Escherichia coli at Maputo Central Hospital, Mozambique

Calvina E L Estaleva; Tomas F Zimba; John Osei Sekyere; Usha Govinden; Hafizah Y Chenia; Gunnar S Simonsen; Bjørg Haldorsen; Sabiha Y Essack; Arnfinn Sundsfjord

doi:10.1186/s12879-020-05696-y

High prevalence of multidrug resistant ESBL- and plasmid mediated AmpC-producing clinical isolates of Escherichia coli at Maputo Central Hospital, Mozambique

BMC Infect Dis. 2021 Jan 6;21(1):16. doi: 10.1186/s12879-020-05696-y.

Authors

Calvina E L Estaleva^{1

2

3}, Tomas F Zimba^{1

2}, John Osei Sekyere³, Usha Govinden³, Hafizah Y Chenia⁴, Gunnar S Simonsen^{3

5

6}, Bjørg Haldorsen⁵, Sabiha Y Essack³, Arnfinn Sundsfjord^{7

8

9}

Affiliations

¹ Microbiology Laboratory, Maputo Central Hospital, Maputo, Mozambique.
² High Institute of Health Sciences (ISCISA), Maputo, Mozambique.
³ Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
⁴ Discipline of Microbiology, School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa.
⁵ Department of Microbiology and Infection Control, Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, University Hospital of North Norway, Tromsø, Norway.
⁶ Research Group for Host-Microbe Interaction, Department of Medical Biology, Faculty of Health Sciences, UiT Arctic University of Norway, NO-9037, Tromsø, Norway.
⁷ Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. arnfinn.sundsfjord@uit.no.
⁸ Department of Microbiology and Infection Control, Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, University Hospital of North Norway, Tromsø, Norway. arnfinn.sundsfjord@uit.no.
⁹ Research Group for Host-Microbe Interaction, Department of Medical Biology, Faculty of Health Sciences, UiT Arctic University of Norway, NO-9037, Tromsø, Norway. arnfinn.sundsfjord@uit.no.

Abstract

Background: Epidemiological data of cephalosporin-resistant Enterobacterales in Sub-Saharan Africa is still restricted, and in particular in Mozambique. The aim of this study was to detect and characterize extended-spectrum β-lactamase (ESBL) - and plasmid-mediated AmpC (pAmpC)-producing clinical strains of Escherichia coli at Maputo Central Hospital (MCH), a 1000-bed reference hospital in Maputo, Mozambique.

Methods: A total of 230 clinical isolates of E. coli from urine (n = 199) and blood cultures (n = 31) were collected at MCH during August-November 2015. Antimicrobial susceptibility testing was performed by the disc diffusion method and interpreted according to EUCAST guidelines. Isolates with reduced susceptibility to 3rd generation cephalosporins were examined further; phenotypically for an ESBL-/AmpC-phenotype by combined disc methods and genetically for ESBL- and pAmpC-encoding genes by PCR and partial amplicon sequencing as well as genetic relatedness by ERIC-PCR.

Results: A total of 75 isolates with reduced susceptibility to cefotaxime and/or ceftazidime (n = 75) from urine (n = 58/199; 29%) and blood (n = 17/31; 55%) were detected. All 75 isolates were phenotypically ESBL-positive and 25/75 (33%) of those also expressed an AmpC-phenotype. ESBL-PCR and amplicon sequencing revealed a majority of bla_CTX-M (n = 58/75; 77%) dominated by bla_CTX-M-15. All AmpC-phenotype positive isolates (n = 25/75; 33%) scored positive for one or more pAmpC-genes dominated by bla_MOX/FOX. Multidrug resistance (resistance ≥ three antibiotic classes) was observed in all the 75 ESBL-positive isolates dominated by resistance to trimethoprim-sulfamethoxazole, ciprofloxacin and gentamicin. ERIC-PCR revealed genetic diversity among strains with minor clusters indicating intra-hospital spread.

Conclusion: We have observed a high prevalence of MDR pAmpC- and/or ESBL-producing clinical E. coli isolates with FOX/MOX and CTX-Ms as the major β-lactamase types, respectively. ERIC-PCR analyses revealed genetic diversity and some clusters indicating within-hospital spread. The overall findings strongly support the urgent need for accurate and rapid diagnostic services to guide antibiotic treatment and improved infection control measures.

Keywords: Escherichia coli; Extended-spectrum β-lactamase; Multidrug resistance; Plasmid-mediated AmpC β-lactamase.

MeSH terms

Anti-Bacterial Agents / therapeutic use*
Bacterial Proteins / genetics*
Cefotaxime / therapeutic use*
Ceftazidime / therapeutic use*
Cross Infection / diagnosis
Cross Infection / microbiology
Drug Resistance, Multiple, Bacterial / genetics*
Escherichia coli / enzymology*
Escherichia coli / isolation & purification*
Escherichia coli Infections / blood
Escherichia coli Infections / drug therapy*
Escherichia coli Infections / epidemiology
Escherichia coli Infections / urine
Humans
Microbial Sensitivity Tests
Mozambique / epidemiology
Phenotype
Plasmids / metabolism*
Prevalence
beta-Lactamases / genetics*

Substances

Anti-Bacterial Agents
Bacterial Proteins
Ceftazidime
AmpC beta-lactamases
beta-Lactamases
Cefotaxime

Grants and funding

QZA 0484 RSA 13/0010/Direktoratet for Utviklingssamarbeid