High proportion of carbapenemase-producing Escherichia coli and Klebsiella pneumoniae among extended-spectrum β-lactamase-producers in Nigerian hospitals. (June 2020)

• Record Type: Journal Article
• Authors: Olalekan, Adesola; Onwugamba, Francis; Iwalokun, Bamidele; Mellmann, Alexander; Becker, Karsten; Schaumburg, Frieder
• Is Part Of: Journal of global antimicrobial resistance. Volume 21(2020)
• Page Start: 8
• Page End: 12
• Publication Date: 2020-06
• Subjects: Nigeria -- Carbapenem-resistant Enterobacterales -- blaNDM -- blaOXA-181 -- Extended-spectrum β-lactamase -- Ceftazidime/avibactam; Drug resistance -- Periodicals; Drug resistance -- Periodicals; Drug resistance; Periodicals; 616.9041
• DOI: 10.1016/j.jgar.2019.09.007
• Languages: English
• ISSNs: 2213-7165

Abstract

Highlights: 27.4% (48/175) of ESBL-producing Enterobacterales were carbapenem-resistant in a multicentre study from Nigeria. The major carbapenemases were bla NDM and bla OXA-181 . Carbapenem-resistant isolates belonged to ST410 for E. coli and ST395 and ST147 for K. pneumoniae . Abstract: Objectives: Carbapenem-resistant Enterobacterales are a global problem, however little is known about the burden and origin of carbapenem resistance in Africa. The objectives of this study were to determine the proportion of carbapenem-resistant isolates among extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E), to identify the underlying mechanisms of resistance and to assess the population structure of carbapenem-resistant isolates from Nigeria. Methods: ESBL-E isolates ( n = 175) from infections were collected at four hospitals in Lagos, Nigeria, from July 2016 to January 2018 and were screened for carbapenem resistance using a VITEK®2 automated system. All carbapenem-resistant ESBL-E (CRE) were screened for bla KPC, bla CTX-M, bla CMY-2, bla NDM, bla VIM, bla IMP, bla OXA-181 and bla OXA-48 genes. Genotyping of randomly selected isolates was performed by whole-genome sequencing. Results: The isolates included Escherichia coli ( n = 113; 64.6%) and Klebsiella pneumoniae ( n = 62; 35.4%). Of the 175 ESBL-E isolates, 48 (27.4%) were resistant to carbapenems (15 E. coli and 33 K. pneumoniae ). CRE isolates carried bla NDM ( n = 30; 62.5%), bla NDM + bla OXA-181 ( n = 10; 20.8%), bla OXA-181 ( n = 2; 4.2%) and bla NDM + bla OXA-48 ( n = 1; 2.1%); no carbapenemase gene was detected in 5 isolates (10.4%). The isolates showed low diversity and were mainly associated with multilocus sequence typing (MLST) sequence types ST410 for E. coli and ST395 and ST147 for K. pneumoniae . Conclusion: Carbapenem resistance is frequent among ESBL-E in Nigeria and is mainly associated with bla NDM . Genotyping suggested that the observed clones possibly originated from Southeast Asia.