Review and mapping of carbapenem-resistant Enterobacteriaceae in Africa: Using diverse data to inform surveillance gaps.

Autor: Mitgang EA; Johns Hopkins University School of Public Health, Department of International Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA., Hartley DM; Cincinnati Children's Hospital, James M. Anderson Center for Health Systems Excellence, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH 45229, USA., Malchione MD; Georgetown University Center on Medical Product Access, Safety and Stewardship, 3900 Reservoir Road, Washington, DC 20057, USA., Koch M; Georgetown University Center on Medical Product Access, Safety and Stewardship, 3900 Reservoir Road, Washington, DC 20057, USA., Goodman JL; Georgetown University Center on Medical Product Access, Safety and Stewardship, 3900 Reservoir Road, Washington, DC 20057, USA. Electronic address: jesse.goodman@georgetown.edu.
Jazyk: angličtina
Zdroj: International journal of antimicrobial agents [Int J Antimicrob Agents] 2018 Sep; Vol. 52 (3), pp. 372-384. Date of Electronic Publication: 2018 Jun 02.
DOI: 10.1016/j.ijantimicag.2018.05.019
Abstrakt: Carbapenem-resistant Enterobacteriaceae (CRE) are among the most difficult to treat emerging multidrug-resistant organisms. Major limitations exist in surveillance needed to address CRE, particularly in areas with inadequate resources. We utilised optimised strategies to search for data on carbapenem susceptibility of Klebsiella spp. and Escherichia coli from the World Health Organization (WHO) Africa Region. Core data elements were extracted for meta-analysis and mapping. Despite sparse data in existing reviews, 180 documents including 314 reports on susceptibility of E. coli and/or Klebsiella were located, providing information on 31 (66%) of 47 nations. Carbapenem-resistant E. coli or Klebsiella were identified in 22 (71%) of these 31 countries. Crude resistance proportions were estimated for nations with >100 representative isolates. Median resistance among E. coli was <1% in 11 (61%) of 18 nations meeting criteria, 1-5% in 6 nations (33%) and >5% in 1 nation (6%). For Klebsiella spp., corresponding figures were <1% in 10 (67%) of 15 nations, 1-5% in 3 nations (20%) and >5% in 2 nations (13%). Comprehensive, customised search strategies with analysis and mapping of defined data elements provide an enhanced view of carbapenem-resistant E. coli and Klebsiella in Africa. These CRE are widely distributed and are generally present at low to moderate levels. Whilst use of diverse and largely clinically derived data has limitations and cannot substitute for surveillance, it can enhance situational awareness. The approaches utilised can support improved risk understanding and prioritisation and may be applied to other micro-organisms and areas where surveillance remains inadequate.
(Copyright © 2018 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.)
Databáze: MEDLINE
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