Search

Objective There is a paucity of data on antimicrobial resistance (AMR) in Malawi. Here we present a study of AMR of extended-spectrum β-lactamases-producing Enterobacterales (ESBL-E) isolated from hospital and community settings in Blantyre, Malawi. Design and Methods A cross-sectional study was conducted between March and November 2020, involving 403 adult participants aged ≥18 years. Screening for ESBL-E was performed using CHROMagar ESBL medium. Production of ESBLs was confirmed by a combination disk test method. Antimicrobial susceptibility was tested using the agar disk diffusion method in accordance with the Clinical Laboratory Standards Institute's 2019 guidelines. Results The mean resistance rate of ESBL-E to antimicrobial agents tested was 49.2% (range from 1.4%–92%). The highest resistance rates were observed for trimethoprim-sulfamethoxazole (92%), amoxicillin and ceftriaxone (79%), doxycycline (75%) and gentamicin (72%). Carbapenems (meropenem and imipenem) were highly active against isolates. The overall rate of multi-drug resistant (MDR) ESBL-E was 47%. The highest MDR was found in Yersinia enterocolitica (51%) and the least in Serratia spp. (40%). Conclusions We found a high resistance rate of ESBL-E isolates to antimicrobial agents; the majority were MDR. Surveillance systems are recommended to monitor AMR in Malawi.

Background. The world prevalence of community and hospital-acquired extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is increasing tremendously. Bacteria harboring ESBLs are currently the number one critical pathogens posing a major threat to human health. Objective. To provide a summary of molecular evidence on the prevalence of ESBL-producing Enterobacteriaceae (ESBL-E) and associated genes at community and hospital settings in East, Central, and Southern African countries. Methods. We conducted a systematic literature search on PubMed and Google Scholar databases for the available molecular studies on ESBL-E in hospitals and community settings in East, Central, and Sothern Africa (ECSA). Published studies in English language involving gene characterization of ESBLs from human samples in hospital and community settings were included in the review, inception to November 2019. A random effect meta-analysis was performed to estimate the prevalence of ESBL-E. Results. A total of 27 studies involving molecular characterization of resistance genes from 20,225 ESBL-E isolates were included in the analysis. Seventy-four percent of all studies were hospital based, 15% were based in community settings, and others were done in both hospital and community settings. Of all the studies, 63% reported E. coli as the dominant isolate among ESBL-E recovered from clinical samples and Klebsiella pneumoniae was reported dominant isolates in 33% of all studies. A random pooled prevalence of ESBL-E was 38% (95% CI = 24–53%), highest in Congo, 92% (95% CI = 90–94%), and lowest in Zimbabwe, 14% (95% CI = 9–20%). Prevalence was higher in hospital settings 41% (95% CI = 23–58%) compared to community settings 34% (95% CI = 8–60%). ESBL genes detected from clinical isolates with ESBL-E phenotypes in ECSA were those of Ambler molecular class A [1] that belongs to both functional groups 2be and 2d of Bush and Jacob classification of 2010 [2]. Majority of studies (n = 22, 81.5%) reported predominance of blaCTX-M gene among isolates, particularly CTX-M-15. Predictors of ESBL-E included increased age, hospital admissions, previous use of antibiotics, and paramedical use of herbs. Conclusion. Few studies have been conducted at a molecular level to understand the genetic basis of increased resistance among members of ESBL-E in ECSA. Limited molecular studies in the ECSA region leave a gap in estimating the burden and risk posed by the carriage of ESBL genes in these countries. We found a high prevalence of ESBL-E most carrying CTX-M enzyme in ECSA with a greater variation between countries. This could be an important call for combined (regional or global) efforts to combat the problem of antimicrobial resistance (AMR) in the region. Antibiotic use and hospital admission increased the carriage of ESBL-E, while poor people contributed little to the increase of AMR due to lack of access and failure to meet the cost of healthcare compared to high income individuals.

The study determined the prevalence of typical signs and symptoms of toxoplasmosis in children born to at risk pregnant women in Temeke district, Dar es Salaam City, Tanzania. It was a cross sectional study of 371 pregnant women attending Prenatal clinics for prenatal health care services in Temeke district. The overall prevalence of signs and symptoms typical of toxoplasmosis was 13% (95% CI=9.5-16.4%).The proportions of signs and symptoms related to Toxoplasmosis reported in children are as follows; eye problems (4.8%, 95% CI=2.7-7.0%), hydrocephalus (3.2%, 95% CI=1.6-5.4%), mental retardation (3%, 95% CI=1.4-5.0%) and paralysis (2%, 95% CI=0.7-3.6%). After adjusting for other factors, we found a very strong association with a wide confidence interval between multigravida and prevalence of typical signs and symptoms of toxoplasmosis in children (AOR=40.89, 95% CI=4.65-359.93%). Marriage was also found to be strongly associated with signs and symptoms of toxoplasmosis in children (AOR=8.22, 95% CI=2.91-23.21%). The study findings indicate that there is low prevalence of signs and symptoms typical of toxoplasmosis among children born to at-risk pregnant women attending prenatal clinics in Temeke district, but are of clinical relevancy considering the sequelae of the disease in affected children. Based on the current study findings, it is imperative to either clinically or serologically screen both pregnant women and newborns for Toxoplasma gondii infection in order to get a conclusive evidence of prevalence of toxoplasmosis in children born to at risk women in Temeke District in Tanzania and thus limits the risk of occurrence of congenital toxoplasmosis and clinical outcomes of the disease in newborns in Tanzania.