title: Extended spectrum beta-lactamase producing Enterobacteriaceae causing bloodstream infections in rural Ghana, 2007-2012.
abstract: High prevalence of Extended Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae threatens treatment options for invasive bloodstream infections in sub-Saharan Africa.
  
  
  
  To explore the frequency and genotype distribution of ESBL producing Enterobacteriaceae causing bloodstream infections in a primary health care setting in rural Ghana.
  
  
  
  Blood cultures from all patients with fever ≥38°C within 24h after admission (community-acquired) and from all neonates with suspected neonatal sepsis (hospital-acquired) were obtained. ESBL-producing isolates were characterized by combined disc test and by amplifying the blaCTX-M, blaTEM and blaSHV genes. Multilocus sequence typing (MLST) was performed for all ESBL-producing Klebsiella pneumoniae and Escherichia coli isolates, and all K. pneumoniae isolates were differentiated by pulsed-field gel electrophoresis (PFGE).
  
  
  
  Among 426 Enterobacteriaceae isolated from blood cultures, non-typhoid Salmonella (n=215, 50.8%), S. Typhi (n=110, 26.0%), E. coli (n=50, 11.8%) and K. pneumoniae (n=41, 9.7%) were the most frequent. ESBL-producing isolates were restricted to the CTX-M-15 genotype and the species K. pneumoniae (n=34, 82.9%), Enterobacter cloacae complex (n=2, 66.7%) and E. coli (n=5, 10.0%). The rates of ESBL-producers in K. pneumoniae were 55.6% and 90.6% in community-acquired and neonatal bloodstream infections, respectively. MLST and PFGE analysis identified four outbreak clusters among neonates.
  
  
  
  Considering the rural primary health care study setting, the high proportion of ESBL-producing Klebsiella pneumoniae is worrisome and might be devastating in the absence of second line antibiotics. Therefore, enhanced diagnostic laboratories for surveillance purposes and sustainable hospital hygiene measures must be considered to prevent further spread of multidrug resistant bacteria within rural communities.
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str.74, 20359 Hamburg, Germany. Electronic address: eibach@bnitm.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Eibach
authors.affiliation: University Medical Centre Hamburg-Eppendorf (UKE), Martinist. 52, 20246 Hamburg, Germany. Electronic address: c.belmar-campos@uke.de.
authors.forename: Cristina
authors.initials: C
authors.lastname: Belmar Campos
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str.74, 20359 Hamburg, Germany; German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Germany. Electronic address: krumkamp@bnitm.de.
authors.forename: Ralf
authors.initials: R
authors.lastname: Krumkamp
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str.74, 20359 Hamburg, Germany. Electronic address: al-emran@bnitm.de.
authors.forename: Hassan M
authors.initials: HM
authors.lastname: Al-Emran
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str.74, 20359 Hamburg, Germany; German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Germany. Electronic address: dekker@bnitm.de.
authors.forename: Denise
authors.initials: D
authors.lastname: Dekker
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana. Electronic address: gyaukennedy@yahoo.com.
authors.forename: Kennedy Gyau
authors.initials: KG
authors.lastname: Boahen
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str.74, 20359 Hamburg, Germany; University Medical Centre Hamburg-Eppendorf (UKE), Martinist. 52, 20246 Hamburg, Germany; German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Germany. Electronic address: b.kreuels@uke.de.
authors.forename: Benno
authors.initials: B
authors.lastname: Kreuels
authors.affiliation: Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. Electronic address: sax@ghanatel.com.gh.
authors.forename: Yaw
authors.initials: Y
authors.lastname: Adu-Sarkodie
authors.affiliation: University Medical Centre Hamburg-Eppendorf (UKE), Martinist. 52, 20246 Hamburg, Germany. Electronic address: maepfelbacher@uke.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Aepfelbacher
authors.affiliation: International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742 Republic of Korea. Electronic address: seeun.park@ivi.int.
authors.forename: Se Eun
authors.initials: SE
authors.lastname: Park
authors.affiliation: International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742 Republic of Korea. Electronic address: upanzner@ivi.int.
authors.forename: Ursula
authors.initials: U
authors.lastname: Panzner
authors.affiliation: International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742 Republic of Korea. Electronic address: fmarks@ivi.int.
authors.forename: Florian
authors.initials: F
authors.lastname: Marks
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine (BNITM), Bernhard-Nocht-Str.74, 20359 Hamburg, Germany; German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Germany. Electronic address: may@bnitm.de.
authors.forename: Jürgen
authors.initials: J
authors.lastname: May
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D052978:Disk Diffusion Antimicrobial Tests; D016521:Electrophoresis, Gel, Pulsed-Field; D004755:Enterobacteriaceae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005838:Genotype; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D016133:Polymerase Chain Reaction; D015995:Prevalence; D011320:Primary Health Care; D012424:Rural Population; D055815:Young Adult; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases
keywords: Bloodstream infection; Extended spectrum β-lactamase; Ghana; Klebsiella pneumoniae; Molecular epidemiology