title: Current State of Resistance to Antibiotics of Last-Resort in South Africa: A Review from a Public Health Perspective.
abstract: A review of the literature was undertaken to delineate the current level and mechanisms of resistance to carbapenems, colistin, and tigecycline in South Africa. Thirty-two English publications and 32 National Institute of Communicable Diseases communiqués identified between early January 2000 and 20 May, 2016 showed substantial reports of NDM (n= 860), OXA-48 (n= 584), VIM (n= 131), and IMP (n= 45) carbapenemases within this period, mainly inKlebsiella pneumoniae(n= 1138),Acinetobacter baumannii(n= 332),Enterobacter cloacae(n= 201), andSerratia marcescens(n= 108). Colistin and tigecycline resistance was prevalent amongK. pneumoniae, A. baumannii, S. marcescens, andE. cloacae. The firstmcr-1colistin resistance gene to be detected in South Africa was reported inEscherichia colifrom livestock as well as from hospitalized and outpatients. There are increasing reports of NDM and OXA-48 carbapenemases among Enterobacteriaceae andA. baumanniiin South Africa.Mcr-1is now present in South African patients and livestock. Resistance to carbapenems, colistin, and tigecycline restricts infection management options for clinicians.
authors.affiliation: Department of Pharmaceutics, Division of Microbiology, Kwame Nkrumah University of Science and Technology , Kumasi , Ghana.
authors.forename: John
authors.initials: J
authors.lastname: Osei Sekyere
keywords: South Africa; antibiotic resistance; carbapenem; carbapenemase; colistin; mcr-1; tigecycline