Antibiotic resistance in West Africa

Transcription

1 Antibiotic resistance in West Africa Prof. Pierre Tattevin Infectious Diseases and ICU, Pontchaillou University Hospital, Rennes, France International Society of Chemotherapy

2 No conflict of Interest International Society of Chemotherapy for Infection and Cancer advance the education and the science of therapy of infection

3 Highlights ü Quality of data available ü Antimicrobial resistance, WHO global report 2014 ü Surveillance studies in West Africa - MRSA - ESBL-producing Enterobacteriaceae - Carbapenemase-producing Gram negative bacilli ü European travellers as sentinels ü Conclusions / prospects

4 Highlights ü Quality of data available ü Antimicrobial resistance, WHO global report 2014 ü Surveillance studies in West Africa - MRSA - ESBL-producing Enterobacteriaceae - Carbapenemase-producing Gram negative bacilli ü European travellers as sentinels ü Conclusions / prospects

5 ü National labs, invited to participate Frean J et al. Bull WHO 2012

6 ü National labs, invited to participate q 63% to 93% agreed q identification / choice of drug for susceptibility testing (DST) = 65% q results of DST ü ü 43% rated unacceptable for enteric pathogens 75% rated unacceptable for meningitis (NB unacceptable => bad ATB choice for patients) Frean J et al. Bull WHO 2012

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9 ü Main findings q deficiencies (equipment, consumables, training, quality control) q no upward trend q advocates for more investment, more support from WHO q evidence-based tools for guiding laboratory-strengthening activities NB. Of 340 lab accredited in Africa, 312 (92%) were in South Africa Gershy-Damet G et al. Am J Clin Pathol 2010

10 Highlights ü Quality of data available ü Antimicrobial resistance, WHO global report 2014 ü Surveillance studies in West Africa - MRSA - ESBL-producing Enterobacteriaceae - Carbapenemase-producing Gram negative bacilli ü European travellers as sentinels ü Conclusions / prospects

11 An+microbial resistance: Global report on surveillance, 2014 ü African regions: information limited q Surveillance of DST in few countries only q No formal network for collaboration in the region q Collection biases ü Severe infections vs. not complicated ü Urban (capitals) vs. rural ü Health-care-associated vs. community-acquired

12 An+microbial resistance: Global report on surveillance, 2014

13 An+microbial resistance: Global report on surveillance, 2014

14 An+microbial resistance: Global report on surveillance, 2014

15 An+microbial resistance: Global report on surveillance, 2014

16 An+microbial resistance: Global report on surveillance, 2014

17 An+microbial resistance: Global report on surveillance, 2014

18 An+microbial resistance: Global report on surveillance, 2014

19 An+microbial resistance: Global report on surveillance, 2014

20 An+microbial resistance: Global report on surveillance, 2014

21 An+microbial resistance: Global report on surveillance, 2014

22 An+microbial resistance: Global report on surveillance, 2014

23 Highlights ü Quality of data available ü Antimicrobial resistance, WHO global report 2014 ü Surveillance studies in West Africa - MRSA - ESBL-producing Enterobacteriaceae - Carbapenemase-producing Gram negative bacilli ü European travellers as sentinels ü Conclusions / prospects

24 Falagas M et al. PLoS ONE 2012

25 Nigeria: 1. High rates of MRSA 9-28% of all S. aureus in the North 20-41% in the South 2. PVL +: 24-47% Falagas M et al. PLoS ONE 2012

26 Falagas M et al. PLoS ONE 2012

27 Sénégal, Niger: 16% MRSA 20% PVL + Ivory Coast: 39% MRSA Falagas M et al. PLoS ONE 2012

28 Main MRSA ST in West Africa: ST88 ST239/241 ST8 ST5 Schaumburg F. et al. Clin Microbiol Infect 2014

29 Tansarli G. et al. J Antimicrob Chemother 2014

30 Tansarli G. et al. J Antimicrob Chemother 2014

31 ESBL in West Africa: Nigeria, Benin 10-22% Sénégal, 4-6% (community-acquired E. coli UTI)

32 1. Carbapenemase-producing Enterobacteriaceae Sierra Leone: OXA-58 + VIM (n=13) Sénégal: OXA-48 (n=11) Rendani I. et al. J Antimicrob Chemother 2014

33 Rendani I. et al. J Antimicrob Chemother 2014

34 2. Carbapenemase-producing non-enterobacteriaceae Ivory Coast, Ghana, Nigeria, Sierra Leone, Sénégal Pseudomonas sp., Acinetobacter baumanii, Burkholderia sp. OXA-23, OXA-58, VIM Rendani I. et al. J Antimicrob Chemother 2014

35 Highlights ü Quality of data available ü Antimicrobial resistance, WHO global report 2014 ü Surveillance studies in West Africa - MRSA - ESBL-producing Enterobacteriaceae - Carbapenemase-producing Gram negative bacilli ü European travellers as sentinels ü Conclusions / prospects

36 Tangden T et al. Antimicrob Agents Chemother 2010

37 Tangden T et al. Antimicrob Agents Chemother 2010

38 French army Aeromedical evacuation (trauma) ESBL-producing enterobacteria fecal carriage: Afghanistan, 35% Mali, 4% Janvier F. et al. Eur J Clin Microbiol Infect Dis 2014

39 Paltansing S. et al. Emerg Infect Dis 2013

40 Paltansing S. et al. Emerg Infect Dis 2013

41 Machado A. et al. Ecotoxicol Environment Safety 2014

42 Highlights ü Quality of data available ü Antimicrobial resistance, WHO global report 2014 ü Surveillance studies in West Africa - MRSA - ESBL-producing Enterobacteriaceae - Carbapenemase-producing Gram negative bacilli ü European travellers as sentinels ü Conclusions / prospects

43 Conclusions / prospects (1) ü Limited data available - Few West African countries with antibacterial resistance surveillance - Not standardized - Selection bias ü Hot spots have been identified - MRSA in Nigeria (PVL+), and Ivory Coast - ESBL in Nigeria, and Benin - CPE in Sierra Leone, Sénégal ü Sentinel data from European travellers reassuring West Africa probably shares the worldwide trend of increasing resistance to antibacterial agents (WHO global report, 2014)

44 Conclusions / prospects (2) ü Future directions - Standardized surveillance studies (transversal, regular) - Data sharing - Regional network for clinical microbiology ü Local epidemiology of ATB resistance is of paramount importance in many aspects: - To feed guidelines for common infections (UTI, CAP, meningitis, etc.) - To support antimicrobial stewardship policies - To adjust antibacterial prophylaxis (surgery, etc.) - To implement adequate infection control procedures

45 Japan 2013 Milan 2011 Geneva 1959 Naples 1961 Stuttgart 1963 Toronto 2009 Munich 2007 Washington DC 1965 Manila 2005 Vienna 1967 Durban 2003 Tokyo 1969 Amsterdam 2001 Prague 1971 Birmingham 1999 Athens 1973 Sydney 1997 London 1975 Montreal 1995 Zurich 1977 Stockholm 1993 Boston 1979 Berlin 1991 Florence 1981 Jerusalem 1989 Istanbul 1987 Vienna 1983 Kyoto 1985

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47 Anti-infective pharmacology Antimicrobials of the Future Antimicrobial Stewardship Antiseptics Bone, Skin and Soft Tissue Infections Clostridium difficile Infection Collateral Effects of Anti-infectives Controlling Antimicrobial Resistance Device Related Infections and Biofilm Endocarditis & Blood Stream Infections Fungal Infections Hepatitis Infection Control Infections in Catastrophic Areas Infections in the ICU and Sepsis Intra-abdominal Infection MRSA OPAT Streptococcal Infections Tuberculosis Urinary Tract Infections Zoonoses Antimicrobial Stewardship & Infection Control African Network Human-Animal Interface in Antimicrobial Resistance Immunisations and Vaccines