Antibiotic resistance in West Africa Prof. Pierre Tattevin Infectious Diseases and ICU, Pontchaillou University Hospital, Rennes, France International Society of Chemotherapy
No conflict of Interest International Society of Chemotherapy for Infection and Cancer www.ischemo.org....to advance the education and the science of therapy of infection
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
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
ü National labs, invited to participate Frean J et al. Bull WHO 2012
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
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
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
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
An+microbial resistance: Global report on surveillance, 2014
An+microbial resistance: Global report on surveillance, 2014
An+microbial resistance: Global report on surveillance, 2014
An+microbial resistance: Global report on surveillance, 2014
An+microbial resistance: Global report on surveillance, 2014
An+microbial resistance: Global report on surveillance, 2014
An+microbial resistance: Global report on surveillance, 2014
An+microbial resistance: Global report on surveillance, 2014
An+microbial resistance: Global report on surveillance, 2014
An+microbial resistance: Global report on surveillance, 2014
An+microbial resistance: Global report on surveillance, 2014
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
Falagas M et al. PLoS ONE 2012
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
Falagas M et al. PLoS ONE 2012
Sénégal, Niger: 16% MRSA 20% PVL + Ivory Coast: 39% MRSA Falagas M et al. PLoS ONE 2012
Main MRSA ST in West Africa: ST88 ST239/241 ST8 ST5 Schaumburg F. et al. Clin Microbiol Infect 2014
Tansarli G. et al. J Antimicrob Chemother 2014
Tansarli G. et al. J Antimicrob Chemother 2014
ESBL in West Africa: Nigeria, Benin 10-22% Sénégal, 4-6% (community-acquired E. coli UTI)
1. Carbapenemase-producing Enterobacteriaceae Sierra Leone: OXA-58 + VIM (n=13) Sénégal: OXA-48 (n=11) Rendani I. et al. J Antimicrob Chemother 2014
Rendani I. et al. J Antimicrob Chemother 2014
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
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
Tangden T et al. Antimicrob Agents Chemother 2010
Tangden T et al. Antimicrob Agents Chemother 2010
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
Paltansing S. et al. Emerg Infect Dis 2013
Paltansing S. et al. Emerg Infect Dis 2013
Machado A. et al. Ecotoxicol Environment Safety 2014
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
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)
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
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
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