Distribution of extended spectrum beta-lactamase antibiotic resistance in Africa 2005-2021

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Introduction Antimicrobial resistance (AMR) is a growing global concern, with Extended Spectrum Beta-Lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae contributing significantly to resistance. Africa experiences a high burden of ESBL-producing organisms, with geographical variations in prevalence and resistance rates. Objectives This project aimed at exploring geographical distribution, resistance patterns, and gene mutations associated with ESBL-producing Escherichia coli and Klebsiella pneumoniae in seven African countries. Methodology Data were obtained from the Pfizer-ATLAS Antibiotic Resistance Database collected between 2005 and 2021. Variables such as age, sample type, and year of isolation were categorized, while the WHO AWaRe classification was used to assess resistance for the 24 antibiotics. Descriptive statistics were used to summarize the data, and geospatial analysis identified regional resistance patterns and gene mutations. Analysis was done using R v.4.4.3 Results Of the 1,820 ESBL-producing E. coli and K. pneumoniae isolates from seven African countries were analyzed, the majority were from South Africa and Nigeria. K. pneumoniae being predominant (55.5%) and was prevalent in pediatric (78.4 %) and respiratory (82.5 %) samples, while E. coli dominated urinary samples. Resistance to ACCESS antibiotics was high, especially ampicillin (>99%), and K. pneumoniae showed greater resistance to amoxicillin-clavulanate, gentamicin, and carbapenems. E. coli exhibited higher resistance to fluoroquinolones. RESERVE antibiotic resistance remained low but was higher in K. pneumoniae. There was country variation with Nigeria and Morocco showing the highest resistance levels. The CTXM1 gene was most prevalent (90.8%), and countries like Egypt and Cameroon had the highest average resistance gene burden per isolate. Intended use These results identify AMR hotspots in Nigeria, Cameroon, Egypt, and Morocco, emphasizing the need for targeted stewardship. The findings also underscore the urgency of preserving last-resort antibiotics to combat growing resistance in Escherichia coli and Klebsiella pneumoniae.

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