背景:抗菌素耐药性与继发感染的发病率增加有关,并且由于环境中耐药性基因的普遍存在而成为全球威胁。最近的估计显示,2019年全球与细菌抗菌素耐药性相关的死亡人数为495万。淋巴丝虫病(LF),被忽视的热带病(NTD),与生活在世界热带地区的穷人有关。LF患者容易发生急性皮肤淋巴管炎(ADLA),这种情况使他们面临因皮肤脱皮而发生继发细菌感染的风险。ADLA尤其恶化患者的预后,导致使用抗生素作为治疗干预。这可能导致由于自我药物治疗和不依从性而不适当地使用抗生素;加剧LF患者的抗菌素耐药性。从这个角度来看,我们评估了LF患者出现抗菌素耐药性的可能性.我们专注于抗生素的使用,金黄色葡萄球菌的抗生素耐药性,大肠杆菌和铜绿假单胞菌分离株并观察了基因(mecA和超广谱β-内酰胺酶[blaCTX-M,blaSHV和blaTEM])编码多药耐药(MDR)细菌分离株的耐药性。
结果:在60名参与者中,54人(n=54,90%)年龄在31-60岁之间,二十名(n=20,33.33%)失业,三十八名(n=38,50.67%)有(以月计)七(7)个月及以上的伤口。阿莫西林(54%)和氯霉素(22%)是最常用的自我药物治疗抗生素。金黄色葡萄球菌(n=26)对青霉素耐药率最高(n=23,88.46%),对红霉素耐药率最低(n=2,7.69%)。大肠杆菌分离株(n=5)对四环素(n=5,100%)和氨苄西林(n=5,100%)耐药,但对美罗培南敏感(n=5,100%)。铜绿假单胞菌(n=8)对美罗培南(n=3,37.50%)和对环丙沙星(n=2,25%)的耐药性最强,庆大霉素(n=2,25%)和头孢他啶(n=2,25%)。多重耐药耐甲氧西林金黄色葡萄球菌(MRSA),耐头孢菌素大肠杆菌。耐碳青霉烯类铜绿假单胞菌4例(n=4,15.38%),两个(n=2,40%)和两个(n=2,25%)。ESBL(blaCTX-M)和mecA基因参与了大肠埃希菌和MRSA的耐药机制,分别。
结论:研究结果表明,存在慢性伤口的LF患者的MDR分离株;因此,需要在优化发病率管理方案的治疗策略中优先考虑MDR细菌的耐药性。这可以指导抗生素选择用于治疗患有ADLA的LF患者。
BACKGROUND: Antimicrobial resistance is associated with increased morbidity in secondary infections and is a global threat owning to the ubiquitous nature of resistance genes in the environment. Recent estimate put the deaths associated with bacterial antimicrobial resistance in 2019 at 4.95 million worldwide. Lymphatic filariasis (LF), a Neglected Tropical Disease (NTD), is associated with the poor living in the tropical regions of the world. LF patients are prone to developing acute dermatolymphangioadenitis (ADLA), a condition that puts them at risk of developing secondary bacterial infections due to skin peeling. ADLA particularly worsens the prognosis of patients leading to usage of antibiotics as a therapeutic intervention. This may result in inappropriate usage of antibiotics due to self-medication and non-compliance; exacerbating antimicrobial resistance in LF patients. In this perspective, we assessed the possibilities of antimicrobial resistance in LF patients. We focused on antibiotic usage, antibiotic resistance in Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa isolates and looked at genes (mecA and Extended-spectrum beta-lactamase [blaCTX-M, blaSHV and blaTEM]) coding for resistance in multi-drug resistant (MDR) bacterial isolates.
RESULTS: Of the sixty (60) participants, fifty-four (n = 54, 90%) were within 31-60 years of age, twenty (n = 20, 33.33%) were unemployed and thirty-eight (n = 38, 50.67%) had wounds aged (in months) seven (7) months and above. Amoxicillin (54%) and chloramphenicol (22%) were the most frequently used antibiotics for self-medication. Staphylococcus aureus isolates (n = 26) were mostly resistant to penicillin (n = 23, 88.46%) and least resistant to erythromycin (n = 2, 7.69%). Escherichia coli isolates (n = 5) were resistant to tetracycline (n = 5, 100%) and ampicillin (n = 5, 100%) but were sensitive to meropenem (n = 5, 100%). Pseudomonas aeruginosa isolates (n = 8) were most resistant to meropenem (n = 3, 37.50%) and to a lesser ciprofloxacin (n = 2, 25%), gentamicin (n = 2, 25%) and ceftazidime (n = 2, 25%). Multi-drug resistant methicillin resistant Staphylococcus aureus (MRSA), cephalosporin resistant Escherichia coli. and carbapenem resistant Pseudomonas aeruginosa were four (n = 4, 15.38%), two (n = 2, 40%) and two (n = 2, 25%) respectively. ESBL (blaCTX-M) and mecA genes were implicated in the resistance mechanism of Escherichia coli and MRSA, respectively.
CONCLUSIONS: The findings show presence of MDR isolates from LF patients presenting with chronic wounds; thus, the need to prioritize resistance of MDR bacteria into treatment strategies optimizing morbidity management protocols. This could guide antibiotic selection for treating LF patients presenting with ADLA.