The rural community in sub-Saharan Africa as a reservoir of antibiotic resistance: a case study from Burkina Faso

Antibiotic resistance (ABR) has become a world-wide critical health issue today Over several decades, to varying degrees, bacteria causing common infections have developed resistance to each new antibiotic (AB), and ABR has evolved to become a worldwide concern. In lowincome and middle-income countries (LMICs), AB use is increasing with high rates of hospitalization with overcrowding and understaffing and few resources for efficient hospital control. Adding to problem are inadequate laboratory diagnosis (lack of facilities and trained staff) to inappropriate AB prescribing. Antibiotic resistance, spreading from the hospital towards the community AB resistant pathogens are spreading from the hospital to the community through unsafe water and poor sanitation, as well as through the commensal flora of healthcare workers. In the case of sub- Saharan Africa, there is the barrier between hospital and community is blurred and hospitalization is an important risk factor for acquisition of resistant infection in family members. Likewise, several factors favor the spread of AB resistant bacteria in the community, such poor hygiene at home but also selfmedication and patients’ pressure to AB prescription. Of note, the widespread implementation of malaria rapid diagnostic tests has witnessed an increase use of AB, particularly in the case of a negative malaria diagnosis. The commensal flora: a potential agent of infection Unlike viruses – which penetrate human cells – numerous bacteria are residing on the surface of the skin and the mucosal surfaces of man, living a peaceful life, harmless to the host. This crowded commensal flora however provides an excellent niche for exchange of AB resistance factors (between different bacterial species and genera. Further, although the majority of the commensal flora is harmless, some among them may behave as pathogens awaiting opportunities to invade the host: breaks in the skin (Staphylococcus aureus), destruction of the upper respiratory tract mucosa (Streptococcus pneumoniae), changes in the physiology of the urinary tract (Escherichia coli in asymptomatic bacteriuria of pregnancy) or co-infections (Salmonella after severe malaria). Knowledge of antibiotic resistance rates in the community, a prerequisite for interventions Knowledge of AB resistance rates allows to define or update standard treatment guidelines, they guide appropriate drug supplies and identify the need for infection control measures. Although in sub- Saharan Africa, studies about pathogen distribution and AB resistance rates, most studies are healthcare-facility based, and few studies have studies the AB resistance rates in the community. The case of Nanoro, Burkina Faso, a rural sub-Saharan setting The Clinical Research Unit of Nanoro (CRUN) has been recently conducting AB resistance surveillance studies on invasive bacteria. It has microbiological facilities, trained clinicians and a demographic surveillance system. The present PhD proposal aims to assess AB resistance rates key commensal bacterial species in the community, focusing on those species that were most prevalent in bacteremic children in a recent study in CRUN: Salmonella Enterica, Streptococcus pneumoniae, Staphylococcus aureus, and Escherichia coli. In addition, relevant virulence factors and molecular hallmarks will be studied, allowing to understand the peculiar clinical presentation of these isolates in sub-Saharan Africa, to understand their pathogenesis and to monitor targets for vaccine development. From Antibiotic Resistance Surveillance to Antibiotic Stewardship Bacterial resistance is increasing worldwide, and has been identified as one of the most serious public health issues of our time by the WHO, and was qualified as a “problem so serious that it threatens the achievements of modern medicine”. Antibiotic stewardship (ABS) programs offer evidence-based tools to control antibiotic prescription rates and thereby influence the incidence of nosocomial infection and contain the development of multidrug-resistant bacteria, but there is limited experience with such programs at hospitals in sub-Saharan Africa, mostly due to lack of leadership and resources

Trefwoorden:B780-tropische-geneeskunde