Keywords
carbapenem resistance
Niger
How to Cite
Abstract
Background :
Carbapenems are broad-spectrum antibiotics used as a last resort for the treatment of infections caused by multidrug-resistant bacteria. This study aimed to determine the prevalence and factors associated with carbapenem resistance in Gram-negative bacilli.
Methods :
This was a cross-sectional study conducted from December 2022 to July 2023. All Gram-negative bacilli (GNB) isolated in the laboratories of the three tertiary hospitals in Niamey were included in this study. Antibiotic susceptibility testing (AST) was performed and interpreted according to EUCAST 2023 recommendations. Univariate and multivariate logistic analyses were performed to determine risk factors associated with carbapenem resistance in GNB. A p-value less than 0.05 was considered significant.
Results :
A total of 502 GNB strains were isolated from different clinical samples. These strains were predominantly from male patients (62,7%, sex ratio = 1.69). The median age of patients was 38 years (interquartile range: 7 - 62 years). The samples from which GNB were isolated were predominantly urine samples (67.7%). Enterobacteriaceae represented 92.8% (n=466) of the isolated BGN. The frequency of GNB resistance to carbapenems was 5.8% (n = 29). In multivariate logistic analysis, risk factors significantly associated with resistance of BGN to carbapenems were non-urinary samples (adjusted odds ratio = 24.9; 95% CI = 5.92 – 122.67; p value < 0.001) and resistance to nitrofurans (adjusted odds ratio = 11.99; 95% CI: 1.80 – 83.46; p value < 0.010).
Conclusion :
This study shows that carbapenem resistance among GNBs was relatively high in Niger. Further studies on circulating carbapenem resistance genes in Niger will be necessary to complete this study.
References
1. Tamma PD, Heil EL, Justo JA, Mathers AJ, Satlin MJ, Bonomo RA. Infectious Diseases Society of America 2024 Guidance on the Treatment of Antimicrobial-Resistant GramNegative Infections. Clin Infect Dis. 7 août 2024;ciae403.
2. Mancuso G, De Gaetano S, Midiri A, Zummo S, Biondo C. The Challenge of Overcoming Antibiotic Resistance in CarbapenemResistant Gram-Negative Bacteria: “Attack on Titan”. Microorganisms. août 2023;11(8):1912.
3. Garcia-Bustos V, Cabañero-Navalón MD, Lletí MS. Resistance to beta-lactams in Gramnegative bacilli: relevance and potential therapeutic alternatives. Rev Esp Quimioter. 2022;35(Suppl 2):1-15.
4. Bologna E, Licari LC, Manfredi C, Ditonno F, Cirillo L, Fusco GM, et al. CarbapenemResistant Enterobacteriaceae in Urinary Tract Infections: From Biological Insights to Emerging Therapeutic Alternatives. Medicina (Mex). févr 2024;60(2):214.
5. Lutgring JD. Carbapenem-resistant Enterobacteriaceae: An emerging bacterial threat. Semin Diagn Pathol. 1 mai 2019;36(3):182-6.
6. Walsh T, Tolman M, Porrel L, Nordmann P. Metallo-β-lactamases: the quiet before the storm? Clin Microbiol Rev. 2005;18:306-25.
7. Hansen GT. Continuous Evolution: Perspective on the Epidemiology of Carbapenemase Resistance Among Enterobacterales and Other Gram-Negative Bacteria. Infect Dis Ther. 1 mars 2021;10(1):75-92.
8. Wise MG, Karlowsky JA, Mohamed N, Hermsen ED, Kamat S, Townsend A, et al. Global trends in carbapenem- and difficult-totreat-resistance among World Health Organization priority bacterial pathogens: ATLAS surveillance program 2018–2022. J Glob Antimicrob Resist. 1 juin 2024;37:168-75.
9. Zha L, Li S, Guo J, Hu Y, Pan L, Wang H, et al. Global and regional burden of bloodstream infections caused by carbapenem-resistant Gram-negative bacteria in 2019: A systematic analysis from the MICROBE database. Int J Infect Dis. 1 avr 2025;153:107769.
10. WHO Bacterial Priority Pathogens List 2024: Bacterial Pathogens of Public Health Importance, to Guide Research, Development, and Strategies to Prevent and Control Antimicrobial Resistance. 1st ed. Geneva: World Health Organization; 2024. 1 p.
11. Arowolo MT, Orababa OQ, Olaitan MO, Osibeluwo BV, Essiet UU, Batholomew OH, et al. Prevalence of carbapenem resistance in Acinetobacter baumannii and Pseudomonas aeruginosa in sub-Saharan Africa: A systematic review and meta-analysis. PLOS ONE. 28 nov 2023;18(11):e0287762.
12. Abdoulaye O, Bacha BSM, Aghali NH, Abdoulaye I, Abdoulaye MB, Lo G, et al. Profil des souches bactériennes multirésistantes isolées à l’Hôpital National de Zinder (HNZ), République du Niger en 2021. Afr J Clin Exp Microbiol. 24 oct 2022;23(4):369-77.
13. Dossouvi KM, Bakpatina-Batako KD. Carbapenem resistance in West Africa: a systematic review. Microbiol Indep Res J MIR J. 20 mars 2024;11:25-56.
14. Dikoumba AC, Onanga R, Jean-Pierre H, Didelot MN, Dumont Y, Ouedraogo AS, et al. Prevalence and Phenotypic and Molecular Characterization of CarbapenemaseProducing Gram-Negative Bacteria in Gabon. Am J Trop Med Hyg. févr 2023;108(2):268-74.
15. Somda NS, Nyarkoh R, Kotey FCN, TettehQuarcoo PB, Donkor ES. A systematic review and meta-analysis of carbapenem-resistant Enterobacteriaceae in West Africa. BMC Med Genomics. 12 nov 2024;17(1):267.
16. Aurilio C, Sansone P, Barbarisi M, Pota V, Giaccari LG, Coppolino F, et al. Mechanisms of Action of Carbapenem Resistance. Antibiotics. mars 2022;11(3):421.
17. Ma J, Song X, Li M, Yu Z, Cheng W, Yu Z, et al. Global spread of carbapenem-resistant Enterobacteriaceae: Epidemiological features, resistance mechanisms, detection and therapy. Microbiol Res. 1 janv 2023;266:127249.
18. Khamari B, Bulagonda EP. Unlocking Nitrofurantoin: Understanding Molecular Mechanisms of Action and Resistance in Enterobacterales. Med Princ Pract. 29 oct 2024;34(2):121-37.
19. Khamari B, Kumar P, Pradeep BE. Resistance to nitrofurantoin is an indicator of extensive drug-resistant (XDR) Enterobacteriaceae. J Med Microbiol. 2021;70(4):001347.
20. Palacios-Baena Z, Giannella M, Manissero D, Rodríguez-Baño J, Viale P, Lopes S. Risk factors for carbapenem-resistant Gramnegative bacterial infections: a systematic review. Clin Microbiol Infect. 1 févr 2021;27(2):228-35.
21. Maina JW, Mutua JM, Musyoki AM. Carbapenem-resistant gram-negative bacterial infections and risk factors for acquisition in a Kenyan intensive care unit. BMC Infect Dis. 23 mai 2024;24(1):522.
22. Tapha O, Degbey CC, Yacouba A, Mahouna Tchioundjro E, Nadakou NT, Alkassoum Salifou I, et al. Antimicrobial use in hospitalized patients: a point prevalence survey across four tertiary hospitals in Niger. JAC-Antimicrob Resist. 1 oct 2024;6(5):dlae175.
23. Baker KS, Jauneikaite E, Nunn JG, Midega JT, Atun R, Holt KE, et al. Evidence review and recommendations for the implementation of genomics for antimicrobial resistance surveillance: reports from an international expert group. Lancet Microbe. 1 déc 2023;4(12):e1035-9.
24. Djordjevic SP, Jarocki VM, Seemann T, Cummins ML, Watt AE, Drigo B, et al. Genomic surveillance for antimicrobial resistance — a One Health perspective. Nat Rev Genet. févr 2024;25(2):142-57.
25. Inzaule SC, Tessema SK, Kebede Y, Ouma AEO, Nkengasong JN. Genomic-informed pathogen surveillance in Africa: opportunities and challenges. Lancet Infect Dis. 1 sept 2021;21(9):e281-9.
Metrics
Downloads
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 A Yacouba, O Tapha, H Abdou Hima, S Moussa Saley, B Abdou Natali, O Abdoulaye, S Amatagas, M Doutchi, S Brah, S Mamadou