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The spread of antimicrobial resistant (AMR) pathogens is not restricted to high-income countries, but will severely affect sub-Sahara Africa in the coming years. For the African continent, a modelling study estimated 4.2 million annual deaths related to AMR for the year 2050, leading to the highest mortality rate worldwide. Multiple factors may contribute to this development. Countries in sub-Sahara Africa suffer from a high burden of poverty-related infectious diseases, amongst them respiratory and gastrointestinal tract infections, which are partly treatable with antibiotic medication. Due to the lack of diagnostic facilities, broad-spectrum antibiotics are prescribed empirically without diagnosing a causative pathogen. In most African countries sub-standard and genuine antibiotics are readily sold without the need of prescriptions in pharmacies and in open street markets both for human consumption and for animal productions. High, insufficiently monitored, antibiotic consumption leads to the emergence of multidrug resistant pathogens, which consecutively spread within hospitals, the community, livestock and wild animals. Nosocomial transmission is facilitated by an African hospital environment that is often characterized by overcrowding, shortage of staff and lack of basic measures of hygiene.
Our research interests include hospital and community surveillance of AMR pathogens in low- and middle-income countries with the aim to integrate data from humans and animals. A special emphasis is put on the identification of transmission routes and reservoirs of AMR bacteria between animals and humans in rural sub-Sahara Africa guiding preventive public health measures.
Antimicrobial resistance (AMR) surveillance is the cornerstone for assessing the burden of AMR and for providing the necessary information for action in support of local, national and global strategies. A number of regional surveillance programmes have been successfully monitoring resistance in selected geographical areas, such as the Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CEASAR), the European Antimicrobial Resistance Surveillance Network (EARS-Net) and the Latin American Antimicrobial Resistance Surveillance Network (ReLAVRA). In sub-Saharan Africa AMR surveillance is recognized as an invaluable tool, however, significant gaps exist in its implementation. International standards, as outlined in the Global Antimicrobial Resistance Surveillance System (GLASS) are yet to be widely implemented. The aim of this project is to build up a hospital-based surveillance systems at four hospitals in sub-Saharan Africa (Burkina Faso, Gabon, Ghana Tanzania) with the objectives to
In recent years policies to curb antimicrobial resistance (AMR) and implement antimicrobial stewardship (AMS) have been launched to tackle the cross-border problem of AMR on a global scale. However, evidence of successful and comprehensive national AMS programs in low- and middle-income countries is scarce, not least due to fragmented health systems in many low- and middle-income countries, which lack governance mechanisms and financial resources. Ghana has taken a pioneering role as a country of the global south to prioritize commitments to implement a comprehensive policy and National Action Plan on Antimicrobial Resistance (NAP) for 2017-2021. While developing a monitoring system is part of the NAP, ample evidence shows that relevant outcome measures and baseline measurements related to antibiotic use and levels of antimicrobial resistance are often missing in the monitoring of such policies. Existing data rather originates from sporadic research project than from systematically collected surveillance data. Furthermore deficits in governance structures are frequently ignored. The assessment of policy implementation and governance mechanisms will identify contextual factors, which facilitate and hinder positive effects of AMS efforts. These factors will be explored in more depth to determine key factors to support sustainable and successful enforcement and oversight of AMR policies.
The spread of antimicrobial resistant (AMR) pathogens will severely affect sub-Saharan Africa in the coming years, with an estimated 4.2 million AMR-associated deaths in 2050. Strengthening molecular biology diagnostics plays an important role in preparing for and managing viral epidemics, but will not be useful during the current AMR epidemic as molecular methods are still suboptimal and too expensive for routine AMR monitoring and detection of emerging bacterial resistance. Rather, classical bacteriology laboratories capable of carrying out bacterial cultures and antibiotic susceptibility testing are urgently needed outside large teaching and university clinics in semi-urban or rural sub-Saharan Africa. This project aims to develop a universally applicable construction plan for a bacteriology laboratory used for the diagnosis of AMR pathogens. Pilot laboratories will be built in Ghana and Mali and laboratory staff will be trained on bacterial and AMR diagnostics. In order to plan training courses and awareness activities appropriately, health professionals’ perceptions and practices on AMR will be investigated. Further, a system to monitor antibiotic consumption/use as well as a laboratory information and management system will be established.
Due to the lack of diagnostic facilities across sub-Saharan Africa, broad-spectrum antibiotics are often prescribed empirically without diagnosing a causative pathogen. High, insufficiently monitored, antibiotic consumption leads to the emergence of multidrug resistant pathogens, which consecutively spread within hospitals and the community. Nosocomial transmission is facilitated by an African hospital environment that is often characterized by overcrowding, shortage of staff and lack of basic measures of hygiene. The routes of nosocomial transmission in African settings, where mainly relatives provide nursing care to the patients, remain unclear. Similarly, it is unknown to what extent zoonotic transmission contributes to high AMR rates in rural communities. In the absence of AMR surveillance systems on the African continent no conclusions can be drawn on the transmission of AMR pathogens between different reservoirs, populations or within health care facilities. Within this project a collection of ESBL-producing E. coli and K. pneumoniae genomes will be used to holistically examine transmission networks between the human and animal reservoirs in the community and the hospital population.
The intestinal microbiota, consisting of the community of commensal, symbiotic and pathogenic microorganisms inhabiting the human gut, greatly impacts human health and disease. After colonisation at birth, the number of microbial species increases and infants demonstrate diverse and varied microbiota profiles, which develop towards a stereotype adult-like profile at about one year. The microbiota acquired in the first years of life primes immune maturation, and disturbances to the gut microbiota were linked with disease susceptibility, notably irritable bowel syndrome. We will use a birth cohort in Agogo, Ghana to investigate the natural development of the microbiota in an African population early in life and assess the impact of malaria episodes.
Cytokine Profile Distinguishes Children With Plasmodium Falciparum Malaria From Those With Bacterial Blood Stream Infections
Struck NS, Zimmermann M, Krumkamp R, Lorenz E, Jacobs T, Rieger T, Wurr S, Günther S, Gyau Boahen K, Marks F, Sarpong N, Owusu-Dabo E, May J, Eibach D.
J Infect Dis . 2020 Mar 16;221(7):1098-1106. doi: 10.1093/infdis/jiz587. PubMed PMID: 31701142; PubMed Central PMCID: PMC7075412.
Multicountry Distribution and Characterization of Extended-spectrum β-Lactamase-associated Gram-negative Bacteria From Bloodstream Infections in Sub-Saharan Africa
Toy T, Pak GD, Duc TP, Campbell JI, El Tayeb MA, Von Kalckreuth V, Im J, Panzner U, Cruz Espinoza LM, Eibach D, Dekker DM, Park SE, Jeon HJ, Konings F, Mogeni OD, Cosmas L, Bjerregaard-Andersen M, Gasmelseed N, Hertz JT, Jaeger A, Krumkamp R, Ley B, Thriemer K, Kabore LP, Niang A, Raminosoa TM, Sampo E, Sarpong N, Soura A, Owusu-Dabo E, Teferi M, Yeshitela B, Poppert S, May J, Kim JH, Chon Y, Park JK, Aseffa A, Breiman RF, Schütt-Gerowitt H, Aaby P, Adu-Sarkodie Y, Crump JA, Rakotozandrindrainy R, Meyer CG, Sow AG, Clemens JD, Wierzba TF, Baker S, Marks F.
Clin Infect Dis. 2019 Nov 15; 69(Suppl 6): S449–S458. doi: 10.1093/cid/ciz450. PubMed PMID: 31665776; PubMed Central PMCID: PMC6821266.
The Prevotella copri Complex Comprises Four Distinct Clades Underrepresented in Westernized Populations
Tett A, Huang KD, Asnicar F, Fehlner-Peach H, Pasolli E, Karcher N, Armanini F, Manghi P, Bonham K, Zolfo M, De Filippis F, Magnabosco C, Bonneau R, Lusingu J, Amuasi J, Reinhard K, Rattei T, Boulund F, Engstrand L, Zink A, Collado MC, Littman DR, Eibach D, Ercolini D, Rota-Stabelli O, Huttenhower C, Maixner F, Segata N.
Cell Host Microbe. 2019 Nov 13;26(5):666-679.e7. doi: 10.1016/j.chom.2019.08.018. PubMed PMID: 31607556 PubMed; Central PMCID: PMC6854460.
Emergence of phylogenetically diverse and fluoroquinolone resistant Salmonella Enteritidis as a cause of invasive nontyphoidal Salmonella disease in Ghana
Aldrich C, Hartman H, Feasey N, Chattaway MA, Dekker D, Al-Emran HM, Larkin L, McCormick J, Sarpong N, Le Hello S, Adu-Sarkodie Y, Panzner U, Park SE, Im J, Marks F, May J, Dallman TJ, Eibach D.
PLoS Negl Trop Dis. 2019 Jun; 13(6): e0007485. Published online 2019 Jun 20. doi: 10.1371/journal.pntd.0007485. PubMed PMID: 31220112; PubMed Central PMCID: PMC6605661.
Extended-spectrum β-lactamase-producing Enterobacteriaceae among geckos (Hemidactylus brookii) in a Ghanaian hospital
Eibach D, Nagel M, Lorenzen S, Hogan B, Belmar Campos C, Aepfelbacher M, Sarpong N, May J.
Clin Microbiol Infect . 2019; pii: S1198-743X(19)30159-4. PubMed PMID: 30986561.
Fluoroquinolone-Resistant Salmonella enterica, Campylobacter Spp., and Arcobacter butzleri From Local and Imported Poultry Meat in Kumasi, Ghana
Dekker D, Eibach D, Boahen KG, Akenten CW, Pfeifer Y, Zautner AE, Mertens E, Krumkamp R, Jaeger A, Flieger A, Owusu-Dabo E, May J.
Foodborne Pathog Dis . 2019 May;16(5):352-358. doi: 10.1089/fpd.2018.2562. PubMed PMID: 30907631; PubMed Central PMCID: PMC6529854.
Detection and Characterization of ESBL-Producing Escherichia coli From Humans and Poultry in Ghana
Falgenhauer L, Imirzalioglu C, Oppong K, Akenten CW, Hogan B, Krumkamp R, Poppert S, Levermann V, Schwengers O, Sarpong N, Owusu-Dabo E, May J, Eibach D.
Front Microbiol. 2019; 9:3358. doi: 10.3389/fmicb.2018.03358. PubMed PMID: 30697208; PubMed Central PMCID: PMC6340976.
Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in local and imported poultry meat in Ghana
Eibach D, Dekker D, Gyau Boahen K, Wiafe Akenten C, Sarpong N, Belmar Campos C, Berneking L, Aepfelbacher M, Krumkamp R, Owusu-Dabo E, May J.
Vet Microbiol . 2018 Apr;217:7-12. doi: 10.1016/j.vetmic.2018.02.023. PubMed PMID: 29615260.
Fever Without Source (FWS) Study Group. Malaria Coinfections in Febrile Pediatric Inpatients: A Hospital-Based Study From Ghana
Hogan B, Eibach D, Krumkamp R, Sarpong N, Dekker D, Kreuels B, Maiga-Ascofaré O, Gyau Boahen K, Wiafe Akenten C, Adu-Sarkodie Y, Owusu-Dabo E, May J
Clin Infect Dis. 2018; 66(12):1838-1845. DOI: 10.1093/cid/cix1120. PubMed PMID: 29408951; PubMed Central PMCID: PMC5982794.
Rickettsia felis Infection in Febrile Children, Ghana
Sothmann P, Keller C, Krumkamp R, Kreuels B, Aldrich C, Sarpong N, Steierberg S, Winter D, Boahen KG, Owusu-Dabo E, May J, Eibach D
Am J Trop Med Hyg. 2017 Jan 23. pii: 16-0754. DOI: 10.4269/ajtmh.16-0754. PubMed PMID: 28115672; PubMed Central PMCID: PMC5392620.
Nasal Carriage of Staphylococcus aureus among Children in the Ashanti Region of Ghana
Eibach D, Nagel M, Hogan B, Azuure C, Krumkamp R, Dekker D, Gajdiss M, Brunke M, Sarpong N, Owusu-Dabo E, May J
PLoS One . 2017 Jan 20;12(1):e0170320. doi: 10.1371/journal.pone.0170320. PubMed PMID: 28107412; PubMed Central PMCID: PMC5249101.
Antibiotic resistance and clonal diversity of invasive Staphylococcus aureus in the rural Ashanti Region, Ghana
Dekker D, Wolters M, Mertens E, Boahen KG, Krumkamp R, Eibach D, Schwarz NG, Adu-Sarkodie Y, Rohde H, Christner M, Marks F, Sarpong N, May J
BMC Infect Dis. 2016 Nov 29;16(1):720. doi: 10.1186/s12879-016-2048-3. PubMed PMID: 27899074; PubMed Central PMCID: PMC5129674.
Molecular Epidemiology and Antibiotic Susceptibility of Vibrio cholerae Associated with a Large Cholera Outbreak in Ghana in 2014
Eibach D, Herrera-León S, Gil H, Hogan B, Ehlkes L, Adjabeng M, Kreuels B, Nagel M, Opare D, Fobil JN, May J
PLoS Negl Trop Dis. 2016;10(5):e0004751. doi: 10.1371/journal.pntd.0004751. PubMed PMID: 27232338; PubMed Central PMCID: PMC4883745.
Extended spectrum beta-lactamase producing Enterobacteriaceae causing bloodstream infections in rural Ghana, 2007-2012
Eibach D, Campos CB, Krumkamp R, Al-Emran HM, Dekker D, Boahen KG, Kreuels B, Adu-Sarkodie Y, Aepfelbacher M, Park SE, Panzner U, Marks F, May J
Int J Med Microbiol . 2016 Jun;306(4):249-54. doi: 10.1016/j.ijmm.2016.05.006. PubMed PMID: 27222489.
Application of a Multiplex PCR Assay for the Detection of Gastrointestinal Pathogens in a Rural African Setting
Eibach D, Krumkamp R, Hahn A, Sarpong N, Adu-Sarkodie Y, Leva A, Käsmaier J, Panning M, May J, Tannich E
MC Infect Dis . 2016 Apr 14;16:150. doi: 10.1186/s12879-016-1481-7. PubMed PMID: 27080387; PubMed Central PMCID: PMC4832549.
A Multicountry Molecular Analysis of Salmonella enterica Serovar Typhi With Reduced Susceptibility to Ciprofloxacin in Sub-Saharan Africa
Al-Emran HM, Eibach D, Krumkamp R, Ali M, Baker S, Biggs HM, Bjerregaard-Andersen M, Breiman RF, Clemens JD, Crump JA, Cruz Espinoza LM, Deerin J, Dekker DM, Gassama Sow A, Hertz JT, Im J, Ibrango S, von Kalckreuth V, Kabore LP, Konings F, Løfberg SV, Meyer CG, Mintz ED, Montgomery JM, Olack B, Pak GD, Panzner U, Park SE, Razafindrabe JL, Rabezanahary H, Rakotondrainiarivelo JP, Rakotozandrindrainy R, Raminosoa TM, Schütt-Gerowitt H, Sampo E, Soura AB, Tall A, Warren M, Wierzba TF, May J, Marks F
Clin Infect Dis. 2016;62 Suppl 1:S42-6. doi: 10.1093/cid/civ788. PubMed PMID: 26933020; PubMed Central PMCID: PMC4772832.
The Emergence of Reduced Ciprofloxacin Susceptibility in Salmonella enterica Causing Bloodstream Infections in Rural Ghana
Eibach D, Al-Emran HM, Dekker DM, Krumkamp R, Adu-Sarkodie Y, Cruz Espinoza LM, Ehmen C, Boahen K, Heisig P, Im J, Jaeger A, von Kalckreuth V, Pak GD, Panzner U, Park SE, Reinhardt A, Sarpong N, Schütt-Gerowitt H, Wierzba TF, Marks F, May J
Clin Infect Dis . 2016 Mar 15;62 Suppl 1:S32-6. doi: 10.1093/cid/civ757. PubMed PMID: 26933017.