Surveillance of Resistance to Third-Generation Cephalosporins in Four Regions of Senegal (Saint-Louis, Diourbel, Kaolack, and Dakar) between January 2020 and September 2021

Abstract

Antibiotic resistance remains a major public health problem, and if no action is taken by 2050, mortality related to multidrug resistance is expected to reach 10 million deaths per year. In Senegal, most studies and interventions on multidrug resistance surveillance have been limited to Dakar. Against this background, the present study was undertaken with the primary aim of surveilling resistance patterns to third-generation cephalosporins (3GCs), the most extensively used antibiotic class in the inpatient setting, particularly in acute care and emergency contexts. Methods: This was a prospective study conducted in the hospitals of Diourbel, Kaolack, Le Dantec (Dakar), Matlaboul Fawzeini Hospital in Touba, and the regional laboratory of Kaolack. Bacterial isolates were identified based on morphological, cultural, and biochemical characteristics. Antimicrobial susceptibility testing was performed according to the recommendations of the French Society of Microbiology Antibiogram Committee (CA-SFM) in force. Data were first recorded in registers, entered into Excel, and analyzed using SPSS. Results: Between January 2020 and September 2021, 329 Enterobacterales isolates resistant to third-generation cephalosporins were collected. These isolates were mainly recovered from Saint-Louis Regional Hospital (n = 130; 39.5%), the Regional Laboratory of Kaolack (n = 55; 16.71%), and Le Dantec Hospital (n = 80; 24.31%). The majority of isolates were obtained from urine samples (n = 178; 54.10%), followed by pus specimens (n = 64; 19.45%). Resistance to 3GCs was mainly mediated by extended-spectrum beta-lactamase (ESBL) production (79.63% of isolates), while 3.34% of isolates were resistant to carbapenems. Escherichia coli and Klebsiella pneumoniae were the main ESBL-producing species, with prevalences of 55.9% and 25.6%, respectively. Conclusion: These findings show that ESBL-producing and 3GC-resistant Enterobacterales represent a major resistance issue reported in clinical laboratories. Antimicrobial resistance control efforts should be implemented at the national level to better understand gene distribution and reduce morbidity and mortality associated with multidrug-resistant bacteria.