Rapid Emergence of Multidrug-Resistance among Gram Negative Isolates at a Tertiary Pediatric and Maternity Hospital in Ulaanbaatar, Mongolia

Main Article Content

Susanna Felsenstein
Sarantsetseg Bira
Narangerel Altanmircheg
Enkhtur Shonkuuz
Ariuntuya Ochirpurev
David Warburton

Abstract

Introduction: Information on microbiological and susceptibility profiles of clinical isolates in Mongolia is scarce, hampering infection control and clinical care.

Methods: Species and resistance profiles of 6334 clinical gram negative isolates, collected at Mongolia’s National Center for Maternal and Child Health between 2014 and 2017 were analyzed.

Results: Annual proportion of multidrug-resistance among E. coli and Enterobacter isolates increased from 2.8% to 16.6% and 3.5% to 22.6% respectively; Klebsiella isolates exhibiting susceptibilities suggestive of extended spectrum beta-lactamase (ESBL) production from 73% to 94%. By 2017, 60.6% of Klebsiella isolates were multidrug-resistant, most originated from intensive care wards.  Enterobacteriaceae exhibiting susceptibility patterns suggestive of ESBL production and multidrug-resistant organisms were common and their incidence increased rapidly.

Conclusion: These findings will serve to build strategies to strengthen microbiological surveillance, diagnostics and infection control; and to develop empiric therapy and stewardship recommendations for Mongolia’s largest Children’s and Maternity hospital.

Article Details

How to Cite
Felsenstein, S., Bira, S., Altanmircheg, N., Shonkuuz, E., Ochirpurev, A., & Warburton, D. (2020). Rapid Emergence of Multidrug-Resistance among Gram Negative Isolates at a Tertiary Pediatric and Maternity Hospital in Ulaanbaatar, Mongolia. Central Asian Journal of Global Health, 9(1). https://doi.org/10.5195/cajgh.2020.371
Section
Research
Author Biographies

Susanna Felsenstein, Department of Paediatric Infectious Diseases and Immunology, Liverpool, United Kingdom

1.Susanna Felsenstein, MSc, DTM&H, Senior Lecturer (corresponding author)

    University College Cork, Department of Pediatrics

    Wilton, Cork, Republic of Ireland

    Tel.: +353 21-492- 2000

    Fax.: +353 21 -492- 2399

    E-mail: susanna.felsenstein@hse.ie; sfelsenstein@protonmail.com

Sarantsetseg Bira, Central Laboratory Department, National Center for Maternal and Child Health, Ulaanbaatar, Mongolia

MD, Master Degree of Medical Sciences

    Head of Central Laboratory Department at NCMCH

Narangerel Altanmircheg, Central Laboratory Department, National Center for Maternal and Child Health, Ulaanbaatar, Mongolia

    Central Laboratory Department, NCMCH

    Khuvisgalchdiin street, Bayangol District, 

    Ulaanbaatar, Mongolia, 160660

Enkhtur Shonkuuz, Critical Care Medicine, National Center for Maternal and Child Health, Ulaanbaatar, Mongolia

Clinical Professor of Pediatrics, Critical Care Medicine

    Head of postgraduate training program in pediatrics at NCMCH

    Director General of the NCMCH

    Khuvisgalchdiin street, Bayangol District, 

    Ulaanbaatar, Mongolia, 16060

Ariuntuya Ochirpurev, Health emergencies and food safety, Office of the WHO Representative in Mongolia, Ulaanbaatar, Mongolia

Technical officer, Health emergencies and food safety,

Office of the WHO Representative in Mongolia

Olympic Street-2, Sukhbaatar district,

Ulaanbaatar, Mongolia

David Warburton, Keck School of Medicine, University of Southern California, USA; Ostrow School of Dentistry, University of Southern California, USA

 Professor of Pediatrics, Surgery and Craniofacial Biology
    Director, Developmental Biology and Regenerative Medicine Program

Director, FIC, NIEHS Center for Global Pollution Health Impact Across the Lifespan

Director NHLBI LungMAP Center

Director Department of the Army Device Development Center
Saban Research Institute, Children’s Hospital Los Angeles
Keck School of Medicine and Ostrow School of  Dentistry
University of Southern California

References

Zhang Z, Chen M, Yu Y, Pan S, Liu Y. Antimicrobial susceptibility among gram-positive and gram-negative blood-borne pathogens collected between 2012-2016 as part of the Tigecycline Evaluation and Surveillance Trial. Antimicrob Resist Infect Control. 2018 Dec 13;7:152. doi: 10.1186/s13756-018-0441-y. eCollection 2018

Bhatia R. Universal health coverage framework to combat antimicrobial resistance. Indian J Med Res 2018;147:228-32

Versporten A, Zarb P, Caniaux I, Gros MF, Drapier N, Miller M, Global-PPS network. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey. Lancet Glob Health. 2018 Jun;6(6):e619-e629

Zhang J, Zhao C, Chen H, Li H, Wang Q, Zhang F et al. A multicenter epidemiology study on the risk factors and clinical outcomes of nosocomial intra-abdominal infections in China: results from the Chinese Antimicrobial Resistance Surveillance of Nosocomial Infections (CARES) 2007-2016.Infect Drug Resist. 2018 Nov 15;11:2311-2319.

Singh P. One Health approach to tackle antimicrobial resistance in South East Asia. BMJ 2017;358:j3625

Central Asian and Eastern European Surveillance of Antimicrobial Resistance. Annual report 2018. http://www.euro.who.int/__data/assets/pdf_file/0007/386161/52238-WHO-CAESAR-AR-2018_low_V9_web.pdf?ua=1

Antimicrobial resistance: global report on surveillance. Geneva: World Health Organization; 2014. http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf

Logan LK, Weinstein RA. The epidemiology of carbapenem-resistant enterobacteriaceae: the impact and evolution of a global menace. J Infect Dis. 2017; 15(215):S28-S36. doi 10.1093/infdis/jiw282.

Park S, Park JY, Song Y, How SH, Jung KS, Respiratory Infections Assembly of the APSR. Emerging respiratory infections threatening public health in the Asia-Pacific region: a position paoer of the Asian Pacific Society of Respirology. Respirology. 2019; 15. doi: 10.1111/resp.13558 [Epub ahead of print]

Lee Y, Wakabayashi M. Key informant interview on antimicrobial resistance (AMR) in some countries in the Western Pacific region. Global Health. 2013 Jul 26;9:34. doi: 10.1186/1744-8603-9-34.

WPRO. Antibiotic awareness week campaign 2017. https://sites.wpro.who.int/antibiotic_awareness/?page_id=1346

National Statistics Office of Mongolia. Social and economic situation of Mongolia (as of October 2018). http://www.en.nso.mn/content/293

UNICEF Multiple Indicative Cluster Surveys, Mongolia. http://mics.unicef.org/surveys

Ayukekbong JA, Ntemgwa M, Atabe AN.The threat of antimicrobial resistance in developing countries: causes and control strategies. Antimicrob Resist Infect Control. 2017 May 15;6:47. doi: 10.1186/s13756-017-0208-x. eCollection 2017.

Gendenjamts’s National Center for Maternal and Child’s Health, Dr. Enkhtur Shonkhuuz, MD, PhD, Clinical Director. Annual Surveillance and Health Provision Data NCMCH, 2017.

CLSI Performance Standards for Antimicrobial Susceptibility Testing. 26th ed. CLSI supplement M100S. Wayne PA. Clinical and Laboratory Standards Institute, 2016.

CLSI. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Third Informational Supplement. CLSI document M100-S23. Wayne, PA: Clinical and Laboratory Standards Institute; 2013.

CLSI. Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data; Approved Guideline—Fourth Edition. CLSI document M39-A4. Wayne, PA: Clinical and Laboratory Standards Institute; 2014.

Exner M, Bhattacharya S, Christiansen B, Gebel J, Goroncy-Bermes P, Hartemann P, et al. Antibiotic resistance: What is so special about multidrug-resistant Gram-negative bacteria? Consensus statement. GMS Hyg Infect Control. 2017 Apr 10;12:Doc05. doi: 10.3205/dgkh000290. eCollection 2017.

Lob SH, Biedenbach DJ, Badal RE, Kazmierczak KM, Sahm DF. Discrepancy between genotypic and phenotypic extended-spectrum β-lactamase rates in Escherichia coli from intra-abdominal infections in the USA. J Med Microbiol. 2016 Sep;65(9):905-9

Munkhdelger Y, Gunregjav N, Dorjpurev A, Juniichiro N, Sarantuya J. Detection of virulence genes, phylogenetic group and antibiotic resistance of uropathogenic Escherichia coli in Mongolia. J Infect Dev Ctries. 2017 Jan 30;11(1):51-57

Kao CY, Udval U, Wu HM, Bolormaa E, Yan JJ, Khosbayar T et al. First characterization of fluoroquinolone resistance mechanisms in CTX-M-producing Escherichia coli from Mongolia. Infect Genet Evol. 2016 Mar;38:79-81

Rello J, Kalwaje Eshwara V, Lagunes L, Alves J, Wunderink RG, Conway-Morris A, et al. A global priority list of the TOp TEn resistant Microorganisms (TOTEM) study at intensive care: a prioritization exercise based on multi-criteria decision analysis. Eur J Clin Microbiol Infect Dis. 2018 Nov 13. doi: 10.1007/s10096-018-3428-y. [Epub ahead of print]

Balain M, Oddie SJ, McGuire W.Antimicrobial-impregnated central venous catheters for prevention of catheter-related bloodstream infection in newborn infants. Cochrane Database Syst Rev. 2015 Sep 27;(9):CD011078.

Mendsaikhan N, Begzjav T, Lundeg G, Brunauer A, Dünser MW. A Nationwide Census of ICU Capacity and Admissions in Mongolia. PLoS One. 2016; Aug 17;11(8):e0160921

Viderman D, Brotfain E, Khamzina Y, Kapanova G, Zhumadilov A, Poddighe D et al. Bacterial Resistance in the Intensive Care Unit of developing countries: report from a tertiary hospital in Kazakhstan. J Glob Antimicrob Resist. 2018 Nov 15. pii: S2213-7165(18)30226-1.[Epub ahead of print]

Seale AC, Gordon NC, Islam J, Peacock SJ, Scott JAG. AMR Surveillance in low and middle-income settings - A roadmap for participation in the Global Antimicrobial Surveillance System (GLASS). Wellcome Open Res. 2017 Sep 26;2:92. doi: 10.12688/wellcomeopenres.12527.1. eCollection 2017.

Global antimicrobial resistance surveillance system (GLASS) report. Early implementation 2016-2017. World Health Organization. Jan. 2018. ISBN: 978-92-4-151344-9

Worldwide Country situation analysis - response to antimicrobial resistance. WHO. http://apps.who.int/iris/bitstream/handle/10665/163468/9789241564946_eng.pdf?sequence=1

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