ARGUS
Study title: Antimicrobial Resistance in Gram-negative bacteria from Urinary Specimens: a study of prevalence, risk factors and molecular mechanisms of resistance
Lead Researcher(s):
Funder(s): Wellcome Trust
Partner(s): Harare City Health
Background:
Antimicrobial resistance (AMR) is a global problem affecting all countries irrespective of income and geographical location and has been highlighted by the World Health Organization as one of the three most important public health threats of the 21st century. Infections due to antimicrobial-resistant organisms are associated with increased mortality and risk of onward transmission, particularly in low-income settings where alternative antibiotics are not readily available and pose an immense burden on weak health systems.
Data from low-resource settings on the prevalence of resistance are scarce because of limited laboratory capacity and access to diagnostics. Further, some individuals, such as people living with HIV, might be at increased risk of infections with antimicrobial-resistant organisms. Urinary tract infections are the most common infections caused by Gram negative bacilli and resistance patterns among patients with urinary tract infections can reflect the community burden of resistance with the added advantage that samples are easy to obtain and process.
Study aim(s)
To determine the prevalence of AMR in key Gram-negative pathogens causing urinary tract infections, to assess other causes that lead to symptoms suggestive of urinary tract infections, and to evaluate simplified phenotypic laboratory methods.
Study design
We conducted a prospective cohort study to investigate the prevalence of AMR among adult outpatients presenting with symptoms of urinary tract infections to primary care clinics in Harare and their treatment outcomes.
In a nested cross-sectional sub-study we investigated the performance of simplified culturing methods (using InTray and Compact Dry) that may have the potential of expanding laboratory testing in limited-capacity settings. We also evaluated the prevalence of sexually transmitted infections among outpatients presenting with symptoms of urinary tract infection.
Additionally, we conducted a survey among health care workers from outpatient clinics to explore their knowledge, attitudes, and practices relating to AMR and antibiotic use.
Duration
June 2019 - April 2022
Publications:
Olaru ID, Ferrand RA, Yeung S et al. Knowledge, attitudes and practices relating to antibiotic use and resistance among prescribers from public primary healthcare facilities in Harare, Zimbabwe [version 1; peer review: awaiting peer review]. Wellcome Open Res 2021, 6:72; doi.org/10.12688/wellcomeopenres.16657.1
Olaru ID, Chisenga M, Yeung S et al. Clinical and bacteriological outcomes in patients with urinary tract infections presenting to primary care in Harare, Zimbabwe: a cohort study [version 1; peer review: 1 approved with reservations]. Wellcome Open Res 2021, 6:135 (https://doi.org/10.12688/wellcomeopenres.16789.
Olaru ID, Chisenga M, Yeung S, Mabey D, Marks M, Chonzi P, Masunda KP, Machiha A, Ferrand RA, Kranzer K. Sexually transmitted infections and prior antibiotic use as important causes for negative urine cultures among adults presenting with urinary tract infection symptoms to primary care clinics in Zimbabwe: a cross-sectional study. BMJ Open. 2021 Aug 11;11(8):e050407.
Olaru ID, Elamin W, Chisenga M, Malou N, Piton J, Yeung S, Ferrand RA, Hopkins H, Chonzi P, Masunda KPE, Manangazira P, Ferreyra C, Kranzer K. Evaluation of the InTray and Compact Dry culture systems for the diagnosis of urinary tract infections in patients presenting to primary health clinics in Harare, Zimbabwe. Eur J Clin Microbiol Infect Dis. 2021 Jul 22.
Olaru ID, Ferrand RA, Chisenga M, Yeung S, Macrae B, Chonzi P, Stabler RA, Hopkins H, Mabey D, Masunda KPE, Kranzer K. Prevalence of ESBL-producing Escherichia coli in adults with and without HIV presenting with urinary tract infections to primary care clinics in Zimbabwe. JAC Antimicrob Resist. 2021 Jun 30;3(2):dlab082.
Olaru ID, Tacconelli E, Yeung S, Ferrand RA, Stabler RA, Hopkins H, Aiken AM, Kranzer K. The association between antimicrobial resistance and HIV infection: a systematic review and meta-analysis. Clin Microbiol Infect. 2021 Apr 1:S1198-743X(21)00161-0. doi: 10.1016/j.cmi.2021.03.026.
Olaru ID, Yeung S, Ferrand RA, Stabler R, Chonzi P, Mabey D, Hopkins H, Bradley J, Masunda KPE, Munyati, S, Kranzer K. Antimicrobial Resistance in Gram-negative bacteria from Urinary Specimens: a study of prevalence, risk factors and molecular mechanisms of resistance (ARGUS) in Zimbabwe - a study protocol. Wellcome Open Res, 2020 Jun 12;5:140.