Introduction: Data on antimicrobial resistance (AMR) are sparse across numerous African
countries, as microbiological analyses are not routinely conducted and surveillance data are not
collected. Accordingly, clinical samples are not routinely tested for carbapenem-resistant bacteria and, therefore, the general understanding of their prevalence in the region remains limited.
Methods: Between January 2020 and June 2022, we collected extended spectrum β-lactamase (ESBL)-
producing Enterobacterales (ESBL-PE) isolates from five hospitals in Burkina Faso. After an initial
culture on ESBL-selective media, the species were identified using API20E and isolates were tested
against 13 antimicrobial agents using the disc diffusion method on Mueller–Hinton (MH) agar. ESBL
production was confirmed via a double-disc synergy test. Production of carbapenemases and AmpCβ-lactamases and phenotypic co-resistance were determined. Results: Among the 473 ESBL-PE,
356 were ESBL-E. coli (ESBL-Ec) and 117 were Klebsiella spp. (ESBL-K). Of these isolates, 5.3% were
carbapenemase and 5.3% were AmpC-β-lactamase-positive. Three types of carbapenemases were
identified: 19 NDM, 3 OXA-48-like and 1 VIM. Two isolates produced both NDM and OXA-48-like
carbapenemases. Carbapenemase producers were detected at all levels of healthcare. Co-resistance
rates were up to 85% for aminoglycosides, 90% for sulfonamides, 95% for fluoroquinolones and 25%
for chloramphenicol. Fosfomycin resistance was 6% for ESBL-Ec and 49% for ESBL-K (49%). Conclusions: Some of the ESBL-Ec and ESBL-K co-produced carbapenemases and/or AmpC-β-lactamases at all healthcare levels and in various sample types with high co-resistance rates to non-betalactams. Carbapenem resistance is no longer rare, calling for testing in routine diagnostics, a comprehensive resistance surveillance system and infection control within healthcare.

epub.

carbapenamases AmpC-Beta E. coli ESBL