Faecal carriage of multi-drug resistant Enterobacteriaceae in hospitalized children at University Teaching Hospital Sylvanus Olympio of Lomé, Togo

Background: High prevalence of infections and associated antibiotherapy may put children at increased risk for development of multidrug-resistance (MDR), mostly to bacterial infections. The objective of this study therefore was to determine the prevalence of gastrointestinal carriage of MDR Enterobacteriaceae among hospitalized children in the Paediatric department of Sylvanus Olympio University Hospital, Lomé, Togo.Methodology: A descriptive cross-sectional study was carried out on randomly selected hospitalized children in the Paediatric wards of the hospital from November 03 to November 10, 2020, after obtaining informed consent from their parents/guardians. Rectal swabs and stool samples were collected from each participant and cultured for isolation of members of the family Enterobacteriaceae on Hektoen enteric agar containing 4 µg/L cefotaxime, which was incubated aerobically at 37oC for 24 hours. The isolates were identified using in-house biochemical tests. Antibiotic susceptibility test (AST) of each isolate to a panel of antibiotics including ertapenem and imipenem was done by the disc diffusion method and interpreted according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoints version 2020 V.1.1. ESBL production was detected by the double-disc synergy test of amoxicillin and clavulanic acid, and resistance to carbapenem was inferred by resistance to ertapenem and imipenem discs in the AST. Multi-drug resistance (MDR) was defined as resistance to at least three families of antibiotics. Statistical analysis of data was carried out on Excel 2010 and EPI INFO 7.2 and p value < 0.05 was considered to be statistical significance. Results: A total of 70 hospitalized children during the study period were randomly recruited with an average age of 4 years 3 days and a range of 1 day to 18 years. The male gender was predominant (54.3%) with a M: F ratio of 1.2. Samples were culture positive in 85.7% (60/70) and a total of 72 species of Enterobacteriaceae were isolated in 93.3% (56/60) of these cultures. Escherichia coli was the most frequently isolated species(56.9%, 41/72). More than 90% (65/72) of the isolates were resistant to ampicillin, 58.3% (42/72) to third generation cephalosporins, 59.7% (43/72) to fourth generation cephalosporins, 43% (31/72) to aminoglycosides, 55.6% (40/72) were multi-drug resistant, 48.6% (35/72) were ESBL-producing strains, and 6.9% (5/72) were carbapenem resistant. Eighty-three percent (29/35) of ESBL-producing and all the carbapenem resistant isolates (5/5) were recovered from children on antibiotic therapy. The prevalence of ESBL-producing phenotypes among culture-positive children on antibiotic treatment (72.5%, 29/40) was significantly higher than among culture-positive children not on antibiotic treatment (20.0%, 4/20), indicating that antibiotic therapy was significantly associated with carriage of MDR isolates (OR=10.545, 95% CI=2.882-38.590, p=0.0002). Conclusion: The high faecal carriage rate of MDR Enterobacteriaceae, which are all ESBL-producing strains, in this study is worrying. There is urgent need to develop measures to monitor and limit the spread of these MDR organisms in children and the community in Togo

Assessment of the performance of six in vitro diagnostic kits for qualitative detection of hepatitis B virus surface antigen (HBsAg) in human serum or plasma in Lomé, Togo

Background: Several in vitro diagnostic (IVD) test kits for hepatitis B surface antigen (HBsAg) are commercially available. The question is whether they are performing well for both screening and diagnosis or not? Thus, this study aimed to evaluate the performance of six commercially available HBsAg detection kits in Togo. Methods: This study was conducted at the National Reference Center for HIV/STI testing in Lomé (CNR-VIH/IST), Togo. Reference sera used for the assessment were collected from blood donors and patients with history of hepatitis B viral (HBV) infection between 2008 and 2014, and includes 200 non-reactive HBsAg and 150 reactive HBsAg sera that were confirmed with a reference method which consisted of the combination of an ELISA, a RDT, and a molecular test. Four ELISA kits (EKOlab ELISA-HBsAg; HEPALISA ULTRA; HEPALISA; Murex AgHBs Version 3) and two RDTs kits (ACON AgHBs and OnSite HBsAg Rapid Test-Cassette) were then evaluated using these serum samples. The EPI-INFO software version 7.2 was used to determine the 95% confidence interval and performed statistical analysis. Results: Reference serum samples were collected from the population with 65.0% under 40 years of age and 61.2% males. The sensitivity of the 4 ELISA tests compared to the reference method was 100%. Apart from the HEPALISA test with a specificity of 100.0%, the specificity of the other three ELISA tests (Murex HBsAg version 3, HEPALISA ULTRA and EKOlab ELISA-HBsAg) were 98.4%, 97.3% and 91.8% respectively. For the RDTs, the sensitivity of ACON HBsAg and OnSite HBsAg Rapid Test-Cassette was 70.0% and 95.6% respectively while the specificity was 100.0% for both. Conclusion: The ELISA tests evaluated were more sensitive than the RDTs, and HEPALISA test was the most efficient. Of the two RDTs, the OnSite HBsAg Rapid Test-Cassette was more sensitive. Our findings highlight the need for onsite verification of in vitro diagnostic kits for qualitative detection of hepatitis B surface antigen before their routine use in Togo. Keywords: HBV, HBsAg, Performance, IVD tes

High faecal carriage of extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-PE) among hospitalized patients at Sylvanus Olympio Teaching Hospital, Lomé, Togo in 2019

Background: Extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-PE) are a global health concern, associated with increased morbidity and mortality. Even in the absence of infections, colonization by these pathogens is still a great threat because of the risk of cross transfer among hospitalized patients. Faecal carriage of ESBL-PE remained poorly documented in Africa. This study aimed to determine faecal carriage rate of ESBL-PE, factors associated with carriage, and antimicrobial susceptibility of the strains among hospitalized patients at Sylvanus Olympio Teaching Hospitals (CHU SO) in Lomé, Togo. Methodology: This was a cross-sectional study of 105 randomly selected hospitalized patients between September and November 2019. Socio-demographic and clinical data as well as rectal swabs were collected after obtaining the consent of the selected participants. Rectal swabs were cultured on selective bromocresol purple (BCP) lactose agar containing 6µg/l ceftazidime, for isolation of Enterobacteriaceae. Identification of each isolate was performed using Uriselect 4 medium and API 20E. Antibiotic susceptibility of the bacterial isolates was performed by the Bauer-Kirby agar disc diffusion test and interpreted according to CASFM-EUCAST recommendations. Results: The faecal carriage rate of ESBL-PE among selected hospitalized patients was 80.9% (85/105). Escherichia coli was the most frequent bacteria 69.5% (73/105), followed by Klebsiella pneumoniae 22.8% (24/105). The antibiotic profile of ESBL producing Escherichia coli showed resistance to amoxycillin+clavulanic acid (72.6%), ticarcillin+clavulanic acid (82.2%), piperacillin+tazobactam (30.1%), cefoxitin (30.1%) ciprofloxacin (84.9%), levofloxacin (76.7%), nalidixic acid (83.6%), chloramphenicol (26.0%), gentamicin (49.3%), sulfamethoxazole-trimethoprim (86.3%), imipenem (5.5%), and ertapenem (21.9%). All (100%) isolates were sensitive to amikacin and fosfomycin. None of the characteristics or risk factors assessed was significantly associated with faecal carriage of ESBL-PE. Conclusion: Faecal carriage rate of ESBL-PE in these hospitalized patients was very high, but no factor was associated with carriage of ESBL-PE among the study population. Implementation of infection control measures, and surveillance are needed to limit the spread of these resistant pathogens within CHU SO healthcare facilities

Hepatitis B infection in HIV-1-infected patients receiving highly active antiretroviral therapy in Lomé, Togo: Prevalence and molecular consequences

Background. No data are available on HIV/hepatitis B virus (HBV) or hepatitis C virus coinfection in Togo, and patients are not routinely tested for HBV infection.Objectives. To determine the prevalence of HBV and the risk of HBV drug resistance during antiretroviral treatment in HIV-coinfected patients in Togo.Method. This cross-sectional study was carried out in Lomé, Togo, from January 2010 to December 2011 among HIV-infected patients who had been on antiretroviral therapy (ART) for at least 6 months.Results. In total, 1 212 patients (74.9% female) living with HIV/AIDS and treated with ART were included in the study. The seroprevalence of hepatitis B surface antigen (HBsAg) was 9.7% (117/1 212; 95% confidence interval (CI) 8.04 - 11.45). Of these 117 HBsAg-positive patients, 16 (13.7%) were hepatitis B e antigen (HBeAg)-positive, and 115 (98.3%) were on lamivudine. The HBV DNA load was >10 IU/ mL in 33/117 patients overall (38%), and in 87.5% of 16 HBeAg positive patients (p<0.0001). In multivariate analysis, factors associated with HBV DNA load >10 IU/mL were HBeAg positivity (adjusted odds ratio (aOR) 6.4; p=0.001) and a higher level of education (aOR 6.5; p=0.026). The prevalence of HBV resistance to lamivudine was 13.0% (15/115; 95% CI 7.0 - 19.0). The detected resistance mutations were rtL180M (14/15 patients) and rtM204V/I (15/15).Conclusion. The seroprevalence of HBV among ART-treated HIV-infected patients in Togo was 9.7%. The prevalence of HBV lamivudine resistance mutations after 2 years of ART was 13.0%. These results suggest that HBV screening before ART initiation can be based on HBsAg testing

High prevalence of HIV-1 drug resistance among patients on first-line antiretroviral treatment in Lomé, Togo

<p>Abstract</p> <p>Background</p> <p>With widespread use of antiretroviral (ARV) drugs in Africa, one of the major potential challenges is the risk of emergence of ARV drug-resistant HIV strains. Our objective is to evaluate the virological failure and genotypic drug-resistance mutations in patients receiving first-line highly active antiretroviral therapy (HAART) in routine clinics that use the World Health Organization public health approach to monitor antiretroviral treatment (ART) in Togo.</p> <p>Methods</p> <p>Patients on HAART for one year (10-14 months) were enrolled between April and October 2008 at three sites in Lomé, the capital city of Togo. Plasma viral load was measured with the NucliSENS EasyQ HIV-1 assay (Biomérieux, Lyon, France) and/or a Generic viral load assay (Biocentric, Bandol, France). Genotypic drug-resistance testing was performed with an inhouse assay on plasma samples from patients with viral loads of more than 1000 copies/ml. CD4 cell counts and demographic data were also obtained from medical records.</p> <p>Results</p> <p>A total of 188 patients receiving first-line antiretroviral treatment were enrolled, and 58 (30.8%) of them experienced virologic failure. Drug-resistance mutations were present in 46 patients, corresponding to 24.5% of all patients enrolled in the study. All 46 patients were resistant to non-nucleoside reverse-transcriptase inhibitors (NNRTIs): of these, 12 were resistant only to NNRTIs, 25 to NNRTIs and lamivudine/emtricitabine, and eight to all three drugs of their ARV regimes. Importantly, eight patients were already predicted to be resistant to etravirine, the new NNRTI, and three patients harboured the K65R mutation, inducing major resistance to tenofovir.</p> <p>Conclusions</p> <p>In Togo, efforts to provide access to ARV therapy for infected persons have increased since 2003, and scaling up of ART started in 2007. The high number of resistant strains observed in Togo shows clearly that the emergence of HIV drug resistance is of increasing concern in countries where ART is now widely used, and can compromise the long-term success of first- and second-line ART.</p

HIV prevalence and risk behaviors among female sex workers in Togo in 2017: a cross-sectional national study

BACKGROUND: The HIV epidemic remains an important public health challenge for the sub-Saharan region. Female Sex Workers (FSW) in this region are among the most vulnerable of the key population groups with HIV prevalence as high as twice that of the general population. The aim of this study was to estimate HIV prevalence and explore sexual risk behaviors among FSW in Togo. METHODS: A cross-sectional study using a Respondent Driven Sampling method was conducted across the six regions of country among FSW in 2017. A comprehensive questionnaire was used to explore socio-demographic characteristics, sexual history, HIV knowledge, and sexual behaviors. HIV rapid tests were used to assess HIV infection. RESULTS: A total of 1,036 FSW, with a median age of 26 years old [interquartile range (IQR): 22-33], participated in the study, with 49.2% (n = 510) of them having reached secondary school. Median age at first sexual intercourse was 20 years old [IQR: 17-25] and estimated number of clients per week was of 5 [IQR: 3-10]. A total of 936 (95.6%) reported the use of a condom during last sexual intercourse with a client and 493 (47.6%) reported the use of a condom during their last sexual intercourse with a partner or husband. HIV prevalence was 13.2% [95% CI: 11.2 - 15.4], and was associated with age (being between 26 and 32 years old; aOR = 4.5; 95% CI: [2.4 - 9.1], p < 0.0001) and ≥ 33 years old; aOR = 6.4; 95% CI [3.5 - 12.7], p < 0.0001), education level (being in primary school or less; aOR = 1.7; 95% CI: [1.1-2.6]; p = 0.012) and the number of partners per week (more than 2 and 3 partners; aOR = 2.5; 95% CI [1.2-5.2]; p = 0.014). CONCLUSIONS: HIV prevalence and sexual risk behaviors remain high among FSW in Togo, despite prevention efforts aimed at curbing this trend. Other factors, such as access and availability of condoms, the social and legal environment in which FSW operate, should be considered for HIV prevention strategies in this population

Hepatitis B infection in HIV-1-infected patients receiving highly active antiretroviral therapy in Lomé, Togo: Prevalence and molecular consequences

Background. No data are available on HIV/hepatitis B virus (HBV) or hepatitis C virus coinfection in Togo, and patients are not routinely tested for HBV infection.Objective. To determine the prevalence of HBV and the risk of HBV drug resistance during antiretroviral treatment in HIV-coinfected patients in Togo.Method. This cross-sectional study was carried out in Lomé, Togo, from January 2010 to December 2011 among HIV-infected patients who had been on antiretroviral therapy (ART) for at least 6 months.Results. In total, 1 212 patients (74.9% female) living with HIV/AIDS and treated with ART were included in the study. The seroprevalence of hepatitis B surface antigen (HBsAg) was 9.7% (117/1 212; 95% confidence interval (CI) 8.04 - 11.45). Of these 117 HBsAg-positive patients, 16 (13.7%) were hepatitis B e-antigen (HBeAg)-positive, and 115 (98.3%) were on lamivudine. The HBV DNA load was &gt;10 IU/mL in 33/117 patients overall (38%), and in 87.5% of 16 HBeAg-positive patients (p&lt;0.0001). In multivariate analysis, factors associated with HBV DNA load &gt;10 IU/mLwere HBeAg positivity (adjusted odds ratio (aOR) 6.4; p=0.001) and a higher level of education (aOR 6.5; p=0.026). The prevalence of HBV resistance to lamivudine was 13.0% (15/115; 95% CI 7.0 - 19.0). The detected resistance mutations were rtL180M (14/15 patients) and rtM204V/I (15/15).Conclusion. The seroprevalence of HBV among ART-treated HIV-infected patients in Togo was 9.7%. The prevalence of HBV lamivudine resistance mutations after 2 years of ART was 13.0%. These results suggest that HBV screening before ART initiation can be based on HBsAg testing

Etiology of Pediatric Bacterial Meningitis Pre- and Post-PCV13 Introduction Among Children Under 5 Years Old in Lomé, Togo.

BACKGROUND: Pediatric bacterial meningitis (PBM) causes severe morbidity and mortality within Togo. Thus, as a member of the World Health Organization coordinated Invasive Bacterial Vaccine Preventable Diseases network, Togo conducts surveillance targeting Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae, at a sentinel hospital within the capital city, Lomé, in the southernmost Maritime region. METHODS: Cerebrospinal fluid was collected from children <5 years with suspected PBM admitted to the Sylvanus Olympio Teaching Hospital. Phenotypic detection of pneumococcus, meningococcus, and H. influenzae was confirmed through microbiological techniques. Samples were shipped to the Regional Reference Laboratory to corroborate results by species-specific polymerase chain reaction. RESULTS: Overall, 3644 suspected PBM cases were reported, and 98 cases (2.7%: 98/3644) were confirmed bacterial meningitis. Pneumococcus was responsible for most infections (67.3%: 66/98), followed by H. influenzae (23.5%: 23/98) and meningococcus (9.2%: 9/98). The number of pneumococcal meningitis cases decreased by 88.1% (52/59) postvaccine introduction with 59 cases from July 2010 to June 2014 and 7 cases from July 2014 to June 2016. However, 5 cases caused by nonvaccine serotypes were observed. Fewer PBM cases caused by vaccine serotypes were observed in infants <1 year compared to children 2-5 years. CONCLUSIONS: Routine surveillance showed that PCV13 vaccination is effective in preventing pneumococcal meningitis among children <5 years of age in the Maritime region. This complements the MenAfriVac vaccination against meningococcal serogroup A to prevent meningitis outbreaks in the northern region of Togo. Continued surveillance is vital for estimating the prevalence of PBM, determining vaccine impact, and anticipating epidemics in Togo

PLoS One

OBJECTIVES: This study aimed to describe HIV testing uptake, as well as HIV prevalence and its associated factors among older adults aged ≥50 years in health facilities in Togo. METHODS: A cross-sectional study was carried out from February 2018 to June 2019 among hospitalized older adults aged ≥50 years in tertiary and secondary hospitals in Togo. HIV testing was performed according to the national algorithm. Socio-demographic data and HIV testing history were collected using a standardized questionnaire. RESULTS: A total of 619 patients (43.9% female) of median age 61 years, (IQR: 55-70) were recruited and offered HIV testing. Among them, 25.7% had never previously tested for HIV. In total, 91.6% (567/619) accepted HIV testing while 8.4% (52/619) refused to be tested. Of those who tested, forty patients were HIV positive, yielding a prevalence of 7.1%. Twenty-three patients (57.5%) were newly diagnosed with HIV infection. In multivariable analysis, two factors were associated with HIV infection: living alone (aOR = 5.83; 95%CI = [2.26-14.53]) and being \textbackslashtextless60 years (aOR = 3.12; 95%CI = [1.51-6.66]). CONCLUSION: The majority of older adults in this study accepted testing for HIV and almost three in five HIV positive older adults were newly diagnosed with HIV as a result of this testing. There is an urgent need to integrate older adults into responses to the HIV epidemic and to strengthen targeted prevention care and treatment in this population

BMJ Open

OBJECTIVES: The aim of this study was to estimate alcohol and tobacco use prevalence and their correlates among female sex workers (FSW), men who have sex with men (MSM) and drug users (DU) in Togo. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional bio-behavioural study was conducted among 2115 MSM, FSW and DU in 2017 using a respondent-driven sampling method, in the eight biggest towns of Togo. Selection criteria for the MSM were being male and having had oral or anal intercourse with a man in the previous 12 months; for FSW, being a female and having exchanged sex for money in the previous 12 months; and for DU, consuming heroin, cocaine or hashish for MSM, FSW and DU, respectively. All participants had to be at least 18 years old and residing in the territory for the past 3 months. RESULTS: The prevalence of alcohol consumption, hazardous/harmful consumption and binge drinking was 64.8%, 38.4% and 45.5%, respectively. Current tobacco use was reported by 30.6% of participants and HIV prevalence was estimated at 12.5%. DU were more likely to engage in binge drinking compared with other key populations (adjusted odds ratio (aOR)=2.0; 95% CI 1.4 to 2.8; p=0.001). Participants who were identified as having hazardous/harmful alcohol consumption had almost three times the odds of tobacco consumption than those with no risky consumption (aOR=2.6; 95% CI 2.0 to 3.4; p=0.001). Hazardous/harmful alcohol consumption was three times more likely among participants with severe psychological distress compared with those with no psychological distress (aOR=3.3, 95% CI 2.2 to 5.1; p=0.001). CONCLUSION: Findings from this study demonstrate the need for the integration of mental health and substance abuse reduction interventions into HIV prevention programme, particularly those geared towards key populations