Antibiotics resistance in El Tor Vibrio cholerae 01 isolated during cholera outbreaks in Mozambique from 2012 to 2015.

Mozambique has recorded cyclically epidemic outbreaks of cholera. Antibiotic therapy is recommended in specific situations for management and control of cholera outbreaks. However, an increase in resistance rates to antibiotics by Vibrio cholerae has been reported in several epidemic outbreaks worldwide. On the other hand, there are few recent records of continuous surveillance of antibiotics susceptibility pattern of V. cholerae in Mozambique.The purpose of this study was to evaluate antibiotics resistance pattern of Vibrio cholerae O1 Ogawa isolated during Cholera outbreaks in Mozambique to commonly used antibiotics.We analyzed data from samples received in the context of surveillance and response to Cholera outbreaks in the National Reference Laboratory of Microbiology from the National Institute of Health of Mozambique, 159 samples suspected of cholera from cholera treatment centers of, Metangula (09), Memba (01), Tete City (08), Moatize (01), Morrumbala (01) districts, City of Quelimane (01), Lichinga (06) and Nampula (86) districts, from 2012 to 2015. Laboratory culture and standard biochemical tests were employed to isolate and identify Vibrio cholerae; serotypes were determined by antisera agglutination reaction in blade. Biotype and presence of important virulence factors analysis was done by PCR. Antibiotics susceptibility pattern was detected by disk diffusion method Kirby Bauer. Antibiotic susceptibility and results were interpreted by following as per recommendations of CLSI (Clinical and Laboratory Standards Institute) 2014. All samples were collected and tested in the context of Africhol Project, approved by the National Bioethics Committee for Health.Among isolates from of Vibrio cholerae O1 El Tor Ogawa resistance to Sulphamethoxazole-trimethropim was 100% (53/53) to Trimethoprim-, being 100% (54/54) for Ampicillin, 99% (72/74) for Nalidixic Acid, 97% (64/66) to Chloramphenicol, 95% (42/44) for Nitrofurantoin and (19/20) Cotrimoxazole, 83% (80/97) Tetracycline, 56% (5/13) Doxycycline, 56% (39/70) Azithromycin and 0% (0/101) for Ciprofloxacin. PCR analysis suggested strains of V. cholerae O1 being descendants of the current seventh pandemic V. cholerae O1 CIRS 101 hybrid variant. The V. cholerae O1 currently causing cholera epidemics in north and central Mozambique confirmed a CTXΦ genotype and a molecular arrangement similar to the V. cholerae O1 CIRS 101.Although V. cholerae infections in Mozambique are generally not treated with antibiotics circulating strains of the bacteria showed high frequency of in vitro resistance to available antibiotics. Continuous monitoring of antibiotic resistance pattern of epidemic strains is therefore crucial since the appearance of antibiotic resistance can influence cholera control strategies

CTX ϕ cluster analysis of <i>Vibrio cholerae</i> O1 El Tor Ogawa isolated during cholera outbreaks in Mozambique from 2012 to 2015.

<p>Showing a classic signature of <i>Vibrio cholerae</i> O1 El Tor variants B33 and CIRS 101. AMP- Ampicillin; TE-Tetracycline; NA- Nalidixic Acid; C-Chloramphenicol; CIP-Ciprofloxacin; SXT- Sulphamethoxazol-trimethropim; F- Nitrofurantoin; AZM- Azithromycin; rstR, ctxB and tcpA- <i>Vibrio cholerae</i> virulence genes; TLC-RS1, CORE-RTX and TCL-RS2—primers for the presence of CTX ϕ on chromosome 1; Chr II—Chromosome 2.</p

AST per district and per year, for <i>V</i>. <i>cholerae</i> O1 El Tor Ogawa isolated during cholera outbreaks in Mozambique from 2012 to 2015.

<p>In 2012 (Cuamba district in Niassa province and Montepuez <i>district</i> in Cabo Delgado province), 2013 (Cuamba district in Niassa province, Pemba city and Montepuez <i>districts</i> in Cabo Delgado province, Nampula city <i>district</i> in Nampula province and Alto-Molócue <i>district</i> in Zambezia province), 2014 (Nampula city <i>district</i> in Nampula province), 2015 (Lichinga city, Lago and Cuamba <i>districts</i> in Niassa province, Nampula city <i>district</i> in Nampula province and Morrumbala and Quelimane city <i>districts</i> in Zambézia province, Tete city and Moatize <i>districts</i> in Tete province, Beira city <i>district</i> in Sofala province and Matola city <i>district</i> in Maputo province). AMP- Ampicillin; TE-Tetracycline; NA- Nalidixic Acid; C-Chloramphenicol; CIP-Ciprofloxacin; SXT- Sulphamethoxazol-trimethropim; F- Nitrofurantoin; AZM- Azithromycin; rstR, ctxB and tcpA- <i>Vibrio cholerae</i> virulence genes; TLC-RS1, CORE-RTX and TCL-RS2—primers for the presence of CTX ϕ on chromosome 1; Chr II—Chromosome 2</p