Epidemiology and prevalence of extended-spectrum ß-lactamase- and carbapenemase-producing Enterobacteriaceae in humans, animals and environments in West and Central Africa.

Abstract Extended-spectrum s-lactamase-producing Enterobacteriaceae (ESBL-PE) and carbapenemase-producing Enterobacteriaceae (CPE) are widespread. Here, we used the “One Health” approach to determine the knowledge gaps on ESBL-PE and CPE in West and Central Africa. We searched all articles on ESBL-PE and CPE in these African regions published in PubMed, African Journals Online, and Google Scholar from 2000 onwards. Among the 1201 articles retrieved, we selected 168 studies (West Africa n=121, and Central Africa n=47) with data from 22 of the 26 West and Central Africa countries. Concerning the settings, 137 articles focused only on humans (carriage and/or infection), 6 articles on humans and animals, 12 on animals, 8 on humans and environments, one on environments, and one on humans, animals and environments. ESBL-PE prevalence ranged from 11% to 72% in humans, and from 7% to 79% in aquatic environments (wastewater). In animals, ESBL-PE prevalence hugely varied: 0% in cattle, 11-36% in chickens, 20% in rats, 21-71% in pigs, and 32-75% in dogs. The blaCTX-M-15 gene was the predominant ESBL-encoding gene and was associated with plasmids of the incompatibility groups F, H, K, Y, N, I1 and R. CPE were studied only in humans. Class B metallo-s-lactamases (NDM) and class D oxacillinases (OXA-48 and OXA-181) were the most common carbapenemases. Our results show major knowledge gaps, particularly on ESBL and CPE in animals and environments, that might limit antimicrobial resistance management in these regions. They also emphasize the urgent need to improve active surveillance programs in each country and to support antimicrobial stewardship.