Poster Presentation Australian Society for Microbiology Annual Scientific Meeting 2022

ESBL and MRSA carriage rates in Timor-Leste: a hospital based surveillance study. (#156)

Sarah Lynar 1 2 , Jessie C Spargo 1 , Adriano Vieira 1 , Tessa Oakley 3 , Benjamin Dingle 1 , Guilherme D.S Ximenes Soares 1 , Karen Champlin 1 , Dirce Moreira Freitas 1 , Aurora Da Silva Fernandes 1 , Natalina Dos Santos Mendonca 1 , Virginia Da Conceicao 1 , Carolina Maia 3 , Messias Soares 1 , Joana Correia Belo 1 , Endang Da Silva 3 , Antonio Salles de Sousa 1 , Jennifer Yan 1 , Ian Marr 1 3 , Joshua R Francis 1 2
  1. Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
  2. Royal Darwin Hospital, Darwin, NT, Australia
  3. National Health Laboratory, Hospital Nacional Guido Valadares (HNGV), Dili, Timor-Leste

Background

Southeast Asia is recognised as an important region in the emergence and spread of anti-microbial resistance (AMR) globally. Timor-Leste’s National Action Plan on AMR called for enhanced surveillance of WHO GLASS organisms to develop safe and coordinated approaches to antibiotic use throughout human and animal health sectors of Timor-Leste.

Methods

We undertook the first multi-site, structured active surveillance of multi-drug resistant organisms in Timor-Leste. This study focused on the carriage of GLASS priority pathogens; Acinetobacter spp., Escherichia. coli, Klebsiella pneumoniae and Staphylococcus aureus. The primary objective of the study was to determine the frequency of MRSA and ESBL carriage in Timor-Leste hospitals. We enrolled a cross-section of children and adults in 6 Timor-Leste hospitals, sampling from a) nose/axilla/groin and b) perianal/stool. All swabs were processed in Timor-Leste and contributed to laboratory capacity building for AMR surveillance in country. 

Results

Of the 517 participants, 70% were outpatients and 30% inpatients. All undertook a nose/axilla/groin swab and 58.6% undertook a perianal/stool swab. Preliminary laboratory results showed 59 participants grew Staph. aureus, of which 5 (8.5%) were carrying MRSA. 187 participants grew either E. coli, K. pneumoniae or both, of which 108 (57.7%) participants carried an ESBL. Rates of ESBL carriage differed between the capital Dili (95.2%) and other regional sites (53.0%) (p<0.001). Of the participants who isolated E.coli, 90 (52.6%) and 67 (39.2%) carried Ciprofloxacin and Gentamycin resistant E.coli respectively. Of the 47 participants who grew K. pneumoniae 40 (85.1%) carried ESBL, 38 (80.9%) and 28 (59.6%) were Ciprofloxacin and Gentamycin resistant respectively.

Conclusion

This study builds on emerging understanding of the epidemiology of AMR in Timor-Leste1,2, and is the first study of its kind to assess AMR carriage in humans outside the capital Dili.

  1. Francis et al., (2020). Antimicrobial resistance and antibiotic use in Timor-Leste: building surveillance capacity with a One Health approach. Communicable Diseases Intelligence, Volume 44. https://doi.org/10.33321/cdi.2020.44.1
  2. Marr et al., (2018). Antimicrobial resistance in urine and skin isolates in Timor-Leste. Journal of Global Antimicrobial Resistance 13: 135-138.