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Background  Antimicrobial resistance (AMR) thwarts the curative power of drugs and is a present-time global problem. We present data on antimicrobial susceptibility and resistance determinants of bacteria the WHO has highlighted as being key antimicrobial resistance concerns in Africa, to strengthen knowledge of AMR patterns in the region.    Methods  Blood, stool, and urine specimens of febrile patients, aged between ≥ 30 days and ≤ 15 years and hospitalized in Burkina Faso, Gabon, Ghana, and Tanzania were cultured from November 2013 to March 2017 (Patients > 15 years were included in Tanzania). Antimicrobial susceptibility testing was performed for all Enterobacterales and  Staphylococcus aureus  isolates using disk diffusion method. Extended-spectrum beta-lactamase (ESBL) production was confirmed by double-disk diffusion test and the detection of  bla  CTX–M ,  bla  TEM  and  bla  SHV . Multilocus sequence typing was conducted for ESBL-producing  Escherichia coli  and  Klebsiella pneumoniae , ciprofloxacin-resistant  Salmonella enterica  and  S. aureus . Ciprofloxacin-resistant  Salmonella enterica  were screened for plasmid-mediated resistance genes and mutations in  gyrA, gyrB, parC, and parE .  S. aureus  isolates were tested for the presence of  mecA  and Panton-Valentine Leukocidin  (PVL)  and further genotyped by  spa  typing.    Results  Among 4,052 specimens from 3,012 patients, 219 cultures were positive of which 88.1% ( n  = 193) were Enterobacterales and 7.3% ( n  = 16)  S. aureus . The prevalence of ESBL-producing Enterobacterales (all CTX-M15 genotype) was 45.2% (14/31; 95% CI: 27.3, 64.0) in Burkina Faso, 25.8% (8/31; 95% CI: 11.9, 44.6) in Gabon, 15.1% (18/119; 95% CI: 9.2, 22.8) in Ghana and 0.0% (0/12; 95% CI: 0.0, 26.5) in Tanzania. ESBL positive non-typhoid  Salmonella  ( n  = 3) were detected in Burkina Faso only and methicillin-resistant  S. aureus  ( n  = 2) were detected in Ghana only. While sequence type (ST)131 predominated among ESBL  E. coli  (39.1%;9/23), STs among ESBL  K. pneumoniae  were highly heterogenous. Ciprofloxacin resistant nt  Salmonella  were commonest in Burkina Faso (50.0%; 6/12) and all harbored  qnrB  genes.  PVL  were found in 81.3%  S. aureus .    Conclusion  Our findings reveal a distinct susceptibility pattern across the various study regions in Africa, with notably high rates of ESBL-producing Enterobacterales and ciprofloxacin-resistant nt  Salmonella  in Burkina Faso. This highlights the need for local AMR surveillance and reporting of resistances to support appropriate action.

frontiers in microbiology

Regional Variation of Extended-Spectrum Beta-Lactamase (ESBL)-Producing Enterobacterales, Fluoroquinolone-Resistant Salmonella enterica and Methicillin-Resistant Staphylococcus aureus Among Febrile Patients in Sub-Saharan Africa