Antimicrobial Drug Resistance of Vibrio cholerae, Democratic Republic of the Congo

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Berthe Miwanda, Sandra Moore, Jean-Jacques Muyembe, Georges Nguefack-Tsague, Ickel Kakongo Kabangwa, Daniel Yassa Ndjakani, Ankur Mutreja, Nicholas Thomson, Helene Thefenne, Eric Garnotel, Gaston Tshapenda, Denis Kandolo Kakongo, Guy Kalambayi, and Renaud Piarroux

Author affiliations: Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (B. Miwanda, J.-J. Muyembe, G. Tshapenda); Aix-Marseille University, Marseille, France (S. Moore, R. Piarroux); University of Kinshasa, Kinshasa (J.-J. Muyembe); University of Yaoundé I, Yaoundé, Cameroon (G. Nguefack-Tsague);Ministry of Higher Education and University, Kinshasa (I.K. Kabangwa, D.K. Kakongo); Field Epidemiology Laboratory Training Program, Kinshasa (D.Y. Ndjakani); Wellcome Trust Sanger Institute, Cambridge, UK (A. Mutreja, N. Thomson); London School of Hygiene and Tropical Medicine, London, UK (N. Thomson); Hôpital d’Instruction des Armées Laveran, Marseille, France (H. Thefenne, E. Garnotel); World Health Organization, Ouagadougou, Burkina Faso (D.K. Kakongo); World Health Organization, Kinshasa (G. Kalambayi)

Abstract

We analyzed 1,093 Vibrio cholerae isolates from the Democratic Republic of the Congo during 1997–2012 and found increasing antimicrobial drug resistance over time. Our study also demonstrated that the 2011–2012 epidemic was caused by an El Tor variant clonal complex with a single antimicrobial drug susceptibility profile.

Cholera is an acute intestinal infection caused by Vibrio cholerae (1). Although hydration remains the primary treatment for cholera, antimicrobial drug therapy is recommended for severely ill patients (2). However, multidrug-resistant V. cholerae strains have long been observed in Africa (3), and strains exhibiting new resistance phenotypes have emerged during recent epidemics (4). It is therefore critical to carefully monitor changes in strains’ susceptibility to antimicrobial drugs in each African country and adapt treatment recommendations accordingly.

Few longitudinal studies assessing shifts in the resistance of V. cholerae to antimicrobial drugs in Africa have been established. The available studies are limited either to a restricted area (5) or a short time period (6). We describe the long-term evolution of antimicrobial drug susceptibility of an extensive set of V. cholerae isolates collected in the Democratic Republic of the Congo (DRC). We applied whole-genome sequencing and multiple locus variable-number tandem-repeat analysis (MLVA) to clarify the mechanisms behind the aggressive epidemic of 2011–2012 that spread throughout the country, affecting regions to which cholera was not endemic (7).

Ms. Miwanda is a biologist specializing in the diagnosis of bacterial diseases of epidemic potential and head of the Surveillance des Maladies à Potentiel Epidémique unit at the DRC Public Health National Laboratory. She is responsible for the diagnosis of meningitis, cholera, plague, and bloody diarrhea.

Acknowledgments

We thank Benoit Kebela Ilunga and Vital Mondonge Makuma for authorizing access to data and sharing their expertise. François-Xavier Mbopi- Kéou, Ditu Kazambu, Dieulla Delissaint, and Louis Koyange Delysogo assisted with the collection of V. cholerae isolates. We also thank the health authorities of the Provincial Directorates and the DRC health zone teams for authorizing and supporting the study.

The collection of strains and biological analyses were supported by many partners, including the World Health Organization, the Veolia Foundation, and the African Cholera Surveillance Network. Epidemiologic surveillance was financially supported by the World Health Organization, Epicentre, and the Belgian Development Cooperation.

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Figures

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Table. Distribution of 1,093 Vibrio cholerae isolates, by year and province, Democratic Republic of the Congo, 1997–2012

Suggested citation for this article: Miwanda B, Moore S, Muyembe J-J, Nguefack-Tsague G, Kabangwa IK, Ndjakani DY, et al. Antimicrobial drug resistance of Vibrio cholerae, Democratic Republic of the Congo. Emerg Infect Dis. 2015 May [date cited]. http://dx.doi.org/10.3201/eid2105.141233

DOI: 10.3201/eid2105.141233

CrossRef reports the first page should be "e00157-11" not "e00157" in reference 15 "Hendriksen, Price, Schupp, Gillece, Kaas, Engelthaler, et al., 2011".