The emergence and spread of antimicrobial resistance (AMR) present a challenge to disease control in East Africa. Resistance to beta-lactams, which are by far the most used antibiotics worldwide and include the penicillins, cephalosporins, monobactams and carbapenems, is reducing options for effective control of both Gram-positive and Gram-negative bacteria. The World Health Organization, Food and Agricultural Organization and the World Organization for Animal Health have all advocated surveillance of AMR using an integrated One Health approach. Regional consortia also have strengthened collaboration to address the AMR problem through surveillance, training and research in a holistic and multisectoral approach. This review paper contains collective information on risk factors for transmission, clinical relevance and diversity of resistance genes relating to extended-spectrum beta-lactamase-producing (ESBL) and carbapenemase-producing Enterobacteriaceae, and Methicillin-resistant Staphylococcus aureus (MRSA) across the human, animal and environmental compartments in East Africa. The review of the AMR literature (years 2001 to 2019) was performed using search engines such as PubMed, Scopus, Science Direct, Google and Web of Science. The search terms included ‘antimicrobial resistance and human-animal-environment’, ‘antimicrobial resistance, risk factors, genetic diversity, and human-animal-environment’ combined with respective countries of East Africa. In general, the risk factors identified were associated with the transmission of AMR. The marked genetic diversity due to multiple sequence types among drug-resistant bacteria and their replicon plasmid types sourced from the animal, human and environment were reported. The main ESBL, MRSA and carbapenem related genes/plasmids were the blaCTX-Ms (45.7%), SCCmec type III (27.3%) and IMP types (23.8%), respectively. The high diversity of the AMR genes suggests there may be multiple sources of resistance bacteria, or the possible exchange of strains or a flow of genes amongst different strains due to transfer by mobile genetic elements. Therefore, there should be harmonized One Health guidelines for the use of antibiotics, as well as regulations governing their importation and sale. Moreover, the trend of ESBLs, MRSA and carbapenem resistant (CAR) carriage rates is dynamic and are on rise over time period, posing a public health concern in East Africa. Collaborative surveillance of AMR in partnership with regional and external institutions using an integrated One Health approach is required for expert knowledge and technology transfer to facilitate information sharing for informed decision-making.

中文翻译：

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东非人类，动物和环境区隔间耐药性传播的遗传多样性和风险因素：综述。

抗菌素耐药性（AMR）的出现和传播对东非的疾病控制提出了挑战。对β-内酰胺类药物的耐药性是迄今为止全世界使用最广泛的抗生素，包括青霉素，头孢菌素，单bactams和碳青霉烯类药物，正在减少有效控制革兰氏阳性和革兰氏阴性细菌的选择。世界卫生组织，粮食及农业组织和世界动物卫生组织都主张采用综合的“一种卫生”方法对抗菌药物耐药进行监测。区域财团还通过整体，多部门的方法，通过监视，培训和研究，加强了合作以解决AMR问题。该评论文件包含有关传播风险因素的集体信息，在东非的人类，动物和环境环境中，与产生广谱β-内酰胺酶（ESBL）和碳青霉烯酶的肠杆菌科以及耐甲氧西林金黄色葡萄球菌（MRSA）有关的耐药基因的临床相关性和多样性。使用搜索引擎（例如PubMed，Scopus，Science Direct，Google和Web of Science）对AMR文献（2001年至2019年）进行了回顾。搜索词包括“抗菌素耐药性和人类-动物环境”，“抗菌素耐药性，危险因素，遗传多样性和人类-动物环境”，并与东非各国结合。通常，确定的风险因素与AMR的传播有关。据报道，由于耐药菌中多种序列类型及其源自动物，人和环境的复制子质粒类型，其遗传多样性显着。与ESBL，MRSA和碳青霉烯有关的主要基因/质粒分别为blaCTX-Ms（45.7％），SCCmec III型（27.3％）和IMP类型（23.8％）。AMR基因的高度多样性表明，可能存在多种耐药菌来源，或者由于可移动遗传元件的转移，不同菌株之间可能发生菌株交换或基因流动。因此，应该统一使用一生指南来使用抗生素，以及管理其进口和销售的法规。此外，ESBL，MRSA和碳青霉烯抗性（CAR）运送率的趋势是动态的，并且随着时间的推移呈上升趋势，在东非引起公众健康关注。专家知识和技术转让需要与区域和外部机构合作使用综合的“单一健康”方法对AMR进行协同监视，以促进信息共享，从而进行明智的决策。