As the global urban populations increase with rapid migration from rural areas, ready-to-eat (RTE) street foods are posing food safety challenges where street foods are prepared with less structured food safety guidelines in small and roadside outlets. The increased presence of extended-spectrum-β-lactamase (ESBL) producing bacteria in street foods is a significant risk for human health because of its epidemiological significance. Escherichia coli and Klebsiella pneumoniae have become important and dangerous foodborne pathogens globally for their relevance to antibiotic resistance. The present study was undertaken to evaluate the potential burden of antibiotic-resistant E. coli and K. pneumoniae contaminating RTE street foods and to assess the microbiological quality of foods in a typical emerging and growing urban suburb of India where RTE street foods are rapidly establishing with public health implications. A total of 100 RTE food samples were collected of which, 22.88% were E. coli and 27.12% K. pneumoniae. The prevalence of ESBL-producing E. coli and K. pneumoniae was 25.42%, isolated mostly from chutneys, salads, paani puri, and chicken. Antimicrobial resistance was observed towards cefepime (72.9%), imipenem (55.9%), cefotaxime (52.5%), and meropenem (16.9%) with 86.44% of the isolates with MAR index above 0.22. Among β-lactamase encoding genes, blaTEM (40.68%) was the most prevalent followed by blaCTX (32.20%) and blaSHV (10.17%). blaNDM gene was detected in 20.34% of the isolates. This study indicated that contaminated RTE street foods present health risks to consumers and there is a high potential of transferring multi-drug-resistant bacteria from foods to humans and from person to person as pathogens or as commensal residents of the human gut leading to challenges for subsequent therapeutic treatments.

BackgroundExtended-spectrum β-lactamase is a major public health problem in hospitals and community that mediate resistance to Penicillin, Cephalosporins, and Monobactams. Data regarding the detection of TEM, CTX-M, and SHV genes by molecular techniques and typing by RAPD in ESBL producing bacteria can be useful in epidemiology and risk factors associated with infections.MethodsTotal of 140 samples were collected. Well water (n = 50), Fish effluents (n = 40), and Diarrheal stool samples (n = 80). Antibiotic susceptibility test was done using the Kirby–Bauer disc diffusion method. Phenotypic detection of ESBL enzyme was done by Double disk diffusion test. PCR analysis was carried out for β-lactamase genes TEM, SHV, and CTX-M. Molecular Typing was done by RAPD.Results38 (57.57%) Klebsiella spp. isolated from Fish Effluents,11 (57.89%) from Well water and 15 (18.98%) from Diarrheal stool samples. ESBL producers were 4 (26.66%) from stool and 12 (31.57%) from fish effluents. Stool isolates showed high resistance to Ampicillin (86.7%), Cefuroxime (83.3%), Cefepime (76.7%), and Ceftazidime (70%). Fish effluents were more resistant to Cefeperazone sulbactum (95.9%), Ampicillin (81.6%) while well water isolates showed high resistance to Ampicillin (94.7%) and Erythromycin (73.7%). Molecular identification showed the presence of more than 2 genes among the isolates. Prevalence of gene bla- TEM was highest, followed by bla-CTX-M and bla-SHV. Genetic relatedness are expressed as percentage similarity and presented as dendogram.ConclusionThe study shows high prevalence of ESBL among Klebsiella isolates mainly rom Fish effluents and diarrheal stool samples. It shows 24% ESBL positive rate. Antibiotic-resistant bacteria from fish effluents highlights the associated human health risk when they enter food chain and become passive carriers. Practice of routine ESBL testing with conventional antibiotic susceptibility testing would be useful for combatting multi drug resistance.Present study shows high prevalence of TEM gene among Klebsiella species. RAPD-PCR will help in descriminating isolates and reflecting the genotypes circulating in the settings either hospital or in community.Disclosures All authors: No reported disclosures.

BackgroundAntimicrobial resistance (AMR) is a major public health problem in India. The World Health Organization recognizes that the education of medical students on antimicrobial stewardship plays a critical role in the efforts to combat AMR, but data related to knowledge, attitudes and practices (KAP) regarding AMR is limited in India.MethodsThis cross-sectional study was conducted in July-August 2017. Medical students at K.S. Hegde Medical Academy in Mangalore, India were surveyed with an anonymous questionnaire using a convenience sampling method involving second year, third year, fourth year, and intern students (n = 347). Data about demographics, sources of information, and antimicrobial training were collected. In addition, AMR knowledge and attitude scores were calculated. A Mann–Whitney U test was used to determine factors that were associated with significant differences in knowledge scores and attitude scores. The primary outcome measure of this study was to determine positive predictors of increased confidence in prescribing antimicrobials in the future using multivariate analysis.ResultsA total of 347 surveys were analyzed (response rate of 98.9%). The mean total knowledge score was 11.47 out to 31 with a standard deviation (SD) of 3.39, and the mean attitude score was 5.99 out of 16 (SD = 4.207). While 13.2% of students were “very familiar” or “familiar” with the term “Antimicrobial Stewardship,” and 88.2% of students said they would like more antimicrobial education in medical school. On multivariate analysis, female gender (OR 2.51, 95% CI (1.51, 4.18)), clinical vignette antimicrobial knowledge scores (OR 1.26, 95% CI (1.05, 1.51)), positive attitude scores (OR 0.94, 95% CI (0.88, 0.995)), awareness of Infection Control Policy (OR 1.87, 95% CI (1.09, 3.22)), and > 3 years of antimicrobial prescribing clinical training (OR 2.48, 95% CI (1.29, 4.75)) were predictors of confidence in antimicrobial prescribing.ConclusionThis study identifies several possible interventions for improving confidence such as increased clinical knowledge through clinical experience, increased awareness of infection control policies and antimicrobial guidelines, and empowering students to be antimicrobial stewards to combat AMR.Disclosures All authors: No reported disclosures.

The study aimed to screen for the presence of multidrug‐resistant Klebsiella pneumoniae from diarrheal stool and environmental water samples and to check the epidemiological link between the two categories. Isolates obtained after culturing on different media were tested for antibiotic resistance and extended‐spectrum beta‐lactamase (ESBL) production. Polymerase chain reaction (PCR) analysis was done for important β‐lactamase encoding genes. Random amplified polymorphic DNA (RAPD) typing was done using two primers. Results showed a high prevalence of K. pneumoniae from fish market effluents compared with stool and well water. Stool isolates showed high resistance to ceftazidime (80.0%) and cefepime (80.0%), fish market effluent isolates to cefoperazone–sulbactam (92.1%), and erythromycin (78.9%), while well water isolates to erythromycin (72.7%) and cefuroxime (54.4%). The ESBL genes blaCTX, blaSHV, and blaTEM were detected in 22.85%, 14.28%, and 42.85% of K. pneumoniae isolates, respectively. The results of RAPD‐PCR showed high genetic similarities between the isolates from different sources. Practitioner Points Detection of multi‐drug resistant Klebsiella strains in hospital wastewater and drinking water sources has progressively increased since its emerging resistance to third‐generation cephalosporins and carbapenems. Detection of beta‐lactamase encoding genes by molecular techniques and typing by random amplified polymorphic DNA (RAPD) can be useful in identifying the genetic fingerprints for epidemiological study. Implementation of effective antimicrobial stewardship program and infection control policy thereby helps assess the risk factors associated with infections.