Acquisition of mcr-1 Plasmid-Mediated Colistin Resistance in Escherichia coli and Klebsiella pneumoniae during Hajj 2013 and 2014

Abstract

bA plasmid-mediated transferable colistin resistance gene, mcr-1, was recently described in China (1) and was rapidly reported in several other countries (2). The spread of the mcr-1 gene was not only reported in Escherichia coli but also associated with other Enterobacteriaceae species isolated from human clinical samples, farm animals, and travelers (2, 3). However, whether or not the mcr-1 gene is acquired during the Hajj (the Muslim pilgrimage to Mecca) remains unknown.We conducted two cohort studies of pilgrims traveling to Mecca in 2013 (22 September to 23 October) (4, 5) and in 2014 (19 September to 12 October) (6). A total of 440 rectal swab samples were collected from pilgrims (in 2013, 129 pilgrims [before and after their pilgrimage]; in 2014, 92 pilgrims before and 90 pilgrims after their pilgrimage) and were then screened for the presence of the mcr-1 gene by real-time PCR and results confirmed by standard PCR and sequencing as described previously (7). All PCR-positive samples were then tested in an attempt to isolate mcr-1-resistant strains by culture on Cepacia agar (bioMérieux, Marcy-l'Étoile, France). Different colonies were tested by matrixassisted laser desorption ionization-time of flight (MALDI-TOF), antibiotic susceptibility testing (EUCAST), Etest (MIC susceptibility, Յ2 mg/liter), PCR, sequencing of the mcr-1 and extendedspectrum-beta-lactamase (ESBL) genes (bla CTX-M , bla TEM , and bla SHV ) (5), and multilocus sequence typing (MLST) analysis (http://mlst.warwick.ac.uk/mlst/dbs/Ecoli/ and http://bigsdb.web .pasteur.fr/klebsiella/klebsiella.html). All mcr-1 and ESBL gene sequencing results were then analyzed with NCBI database.

Infectious Diseases and Mass Gatherings

“…Two French pilgrims carried S. enterica, resistant to ceftriaxone, gentamycin, and colistin after the 2013 Hajj [62]. Mrc-1 resistance gene screening from rectal swabs was conducted in French pilgrims in 2013-2014 and found an acquisition rate of 9.0% after Hajj [63].…”

How should we respond to the emergence of plasmid-mediated colistin resistance in humans and animals?

“…55 The identification of mcr-1mediated colistin resistance in E. coli and Klebsiella pneumoniae in pilgrims attending the annual Hajj indicates a risk for acquisition in those attending mass gatherings. 60 The initial description of mcr-1 was in 21% of healthy swine at slaughter, 15% of marketed pork and chicken meat, and 1% of hospitalized patients in China. 20 The first human isolate was detected in E. coli in Latin America.…”

Acquisition of enteric pathogens by pilgrims during the 2016 Hajj pilgrimage: A prospective cohort study

“…Recently studies on returning French pilgrims have shown that participation in the Hajj increases carriage rates of enteric pathogens including Tropheryma whipplei [4], multidrug-resistant nontyphoidal Salmonella [5], CTX-M type extended-spectrum β-lactamase producing E. coli and Klebsiella pneumoniae [6], colistin-resistant E. coli and K. pneumoniae and carbapenemase-producing E. coli [7,8]. Moreover, acquisition of CTX-M genes at the Hajj was associated with the occurrence of diarrhea and use of β-lactams [9].…”