Asymptomatic faecal carriage of ESBL producing enterobacteriaceae in Hungarian healthy individuals and in long-term care applicants: A shift towards CTX-M producers in the community

Abstract

26Background: Faecal carriage of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae 27 in healthy individuals was examined and compared to previous results obtained in such individuals a few 28 years earlier. 29Methods: Faecal samples from 779 individuals screened for employment purposes and from 225 30 applicants to long-term care (LTC) were screened between November 2013 and May 2014. 31Results: The overall rate of fecal carriage was 3.0% (30/1004). The carriage rate was significantly higher 32 in applicants for LTC (5.3% vs. 2.3%; p=0.019). All isolates carried CTX-M ESBLs, with an 33 overwhelming dominance of bla (84.4%) in both groups and in both E. coli and Klebsiella 34 pneumoniae. 35Conclusions: The prevalences were comparable to those in the earlier study, but a marked decrease of the 36 diversity of ESBL genes in E. coli from the employment screening group was found, suggesting that the 37 ESBL-producing isolates originating from diverse sources are being replaced by highly successful bla CTX- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 To screen for ESBL production, faecal samples were inoculated onto eosin methylene blue agar plates 60 supplemented with 2 mg/l cefotaxime. Confirmation of ESBL phenotype was performed using double 61 disk synergy test (Oxoid, Basingstoke, UK). The isolates were identified by MALDI Biotyper (Bruker, 62Bremen, Germany) and by species-specific PCRs. Susceptibility to ertapenem, meropenem, imipenem, 63 cefotaxime, ceftazidime, cefepime, ciprofloxacin, co-trimoxazole, colistin, amikacin, gentamicin and 64 tobramycin was tested by disk diffusion according to EUCAST recommendations. All isolates were 65 screened for the genes bla TEM , bla SHV , and bla CTX-M , amplified genes were sequenced. Five 66 aminoglycoside resistance genes aac(3')-IIa, aac(6')-Ib, aph(3')-Ia, ant(2")-Ia, ant(3")-Ia, and class 1 67 and 2 integrons were sought for by PCRs. Gene cassette arrays were determined by sequencing. For 68 Escherichia coli phylogenetic group and the clone O25b-ST131 were determined by PCRs. All technical 69 protocols were described in our earlier publication [5] Resistance to other antibiotic classes than beta-lactamases was common. Eleven, twelve, eight and 13 of 84 14 isolates were resistant to ciprofloxacin, co-trimoxazole, gentamicin and amikacin, respectively, in the 85 LTC group, while these numbers were eleven, eleven, six and six of 18 isolates in healthy individuals. 86This difference in susceptibility to amikacin was also evident when comparing only E. coli isolates. 87Integron carriage rates were comparable. In the LTC group class 1 integrons were detected in four K. 0/18, p=0.02, respectively). This applied when comparing only E. coli isolates from the two groups (5/7 96 vs. 2/18, p=0.007 and 3/7 vs. 0/18, p=0.015, respectively). Phylogroup distributions wer...

Comparisons of microbiological characteristics and antibiotic resistance of Klebsiella pneumoniae isolates from urban rodents, shrews, and healthy people

“…In China, 30.1-39.3% of the total isolates collected from hospital or community acquired infections during 2003-2013 period were ESBL-positive [27]. In our study, we identified 7.94 and 12.79% of KP isolated from rodents and shrews to be ESBL-producers, the ESBL-positive rate among healthy adults was higher than that in studies conducted in Hungary [28,29]. Notably, there was no significant difference in the ESBL-positive rate among urban rodents, shrews, and healthy adults.…”

ESBL-producing <i>Escherichia coli</i> and Its Rapid Rise among Healthy People

“…The isolation frequencies of ESBL producers from healthy adults in Europe were usually lower than 10% [102][103][104][105][106] except for the healthy young children in Spain 107) at the end of 2016, and these values were much lower than those in Asia where the isolation frequencies are usually above 20% [108][109][110][111][112][113] . The carriage rate of ESBL producers in 2011 was reportedly 20.3% in Korea 114) .…”

Extended Spectrum Beta-Lactamases (ESBLs)-producing Escherichia coli and Klebsiella pneumoniae among asymptomatic Out-patients in a University Health Centre

“…[1] The switch from Klebsiella spp to Escherichia coli as the major ESBL-producing species is linked to the dissemination of blaCTX-M genes. [4] ESBL genes have been reported in clinical isolates, normal bacteria flora from humans and animals, food and sewage, [5] indicating the widespread distribution and presence of environmental reservoirs of the genes. [6] The carriers of ESBL-producing Enterobacteriaceae serve as a reservoir for antibiotics resistance in the community, becoming a risk to other individuals through human-to-human transmission.…”