Detection of MCR-1 Gene in Multiple Drug Resistant Escherichia coli and Klebsiella pneumoniae in Human Clinical Samples from Peshawar, Pakistan

Abstract

Background: The presence of plasmid mediated mcr-1 gene in multidrug resistant Gram-negative bacteria poses a serious public health concern in today’s world. Objectives: The present study was aimed to detect the presence of plasmid mediated mcr-1 encoding resistance to colistin in multiple drug resistant (MDR) E. coli and K. pneumoniae isolates. Methods: A total 180 clinical isolates of E. coli (n=120) and K. pneumoniae (n=60) were isolated from different clinical specimens i.e. urine, blood, stool and pus, from diagnostic labs of two major public sector tertiary care hospitals in Peshawar, Pakistan. MDR profile of these isolates was assessed through Kirby-Baur disc diffusion method. All isolates were screened for colistin resistance by dilution methods. Colistin resistant isolates were subjected to PCR for mcr-1 detection and confirmation was done by Sanger sequencing method. Results: Overall 83.3% (100/120) E. coli and 93.3% (56/60) K. pneumoniae were detected as MDR. Colistin resistance was found in 23.3% (28/120) E. coli and 40% (24/60) K. pneumoniae isolates whereas mcr-1 gene was detected in 10 out of 52 colistin resistant isolates including six E. coli and four K. pneumoniae isolates. Minimum inhibitory concentrations (MICs) of colistin in these ten mcr-1 positive isolates ranged from 4µg/ml to 16µg/ml. All mcr-1 positive isolates showed 99% sequence similarity when compared with other present sequences in GenBank. Conclusion: Hence, our study confirms the presence of mcr-1 mediated colistin resistance in the studied area. Therefore, urgently larger scale surveillance studies are recommended to investigate prevalence of mcr-1 mediated colistin resistance and to prevent its further spread in the area.

Identification of colistin resistance and its bactericidal activity against uropathogenic gram negative bacteria from Hayatabad Medical Complex Peshawar

“…15 Another study done in Peshawar indicated that 40% Klebsiella pneumoniae and 23% E.coli showed resistance to colistin. 4 Colistin resistant E.coli showed resistance to ciprofloxacin 81.2%, Amoxicillin and clavulanic acid 70.8%, Ceftazidim 66.7%, Cefepime 50% and Cefotaxim 77.1% in this study. These results are comparable to other study done in china.…”

“…E-mail: drihsan.ibms@kmu.edu.pk medical community to reconsider the colistin for the treatment of Multidrug resistant gram negative bacteria worldwide. 4,5 Colistin is an old antibiotic, which also known as polymyxin E antibiotic which was approved by the FDA in 1959. 6 It is widely used for the treatment of animals and now increasingly given worldwide to human for the treatment of multi drug resistant bacteria e.g.…”

“…13,14 Increasing resistance of gram negative bacteria and emergence of plasmid-mediated colistin resistance is the threat for this last-resort antibiotic which was also identified in Karachi and Peshawar, Pakistan. 4,15 Therefore, this study was designed to identify the colistin resistance in uropthaogenic gram negative bacteria from Hayatabad Medical Complex, Peshawar.…”

Molecular Epidemiology of mcr-1, blaKPC-2, and blaNDM-1 Harboring Clinically Isolated Escherichia coli from Pakistan

“…In Peshawar, Pakistan, a study reported 5% mcr-1 out of 120 multiple drug-resistant E. coli . 42 Similarly, a study from Faisalabad, Pakistan, detected one mcr-1 bearing E. coli out of 29 ESBL producing strains. 15 The two earlier reported studies and our current study are from different geographical regions in Pakistan.…”

Lipid A-Ara4N as an alternate pathway for (colistin) resistance in Klebsiella pneumonia isolates in Pakistan

“…In Pakistan mcr-1 gene has been detected in 23.3% E. coli (n = 120) and 40% of K. pneumoniae (n = 60) [ 24 ]. Our study however revealed absence of mcr-1 gene in all isolates tested.…”