Extended-spectrum β-lactamase, plasmid-mediated AmpC β-lactamase, fluoroquinolone resistance, and decreased susceptibility to carbapenems in Enterobacteriaceae: fecal carriage rates and associated risk factors in the community of Northern Cyprus

Abstract

Background Antibiotic-resistant Enterobacteriaceae in the gastrointestinal flora can lead to infections with limited therapeutic options. Also, the resistant bacteria can be transferred from colonized persons to others. The present study was conducted to search the fecal carriage rates of (i) Enterobacteriaceae that produce extended-spectrum β-lactamase (ESBL-E) and/or (ii) plasmid-mediated AmpC β-lactamase (pAmpC-E), (iii) ciprofloxacin-resistant Enterobacteriaceae (CIP-RE), and (iv) carbapenem-intermediate or -resistant Enterobacteriaceae (CIRE) in Northern Cyprus. Methods A total of 500 community-dwellers were recruited from consecutive admissions to the clinical laboratories of four hospitals. One rectal swab or stool sample was collected from each participant. A questionnaire was applied to evaluate possible risk factors associated with intestinal colonization of resistant bacteria. The samples were cultured on antibiotic containing media to screen for resistant bacteria colonization. The bacterial colonies that grew on the plates were subjected to further phenotypic tests to confirm the resistance. Results Of 500 volunteers, ESBL-E, pAmpC-E, CIP-RE and CIRE carriage were detected in 107 (21.4%), 15 (3.0%), 51 (10.2%) and six (1.2%) participants, respectively. Escherichia coli was the most commonly recovered species among Enterobacteriaceae isolates. A significant proportion of ESBL-producing E. coli isolates ( n = 22/107; 20.6%) was found to be co-resistant to CIP ( p = 0.000, OR 3.21, 95% CI 1.76–5.87). In this study, higher socioeconomic status (CIP-RE: p = 0.024, OR 1.96, 95% CI 1.09–3.53), presence of gastrointestinal symptoms (CIRE: p = 0.033; OR 6.79, 95% CI 1.34–34.39), antibiotic use (ESBL-E: p = 0.031; OR 1.67, 95% CI 1.04–2.67; and CIRE: p = 0.033; OR 6.40, 95% CI 1.16–35.39), and travelling abroad (pAmpC-E: p = 0.010; OR 4.12, 95% CI 1.45–11.66) were indentified as risk factors. Conclusion The study indicates that resistant Enterobacteriaceae isolates are carried by humans in the community. To prevent further spread of resistance, rational use of antibiotics should be encouraged, and antibiotic resistance should be carefully monitored in Northern Cyprus.

Acquired AmpC β-Lactamases among Enterobacteriaceae from Healthy Humans and Animals, Food, Aquatic and Trout Aquaculture Environments in Portugal

“…It is of note that, although the human faecal carriage rate of qAmpC-producers was low, a slight increase between 2001-2004 (0%) and 2013-2014 (1.0%; n = 3/312) was identified, possibly suggesting a higher colonization density that should be monitored. The current rate (1.0%) is comparable to those reported in a few other European countries [8]. The absence of qAmpC producers among livestock animals (swine, chickens) is surprising since livestock animals are known as reservoirs of bla CMY-2 [3], which might be explained by the low number of analysed samples from each period.…”

Risk factors for fecal carriage of drug-resistant Escherichia coli: a systematic review and meta-analysis

“…Of these, 58 studies were forwarded to full-text article screening. Of the 58 full-text articles, we identified 15 relevant articles that reported risk factors associated with drug-resistant Enterobacteriaceae (10) or E. coli (5) carriage [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51].…”

The prevalence of ESBL and AmpC β-lactamases in uropathogenic isolates of Escherichia coli in a tertiary care hospital in Southwest Iran

“…Extended-spectrum β-lactamases (ESBLs) are the major cause of acquired drug resistance seen in gramnegative bacteria (GNB) (1). The ability of ESBL enzymes to hydrolyze most of β-lactam antibiotics is not active against cephamycins and carbapenems (2).…”