Faecal carriage of ESBL-producing Enterobacteriaceae and carbapenem-resistant Gram-negative bacilli in community settings

Abstract

Introduction: The aim of this study was to determine the prevalence of intestinal carriage of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and carbapenem-resistant Gram-negative bacilli in the community in Buenos Aires, Argentina. Methodology: Faecal samples from 164 non-hospitalized patients were cultured on CHROMagar KPC and CHROMagar ESBL plates. Isolates resistant to third-generation cephalosporins or carbapenems were selected for further study. The minimal inhibitory concentration (MIC) of the isolates was determined using the E-test method. The phenotypic detection of ESBLs and carbapenemases was performed using the double-disc synergy test. Results: The rate of faecal carriage of Enterobacteriaceae resistant to third-generation cephalosporins was 26.8%. Escherichia coli represented a large majority (75%) of the isolates recovered. Thirty-three ESBL-producing isolates were detected from 31 faecal samples (18.9% of the collected specimens). Eight carbapenem-resistant Gram-negative bacilli were recovered from eight specimens (4.9%). Conclusions: This study revealed a high prevalence of faecal carriage of multidrug-resistant Gram-negative bacteria, including ESBLs, in Buenos Aires. Therefore, the use of surveillance cultures will be helpful for tracking and monitoring the spread of ESBL-producing Enterobacteriaceae within community settings.

Carbapenem-resistant Enterobacteriaceae in the community: a scoping review

“…Similar increases were found in southern Europe, with Greece reporting an incidence of carbapenem resistance upwards of 60% in K. pneumoniae isolates for 2014 [28]. Recent studies have identified a high prevalence (16–19%) of ESBL-producing GNB in community settings [29]. With carbapenemases following similar plasmid-mediated genetic exchange as ESBLs, there has been a call for further research on the spread of CRE into community settings owing to the highly transmissible nature of carbapenemase-producing genetic elements [25].…”

“…Urine was the primary source of isolates [16,25,35,37,40,43], followed by faeces [29,41,45,46], intra-abdominal fluid [38,39,44], blood [42] and respiratory culture [36]. For the five studies only including CRE, K. pneumoniae was the most common organism [16,25,36,37], except a US-based study that had a slightly higher percentage of Enterobacter spp.…”

“…For the other 10 studies testing for the presence of CRE among hospital and community samples, E. coli was the most common organism overall, followed by K. pneumoniae or Enterobacter cloacae . The most common mechanism of antibiotic resistance among these studies was the presence of ESBLs [29,38–44]. …”

“…In addition, eight studies used the modified Hodge test to detect the presence of carbapenemase activity among Enterobacteriaceae [16,25,29,37,39–41,46]. Further genotypic analyses were uncommon.…”

Detection of Escherichia coli O157:H7 and O104:H4 in patients with diarrhea in Northern Lebanon and characterization of fecal E.coli producing ESBL and carbapenemase genes

“…The present study shows that 19.8% of E.coli isolates from fecal specimens of Lebanese patients with diarrhea were ESBL-producers .This result is similar to other recent reported studies from other continents . For example a study from Argentina in 2012, showed that the carrier rate of ESBL-positive E. coli strains in the fecal flora was 17.0% [26], while the study from Libya in 2014, demonstrated the prevalence of ESBL-producing E. coli at 13.4% [27]. In addition, our study indicated that bla CTX-M gene was predominant (85%), followed by the bla TEM (50%) and bla OXA (6%) genes, whereas the bla SHV , bla PER and bla GES were absent in our E.coli isolates.…”