High Rates of Intestinal Colonization with Extended-Spectrum Lactamase-Producing Enterobacteriaceae among Healthy Individuals

Rahman, Eiman Mohammed Abdul; Elsherif, Rasha

doi:10.2310/jim.0b013e318238748e

Cited by 36 publications

(11 citation statements)

References 13 publications

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“…The prevalence of fecal ESBL-E found in a study conducted in Cairo by Abdul Rahman and El-Sherif in 2011, was similar to what we observed [14]. In that study, ESBL-E were detected phenotypically, without genotypic confirmation and the prevalence of CPE was not determined.…”

Section: Discussionsupporting

confidence: 87%

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Fecal carriage of extended-spectrum β-lactamase- and carbapenemase-producing Enterobacteriaceae in Egyptian patients with community-onset gastrointestinal complaints: a hospital -based cross-sectional study

Abdallah

alNaiemi

Reuland

et al. 2017

Antimicrob Resist Infect Control

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ObjectivesThe aim of this study was to determine the prevalence of extended-spectrum β-lactamase (ESBL) and carbapenemase production among Enterobacteriaceae isolated from ambulatory patients with gastrointestinal complaints admitted to El-Ahrar General Hospital, Zagazig, Egypt in the period between January 2013 and May 2013.MethodsOne hundred and thirteen Enterobacteriaceae isolates were recovered from 100 consecutive Egyptian patients with community–onset gastrointestinal complaints. The fecal samples were plated directly on selective EbSA-ESBL Screening Agar and on MacConkey agar. Isolate identification was performed with matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS). Screening for ESBLs and carbapenemases production was done by both the automated VITEK®2 system with AST N198 and by disk diffusion method. Real-time PCR and sequencing were used to characterize the resistance genes. Phylogroups of the E. coli isolates were determined by a triplex PCR-based method.ResultsOf 100 patients screened for fecal colonization with extended-spectrum β-lactamase -producing Enterobacteriaceae (ESBL-E) and carbapenemase- producing Enterobacteriaceae (CPE), 68 were colonized with ESBL-E whereas five patients were positive for CPE. One hundred and thirteen Enterobacterceae isolates were recovered from 100 fecal samples, they belonged to E. coli (n = 72), Klebsiella pneumoniae (n = 23), Enterobacter cloacae(n = 3), Salmonella spp. (n = 1) and other Enterobacterceae isolates (n = 14). The bla CTX-M gene was detected in 89.04% (65/73) of the ESBL-producing Enterobacteriaceae, whereas bla SHV and bla TEM were detected in 30.14% (22/73) and 19.18% (14/73) respectively. Three out of 5 carbapenem-resistant isolates harbored New Delhi metallo-beta-lactamase (NDM) and 2 produced Verona integron-encoded metallo- beta -lactamase (VIM). Twenty-two (47.83%) of the ESBL positive isolates were multidrug resistant (MDR). Phylogenetic analysis showed that, of the 51 ESBL-EC isolates, 17 belonged to group B2, 13 to group D, 11 to group A and 10 to group B1.ConclusionsNearly two-thirds of the Enterobacteriaceae isolates recovered from feces of ambulatory patients with community–onset gastrointestinal complaints admitted to El-Ahrar General Hospital, Zagazig, Egypt were ESBL producers and one in every 20 patients included in our study was colonized by carbapenemase-producing Enterobacteriaceae. These high colonization rates are worrying, therefore prudent antimicrobial use should be adopted in Egyptian community settings.

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Section: Discussionsupporting

confidence: 87%

“…In Egypt, data on the prevalence of ESBL-E in the community remain scarce. A study performed in Cairo (urban population) reported high fecal carriage rate (63.3%) of ESBL-E among healthy individuals [14]. To the best of our knowledge, no previous research has been carried out to determine the fecal carriage rate of CPE in the community.…”

Section: Introductionmentioning

confidence: 99%

Fecal carriage of extended-spectrum β-lactamase- and carbapenemase-producing Enterobacteriaceae in Egyptian patients with community-onset gastrointestinal complaints: a hospital -based cross-sectional study

Abdallah

alNaiemi

Reuland

et al. 2017

Antimicrob Resist Infect Control

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“…Overall, the percentage of fecal ESBL-producing E. coli recovered is comparable to those reported from other parts of the world including Saudi Arabia [30] and Tunisia [14], but lower than those found in Egypt [18], Thailand [17], China [13], and Japan [31]. In our study, the majority of ESBL-producing E. coli was isolated from patients with community-acquired infections and not from hospitalized patients with diarrhea which suggests the ability of ESBL-producing isolates to spread in the community beyond the hospital environment and potentially exclude their limitation to nosocomial infections, thus helping to exacerbate public health concerns [5].…”

Section: Discussionsupporting

confidence: 74%

Fecal carriage of extended-spectrum β-lactamases and AmpC-producing Escherichia coli in a Libyan community

Ahmed

Ali

Kamel

et al. 2014

Ann Clin Microbiol Antimicrob

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BackgroundExtended-spectrum β-lactamases (ESBLs), including the AmpC type, are important mechanisms of resistance among Enterobacteriaeceae. CTX-M type extended-spectrum β- lactamases, of which there are now over 90 variants, are distributed globally, yet appear to vary in regional distribution. AmpC β-lactamases hydrolyze third generation cephalosporins, but are resistant to inhibition by clavulanate or other β-lactamase inhibitors in vitro. Fecal carriage and rates of colonization by bacteria harboring these resistance mechanisms have been reported in patients with community-acquired infections and in healthy members of their households. Expression of these ESBLs compromises the efficacy of current antibacterial therapies, potentially increasing the seriousness of hospital- and community-acquired Escherichia coli (E. coli) infections.To investigate the occurrence of ESBL-producing E. coli in human fecal flora isolated from two pediatric populations residing in the Libyan cities Zleiten and Abou El Khoms. Isolates were further studied to characterize genes encoding β-lactam resistance, and establish genetic relationships.MethodsAntibiotic resistance profiles of phenotypically characterized E. coli isolates recovered from the stools of 243 Libyan children during two surveillance periods in 2001 and 2007 were determined by the disk diffusion method. ESBL-screening was performed using the cephalosporin/clavulanate double synergy disc method, and the AmpC-phenotype was confirmed by the aminophenyl-boronic acid test. ESBL genes were molecularly characterized. Phylogenetic group and multilocus sequence typing (MLST) were determined for ESBL-producing isolates and PFGE was performed to compare banding profiles of some dominant strains.ResultsESBLs were identified in 13.4% (18/134) of E. coli isolates, and nine isolates (6.7%) demonstrated AmpC activity; all 18 isolates contained a CTX-M gene. Three CTX-M gene families (CTX-M-1, n = 9; CTX-M-15, n = 8 and CTX-M-3, n = 1) were distributed in diverse E. coli backgrounds (phylogenetic group D, 39%; B2, 28%; B1, 22% and A, 11%). MLST analysis revealed 14 sequence type (ST) with six new sequence types. The gene encoding the CMY-2 enzyme was detected in five AmpC-positive E. coli.ConclusionsThese results identified heterogeneous clones of CTX-M-producing E. coli in the fecal isolates, indicating that the intestinal tract acts as a reservoir for ESBL-producing organisms, and a trafficker of antibiotic resistance genes.

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“…Notably, there was a considerable increase in the rate of ESBL fecal carriage (0.6%–6%) in healthy subjects in France over a 5-year period, and it was indicated that acquisition of ESBL E. coli was associated with common food sources and person-to-person transmission through oral–fecal route. 23 – 25 More recently, extremely higher rates of ESBL-producing commensal enterobacterial strains have been reported by Rahman et al (63.3%) from Egypt, 26 Sasaki et al (58.2%) from Thailand, 27 and Mathai et al (19%) from India. 28 These reports suggest the continuous evolution and dissemination of multiresistant enterobacterial commensals in the healthy guts.…”

Section: Discussionmentioning

confidence: 88%

Ugly bugs in healthy guts! Carriage of multidrug-resistant and ESBL-producing commensal Enterobacteriaceae in the intestine of healthy Nepalese adults

Maharjan

Bhetwal

Shakya

et al. 2018

IDR

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BackgroundFecal carriage of multidrug-resistant and extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is one of the important risk factors for infection with antibiotic-resistant bacteria. In this report, we examined the prevalence of multidrug-resistant and ESBL-producing common enterobacterial strains colonizing the intestinal tract of apparently healthy adults in Kathmandu, Nepal.MethodsDuring a 6-month period (February–July 2016), a total of 510 stool specimens were obtained from apparently healthy students of Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal. Stool specimens were cultured, and the most common enterobacterial isolates (Escherichia coli and Klebsiella species) were subjected to antimicrobial susceptibility tests according to the standard microbiologic guidelines. Multidrug-resistant isolates were selected for ESBL confirmation by combined disk test and E-test methods. Molecular characterization of plasmid-borne ESBL genes was performed by using specific primers of cefotaximase Munich (CTX-M), sulfhydryl variant (SHV), and temoniera (TEM) by polymerase chain reaction.ResultsAmong 510 bacterial strains, E. coli (432, 84.71%) was the predominant organism followed by Klebsiella oxytoca (48, 9.41%) and K. pneumoniae (30, 5.88%). ESBLs were isolated in 9.8% of the total isolates including K. oxytoca (29.17%), E. coli (7.87%), and K. pneumoniae (6.67%). Among ESBLs, bla-TEM was the predominant type (92%) followed by bla-CTX-M (60%) and bla-SHV (4%).ConclusionMultidrug-resistant and ESBL-producing enterobacterial commensal strains among healthy individuals are of serious concern. Persistent carriage of ESBL organisms in healthy individuals suggests the possibility of sustained ESBL carriage among the diseased and hospitalized patients. We recommend similar types of epidemiologic surveys in larger communities and in hospital settings to ascertain the extent of ESBL resistance.

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High Rates of Intestinal Colonization with Extended-Spectrum Lactamase-Producing Enterobacteriaceae among Healthy Individuals

Cited by 36 publications

References 13 publications

Fecal carriage of extended-spectrum β-lactamase- and carbapenemase-producing Enterobacteriaceae in Egyptian patients with community-onset gastrointestinal complaints: a hospital -based cross-sectional study

Fecal carriage of extended-spectrum β-lactamase- and carbapenemase-producing Enterobacteriaceae in Egyptian patients with community-onset gastrointestinal complaints: a hospital -based cross-sectional study

Fecal carriage of extended-spectrum β-lactamases and AmpC-producing Escherichia coli in a Libyan community

Ugly bugs in healthy guts! Carriage of multidrug-resistant and ESBL-producing commensal Enterobacteriaceae in the intestine of healthy Nepalese adults

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