Ugly Bugs in Healthy Guts! Carriage of Multidrug-resistant and ESBL-producing Commensal Enterobacteriaceae in the Intestine of Healthy Nepalese Adults

Overview

Journal Infect Drug Resist

Publisher Dove Medical Press

Date 2018 May 8

PMID 29731643

Citations 13

Authors

Anjila Maharjan

Anjeela Bhetwal

Shreena Shakya

Deepa Satyal

Shashikala Shah

Govardhan Joshi

Puspa Raj Khanal

Narayan Prasad Parajuli

Affiliations

Soon will be listed here.

Abstract

Background: Fecal 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.

Methods: During 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 ( and 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.

Results: Among 510 bacterial strains, (432, 84.71%) was the predominant organism followed by (48, 9.41%) and (30, 5.88%). ESBLs were isolated in 9.8% of the total isolates including (29.17%), (7.87%), and (6.67%). Among ESBLs, -TEM was the predominant type (92%) followed by -CTX-M (60%) and -SHV (4%).

Conclusion: Multidrug-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.

Citing Articles

High prevalence of colonization with extended-spectrum β-lactamase-producing and multidrug-resistant Enterobacterales in the community in Addis Ababa Ethiopia: risk factors, carbapenem resistance, and molecular characterization.

Abera D, Negash A, Fentaw S, Mekonnen Y, Cataldo R, Wami A BMC Microbiol. 2024; 24(1):402.

PMID: 39390409 PMC: 11465526. DOI: 10.1186/s12866-024-03552-6.

Antimicrobial resistance and virulence genes of invasive from children with bacteremia in north-central Nigeria.

Uzairue L, Shittu O, Ojo O, Obuotor T, Olanipekun G, Ajose T SAGE Open Med. 2023; 11:20503121231175322.

PMID: 37223673 PMC: 10201152. DOI: 10.1177/20503121231175322.

Systematic Review and Meta-analysis on Extended-Spectrum β-lactamases Producing in Nepal.

Shyaula M, Khadka C, Dawadi P, Banjara M Microbiol Insights. 2023; 16:11786361221145179.

PMID: 36655025 PMC: 9841864. DOI: 10.1177/11786361221145179.

High frequency of colonization by extended-spectrum beta-lactamase-producing Gram-negative bacilli in hemodialysis patients and their household contacts in Colombia: dissemination between the community and the hospital.

Montoya-Urrego D, Tellez-Carrasquilla S, Vanegas J, Quiceno J Epidemiol Health. 2022; 44:e2022069.

PMID: 36097808 PMC: 9943636. DOI: 10.4178/epih.e2022069.

Comparison of the global prevalence and trend of human intestinal carriage of ESBL-producing between healthcare and community settings: a systematic review and meta-analysis.

Bezabih Y, Bezabih A, Dion M, Batard E, Teka S, Obole A JAC Antimicrob Resist. 2022; 4(3):dlac048.

PMID: 35668909 PMC: 9160884. DOI: 10.1093/jacamr/dlac048.

References

Shanahan P, Thomson C, Amyes S . Beta-lactam resistance in normal faecal flora from South Africa. Epidemiol Infect. 1995; 115(2):243-53. PMC: 2271412. DOI: 10.1017/s0950268800058374. View

Nys S, Okeke I, Kariuki S, Dinant G, Driessen C, Stobberingh E . Antibiotic resistance of faecal Escherichia coli from healthy volunteers from eight developing countries. J Antimicrob Chemother. 2004; 54(5):952-5. DOI: 10.1093/jac/dkh448. View

Villar H, Baserni M, Jugo M . Faecal carriage of ESBL-producing Enterobacteriaceae and carbapenem-resistant Gram-negative bacilli in community settings. J Infect Dev Ctries. 2013; 7(8):630-4. DOI: 10.3855/jidc.2900. View

Spellberg B, Powers J, Brass E, Miller L, Edwards Jr J . Trends in antimicrobial drug development: implications for the future. Clin Infect Dis. 2004; 38(9):1279-86. DOI: 10.1086/420937. View

Abdul Rahman E, El-Sherif R . High rates of intestinal colonization with extended-spectrum lactamase-producing Enterobacteriaceae among healthy individuals. J Investig Med. 2011; 59(8):1284-6. DOI: 10.2130/JIM.0b013e318238748e. View

Al-Agamy M, El Mahdy T, Shibl A . Fecal Colonization with Extended-Spectrum Beta-Lactamase and AmpC-Producing Escherichia coli. Biomed Res Int. 2016; 2016:3704150. PMC: 4906171. DOI: 10.1155/2016/3704150. View

Rossi F, Baquero F, Hsueh P, Paterson D, Bochicchio G, Snyder T . In vitro susceptibilities of aerobic and facultatively anaerobic Gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: 2004 results from SMART (Study for Monitoring Antimicrobial Resistance Trends). J Antimicrob Chemother. 2006; 58(1):205-10. DOI: 10.1093/jac/dkl199. View

Rausch D, Ruan X, Nandre R, Duan Q, Hashish E, Casey T . Antibodies derived from a toxoid MEFA (multiepitope fusion antigen) show neutralizing activities against heat-labile toxin (LT), heat-stable toxins (STa, STb), and Shiga toxin 2e (Stx2e) of porcine enterotoxigenic Escherichia coli (ETEC). Vet Microbiol. 2016; 202:79-89. PMC: 7172483. DOI: 10.1016/j.vetmic.2016.02.002. View

Jena J, Debata N, Sahoo R, Gaur M, Subudhi E . Molecular characterization of extended spectrum β-lactamase-producing Enterobacteriaceae strains isolated from a tertiary care hospital. Microb Pathog. 2017; 115:112-116. DOI: 10.1016/j.micpath.2017.12.056. View

10.

Boonyasiri A, Tangkoskul T, Seenama C, Saiyarin J, Tiengrim S, Thamlikitkul V . Prevalence of antibiotic resistant bacteria in healthy adults, foods, food animals, and the environment in selected areas in Thailand. Pathog Glob Health. 2014; 108(5):235-45. PMC: 4153825. DOI: 10.1179/2047773214Y.0000000148. View

11.

Livermore D . Current epidemiology and growing resistance of gram-negative pathogens. Korean J Intern Med. 2012; 27(2):128-42. PMC: 3372794. DOI: 10.3904/kjim.2012.27.2.128. View

12.

Leflon-Guibout V, Blanco J, Amaqdouf K, Mora A, Guize L, Nicolas-Chanoine M . Absence of CTX-M enzymes but high prevalence of clones, including clone ST131, among fecal Escherichia coli isolates from healthy subjects living in the area of Paris, France. J Clin Microbiol. 2008; 46(12):3900-5. PMC: 2593250. DOI: 10.1128/JCM.00734-08. View

13.

Kader A, Kumar A, Kamath K . Fecal carriage of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in patients and asymptomatic healthy individuals. Infect Control Hosp Epidemiol. 2007; 28(9):1114-6. DOI: 10.1086/519865. View

14.

Sasaki T, Hirai I, Niki M, Nakamura T, Komalamisra C, Maipanich W . High prevalence of CTX-M beta-lactamase-producing Enterobacteriaceae in stool specimens obtained from healthy individuals in Thailand. J Antimicrob Chemother. 2010; 65(4):666-8. DOI: 10.1093/jac/dkq008. View

15.

Pilmis B, Delory T, Groh M, Weiss E, Emirian A, Lecuyer H . Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) infections: are carbapenem alternatives achievable in daily practice?. Int J Infect Dis. 2015; 39:62-7. DOI: 10.1016/j.ijid.2015.08.011. View

16.

Alanis A . Resistance to antibiotics: are we in the post-antibiotic era?. Arch Med Res. 2005; 36(6):697-705. DOI: 10.1016/j.arcmed.2005.06.009. View

17.

Li B, Sun J, Liu Q, Han L, Huang X, Ni Y . High prevalence of CTX-M β-lactamases in faecal Escherichia coli strains from healthy humans in Fuzhou, China. Scand J Infect Dis. 2010; 43(3):170-4. DOI: 10.3109/00365548.2010.538856. View

18.

Wenzel R, Edmond M . Managing antibiotic resistance. N Engl J Med. 2001; 343(26):1961-3. DOI: 10.1056/NEJM200012283432610. View

19.

Carlet J . The gut is the epicentre of antibiotic resistance. Antimicrob Resist Infect Control. 2012; 1(1):39. PMC: 3554492. DOI: 10.1186/2047-2994-1-39. View

20.

Ahmed S, Ali M, Mohamed Z, Moussa T, Klena J . Fecal carriage of extended-spectrum β-lactamases and AmpC-producing Escherichia coli in a Libyan community. Ann Clin Microbiol Antimicrob. 2014; 13:22. PMC: 4107601. DOI: 10.1186/1476-0711-13-22. View