Fecal Carriage of Extended-spectrum β-lactamase-producing Enterobacterales from Hospitals and Community Settings in Gaza Strip, Palestine

Overview

Journal BMC Microbiol

Publisher Biomed Central

Specialty Microbiology

Date 2023 Nov 30

PMID 38036965

Authors

Nabil Abdullah El Aila

Nahed Ali Al Laham

Basim Mohammed Ayesh

Thierry Naas

Affiliations

Soon will be listed here.

Abstract

Background: The fecal carriage of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) is a major driver of the global spread of these antibiotic resistance determinants. Here we determined the rate of fecal ESBL-PE carriage in pediatric hospitals and community-serving healthcare centers serving adults and children in the Gaza Strip, Palestine.

Methods: A total of 373 fecal and rectal samples were collected from different hospitals and clinics in Gaza. The antibiotic susceptibility was determined using the disk diffusion method and interpreted according to CLSI guidelines. The bacterial isolates were tested for ESBL production using phenotypic methods (double disk synergy test and growth on selective chromogenic media). Bla, bla, and bla genes were sought by PCR.

Results: Out of the 373 isolates tested, 138 (37%) were considered ESBL positive as revealed by phenotypic tests. The prevalence of ESBLs among hospitalized patients was 39.1% (hospital setting) whereas, among outpatients attending community healthcare centers, it was 35.1% (community setting). ESBL production among Escherichia coli, Klebsiella pneumoniae, Citrobacter freundii, Proteus mirabilis, and Klebsiella aerogenes isolates was 52.8%, 39.1%, 26.7%, 2.8%, and 2.1% respectively. Meropenem and amikacin were the most effective antibiotics against ESBL producers (68.9% and 73.6% susceptibility, respectively), while only 15.2%, 22.5%, and 24.6% remained susceptible to ceftazidime, cefotaxime, and ceftriaxone, respectively. Out of 138 phenotypically ESBL-positive isolates, 98 randomly chosen were screened for bla, bla, and bla genes. The prevalence rate of bla was 45.9%, while bla and bla genes were detected in 16.8% and 5.2% of CTX-M-negative isolates (corresponding mostly for K. pneumoniae isolates in the case of SHV-PCR), respectively.

Conclusions: The study revealed an alarmingly high prevalence of fecal carriage of ESBL-producing Enterobacterales among hospitalized children but also in the community of the Gaza Strip. In addition, 30% of ESBL-producers were already resistant to carbapenems, the treatment of choice of infections with ESBL-producers.

Citing Articles

Identification of beta-lactamase genes and molecular genotyping of multidrug-resistant clinical isolates of Klebsiella pneumoniae.

Ferdosi-Shahandashti A, Pournajaf A, Ferdosi-Shahandashti E, Zaboli F, Javadi K BMC Microbiol. 2024; 24(1):549.

PMID: 39732628 PMC: 11681741. DOI: 10.1186/s12866-024-03679-6.

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