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

• Published in: Antimicrobial resistance & infection control 2017-06, Vol.6 (1), p.62-62, Article 62
• Main Authors: Abdallah, H M, Alnaiemi, N, Reuland, E A, Wintermans, B B, Koek, A, Abdelwahab, A M, Samy, A, Abdelsalam, K W, Vandenbroucke-Grauls, C M J E
• Format: Article
• Language: English
• Subjects: Antibiotics; Antimicrobial agents; Automation; Bacteria; Beta lactamases; Carbapenemase-ESBL-Egypt-resistance-Enterobacteriaceae; Carbapenems; Colonization; Cross-sectional studies; Deoxyribonucleic acid; Disease control; DNA; Drug resistance; Drug resistance in microorganisms; E coli; Enterobacter; Enterobacteriaceae; Enzymes; Feces; Genetic aspects; Health aspects; Infections; Internet; Ionization; Mass spectrometry; Studies
• ISSN: 2047-2994; 2047-2994
• DOI: 10.1186/s13756-017-0219-7

The 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. One 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 isolates were determined by a triplex PCR-based method. Of 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 (  = 72), (  = 23), (  = 3), spp. (  = 1) and other Enterobacterceae isolates (  = 14). The gene was detected in 89.04% (65/73) of the ESBL-producing Enterobacteriaceae, whereas and 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. Nearly 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.