Antibiotic resistance patterns and beta-lactamase identification in Escherichia coli isolated from young children in rural Limpopo Province, South Africa: The MAL-ED cohort

Abstract

Background. Antibiotic resistance is a growing problem worldwide. Mechanisms of resistance vary, and some can confer resistance to multiple classes of antibiotics. Objective. To characterise the antibiotic resistance profiles of Escherichia coli isolates obtained from stool samples of young rural children exposed or unexposed to antibiotics. Methodology. The samples were collected from children aged 4 -12 months who were participants in the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) project at the South Africa research site. We isolated 87 E. coli samples (clones) from 65 individual participants, all of which were subjected to disc diffusion assay to determine resistance. We characterised the minimum inhibitory concentration of antibiotics in a subset of strains as well as the mechanism by which these strains were resistant to beta-lactam antibiotics. Results. Our results revealed high resistance rates to co-trimoxazole (54.0%), penicillin (47.1%) and tetracycline (44.8%) in our isolates, and indicated that the beta-lactamase TEM-1 is a prevalent source of beta-lactam resistance. We also identified two isolates with the extendedspectrum beta-lactamase CTX-M-14. Conclusions. This study identified antibiotic-resistant E. coli in children with and without prior exposure to antibiotics, with some isolates showing resistance to multiple classes of antibiotics. Clinicians should bear in mind that transmission of extended-spectrum betalactamase-resistant E. coli exists at the community level, and that children as young as 2 years may be harbouring these resistant phenotypes.

Evidence of potentially unrelated AmpC beta-lactamase producing Enterobacteriaceae from cattle, cattle products and hospital environments commonly harboring the blaACC resistance determinant

“…In the present study, large proportions of the isolates originating from various sources displayed significant susceptibilities to the aminoglycoside; amikacin and the carbapenem; meropenem. A similar outcome of no resistance against imipenem and two aminoglycosides was obtained in a previous study among young children in the Limpopo Province of South Africa [69]. These findings are of great therapeutic significance particularly because carbapenems especially meropenem are often used as the first-line antibacterial agents for infections caused by AmpC beta-lactamase-producing Enterobacteriaceae.…”

“…Although the CTX-M enzymes in ESBL producers are the most frequently detected globally [78], the TEM type enzymes are known to be horizontally transferrable with ease and are degraded by clavulanic acid [78,79]. The significant number of ESBL producing isolates positive for the bla TEM gene, do not agree with previous studies by Oduro-Mensah et al [80] and Bajai et al [81] who reported lower frequencies of detection; 41.8% and 48.7% respectively although comparable to a very high occurrence rate (95.1%) in penicillin-resistant E. coli isolated from young children in the Limpopo province of South Africa [69]. It is worth mentioning that ESBL producers are clinically significant because associated infections are related to high mortality, lengthened hospital stay, failure of therapy and general health cost.…”

Inactivation of antibiotic-resistant bacteria and antibiotic-resistance genes in wastewater streams: Current challenges and future perspectives

“…Penicillin’s (ampicillin, amoxicillin and clavulanic acid) and cephalosporins (cefotaxime) are the main β - lactam antibiotics used for veterinary and human medicine ( Defrancesco et al, 2017 ; Pazda et al, 2019 ). The instability of the β - lactam ring and its susceptibility to hydrolysis makes β - lactam antibiotics, especially penicillin, not easily detected in WWTPs ( Pazda et al, 2019 ).…”

“…This may be because clinical E. coli isolates frequently co-carry multiple ESBL genes with varying hydrolysis spectra to different antibiotics, leading to treatment failure ( Seyedjavadi et al, 2016 ; Gumede et al, 2021 ). The genes that confer resistances to ESBL is the bla CTX-M ( Bockelmann et al, 2009 ; Defrancesco et al, 2017 ), while the bla TEM and bla SHV genes confer resistance to the narrow-spectrum β-lactams ( Defrancesco et al, 2017 ). Specific variants of these, such as bla SHV-5 , have the ability to hydrolyze broad-spectrum cephalosporins and monobactams ( Nzima et al, 2020 ).…”

Improving our understanding of antibiotic resistance: The relevance of surveillance at the population level

“…MAL-ED is a multicountry, prospective, observational birth cohort study carried out to improve understanding of the interactions of enteric infections, childhood illnesses, vaccine responses, environmental enteropathy, physical growth and cognitive development. [7] In this edition of the SAMJ, DeFrancesco et al [8] demonstrate that strains of Escherichia coli, a common cause of bacterial gastroenteritis, produce extended-spectrum beta-lactamase (ESBL). The production of ESBL allows bacteria to thrive in the presence of therapeutic doses of several clinically important antibiotics, potentially complicating management.…”