Frequency and factors associated with carriage of multi-drug resistant commensal Escherichia coliamong women attending antenatal clinics in Central India

Abstract

BackgroundCommensal Escherichia coli are a prominent reservoir of genes coding for antibiotic resistance and also responsible for endogenous infections in pregnant women. We studied the factors in pregnant women associated with carriage of multi-drug resistant (MDR) E. coli and genetic determinants of antibiotic resistance in them.MethodsWomen attending to Obstetric and Gynaecology department outpatient clinics for routine antenatal check-up were administered a questionnaire. Peri-anal swabs were collected for culture isolation and identification of E.coil. Antibiotic sensitivity was done using the Kirby-Bauer disc diffusion method as recommended by the CLSI guidelines. MICs for quinolones and third generation cephalosporins were done using the agar dilution method. Genes coding for production of beta lactamses and for the quinolone resistance determinant were screened by polymerase chain reaction. Rep-PCR was done on MDR isolates for detecting possible genetic similarity. Multiple logistic regression models were used to determine the independent factors associated with carriage of MDR isolates.ResultsA total of 710 isolates of E. coli from 710 women (mean age 26 years) were included in the study. Resistance to at least one antibiotic tested was detected in 94% of the E. coli isolates. A total of 109 isolates were ESBL producing and 35 isolates were MDR. In the MDR isolates MIC50 and MIC90 for quinolones and third generation cephalosporins were high for those isolates that carried blaTEM gene (26 isolates) and blaCTX-M gene (24 isolates). Both blaTEM and blaCTX-M genes were detected in 19 isolates. The commonest Plasmid Mediated Quinolone Resistance (PMQR) gene identified was aac(6′)-Ib-cr (n = 23/25). All isolates carrying the PMQR genes were also positive for blaCTX-M and blaTEM gene. Mutations in gyr A and par C genes were present in all 35 MDR isolates. The statistically significant risk factors for carriage of MDR E. coli were graduate or post-graduate education, a self-employed status, a family size of more than 10 members, antibiotic usage in last four weeks, and history of hospitalization in the last four weeks.ConclusionsThe presence of genes coding for extended spectrum of beta lactamases and plasmid mediated quinolone resistance in commensal E. coli is disconcerting. The study provides strong basis good antibiotic stewardship.

Colonization of Extended-Spectrum-β-Lactamase- and NDM-1-Producing Enterobacteriaceae among Pregnant Women in the Community in a Low-Income Country: a Potential Reservoir for Transmission of Multiresistant Enterobacteriaceae to Neonates

“…Our estimation of the ESBL-PE colonization rate among pregnant women in the community (18.5%) is similar to those reported in Tanzania (15% in 2013) (15) and India (15% in 2007 to 2009) (16). A previous community-based study conducted in Madagascar in 2009 estimated an ESBL-PE carriage rate of 10% (17).…”

“…Living in an individual house and having a private inside access to drinking water were associated with ESBL-PE colonization. These conditions reflect a higher socioeconomic status in a globally underprivileged population and may correlate with more frequent access to health care services or a higher antibiotic consumption (16). However, we did not find any association between individual antibiotic consumption and ESBL-PE colonization.…”

Prevalence of Aac(6’)-Ib-Cr and Qepa Genes among Quinolone Resistant Uropathogens Isolated from Asymptomatic Female Students of a Northern University on Nigeria.

“…The presence of PMQR gene in resistant isolates was 6.75%. This agrees with other studies that reported prevalenece of PMQR gene [30,31].…”

“…Also a study by [31] recorded aac(6')-Ib-cr gene (95%) as the most common PMQR gene isolated from multidrug resistant E. coli in India. This agrees with the result obtained in this study as a high prevalence of isolation of the aac(6')-Ib-cr was recorded.…”

Fecal carriage of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp. in a Turkish community

“…Poor health and sanitation conditions were set forth to increase the spread of ESBL by fecal-oral route and compliance with the rules of hygiene was suggested to be worth investigation (37). In a study in India, the ESBL fecal carriage rate was high in people with high levels of education and this situation was thought to be associated with the fact that it was easier for these people to obtain antibiotics (38). In our study, the carriage rates in university graduates were determined to be significantly lower.…”