Plasmid-mediated quinolone resistance genes detected in Ciprofloxacin non-susceptible Escherichia coli and Klebsiella isolated from children under five years at hospital discharge, Kenya

Abstract

Background The increasing spread of fluoroquinolone resistant enteric bacteria is a global public health concern. Children recently discharged from the hospital are at high risk of carriage of antimicrobial resistance (AMR) due to frequent exposure to antimicrobials during inpatient stays. This study aimed to determine the prevalence, correlates of ciprofloxacin (CIP) non-susceptibility, and distribution of plasmid-mediated quinolone resistance (PMQR) genes in Escherichia coli (E. coli) and Klebsiella spp isolated from children under five years being discharged from two Kenyan Hospitals. Methods E. coli and Klebsiella spp were isolated from fecal samples from children discharged from hospital and subjected to antimicrobial susceptibility testing (AST) by disc diffusion and E-test. CIP non-susceptible isolates were screened for seven PMQR genes using multiplex polymerase chain reaction (PCR). Poisson regression was used to determine the association between the carriage of CIP non-susceptible isolates and patient characteristics. Results Of the 280 CIP non-susceptible isolates: 188 E. coli and 92 Klebsiella spp isolates identified among 266 discharged children, 195 (68%) were CIP-non-susceptible with minimum inhibitory concentrations (MICs) of ≥ 1 µg/mL. Among these 195 isolates, 130 (67%) had high-level CIP MIC = ≥ 32 µg/mL). Over 80% of the isolates had at least one PMQR gene identified: aac(6’)lb-cr (60%), qnrB (24%), oqxAB (22%), qnrS (16%), and qepA (6%), however, qnrA was not identified in any isolates tested. Co-carriage of qnrB with acc(6’)-lb-cr was the most predominant accounting for 20% of all the isolates. Ceftriaxone use during hospital admission and the presence of extended spectrum beta-lactamase (ESBL) production were significantly associated with the carriage of CIP non-susceptible E. coli and Klebsiella spp. Conclusion CIP non-susceptibility is common among E. coli and Klebsiella spp isolated from hospital discharged children in Kenya. Carriage and co-carriage of PMQR, including the newly identified qepA gene, were frequently observed. These findings suggest that children leaving the hospital may serve as an important reservoir for transmission of resistant E. coli and Klebsiella spp to the community. Enhanced surveillance for AMR determinants is critical to inform interventions to control antimicrobial-resistant bacteria.

Characterization of Beta-Lactamase and Fluoroquinolone Resistance Determinants in Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa Isolates from a Tertiary Hospital in Yola, Nigeria

“…Consistent with our findings, a study at a tertiary hospital in southern Nigeria revealed that 93.3% of E. coli isolates harboured at least one fluoroquinolone resistance gene [27]. Similar patterns of high levels of fluoroquinolone re-sistance have been reported in other parts of sub-Saharan Africa including South Africa and Kenya [10,[28][29][30][31]. In our study, fluoroquinolone resistance in E.coli and P. aeruginosa was primarily conferred by double or triple mutations in the gyrA gene.…”

Phenotypic and molecular characterization of β-lactamase-producing Klebsiella species among children discharged from hospital in Western Kenya

“…Antibiotics are an essential, and often life-saving tool for hospitalized children in settings of high infectious-disease related morbidity and mortality. Phenotypic AMR was associated with longer period of hospitalization and antibiotic use during hospitalization consistent with our previous findings [ 17 , 18 ] and findings from studies conducted elsewhere [ 19 ]. We observed a high prevalence of non-susceptibility to 3 rd generation cephalosporins (cefotaxime, ceftriaxone and ceftazidime) in our study sites, as has been described elsewhere in SSA [ 20 – 22 ].…”

Antimicrobial resistance in E. Coli of animal origin and discovery of a novel ICE mobile element in Northeast China

“…Polymerase chain reaction (PCR) was used to detect the respective ARGs (Table S1 ) of chloramphenicol, macrolides, quinolones, β-lactams, tetracyclines, and aminoglycosides, which are widely used in animals. gyr A and par C targets in the quinolone resistance determining region (QRDR) of 7 strains with different PFGE types and high fluoroquinolone resistance [ 27 ] (MIC ≥ 32 mg/L) were detected. The gyrA and parC sequences were compared with those of E. coli K12 available in the NCBI database.…”

“…The World Health Organization (WHO) has classified fluoroquinolones as “critically important antimicrobials” because of their broad-spectrum effects and clinical importance in human and animal medicine [ 25 ]. Some studies have shown that minimal inhibitory concentration (MIC) ≥ 32 mg/L is a high-level resistant strain [ 26 , 27 ]. In this study, an MDR E. coli C3 highly resistant to multiple antibiotics was isolated from E. coli isolated from different animals in northeast China.…”