Prevalence and risk factors for intestinal carriage of CTX-M-type ESBLs in Enterobacteriaceae from a Thai community

Abstract

The incidence of infections caused by antimicrobial-resistant Enterobacteriaceae in Thailand is increasing and human intestinal flora is an important reservoir for these organisms. This study was carried out to determine the intestinal carriage of bla extended spectrum ß-lactamase-positive Enterobacteriaceae (ESBL + E) and AmpC-positive Enterobacteriaceae in a community setting in Northern Thailand, and to identify potential risk factors for carriage. A total of 307 fecal samples were collected from healthy volunteers in Phitsanulok province, and cefotaxime-resistant Enterobacteriaceae (CtxRE) were isolated using selective media. Polymerase chain reaction (PCR) was used to detect ESBL and AmpC genes. Risk factors were analyzed using multiple logistic regression. Genotyping was performed by multilocus sequence typing (MLST) analysis. Two hundred ninety-one CtxRE isolates were obtained and Escherichia coli was the predominant organism (66.3%). The intestinal carriage rates of bla ESBL + E and AmpC-positive Enterobacteriaceae were 52.1% and 6.2%, respectively. Comparative levels of bla and bla were found while bla was the predominant genotype among AmpC genes. Co-existence of two ß-lactamase genes in a single isolate was found in 6.5% of isolates. Consumption of undercooked meat was strongly associated with intestinal carriage of bla ESBL + E (p = 0.003, OR = 2.133, 95% CI = 1.289-3.530). Phylogenetic grouping and MLST analysis of E. coli isolates revealed the presence of E. coli B2-ST131 (n = 8). Of these, seven carried bla and 1 carried bla. Our results suggest that residents in Thailand are at high risk for developing endogenous infections caused by antibiotic-resistant Enterobacteriaceae.

Carriage of carbapenemase‐ and extended‐spectrum cephalosporinase‐producing Escherichia coli and Klebsiella pneumoniae in humans and livestock in rural Cambodia; gender and age differences and detection of blaOXA‐48 in humans

“…The possible impact of home slaughter is supported by a study in Cameroon showing that ESBL‐producing K. pneumoniae isolates disseminate from animals to abattoir workers (Founou et al, ). There were no significant associations between meat consumption and faecal carriage of ESCE/K, which contrast previous studies that have shown regular consumption of meat and consumption of undercooked meat to be risk factors for community carriage of ESBL‐producing Enterobacteriaceae (Hijazi et al, ; Niumsup et al, ).…”

“…The demonstrated community carriage of ESCE/K in humans and livestock in Cambodia (20% in humans and 23% in livestock) is similar to a recent report on ESBL‐producing E. coli colonization in chicken farmers (20%) and chickens (35%) from Vietnam (Nguyen et al, ) but lower than in reports from Thailand (62%) and Vietnam/Laos (41%–70%) (Nakayama et al, ; Niumsup et al, ). The lower detection frequency in our study could be due to the rural habitat of the sampled population and that previous thawing of some samples has led to an underestimation of human carriage.…”

“…Vietnam/Laos (41%-70%) (Nakayama et al, 2015;Niumsup et al, 2018). The lower detection frequency in our study could be due to the rural habitat of the sampled population and that previous thawing of some samples has led to an underestimation of human carriage.…”

“…Community carriage of CPE/K has only been described in a few countries such as Lebanon (Beyrouthy et al, 2014) and Spain (Rios, Lopez, Rodriguez-Avial, Culebras, & Picazo, 2017), whereas community carriage of ESCE/K is common worldwide (Woerther, Burdet, Chachaty, & Andremont, 2013), with Southeast Asia identified as an area with a particularly high carriage of ESC-producing Enterobacteriaceae (Hawkey, 2008;Karanika, Karantanos, Arvanitis, Grigoras, & Mylonakis, 2016;Woerther et al, 2013). In China and Thailand, community carriage of ESCE varies between 30% and 58% (Li et al, 2011;Ni et al, 2016;Zhou et al, 2015) and 58% and 62%, respectively (Niumsup et al, 2018;Sasaki et al, 2010). Several studies have indicated that foreign travel from countries with low ESBL frequency to Southeast Asia is a major risk factor for acquiring ESBL-producing Enterobacteriaceae (Karanika et al, 2016).…”

Meat and Fish as Sources of Extended-Spectrum β-Lactamase–Producing Escherichia coli, Cambodia

“…Although we did not test dried meat samples for ESBL-producing E. coli contamination, our finding is consistent with those of other studies ( 8 , 9 ). Women reported having prepared dried poultry at home.…”