The Gut of Healthy Infants in the Community as a Reservoir of ESBL and Carbapenemase-Producing Bacteria

Abstract

The recent rapid rise of multi-drug resistant Enterobacteriaceae (MDR-E) is threatening the treatment of common infectious diseases. Infections with such strains lead to increased mortality and morbidity. Using a cross-sectional study, we aimed to estimate the prevalence of gut colonization with extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae among healthy infants born in Pakistan, a setting with high incidence of MDR-E infections. Stool samples were collected from 104 healthy infants between the ages of 5 and 7 months. Enterobacteriaceae isolates were screened for resistance against several antimicrobial classes. Presence of ESBL and carbapenemase genes was determined using multiplex PCR. Sequence types were assigned to individual strains by multi-locus sequence typing. Phylogenetic analysis of Escherichia coli was done using the triplex PCR method. Forty-three percent of the infants were positive for ESBL-producing Enterobacteriaceae, the majority of which were E. coli. We identified several different ESBL E. coli sequence types most of which belonged to the phylogenetic group B2 (23%) or D (73%). The widespread colonization of infants in a developing country with ESBL-producing Enterobacteriaceae is concerning. The multiple sequence types and reported non-human sources support that multiple non-epidemic MDR lineages are circulating in Pakistan with healthy infants as a common reservoir.

Community Fecal Carriage and Molecular Epidemiology of Extended-Spectrum β-Lactamase- and Carbapenemase-Producing Escherichia coli from Healthy Children in the Central South China

“…In the study by Bunt et al, daycare center attendance has been shown to be a risk factor for preschoolers carrying ESBL/AmpC-producing bacteria. 25 The prevalence of ESBL-EC carriage in the healthy children in the present study was higher than that in France (7.6%) and Spain (31%) 26 , 27 and lower than that in Cambodia (55%) and Pakistan (43%), 28 , 29 which may be partly due to the differences in sanitary conditions, climate, and eating habits in different regions of the world. Although the carriage rate of ESBL-EC in this study was relatively high compared to that observed in the above studies, it was still lower than that in pediatric patients in China, which has been reported to be 46.7%.…”

“… 20 , 32 Although few countries have reported CP-EC carriage among community healthy children to date, a report from Pakistan showed that a quarter of infants in their research harbored CP-EC, indicating that the intestine of healthy children may be a reservoir of CP-EC and should be considered as a serious health issue. 29 …”

Specificities and Commonalities of Carbapenemase-Producing Escherichia coli Isolated in France from 2012 to 2015

“…Therefore, multidrug resistance (MDR) in E. coli is a major public health issue making E. coli infections more difficult to treat. In addition, as carbapenemase-producing Enterobacterales (CPE) are increasingly detected ( 2 , 3 ) and E. coli is a ubiquitous member of the human gut microbiome, carbapenemase-producing E. coli (CP- Ec ) is also becoming a major actor for the global dissemination of carbapenemase genes ( 4 ).…”

Can breastfeeding protect against antimicrobial resistance?

“…By 2050, up to 90% of AMR-related mortality is predicted to occur in countries in Asia and Africa [1], most of which are low-or middle-income. Although systematic investigations are sparse, several studies of healthy children in LMICs [5,7,102] report colonization with enteric multidrug-resistant gram-negative bacteria at rates that far exceed what is observed in the USA and Europe. For example, 82% of 1-2-year-old children in Bangladesh [103] were recently reported to be colonized with third-generation cephalosporin-resistant Enterobacteriaceae, compared to 4.5% of similarly aged children in the USA [104] and~14% in Switzerland [105].…”