Abstract
Colistin is a last-resort antibiotic against multidrug-resistant, Gram-negative bacteria. Colistin resistance has been described in the clinical settings in South Africa. However, information on carriage of these bacteria in communities is limited. This study investigated gastrointestinal carriage of colistin-resistant Escherichia coli and Klebsiella spp. and mcr genes in children from communities in Cape Town. Colistin-resistant E. coli was isolated from two participants (4%, 2/50), and mcr-1-mcr-9 genes were not detected. Gastrointestinal carriage of colistin-resistant Enterobacterales was rare; however, continuous extensive surveillance is necessary to determine the extent of carriage and its contribution to resistance observed in clinical settings.
Highlights
Antibiotic resistance is threatening public health globally, and colistin remains one of the last-resort antibiotics for treating infections because of carbapenem-resistant Enterobacterales
This study aimed to describe the gastrointestinal carriage of colistin-resistant organisms and mcr genes in children from Cape Town communities
Colistin resistance was confirmed by broth microdilution (BMD) in only 3% (2/70) of the isolates, both of which were E. coli (MIC = 4 milligrams per litre (mg/L))
Summary
Antibiotic resistance is threatening public health globally, and colistin remains one of the last-resort antibiotics for treating infections because of carbapenem-resistant Enterobacterales. Colistin resistance is increasingly being reported in Enterobacterales both worldwide and in South Africa, which is of great concern.[1,2,3,4,5,6,7,8,9]. Mutations in the two-component regulatory systems, PhoPQ and PmrAB, and inactivation of the mgrB gene are the most common causes of colistin resistance. Additional plasmid-mediated mcr genes, mcr-2-mcr-10 and different variants thereof, have since been detected, which confer colistin resistance.[1,2] mcr genes have been mostly isolated from Enterobacterales, especially Escherichia coli and Klebsiella pneumoniae, which are responsible for both nosocomial and community-acquired (CA) infections, including sepsis, pneumonia, urinary tract infections and intra-abdominal infections[10,11]; these organisms are common gut commensal organisms. Numerous studies have detected the mcr gene in isolates from clinical, community and environmental settings.[1,2,3,4,5,6]
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