Emergence of Colistin and Carbapenem Resistance in Extended-Spectrum β-Lactamase Producing Klebsiella pneumoniae Isolated from Chickens and Humans in Egypt.

Etab M Abo Remela,Ahmed Abdel Tawab,Walid Elmonir,Radwa Eissa,Norhan K Abd El-Aziz,Hosam A Saad,Samar M Moustafa,Yasmine H Tartor

doi:10.3390/biology10050373

Abstract

Simple SummaryCarbapenems and colistin are reserved as the last-resort treatments of multidrug-resistant (MDR) infections in humans. Consequently, the emergence of carbapenem and colistin-resistant Klebsiella pneumoniae (K. pneumoniae) in poultry, contact workers and hospitalized patients is of grave concern for therapeutic options, and no data are available supporting this assumption on a regional or countrywide scale. We investigated the frequency and typing of extended-spectrum β-lactamase (ESBL) and carbapenemase-producing K. pneumoniae (ESBLK and CPK) in hospitalized patients, chickens from 10 poultry farms and their environment (water, food and litter) and farm workers in Egypt. All isolates from patients (13/90, 14.4%), workers (5/22, 22.7%), chickens (9/100, 9%) and the environment (10/60, 16.7%) harbored a single or multiple β-lactamase genes, blaSHV, blaTEM, blaCTX-M1 and blaOXA-1, often in combination with carbapenemase genes (blaVIM, blaNDM-1 or blaIMP; 45.9%), the mcr-1 gene (18.9%) or both (13.5%). Enterobacterial repetitive intergenic consensus (ERIC)-PCR genotyping highlighted potential inter and intraspecies clonal dissemination in the study area. The increased frequency and genetic relatedness of ESBLK and CPK from chickens and humans pose a public health threat that urges more prudent use of antimicrobials in chicken farms to avoid the propagation and expansion of both ESBLK and CPK from the chicken sources to humans.This study investigated the frequency of carbapenem and colistin resistance in ESBL-producing K. pneumoniae (ESBLK) isolates recovered from chickens and their environment, contact farm workers and hospitalized patients in Egypt. Further, the phenotypic and genotypic relationships between the community and hospital-acquired K. pneumoniae isolates in the same geographical area were investigated. From 272 total samples, 37 (13.6%) K. pneumoniae isolates were identified, of which 20 (54.1%) were hypervirulent. All isolates (100%) were multidrug-resistant (MDR) with multiple antibiotic resistance (MAR) indices ranging from 0.19 to 0.94. Colistin-resistant isolates (18.9%) displayed colistin MIC values >2 μg/mL, all harbored the mcr-1 gene. All isolates from patients (13/90, 14.4%), workers (5/22, 22.7%), chickens (9/100, 9%) and the environment (10/60, 16.7%) harbored a single or multiple β-lactamase genes, blaSHV, blaTEM, blaCTX-M1 and blaOXA-1, often in combination with carbapenemase genes (blaVIM, blaNDM-1 or blaIMP; 45.9%), the mcr-1 gene (18.9%) or both (13.5%). Enterobacterial repetitive intergenic consensus (ERIC)–PCR genotyping revealed 24 distinct ERIC types (ETs) with a discrimination index of 0.961. Six ETs showed clusters of identical isolates from chicken and human sources. The increased frequency and genetic relatedness of ESBLK and carbapenemase-producing K. pneumoniae (CPK) from chickens and humans pose a public health threat that urge more prudent use of antimicrobials in chicken farms to avoid the propagation and expansion of both ESBLK and CPK from the chicken sources to humans.

Highlights

Klebsiella pneumoniae (K. pneumoniae) is a pervasive nosocomial and community associated-pathogen causing a wide range of infections in humans and animals [1,2]
For determination of the potential risk for chicken-human cross-transmission, we detected the occurrence of carbapenemase and colistin resistance in ESBLproducing K. pneumoniae (ESBLK) in hospitalized patients, workers who were in close contact with broiler chickens, broilers and their environment
60 environmental samples were included: two pooled samples for water, food and litter (n = 2 each) per farm were separately screened for carbapenem and colistin resistance in ESBLK

Summary

Introduction

Klebsiella pneumoniae (K. pneumoniae) is a pervasive nosocomial and community associated-pathogen causing a wide range of infections in humans and animals [1,2]. Bacterial invasion in livestock animals poses a potential hazard to public health, as infected animals act as a reservoir of multidrug-resistant (MDR) isolates [1,3]. In Egypt, no regulations are controlling the use of antimicrobials in animals [4], which may be used as growth promoters or for the prevention and treatment of zoonotic diseases. This supports the evidence linking consumption of antimicrobials in livestock animals to their resistance in humans [5]. Previous studies suggested that food-producing animals, chickens, have been considered a possible source for transmission of ESBLK to humans [6,7]. Integrated studies on chickens and their environment, contact workers and hospitalized patients in the same area are still missing

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