Abstract
BackgroundAntibiotic-resistant Enterobacteriaceae in the gastrointestinal flora can lead to infections with limited therapeutic options. Also, the resistant bacteria can be transferred from colonized persons to others. The present study was conducted to search the fecal carriage rates of (i) Enterobacteriaceae that produce extended-spectrum β-lactamase (ESBL-E) and/or (ii) plasmid-mediated AmpC β-lactamase (pAmpC-E), (iii) ciprofloxacin-resistant Enterobacteriaceae (CIP-RE), and (iv) carbapenem-intermediate or -resistant Enterobacteriaceae (CIRE) in Northern Cyprus.MethodsA total of 500 community-dwellers were recruited from consecutive admissions to the clinical laboratories of four hospitals. One rectal swab or stool sample was collected from each participant. A questionnaire was applied to evaluate possible risk factors associated with intestinal colonization of resistant bacteria. The samples were cultured on antibiotic containing media to screen for resistant bacteria colonization. The bacterial colonies that grew on the plates were subjected to further phenotypic tests to confirm the resistance.ResultsOf 500 volunteers, ESBL-E, pAmpC-E, CIP-RE and CIRE carriage were detected in 107 (21.4%), 15 (3.0%), 51 (10.2%) and six (1.2%) participants, respectively. Escherichia coli was the most commonly recovered species among Enterobacteriaceae isolates. A significant proportion of ESBL-producing E. coli isolates (n = 22/107; 20.6%) was found to be co-resistant to CIP (p = 0.000, OR 3.21, 95% CI 1.76–5.87). In this study, higher socioeconomic status (CIP-RE: p = 0.024, OR 1.96, 95% CI 1.09–3.53), presence of gastrointestinal symptoms (CIRE: p = 0.033; OR 6.79, 95% CI 1.34–34.39), antibiotic use (ESBL-E: p = 0.031; OR 1.67, 95% CI 1.04–2.67; and CIRE: p = 0.033; OR 6.40, 95% CI 1.16–35.39), and travelling abroad (pAmpC-E: p = 0.010; OR 4.12, 95% CI 1.45–11.66) were indentified as risk factors.ConclusionThe study indicates that resistant Enterobacteriaceae isolates are carried by humans in the community. To prevent further spread of resistance, rational use of antibiotics should be encouraged, and antibiotic resistance should be carefully monitored in Northern Cyprus.
Highlights
Antibiotic-resistant Enterobacteriaceae in the gastrointestinal flora can lead to infections with limited therapeutic options
To prevent further spread of resistance, rational use of antibiotics should be encouraged, and antibiotic resistance should be carefully monitored in Northern Cyprus
Risk factors associated with the fecal carriage of resistant Enterobacteriaceae were identified as higher socioeconomic status (CIP-RE), presence of any gastrointestinal complaints at the time of sample collection (CIRE), antibiotic use in the last six months (ESBL-E and carbapenem-intermediate or -resistant Enterobacteriaceae (CIRE)), and travelling abroad within six months prior to the study
Summary
Antibiotic-resistant Enterobacteriaceae in the gastrointestinal flora can lead to infections with limited therapeutic options. Enterobacteriaceae are gram-negative bacteria that are members of normal intestinal flora. These bacteria are the most common cause of infections in hospital and community settings [1]. Increasing rates of antibiotic resistance in Enterobacteriaceae are reported globally [2]. Extended-spectrum β-lactamases (ESBLs) are the primary reason of acquired drug resistance seen in gramnegative bacteria [3]. Apart from ESBLs, production of AmpC β-lactamases is the other mechanism that confers resistance to broad-spectrum cephalosporins [6]. These enzymes have the ability to hydrolyze cephamycins [7]
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