Abstract
BackgroundIn recent years, the world has seen a surge in Enterobacteriaceae resistant to broad-spectrum beta-lactam antibiotics due to the production of extended-spectrum beta-lactamases (ESBLs) or plasmid-mediated AmpC (pAmpC) enzymes. Data on the epidemiology of cephalosporin-resistant Enterobacteriaceae in Sub-Saharan Africa are still limited.MethodsTwo hundred seventy-five non-repetitive stool samples were collected from Mozambican university students of both sexes. Samples were cultured on MacConkey agar with and without ceftriaxone (1 mg/L) for selection of third-generation cephalosporin-resistant isolates, which were subjected to antimicrobial susceptibility testing by disc diffusion, characterization of resistance genes by PCR and ERIC-PCR analysis for strain clonality.ResultsAmong the 275 students, 55 (20%) carried a total of 56 E. coli (n = 35) and Klebsiella spp. (n = 21) isolates resistant to ceftriaxone and phenotypically positive for ESBL- and/or pAmpC-production. Forty-three percent of the isolates (24/56) contained only ESBL genes, 11% (6/56) only pAmpC genes, and 36% (20/56) both ESBL and pAmpC genes. The remaining six isolates were negative for the CTX-M/pAmpC genes included in the test panel. E. coli and Klebsiella spp. combined demonstrated 70% resistance to tetracycline and co-trimoxazole, 63% to ceftazidime and 34% to ciprofloxacin. In total, 89% of ESBL/pAmpC-positive isolates were defined as multi-resistant by being resistant to three or more antibiotic classes. ERIC-PCR fingerprinting demonstrated low similarity among isolates. None of the participants reported recent hospitalization and just 12.5% had taken antibiotics 3 months prior to the study.ConclusionThis study demonstrated 20% colonization with multi-resistant E. coli and Klebsiella spp. among Mozambican students with a diversity of ESBL and pAmpC genes. Colonization was not related to prior hospitalization or antimicrobial consumption.
Highlights
In recent years, the world has seen a surge in Enterobacteriaceae resistant to broad-spectrum beta-lactam antibiotics attributed to the production of extended-spectrum beta-lactamases (ESBLs) and/or plasmid-mediated AmpC enzymes [1, 2]
The aim of this study was to determine the prevalence of fecal colonization with ESBL- and plasmid-mediated AmpC (pAmpC)-producing E. coli and Klebsiella spp. among healthy university students in Maputo, Mozambique, and to analyze the resistance phenotype, ESBL- and pAmpC resistance gene content and clonal relatedness of isolates
We systematically collected samples from healthy students to determine the prevalence of colonization by E. coli and Klebsiella spp. carrying ESBL and/or pAmpC, as well as their antibiotic susceptibility
Summary
The world has seen a surge in Enterobacteriaceae resistant to broad-spectrum betalactam antibiotics due to the production of extended-spectrum beta-lactamases (ESBLs) or plasmid-mediated AmpC (pAmpC) enzymes. The world has seen a surge in Enterobacteriaceae resistant to broad-spectrum beta-lactam antibiotics attributed to the production of extended-spectrum beta-lactamases (ESBLs) and/or plasmid-mediated AmpC (pAmpC) enzymes [1, 2]. Escherichia coli and Klebsiella pneumoniae are constituents of the commensal gut flora and common opportunistic pathogens often implicated in urinary tract and bloodstream infections [7, 8]. They frequently harbor ESBL- and pAmpC-encoding genes. Broad-spectrum beta-lactamase production is associated with increased morbidity and mortality in both highand low/middle-income countries [9, 10]
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