Abstract
Carbapenem-resistant Enterobacterales (CRE) are pathogens that have been found in several countries, with a significant public health concern. Characterizing the mode of resistance and determining the prevailing clones are vital to the epidemiology of CRE in our community. This study was conducted to characterize the molecular mode of resistance and to determine the clonality of the CRE fecal isolates among community food handlers (FHs) vs. infected control patients (ICPs) in Kuwait. Fecal CRE isolates obtained from FHs and ICPs from September 2016 to September 2018 were analyzed for their resistance genes. Gene characterization was carried out by polymerase chain reaction (PCR) assays and sequencing. Clonality of isolates was established by multilocus sequence typing (MLST). Of the 681 and 95 isolates of the family Enterobacterales isolated from FHs and ICPs, 425 (62.4%) and 16 (16.8%) were Escherichia coli, and 18 (2.6%) and 69 (72.6%) were Klebsiella pneumoniae, respectively. A total of 36 isolates were CRE with a prevalence of 5.3% among FH isolates and 87 (91.6%) among the ICPs. Of these, carbapenemase genes were detected in 22 (61.1%) and 65 (74.7%) isolates, respectively (p < 0.05). The detected specific genes among FHs and ICPs were positive for blaKPC 19 (86.4%) and 35 (40.2%), and blaOXA 10 (45.5%) and 59 (67.8%), in addition to blaNDM 2 (9.1%) and 32 (36.8%), respectively. MLST assays of the E. coli and K. pneumoniae isolates revealed considerable genetic diversity and polyclonality as well as demonstrated multiple known ST types and eight novel sequence types. The study revealed a relatively high number of CRE harboring predominantly blaKPC-mediated CRE among the community FH isolates vs. predominant blaOXA genes among the ICPs. Those heterogeneous CRE isolates raise concerns and mandate more efforts toward molecular surveillance. A multinational study is recommended to monitor the spread of genes mediating CRE in the community of Arabian Peninsula countries.
Highlights
Carbapenems have been used as effective and drugs of choice over the years to treat life-threatening nosocomial infections, bloodstream infections, transplant-related infections, ventilator-associated infections, and infections in hospitalized patients in intensive care units, in addition to infections caused by extended-spectrum β-lactamases and AmpC-producing species of the family Enterobacterales
A total of 31 food handlers (FHs) and 84 infected control patients (ICPs) were found to be colonized with Carbapenem-resistant Enterobacterales (CRE)
We described the occurrence of the CRE isolates among FHs in our community
Summary
Carbapenems have been used as effective and drugs of choice over the years to treat life-threatening nosocomial infections, bloodstream infections, transplant-related infections, ventilator-associated infections, and infections in hospitalized patients in intensive care units, in addition to infections caused by extended-spectrum β-lactamases and AmpC-producing species of the family Enterobacterales. KPC genes have spread internationally among Gram-negative bacteria in China, Greece, Italy, Poland, Colombia, Argentina, Brazil, and some states in the United States but not in Kuwait (Munoz-Price et al, 2013; Stoesser et al, 2017; Cienfuegos-Gallet et al, 2019) Other carbapenemases, such as OXA-48, are present in Turkey and North Africa (Temkin et al, 2014). Food handlers (FHs) who are considered an important link in the chain from farm to fork are at high risk of being CRE colonized or infected Those unrecognized workers may serve as a reservoir for CRE transmission and play an essential role in spreading these organisms in community as well as healthcare settings.
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