Prevalence of carbapenem-resistant Enterobacteriaceae and emergence of high rectal colonization rates of blaOXA-181-positive isolates in patients admitted to two major hospital intensive care units in Kuwait.

Amani H Al Fadhli,Wafaa Y Jamal,Vincent O Rotimi

doi:10.1371/journal.pone.0241971

Abstract

BackgroundFecal colonization by carbapenem-resistant Enterobacteriaceae (CRE) can be the main reservoir for transmission of these resistant organisms especially in the Intensive Care Units (ICUs).AimThis study was conducted to evaluate the rate of rectal carriage and molecular characterization of CRE in patients hospitalized in the ICUs of 2 major hospitals (Adan and Mubarak Al Kabeer Hospitals) in Kuwait.Materials and methodsRectal swabs were collected from all patients at admission, 48 h after admission and once weekly from April 2017- March 2018. Initial CRE screening was carried out on MacConkey agar on which meropenem disc 10μg was placed. Identification of isolates was by API 20E. Susceptibility testing was performed using the E-test method. Polymerase chain reaction (PCR) was used to detect the carbapenemase-encoding genes. Clonal relationship was investigated by pulsed-field electrophoresis (PFGE). Genes of blaOXA-181 and blaNDM-5–carrying plasmids were detected in some strains.ResultsA total of 590 patients were recruited into the study. Of these, 58 were positive for CRE, giving a prevalence of 9.8%; 25/320 (7.8%) in Adan and 33/270 (12.2%) in Mubarak Al Kabeer Hospitals. All isolates were resistant to multiple antibiotics. Resistance rates to colistin and tigecycline were 17% and 83%, respectively. Single genes of blaOXA-181 were detected in isolates from 38 (65.5%) out of 58 patients and in 5 patients colonized by blaOXA-48-positive CRE. A combination of 2 genes was detected in 12 isolates; 5 blaKPC-2 and blaOXA-181, 4 blaVIM-1 and blaOXA-181, and 3 blaNDM-5 and blaOXA-181. PFGE showed an overall level of similarity of 38%. Southern hybridization studies localized the blaOXA-181 and blaNDM-5 genes to a large plasmid of 200kb in 3 K. pneumoniae isolates and a small plasmid of 80kb in 2 E. coli isolates, respectively.ConclusionThe prevalence of CRE colonization in the 2 hospital ICUs was relatively high and the emergence of blaOXA-181-mediated CRE is a cause for concern as there is the possibility of rapid horizontal spread among hospital patients in Kuwait. Active surveillance of CRE in the ICUs is highly recommended to stem its spread.

Highlights

Single genes of blaOXA-181 were detected in isolates from 38 (65.5%) out of 58 patients and in 5 patients colonized by blaOXA-48-positive carbapenem-resistant Enterobacteriaceae (CRE)
Gut flora is a major reservoir for Enterobacteriaceae which are potentially pathogenic to hospitalized patients especially those in the Intensive Care Units (ICUs)
These Enterobacteriaceae have acquired resistance to several antimicrobial agents over time including the cephalosporins due inactivation by extended-spectrum β-lactamases (ESBLs) and AmpC production [1, 2]. This has led to excessive use of carbapenems for treating documented infections as well as for empirical therapy of suspected ESBL-associated infections especially those acquired in the ICUs [3]

Summary

Introduction

Gut flora is a major reservoir for Enterobacteriaceae which are potentially pathogenic to hospitalized patients especially those in the Intensive Care Units (ICUs) These Enterobacteriaceae have acquired resistance to several antimicrobial agents over time including the cephalosporins due inactivation by extended-spectrum β-lactamases (ESBLs) and AmpC production [1, 2]. This has led to excessive use of carbapenems for treating documented infections as well as for empirical therapy of suspected ESBL-associated infections especially those acquired in the ICUs [3]. Fecal colonization by carbapenem-resistant Enterobacteriaceae (CRE) can be the main reservoir for transmission of these resistant organisms especially in the Intensive Care Units (ICUs)

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Conclusion