Carriage Of Antibiotic-resistant Bacteria Research Articles

Carriage of Antibiotic Resistant Bacteria and Associated Factors Among Food Handlers in Tamale Metropolis, Ghana: Implications for Food Safety.

Bacteria pathogens constitute a significant proportion of diarrhoea-causing food contaminants. Transmission of antibiotic resistant foodborne pathogens to humans is a major threat to food safety, especially in developing countries where quality hygiene and sanitation facilities are lacking. Factors related to antibiotic use, sanitation and hand hygiene have been associated with the spread of infectious diseases as well as antibiotic resistant bacteria. Proper food handling ensures that food is not contaminated with potential pathogenic bacteria. This study assessed the carriage of antibiotic resistant bacteria and associated factors. A cross-sectional study was conducted among food handlers who sell ready to eat food in the Tamale metropolis of the Northern Region of Ghana. Food vending stations with huge customer base were randomly selected and the food handlers recruited using written informed consent. Structured questionnaires were used to collect participants sociodemographic details and information on sanitation, hand hygiene practice and antibiotic use. Sterile cotton swabs soaked in phosphate buffered saline was used to swab the palms of participating food handlers for bacteria isolation. All identified bacteria were tested for susceptibility to 12 antibiotics. In all, 406 food handlers participated in this study, the mean (SD) age was 26.5 (2.64) years. Bacteria isolated were predominantly Staphylococci 60 (14.8%) and Escherichia coli 54 (13.3%). All the isolates were resistant to at least one antibiotic tested. The isolates showed high resistance to broad-spectrum antibiotics such as ampicillin (40.0%-75.0%), tetracycline (40.0%-80.0%), amoxiclav (20.0%-80.0%) and chloramphenicol (7.7%-50.0%). Logistic regression model revealed that the carriage of antibiotic resistant bacteria by food handlers was significantly associated with age, educational level, years on the job, training in food preparation, hygiene practice, water source, type of toilet facility used and antibiotic use. Street food handlers could be potential sources of food-borne transmission of antibiotic resistant bacteria.

Carriage of antibiotic resistant bacteria in endangered and declining Australian pinniped pups.

The rapid emergence of antimicrobial resistance (AMR) is a major concern for wildlife and ecosystem health globally. Genetic determinants of AMR have become indicators of anthropogenic pollution due to their greater association with humans and rarer presence in environments less affected by humans. The objective of this study was to determine the distribution and frequency of the class 1 integron, a genetic determinant of AMR, in both the faecal microbiome and in Escherichia coli isolated from neonates of three pinniped species. Australian sea lion (Neophoca cinerea), Australian fur seal (Arctocephalus pusillus doriferus) and long-nosed fur seal (Arctocephalus forsteri) pups from eight breeding colonies along the Southern Australian coast were sampled between 2016–2019. DNA from faecal samples (n = 309) and from E. coli (n = 795) isolated from 884 faecal samples were analysed for class 1 integrons using PCRs targeting the conserved integrase gene (intI) and the gene cassette array. Class 1 integrons were detected in A. p. doriferus and N. cinerea pups sampled at seven of the eight breeding colonies investigated in 4.85% of faecal samples (n = 15) and 4.52% of E. coli isolates (n = 36). Integrons were not detected in any A. forsteri samples. DNA sequencing of the class 1 integron gene cassette array identified diverse genes conferring resistance to four antibiotic classes. The relationship between class 1 integron carriage and the concentration of five trace elements and heavy metals was also investigated, finding no significant association. The results of this study add to the growing evidence of the extent to which antimicrobial resistant bacteria are polluting the marine environment. As AMR determinants are frequently associated with bacterial pathogens, their occurrence suggests that these pinniped species are vulnerable to potential health risks. The implications for individual and population health as a consequence of AMR carriage is a critical component of ongoing health investigations.

Carriage of antibiotic-resistant bacteria and etiology of postoperative infectious complications in infants with congenital heart defects

Objective. To determine resistant microorganisms carriage, the frequency and etiology of postoperative infectious complications in high-risk infants with congenital heart defects (CHD). Materials and Methods. The retrospective analysis included 489 patients admitted for surgical treatment for CHD. The median age was 0.23 (0–12) months. Swabs were taken from the oropharynx and rectum for microbiological examination no later than 72 hours after admission (a total of 978 samples). The growth of resistant microorganisms (ESBL and/or carbapenemase-producing Enterobacterales, resistant non-fermentative Gram-negative bacteria, MRSA and VRE) was recorded. Results. Of 489 patients, 128 (26.2%) were colonized with resistant bacteria. The majority of patients were carriers of ESBL-producers (81.3%), in some cases (24%) with concomitant production of several carbapenemases. The rate of VRE carriage was 21.1%, in 8 cases – in combination with other resistant microorganisms. MRSA was detected in 1.6% of carriers, other multidrug-resistant microorganisms – in 3.9% of carriers. In early postoperative period, 145⁄489 (29.7%) patients developed infectious complications. The ventilator-associated respiratory tract infections were the most common. In most cases (73.8%) infectious complications were caused by ESBL producers, in 43.9% of cases those microorganisms also produced carbapenemases. Resistant non-fermentative Gram-negative bacteria caused postoperative infections in 4.8% of cases. The rates of MRSA and VRE in infants with infectious complications were 3.4% and 1.4%, respectively. There were no differences in the incidence of infectious complications in colonized and non-colonized patients – 42⁄128 (32.8%) versus 103⁄361 (28.5%), respectively (p = 0.6). Postoperative infectious complications were caused by resistant microorganisms in colonized patients significantly more often than in non-colonized patients – 41⁄42 (97.6%) and 82⁄103 (79.6%) cases, respectively (p = 0.008). Conclusions. It is confirmed the active process of the introduction of resistant microorganisms into the hospital with the possible development of complications of the corresponding etiology. Gram-negative bacteria with different mechanisms of antibiotic resistance present the greatest problem. In order to manage this process, it is advisable to screen hospitalizing patients with the implementation of the infection control measures.

Impact of antibiotic consumption on the carriage of antibiotic-resistant bacteria by school children.

Antibiotic consumption in the paediatric population is one of the key drivers of the emergence and spread of antimicrobial resistance, which is a serious global threat to public health and clinical medicine. The aims of this study were to investigate systemic antibiotic consumption in school children and to assess the associations among antibiotic consumption, carriage rate and resistance of respiratory pathogens residing in the upper respiratory tract mucosa. In this prospective study, throat and nasopharyngeal swabs from 450 school children, 6-15 years of age (225 healthy children and 225 patients who were ambulatory treated for upper respiratory tract infection), were processed in 2014 in Rijeka, Croatia, and clinical data were obtained via a questionnaire. In total, 17% of the children had consumed an antibiotic in the previous 6 months, including 7% of the healthy children and 27% of the acutely ill patients. The most commonly prescribed antibiotics were amoxicillin (26%), amoxicillin with clavulanic acid (26%) and macrolides (18%). Respiratory pathogens were more frequently isolated from children who had consumed an antibiotic in the previous 6 months [odds ratio (OR) 3.67, P < 0.001]. Antibiotic-resistant bacteria were also more frequent in children who had been exposed to antibiotics (OR 5.44, P < 0.001). Penicillins are the most frequently used antibiotics among school children. The results of this study demonstrate that antibiotic consumption is linked with higher carriage rates and resistance rates of respiratory tract pathogens. Therefore, rational use of antibiotics could prevent the emergence and spread of resistant bacteria.

Efficacy of Oral Antibiotics for Non-Severe Exacerbations of Bronchiectasis in Children (BEST 1): A Multi-Centre, Double-Blind, Double-Dummy, Randomised Placebo-Controlled Trial

Background: Bronchiectasis guidelines recommend antibiotics for treating acute respiratory exacerbations, but placebo-controlled, randomised-controlled trials (RCTs) are lacking in children. Since many exacerbations are virus-triggered, antibiotics may be unnecessary for non-severe (non-hospitalised) episodes. We hypothesised that oral amoxicillin-clavulanate and azithromycin are both superior to placebo for achieving symptom resolution by day-14 when treating non-severe exacerbations in children. Methods: In this multicentre (n=4), parallel, double-dummy, double-blind, placebo-controlled three-arm RCT, children aged 1-19 years were randomised at exacerbation onset to receive: (a) amoxicillin-clavulanate (45mg/kg/day)/azithromycin-placebo, (b) azithromycin (5mg/kg/day)/amoxicillin-clavulanate-placebo, or (c) placebo/placebo for 14-days (Australian-New Zealand Registry, ACTRN12612000011886). The primary outcome was exacerbation resolution by day-14. Secondary outcomes included exacerbation duration, time-to-next exacerbation, parent cough-specific quality-of-life, laboratory and spirometry assessments and nasopharyngeal microbiology. Treatment arms were compared using generalised-linear-models. Statistical significance was set at p<0·0245. Findings: Between April 2012 and December 2017, 197 children were randomised (amoxicillin-clavulanate n=63, azithromycin n=67, placebo n=67). By day-14, exacerbations had resolved in 41 (65%), 41 (61%) and 29 (43%) children in the respective groups. Compared to placebo, the relative risk of resolution by day-14 for amoxicillin-clavulanate was 1·50 (95% confidence interval [CI] 1·08-2·09; p=0·02, number needed-to-treat-for-benefit=5, 95%CI 3-20) and for azithromycin 1·41 (95%CI 1·01-1·97; p=0·04). Compared to placebo, the median exacerbation duration was significantly shorter in the amoxicillin-clavulanate (7 versus 10-days, p=0·02), but not the azithromycin group (8 vs 10-days, p=0·24). Other secondary between-group outcomes were not significantly different. Azithromycin was associated with increased nasopharyngeal carriage of macrolide-resistant-bacteria, while respiratory viruses were identified in 53% of exacerbations. Interpretation: Amoxicillin-clavulanate and azithromycin both showed benefit compared to placebo for treating non-severe exacerbations of bronchiectasis in children. However, azithromycin was associated with increased carriage of antibiotic-resistant bacteria. Consequently, amoxicillin-clavulanate should remain the first-line oral antibiotic for treating non-severe exacerbations of bronchiectasis in children. Funding: This work was supported by the Australian National Health and Medical Research Council (NHMRC; project grant number 1019834,) the NHMRC Centre for Research Excellence in Lung Health of Aboriginal and Torres Strait Islander Children (1040830), and Cure Kids, Auckland, New Zealand (3702764/3539). VG was supported by an NHMRC post-graduate scholarship (1075119). ABC is supported by an NHMRC practitioner fellowship (1058213). KFO and HSV were supported by NHMRC CRE in Children’s Indigenous Lung Health fellowships (10450830). MB is supported by a NHMRC Hot North Fellowship (1131932). Declaration of Interest: We declare that we have no conflicts of interest. Ethical Approval: The protocol has received ethical approval from the respective Human Research Ethics Committees of all the participating institutions (Darwin: Department of Health and Families and Menzies School of Health Research; Brisbane: Children’s Health Services (Royal Children’s Hospital) and University of Queensland; Perth: Princess Margaret Hospital; Melbourne: Royal Children’s Hospital; Auckland: Northern Ethics Committee, Ministry of Health and Starship Children’s Health local ethics committee). The study is being conducted under Australia’s Therapeutic Goods Administration Clinical Trial Notification scheme.

Carriage of antibiotic-resistant bacteria in urban versus rural wild boars

The Western European population of wild boar (Sus scrofa) has increased its distribution over the past several decades, and some populations have colonized areas strongly influenced by human activity. Wild boars are known carriers of antibiotic-resistant bacteria acquired from the environment, and urban populations of wild boars may be more exposed than their rural counterparts. In this work, we compared the frequency of antibiotic resistance in indicator bacteria (Escherichia coli, Enterococcus faecalis, Enterococcus faecium) isolated from urban wild boars with that from rural wild boars in NE Spain. We further assessed whether bacterial isolates from the urban wild boars had a higher probability of showing antibiotic resistance when their host was highly associated to urban features. Seventy-two and 100 bacterial isolates from urban and rural habitat, respectively, were screened for antibiotic resistance against a set of antibiotics (13 per bacterial species). We found a significantly higher frequency of E. faecium showing resistance to tetracycline (70.0% vs 36.4%) and high-level resistance to streptomycin (30.0% vs 4.5%) in urban wild boars compared to rural wild boars (p < 0.05). E. faecalis was more frequently resistant to trimethoprim in urban than rural wild boars (33.3% vs 0.0%, p < 0.05). In isolates from urban origin, 55.6% of the likelihood of detecting antibiotic resistance depended only on the bacterial species, being more likely in the enterococci than in E. coli. These results suggest that urban wild boars may be more exposed to certain antibiotic-resistant bacteria or antibiotic resistance genes that they may acquire from the urban environment, although implications are uncertain.

The relative importance of large problems far away versus small problems closer to home: insights into limiting the spread of antimicrobial resistance in England

BackgroundTo combat the spread of antimicrobial resistance (AMR), hospitals are advised to screen high-risk patients for carriage of antibiotic-resistant bacteria on admission. This often includes patients previously admitted to hospitals with a high AMR prevalence. However, the ability of such a strategy to identify introductions (and hence prevent onward transmission) is unclear, as it depends on AMR prevalence in each hospital, the number of patients moving between hospitals, and the number of hospitals considered ‘high risk’.MethodsWe tracked patient movements using data from the National Health Service of England Hospital Episode Statistics and estimated differences in regional AMR prevalences using, as an exemplar, data collected through the national reference laboratory service of Public Health England on carbapenemase-producing Enterobacteriaceae (CPE) from 2008 to 2014. Combining these datasets, we calculated expected CPE introductions into hospitals from across the hospital network to assess the effectiveness of admission screening based on defining high-prevalence hospitals as high risk.ResultsBased on numbers of exchanged patients, the English hospital network can be divided into 14 referral regions. England saw a sharp increase in numbers of CPE isolates referred to the national reference laboratory over 7 years, from 26 isolates in 2008 to 1649 in 2014. Large regional differences in numbers of confirmed CPE isolates overlapped with regional structuring of patient movements between hospitals. However, despite these large differences in prevalence between regions, we estimated that hospitals received only a small proportion (1.8%) of CPE-colonised patients from hospitals outside their own region, which decreased over time.ConclusionsIn contrast to the focus on import screening based on assigning a few hospitals as ‘high risk’, patient transfers between hospitals with small AMR problems in the same region often pose a larger absolute threat than patient transfers from hospitals in other regions with large problems, even if the prevalence in other regions is orders of magnitude higher. Because the difference in numbers of exchanged patients, between and within regions, was mostly larger than the difference in CPE prevalence, it would be more effective for hospitals to focus on their own populations or region to inform control efforts rather than focussing on problems elsewhere.

The beach bum survey: investigating the association between surfing and faecal carriage of antibiotic resistant bacteria

Introduction: Antibiotic resistant bacteria (ARB) represent one of the greatest health threats to public health. Much research has been done on how people acquire ARB, particularly in healthcare settings. Very little has been done on the role natural environments play in the spread of ARB to people. Coastal waters are regularly polluted by sewage carrying many ARB, and the densities detected have been high enough to pose an exposure risk to surfers when they swallow seawater. Methods: In a cross-sectional study, we collected rectal swabs from 273 healthy adults in the UK: 143 regular surfers and 130 non-surfers. We screened the swabs for enteric coliforms resistant to two clinically important antibiotics: cefotaxime, and meropenem. Polymerase chain reaction was used to determine whether resistant colonies were carrying the clinically important plasmid-borne resistance genes responsible for the observed phenotypes, such as blaCTX-M, which encodes resistance to multiple beta-lactam antibiotics. Results: While phenotypically resistant bacteria were equally prevalent in both surfers and non-surfers, surfers were at an increased risk of carrying CTX-M-bearing bacteria compared to non-surfers (risk ratio = 4.09, 95% confidence interval 1.02 – 16.4). Conclusions: Thus surfing was associated with the carriage of gut bacteria harbouring CTX-M genes, which are responsible for multi-drug resistance in bacteria. This is the first study to investigate the association between recreational use of coastal waters and gut colonisation by ARB. However determining the causal nature of this relationship will require further work. Nevertheless, surfers could be contributing to the prevalence of ARB in the wider population. Identifying environmental transmission pathways will be critical to understanding the spread of ARB, and thus essential in developing effective mitigation strategies to reduce their worrying proliferation amongst the wider public.

Carriage of antibiotic-resistant fecal bacteria in Nepal reflects proximity to Kathmandu.

Within Nepal, geographic, social, and economic barriers greatly limit access to allopathic health care. The country therefore offered the opportunity to evaluate the effect of antibiotic accessibility (as measured by allopathic medicine consumption) on antibiotic resistance in the normal intestinal flora. The aerobic gram-negative fecal flora of 33-34 healthy adults from each of 3 villages with different access to health care facilities in Kathmandu were examined for antibiotic susceptibility. The frequency of antibiotic resistance decreased significantly with increasing distance from Kathmandu and decreasing population density but did not reflect contact with health care providers or individual medicine consumption. The findings suggest that an individual's overall exposure to antibiotics and antibiotic-resistant bacteria (resulting from close proximity to other community members and to sources of accessible allopathic health care, such as in the vicinity of Kathmandu), has an equal or greater impact on an individual's carriage of antibiotic-resistant bacteria than does direct consumption of antibiotics.

Carriage of antibiotic-resistant bacteria by healthy children.

The frequency of carriage of antibiotic-resistant bacteria in healthy 7- and 8-year-old children in Bristol was studied. Children born in Avon between 1 April 1991 and 31 December 1992, attending the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) 7 year follow-up clinic, formed the study population. Carriage was estimated using mouth and stool samples. None of 105 children on whom information was available had received tetracycline, chloramphenicol, ciprofloxacin or an extended-spectrum cephalosporin in the previous year. Staphylococcus aureus was isolated from mouthwashes from 200 (37.1%) of 539 children sampled. Six (3%) of the isolates were resistant to chloramphenicol or tetracycline and four (2%) were methicillin resistant. Haemophilus spp. were isolated from 369 (72%) of 513 samples and 63 (17%) were ampicillin resistant, 49 (13.3%) were erythromycin resistant and seven (1.9%) were tetracycline resistant. Branhamella catarrhalis was isolated from 333 (74%) of 450 samples. Twenty-eight (8.4%) were erythromycin resistant and 14 (4.2%) strains were tetracycline resistant. Group A beta-haemolytic streptococci were isolated from 17 of 507 children sampled. One (5.9%) was tetracycline resistant. Stool samples were returned from 335 (62%) of 539 children from whom they were requested. Eleven per cent of samples yielded Gram-negative bacilli with high-level resistance to chloramphenicol, which was frequently linked to resistance to ampicillin, spectinomycin and streptomycin. Isolates demonstrating resistance to the third-generation cephalosporin ceftazidime were recovered from 17 subjects (3.2%). Six (35%) of 17 isolates possessed extended-spectrum beta-lactamases. Healthy children carry bacteria resistant to antibiotics to which children are not usually exposed. Resistance to ceftazidime, chloramphenicol and tetracycline may be co-selected by exposure to other antibiotics used in children or may be acquired from family members, pets, other children or food. These results suggest that antibiotic-resistant bacteria are widely disseminated and may be acquired by children before exposure to specific selection pressure.