Intestinal colonization with multidrug-resistant enterobacteriaceae in a healthy adult population

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Research Paper 01/07/2021
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Intestinal colonization with multidrug-resistant enterobacteriaceae in a healthy adult population

WV. Vandana K. Dinesha, MK. Kalaivanib, Sofiya Rabye
Int. J. Micro. Myco.13( 1), 18-25, July 2021.
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Intestinal colonization of healthy individuals with multidrug-resistant bacteria could contribute to the amplification of resistant bacteria both at community level and in hospital settings leading to treatment failure, high treatment costs, and increased mortality. This cross-sectional study aims is to determine the rate of intestinal colonization with multidrug resistant bacteria belonging to Enterobacteriaceae family among adult healthy population in a suburban community of Bangalore. 163 stool specimens from 163 participants were obtained from four suburban areas of East Bangalore during a period of 4 months (Oct, 2020–Jan, 2021). A total 165 isolates were identified. Stool specimens were cultured and the isolates were subjected to antimicrobial susceptibility tests according to the standard microbiological procedures. ESBLs, AmpC β-lactamase, and carbapenemase producers were screened and identified phenotypically as per CLSI guidelines. Colonization of MDR enteric bacteria in the community was 70%. Among these MDROs, Klebsiella was the predominant bacteria 53(45.6%) followed by E. coli 45(38.8%) and Enterobacter 17(14.6%). Confirmed ESBL producers were 47(28.4%) which included E. coli 24 (51%), Klebsiella 18 (38.2%) and Enterobacter 5 (10.6%). Confirmed AmpC producers were 8 (5%) among which Klebsiella were 5 (62.5%) and E. coli 3 (37.5%). 3 (1.8%) isolates were coproducers of ESBL and AmpC β lactamases. No carbapenemase-producing bacteria were isolated. This study shows an overall prevalence of MDRO in the intestines of study population and highlights the importance of routine surveillance to monitor the changing epidemiology. It also helps to identify the causal associations for appropriate infection control practices and antibiotic prescribing policies to prevent further spread.


Ahmed, Salwa F, Mostafa Mohamed M, Ali, Zienat K. Mohamed, Tarek A. Moussa, and John Klena D. 2014. “Fecal Carriage of Extended-Spectrum β-Lactamases and AmpC-Producing Escherichia Coli in a Libyan Community.” Annals of Clinical Microbiology and Antimicrobials 13(1).

Al-Agamy, Mohamed H, Taghrid S, El Mahdy and Atef Shibl M. 2016. “Fecal Colonization with Extended-Spectrum Beta-Lactamase and AmpC-Producing Escherichia Coli.” BioMed Research International 2016.

Antony, Sherly, Kandasamy Ravichandran, and Reba Kanungo. 2018. “Multidrug-Resistant Enterobacteriaceae Colonising the Gut of Adult Rural Population in South India.” Indian Journal of Medical Microbiology 36(4), 488-93.

Baljin, Bayaraa, Ganbaatar Baldan, Battogtokh Chimeddorj, Khosbayar Tulgaa, Batbaatar Gunchin, Tsogtsaikhan Sandag, Klaus Pfeffer, Colin R. MacKenzie, and Andreas, Wendel F. 2016. “Faecal Carriage of Gram-Negative Multidrug-Resistant Bacteria among Patients Hospitalized in Two Centres in Ulaanbaatar, Mongolia.” PLoS ONE 11(12).

Casals-Pascual, Climent, Andrea Vergara, and Jordi Vila. 2018. “Intestinal Microbiota and Antibiotic Resistance: Perspectives and Solutions.” Human Microbiome Journal 9, 11-15.

Farra A, Frank T, Tondeur L, Bata P, Gody JC, Onambele M, Rafaï C, Vray M, Breurec S. 2016. “High Rate of Faecal Carriage of Extended-Spectrum β-Lactamase-Producing Enteroba-cteriaceae in Healthy Children in Bangui, Central African Republic.” Clinical Microbiology and Infection 22(10), 891.e1-891.e4. https://doi. org/10.1016/j.cmi.2016.07.001.

Gargiullo, Livia, Federica Del Chierico, Patrizia D’Argenio, and Lorenza Putignani. 2019. “Gut Microbiota Modulation for Multidrug-Resistant Organism Decolonization: Present and Future Perspectives.” Frontiers in Microbiology. Frontiers Media S.A. fmicb.2019.01704.

Jakobsson, Hedvig E., Cecilia Jernberg, Anders F. Andersson, Maria Sjölund-Karlsson, Janet K. Jansson, and Lars Engstrand. 2010. “Short-Term Antibiotic Treatment Has Differing Long- Term Impacts on the Human Throat and Gut Microbiome.” PLoS ONE 5(3).

Karanika, Styliani, Theodoros Karantanos, Marios Arvanitis, Christos Grigoras, and Eleftherios Mylonakis. 2016. “Fecal Colonization with Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae and Risk Factors among Healthy Individuals: A Systematic Review and Metaanalysis.” Clinical Infectious Diseases 63(3), 310-18.

Lautenbach, Ebbing, Jean Baldus Patel, Warren B. Bilker, Paul H. Edelstein, and Neil Fishman O. 2001. “Extended-Spectrum β-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae: Risk Factors for Infection and Impact of Resistance on Outcomes.” Clinical Infectious Diseases 32(8), 1162-71.

Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S. 2012. “Multidrug-Resistant, Extensively Drug-Resistant and Pandrug-Resistant Bacteria: An International Expert Proposal for Interim Standard Definitions for Acquired Resistance.” Clinical Microbiology and Infection 18(3), 268-81.

Mandal, Dipendra Kumar, Shiv Kumar Sah, Shyam Kumar Mishra, Sangita Sharma, Hari Prasad Kattel, Sanjeet Pandit, Pranav Kumar Yadav. 2020. “Carriage of Extended-Spectrum- β -Lactamase- And AmpC- β -Lactamase-Producing Enterobacteriaceae (ESBL-PE) in Healthy Community and Outpatient Department (OPD) Patients in Nepal.” Canadian Journal of Infectious Diseases and Medical Microbiology 2020.

Molton, James S, Paul A, Tambyah, Brenda SP, Ang, Moi Lin Ling, and Dale Fisher A. 2013. “The Global Spread of Healthcare-Associated Multidrug-Resistant Bacteria: A Perspective from Asia.” Clinical Infectious Diseases 56(9), 1310-18.

Monira, Shirajum, Syeda Antara Shabnam, Sk Imran Ali, Abdus Sadique, Fatema Tuz Johura, Kazi Zillur Rahman, Nur Haque Alam, Haruo Watanabe, and Munirul Alam. 2017. “Multi-Drug Resistant Pathogenic Bacteria in the Gut of Young Children in Bangladesh.” Gut Pathogens 9(1).

Ojer-Usoz, Elena, David González, Ana Isabel Vitas, José Leiva, Isabel García-Jalón, Alejandro Febles-Casquero, and María de la Soledad Escolano. 2013. “Prevalence of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Meat Products Sold in Navarra, Spain.” Meat Science 93(2), 316-21.

Pathak, Ashish, Salesh P. Chandran, Kalpana Mahadik, Ragini Macaden and Cecilia Stålsby Lundborg. 2013. “Frequency and Factors Associated with Carriage of Multi-Drug Resistant Commensal Escherichia Coli among Women Attending Antenatal Clinics in Central India.” BMC Infectious Diseases 13(1).

Sandhu, Raminder, Aditi Aggarwal, Pallavi Sayal and Surinder Kumar. 2019. “Intestinal Carriage of Drug‑resistant Gram‑negative Bacteria Belonging to Family Enterobacteriaceae in Children Aged 3–14 Years: An Emerging Threat.” International Journal of Health & Allied Sciences 8, 108-15.

Sayed, Amal Mohamed, Iman Kamal Behiry, Rasha Hamed Elsherief, and Sara Ali Elsir. 2017. “Detection of Carbapenemase-Producing Enterobacteriaceae in Rectal Surveillance Cultures in Non-Hospitalized Patients.” Journal of Analytical Science and Technology 8(1).

Shakya, Pragya, Peter Barrett, Vishal Diwan, Yogyata Marothi, Harshada Shah, Neeraj Chhari, Ashok J. Tamhankar, Ashish Pathak and Cecilia S. Lundborg. 2013. “Antibiotic Resistance among Escherichia Coli Isolates from Stool Samples of Children Aged 3 to 14 Years from Ujjain, India.” BMC Infectious Diseases 13(1).

Subramanya, Supram Hosuru, Indira Bairy, Niranjan Nayak, Shashiraja Padukone, Brijesh Sathian and Shishir Gokhale. 2019. “Low Rate of Gut Colonization by Extended-Spectrum β-Lactamase Producing Enterobacteriaceae in HIV Infected Persons as Compared to Healthy Individuals in Nepal.” PLoS ONE 14(2).

Valverde, Aránzazu, Fabio Grill, Teresa M. Coque, Vicente Pintado, Fernando Baquero, Rafael Cantón and Javier Cobo. 2008. “High Rate of Intestinal Colonization with Extended-Spectrum-β- Lactamase-Producing Organisms in Household Contacts of Infected Community Patients.” Journal of Clinical Microbiology 46(8), 2796-99.

Wayne PA. 2011. “Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing.

Woerther, Paul Louis, Charles Burdet, Elisabeth Chachaty and Antoine Andremont. 2013. “Trends in Human Fecal Carriage of Extended-Spectrum β-Lactamases in the Community: Toward the Globalization of CTX-M.” Clinical Microbiology Reviews 26(4), 744-58.