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. 2020 May 27;9(6):286.
doi: 10.3390/antibiotics9060286.

The Gut of Healthy Infants in the Community as a Reservoir of ESBL and Carbapenemase-Producing Bacteria

Ali F Saleem  1 , Ahreen Allana  1 , Lauren Hale  2 , Alondra Diaz  3 , Raul Salinas  2 , Cristina Salinas  2 , Shahida M Qureshi  1 , Aneeta Hotwani  1 , Najeeb Rahman  1 , Asia Khan  1 , Anita K Zaidi  1 , Patrick C Seed  3   4   5 , Mehreen Arshad  2   3   4   5
Affiliations

The Gut of Healthy Infants in the Community as a Reservoir of ESBL and Carbapenemase-Producing Bacteria

Ali F Saleem et al. Antibiotics (Basel). .

Abstract

The recent rapid rise of multi-drug resistant Enterobacteriaceae (MDR-E) is threatening the treatment of common infectious diseases. Infections with such strains lead to increased mortality and morbidity. Using a cross-sectional study, we aimed to estimate the prevalence of gut colonization with extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae among healthy infants born in Pakistan, a setting with high incidence of MDR-E infections. Stool samples were collected from 104 healthy infants between the ages of 5 and 7 months. Enterobacteriaceae isolates were screened for resistance against several antimicrobial classes. Presence of ESBL and carbapenemase genes was determined using multiplex PCR. Sequence types were assigned to individual strains by multi-locus sequence typing. Phylogenetic analysis of Escherichia coli was done using the triplex PCR method. Forty-three percent of the infants were positive for ESBL-producing Enterobacteriaceae, the majority of which were E. coli. We identified several different ESBL E. coli sequence types most of which belonged to the phylogenetic group B2 (23%) or D (73%). The widespread colonization of infants in a developing country with ESBL-producing Enterobacteriaceae is concerning. The multiple sequence types and reported non-human sources support that multiple non-epidemic MDR lineages are circulating in Pakistan with healthy infants as a common reservoir.

Keywords: Enterobacteriaceae; carbapenemase; extended-spectrum beta-lactamase; gut colonization; infants; multi-drug resistant.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
(A) Distribution of Extended Spectrum Beta-lactamase (ESBL) + and ESBL—isolates among the three most common Enterobacteriaceae. (B) Susceptibility pattern of ESBL E. coli isolates. Resistance against beta-lactams was ubiquitous, sensitivities against other common antibiotics was shown. (C) Susceptibility pattern of non-ESBL E. coli isolates against commonly used antibiotics. AM ampicillin, CRO ceftriaxone, CTX cefotaxime, CAZ ceftazidime, AmC amoxicillin-clavulanate, TZP pipercillin-tazobactam, ATM aztreonam, IPM imipenem, MEM meropenem, GM gentamicin, AN amikacin, AZM azithromycin.
Figure 1
Figure 1
(A) Distribution of Extended Spectrum Beta-lactamase (ESBL) + and ESBL—isolates among the three most common Enterobacteriaceae. (B) Susceptibility pattern of ESBL E. coli isolates. Resistance against beta-lactams was ubiquitous, sensitivities against other common antibiotics was shown. (C) Susceptibility pattern of non-ESBL E. coli isolates against commonly used antibiotics. AM ampicillin, CRO ceftriaxone, CTX cefotaxime, CAZ ceftazidime, AmC amoxicillin-clavulanate, TZP pipercillin-tazobactam, ATM aztreonam, IPM imipenem, MEM meropenem, GM gentamicin, AN amikacin, AZM azithromycin.
Figure 2
Figure 2
(A) Resistance genes carried by infants as determined by PCR testing for ESBL and carbapenemase genes. (B) Number of resistance genes per infant stool.
See this image and copyright information in PMC

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