Extended-Spectrum Beta-Lactamase-Producing Escherichia coli in Drinking Water Samples From a Forcibly Displaced, Densely Populated Community Setting in Bangladesh

Abstract

Introduction: Community-acquired infections due to extended-spectrum beta-lactamase (ESBL) producing Escherichia coli are rising worldwide, resulting in increased morbidity, mortality, and healthcare costs, especially where poor sanitation and inadequate hygienic practices are very common. Objective: This study was conducted to investigate the prevalence and characterization of multidrug-resistant (MDR) and ESBL-producing E. coli in drinking water samples collected from Rohingya camps, Bangladesh. Methods: A total of 384 E. coli isolates were analyzed in this study, of which 203 were from household or point-of-use (POU) water samples, and 181 were from source water samples. The isolates were tested for virulence genes, ESBL-producing genes, antimicrobial susceptibility by VITEK 2 assay, plasmid profiling, and conjugal transfer of AMR genes. Results: Of the 384 E. coli isolates tested, 17% (66/384) were found to be ESBL producers. The abundance of ESBL-producers in source water contaminated with E. coli was observed to be 14% (27/181), whereas, 19% (39/203) ESBL producers was found in household POU water samples contaminated with E. coli. We detected 71% (47/66) ESBL-E. coli to be MDR. Among these 47 MDR isolates, 20 were resistant to three classes, and 27 were resistant to four different classes of antibiotics. Sixty-four percent (42/66) of the ESBL producing E. coli carried 1 to 7 plasmids ranging from 1 to 103 MDa. Only large plasmids with antibiotic resistance properties were found transferrable via conjugation. Moreover, around 7% (29/384) of E. coli isolates harbored at least one of 10 virulence factors belonging to different E. coli pathotypes. Conclusions: The findings of this study suggest that the drinking water samples analyzed herein could serve as an important source for exposure and dissemination of MDR, ESBL-producing and pathogenic E. coli lineages, which therewith pose a health risk to the displaced Rohingya people residing in the densely populated camps of Bangladesh.

Keywords: Bangladesh; ESBL-producing E. coli; Rohingya camps; drinking water; multidrug-resistant.

Figure 1

Antibiotic resistant pattern of ESBL producing Escherichia coli.

Figure 2

Presence of antibiotic resistant genes in ESBL producing Escherichia coli.

Figure 3

(A) Distribution of pathogenic and non pathogenic E. coli. (B) Distribution of different E. coli pathotypes.

Figure 4

Distribution of different E. coli phylogenetic group.

Figure 5

Agarose gel electrophoresis of plasmid DNA showing the patterns among the ESBL positive isolates. Lane-3: E. coli strain pDK9 (140, 105, 2.7, 2.1 MDa), Lane-6: V517 (23MDa), Lane-9:RP4 (36MDa), Lane-11: V517 (35.8, 3.4,3.7, 2,1.8,1.4), Lane-13: R1 (62MDa), Lane-1,2,4,5,7,8,10, and 12 are ESBL positive E. coli. The molecular weight of the markers is shown in the picture.