SHV-5 EXTENDED-SPECTRUM ß-LACTAMASES IN CLINICAL ISOLATES OF ESCHERICHIA COLI IN MALAYSIA

ESBL Producing E. coli in Chickens and Poultry Farms Environment in Selangor, Malaysia: A Cross-Sectional Study on Their Occurrence and Associated Risk Factors With Environment and Public Health Importance

INTRODUCTION

Extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) are widespread multidrug-resistant zoonotic bacteria that threaten animal production, food safety and antimicrobial therapy worldwide including Malaysia. Poultry has been reported as one of the pathways for human exposure to ESBL-EC. There has been little research on the occurrence of ESBL-EC within the Malaysian poultry food chain. Hence, the objectives of the study were to determine the occurrence of ESBL-EC in chickens and to identify the potential risk factors associated with their occurrence in poultry farms.

METHODS

A cross-sectional study was conducted on 400 samples, consisting of 240 cloacal swabs from chickens and 160 from poultry farms environments in eight districts in Selangor, Malaysia using culture and disk combination methods and multiple polymerase chain reaction assays. In the determination of possible factors associated with the presence of ESBL-EC at poultry farms, a questionnaire was used to obtain the information and data.

RESULTS

The findings demonstrated the wide distribution of ESBL-EC in all the farms with an overall occurrence of 37.2%. Farms in Gombak, Klang and Hulu Selangor had the highest occurrence rates at 62%, 50% and 50%, respectively, followed by farms in Petaling 38%, Sepang at 34%, Kuala Langat at 26% and Kuala Selangor at 24%, and the lowest was in Hulu Langat 14%. Among the study samples, chickens had the highest occurrence rate at 45.4%, followed by chicken house floors at 40% and flies at 30%, while feed and water samples at 17.5% and 12.5%, respectively. The present study indicated the high occurrence and wide dissemination of ESBL-EC in chickens and poultry farms environment. The ESBL-EC occurrence was associated with several factors including imprudent use of antibiotics, poor husbandry, management and biosecurity practices at the farms.

CONCLUSIONS

Our study showed the presence and spread of ESBL EC among chickens in the farms and their environment; this may lead to being spread to outside of farm environment by flies, vermins, flying birds, litter and farm wastes and possibly to humans upon contact with the contaminated environment and by poultry meat. Thus, the findings of the study can assist to serve as a piece of useful information to veterinary authority in designing evidence-based mitigation strategies for the control of ESBL-EC in poultry farms.

Extended Spectrum Beta-Lactamase (ESBL) Produced by Gram-Negative Bacteria in Trinidad and Tobago

Gram-negative bacterial infections are a global health problem. The production of beta-lactamase is still the most vital factor leading to beta-lactam resistance. In Trinidad and Tobago, extended spectrum beta-lactamase (ESBL) production has been detected and reported mainly in the isolates of Klebsiella pneumoniae and Escherichia coli and constitutes a public health emergency that causes high morbidity and mortality in some patients. In this literature review, the authors cover vast information on ESBL frequency and laboratory detection using both conventional and molecular methods from clinical data. The aim is to make the reader reflect on how the actual knowledge can be used for rapid detection and understanding of the spread of antimicrobial resistance problems stemming from ESBL production among common Gram-negative organisms in the health care system.

Characterization of multidrug resistant ESBL-producing Escherichia coli isolates from hospitals in Malaysia

The emergence of Escherichia coli that produce extended spectrum beta-lactamases (ESBLs) and are multidrug resistant (MDR) poses antibiotic management problems. Forty-seven E. coli isolates from various public hospitals in Malaysia were studied. All isolates were sensitive to imipenem whereas 36 were MDR (resistant to 2 or more classes of antibiotics). PCR detection using gene-specific primers showed that 87.5% of the ESBL-producing E. coli harbored the blaTEM gene. Other ESBL-encoding genes detected were blaOXA, blaSHV, and blaCTX-M. Integron-encoded integrases were detected in 55.3% of isolates, with class 1 integron-encoded intI1 integrase being the majority. Amplification and sequence analysis of the 5'CS region of the integrons showed known antibiotic resistance-encoding gene cassettes of various sizes that were inserted within the respective integrons. Conjugation and transformation experiments indicated that some of the antibiotic resistance genes were likely plasmid-encoded and transmissible. All 47 isolates were subtyped by PFGE and PCR-based fingerprinting using random amplified polymorphic DNA (RAPD), repetitive extragenic palindromes (REPs), and enterobacterial repetitive intergenic consensus (ERIC). These isolates were very diverse and heterogeneous. PFGE, ERIC, and REP-PCR methods were more discriminative than RAPD in subtyping the E. coli isolates.

Prevalence and clonality of extended-spectrum beta-lactamases in Asia

Asia is almost certainly a part of the world in which extended-spectrum beta-lactamases (ESBLs) have emerged de novo, with some early antimicrobial resistance studies showing high levels of the ESBL phenotype, particularly among Klebsiella, and most notably in China, Korea, Japan and India. There is a lack of genotyping studies but work from the late 1990s suggests that SHV-5 and SHV-12 were most common then, with only very rare reports of TEM-related ESBL genes. As in other parts of the world, quite marked differences have since been seen in the pattern of ESBL genes, particularly in relation to the CTX-M family. The early emergence of TOHO CTX-M-2 in Japan contrasted with CTX-M-3 and -14 in China and many other parts of the Far East, suggesting the separate transfer of genes from the genome of Kluyvera spp. to mobile genetic elements in human-associated Enterobacteriaceae. ESBL production rates are now very high compared with Europe. In most countries, there are mixtures of CTX-M types, with VEB appearing significantly in Vietnam and Thailand, and ESBL isolates from India being completely dominated by the presence of bla(CTX-M-15) alone, with no other CTX-M types reported. With the total population of India and China being c. 2.4 billion and with faecal carriage rates of, probably, c. 10%, these countries represent major reservoirs of bla(CTX-M) genes. Increasing international travel and trade will lead to the movement of many of these ESBL genes. The high prevalence of ESBL genes in Asia means that the empirical treatment of serious infections with beta-lactam antibiotics, except carbapenems, is seriously compromised.