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Das T, Nath C, Das P, Ghosh K, Logno TA, Debnath P, Dash S, Devnath HS, Das S, Islam MZ. High prevalence of ciprofloxacin resistance in Escherichia coli isolated from chickens, humans and the environment: An emerging one health issue. PLoS One 2023; 18:e0294043. [PMID: 37983240 PMCID: PMC10659180 DOI: 10.1371/journal.pone.0294043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 09/29/2023] [Indexed: 11/22/2023] Open
Abstract
The emergence of antimicrobial resistance in commensal bacteria poses a serious public health burden worldwide. Commensals can disseminate the resistance genes to pathogenic bacteria causing life-threatening infections. This cross-sectional study was designed to investigate the antimicrobial resistance pattern and molecular mechanism(s) of ciprofloxacin resistance in commensal E. coli from three major one health components (humans, animals and the environment) in Bangladesh. Samples were randomly collected from broiler chickens, broiler farm environments and hospitalized human patients from the same geographical area. Isolation and identification of E. coli were performed following standard bacteriological techniques. Antimicrobial susceptibility testing (AST) was performed by disk diffusion and broth microdilution methods. Mutation at the quinolone-resistance determining region (QRDR) was analyzed by sequencing. Of 450 samples, a total of 287 (63.8%; 95% CI 59.2-68.1%) E. coli strains was isolated, where 240 (83.6%; 95% CI 78.9-87.5%) strains were phenotypically resistant to ciprofloxacin. The prevalence of ciprofloxacin-resistant E. coli in broiler chicken, broiler farm environments and hospitalized human patients are 77.6%, 88.8% and 89% respectively. In AST against nine antimicrobials, all the isolates were found to be multidrug-resistant (MDR). The minimum inhibitory concentration (MIC) of ciprofloxacin was ranged from 4 to >128mg/L. Point mutations were detected in several sites of QRDR, specifically at 83 and 87 amino acid positions in gyrA gene, and 56, 57, 78, 80 and 84 amino acid positions in parC gene. Mutations resulted in amino acid substitutions. Phylogenetic analysis of gyrA and parC gene sequences showed a close relationship between the strains isolated from different sources. This study demonstrates a high prevalence of ciprofloxacin resistance in commensal E. coli in humans, animals and environment interface and their genealogically similarity poses an alarming public health consequence.
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Affiliation(s)
- Tridip Das
- Poultry Research and Training Centre, Chattogram Veterinary and Animal Sciences University, Chattogram, Bangladesh
| | - Chandan Nath
- Department of Microbiology and Veterinary Public Health, Chattogram Veterinary and Animal Sciences University, Chattogram, Bangladesh
| | - Pallabi Das
- Chattogram Maa-O-Shishu Hospital, Chattogram, Bangladesh
| | - Keya Ghosh
- Department of Microbiology and Veterinary Public Health, Chattogram Veterinary and Animal Sciences University, Chattogram, Bangladesh
| | - Tahia Ahmed Logno
- Department of Microbiology and Veterinary Public Health, Chattogram Veterinary and Animal Sciences University, Chattogram, Bangladesh
| | - Pankqj Debnath
- Department of Molecular Life Science, Faculty of Biology, Friedrich Schiller University Jena, Jena, Germany
| | - Shuvo Dash
- Department of Pharmacy, University of Science and Technology Chittagong, Chattogram, Bangladesh
| | | | - Shubhagata Das
- School of Agricultural, Environmental and Veterinary Sciences, Faculty of Sciences and Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Md Zohorul Islam
- Department of Microbiology and Veterinary Public Health, Chattogram Veterinary and Animal Sciences University, Chattogram, Bangladesh
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
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San T, Aung MS, San N, Aung MMZ, Mon WLY, Thazin TE, Kobayashi N. Bacterial Species and Antimicrobial Resistance of Clinical Isolates from Pediatric Patients in Yangon, Myanmar, 2020. Infect Dis Rep 2022; 14:26-32. [PMID: 35076535 PMCID: PMC8788269 DOI: 10.3390/idr14010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/04/2022] [Accepted: 01/04/2022] [Indexed: 02/04/2023] Open
Abstract
Antimicrobial resistance (AMR) is a concern in medical care for children who have high burden of infectious diseases. We investigated the prevalence of bacterial species and their susceptibility to antimicrobials of 1019 clinical isolates from pediatric patients in a tertiary-care hospital in Yangon, Myanmar for one-year period (2020). The most frequently recovered species was Escherichia coli, followed by Klebsiella pneumoniae and Staphylococcus aureus, all of which accounted for 43% of clinical isolates, while 25% of isolates comprised non-fermenter, including Pseudomonas sp. and Acinetobacter sp. Phenotypically determined ESBL (extended-spectrum beta-lactamase)-positive rates in E. coli, K. pneumoniae, and Enterobacter sp. were 82%, 88%, and 65%, respectively. High rates of multiple drug resistance were noted for E. coli (84%), K. pneumoniae (81%), and Acinetobacter sp. (65%), associated with carbapenem resistance in 48%, 42%, and 59% of isolates, respectively. In contrast, S. aureus isolates exhibited low resistance rates (<30%) to most of antimicrobials, with 22% being resistant to oxacillin/cefoxitin. Fluoroquinolone resistance was found in most of bacterial species with different prevalence rates. The present study revealed the current status on prevalence of bacterial species causing infections in pediatric patients in Myanmar, highlighting the significance to monitor AMR among children.
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Affiliation(s)
- Thida San
- Department of Clinical Laboratory, Yangon Children’s Hospital, Yangon 11191, Myanmar; (T.S.); (T.E.T.)
| | - Meiji Soe Aung
- Department of Hygiene, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan;
| | - Nilar San
- Department of Microbiology, University of Medicine 2, Yangon 11031, Myanmar;
| | - Myat Myint Zu Aung
- Department of Microbiology, University of Medicine 1, Yangon 11131, Myanmar;
| | - Win Lei Yi Mon
- Department of Clinical Laboratory, Yangon General Hospital, Yangon 11131, Myanmar;
| | - Thin Ei Thazin
- Department of Clinical Laboratory, Yangon Children’s Hospital, Yangon 11191, Myanmar; (T.S.); (T.E.T.)
| | - Nobumichi Kobayashi
- Department of Hygiene, School of Medicine, Sapporo Medical University, Sapporo 060-8556, Japan;
- Correspondence: ; Tel.: +81-11-611-2111
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Singh SR, Teo AKJ, Prem K, Ong RTH, Ashley EA, van Doorn HR, Limmathurotsakul D, Turner P, Hsu LY. Epidemiology of Extended-Spectrum Beta-Lactamase and Carbapenemase-Producing Enterobacterales in the Greater Mekong Subregion: A Systematic-Review and Meta-Analysis of Risk Factors Associated With Extended-Spectrum Beta-Lactamase and Carbapenemase Isolation. Front Microbiol 2021; 12:695027. [PMID: 34899618 PMCID: PMC8661499 DOI: 10.3389/fmicb.2021.695027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Despite the rapid spread of extended-spectrum beta-lactamase (ESBL) producing-Enterobacterales (ESBL-E) and carbapenemase-producing Enterobacterales (CPE), little is known about the extent of their prevalence in the Greater Mekong Subregion (GMS). In this systematic review, we aimed to determine the epidemiology of ESBL-E and CPE in clinically significant Enterobacterales: Escherichia coli and Klebsiella pneumoniae from the GMS (comprising of Cambodia, Laos, Myanmar, Thailand, Vietnam and Yunnan province and Guangxi Zhuang region of China). Methods: Following a list of search terms adapted to subject headings, we systematically searched databases: Medline, EMBASE, Scopus and Web of Science for articles published on and before October 20th, 2020. The search string consisted of the bacterial names, methods involved in detecting drug-resistance phenotype and genotype, GMS countries, and ESBL and carbapenemase detection as the outcomes. Meta-analyses of the association between the isolation of ESBL from human clinical and non-clinical specimens were performed using the "METAN" function in STATA 14. Results: One hundred and thirty-nine studies were included from a total of 1,513 identified studies. Despite the heterogeneity in study methods, analyzing the prevalence proportions on log-linear model scale for ESBL producing-E. coli showed a trend that increased by 13.2% (95%CI: 6.1-20.2) in clinical blood specimens, 8.1% (95%CI: 1.7-14.4) in all clinical specimens and 17.7% (95%CI: 4.9-30.4) increase in carriage specimens. Under the log-linear model assumption, no significant trend over time was found for ESBL producing K. pneumoniae and ESBL-E specimens. CPE was reported in clinical studies and carriage studies past 2010, however a trend could not be determined because of the small dataset. Twelve studies were included in the meta-analysis of risk factors associated with isolation of ESBL. Recent antibiotic exposure was the most studied variable and showed a significant positive association with ESBL-E isolation (pooled OR: 2.9, 95%CI: 2.3-3.8) followed by chronic kidney disease (pooled OR: 4.7, 95%CI: 1.8-11.9), and other co-morbidities (pooled OR: 1.6, 95%CI: 1.2-2.9). Conclusion: Data from GMS is heterogeneous with significant data-gaps, especially in community settings from Laos, Myanmar, Cambodia and Yunnan and Guangxi provinces of China. Collaborative work standardizing the methodology of studies will aid in better monitoring, surveillance and evaluation of interventions across the GMS.
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Affiliation(s)
- Shweta R. Singh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Infectious Disease Epidemiology, Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rick Twee-Hee Ong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Elizabeth A. Ashley
- Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - H. Rogier van Doorn
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Direk Limmathurotsakul
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Paul Turner
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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