Antimicrobial Resistance, Virulence Factors, and Pathotypes of Escherichia coli Isolated from Drinking Water Sources in Jordan

Pathogenic E. coli in the Food Chain across the Arab Countries: A Descriptive Review

Foodborne bacterial infections caused by pathogens are a widespread problem in the Middle East, leading to significant economic losses and negative impacts on public health. This review aims to offer insights into the recent literature regarding the occurrence of harmful E. coli bacteria in the food supply of Arab countries. Additionally, it aims to summarize existing information on health issues and the state of resistance to antibiotics. The reviewed evidence highlights a lack of a comprehensive understanding of the extent to which harmful E. coli genes are present in the food supply of Arab countries. Efforts to identify the source of harmful E. coli in the Arab world through molecular characterization are limited. The Gulf Cooperation Council (GCC) countries have conducted few surveys specifically targeting harmful E. coli in the food supply. Despite having qualitative data that indicate the presence or absence of harmful E. coli, there is a noticeable absence of quantitative data regarding the actual numbers of harmful E. coli in chicken meat supplies across all Arab countries. While reports about harmful E. coli in animal-derived foods are common, especially in North African Arab countries, the literature emphasized in this review underscores the ongoing challenge that harmful E. coli pose to food safety and public health in Arab countries.

Antimicrobial Resistance Is Prevalent in E. coli and Other Enterobacterales Isolated from Public and Private Drinking Water Supplies in the Republic of Ireland

High levels of bacterial antimicrobial resistance (AMR) have been reported in many environmental studies conducted in Ireland and elsewhere. The inappropriate use of antibiotics in both human and animal healthcare as well as concentrations of residual antibiotics being released into the environment from wastewaters are thought to be contributing factors. Few reports of AMR in drinking water-associated microbes are available for Ireland or internationally. We analysed 201 enterobacterales from group water schemes and public and private water supplies, only the latter having been surveyed in Ireland previously. The organisms were identified using conventional or molecular techniques. Antimicrobial susceptibility testing for a range of antibiotics was performed using the ARIS 2X interpreted in accordance with EUCAST guidelines. A total of 53 Escherichia coli isolates, 37 Serratia species, 32 Enterobacter species and enterobacterales from seven other genera were identified. A total of 55% of isolates were amoxicillin resistant, and 22% were amoxicillin-clavulanic acid resistant. A lower level of resistance (<10%) was observed to aztreonam, chloramphenicol, ciprofloxacin, gentamicin, ceftriaxone and trimethoprim-sulfamethoxazole. No resistance to amikacin, piperacillin/tazobactam, ertapenem or meropenem was detected. The level of AMR detected in this study was low but not insignificant and justifies ongoing surveillance of drinking water as a potential source of antimicrobial resistance.

Metatranscriptome deciphers the effects of non-antibiotic antimicrobial agents on antibiotic resistance and virulence factors in freshwater microcosms

The emergence and transmission of antibiotic resistance genes (ARGs) and virulence factors (VFs) pose health risks to the ecosystem and humans. Understanding how non-antibiotic antimicrobial agents drive the expression of ARGs and VFs in freshwater ecosystems, however, remains large challenges. Here, we employed freshwater microcosms and performed metatranscriptomic analysis to investigate the expression profiles of ARGs and VFs in response to pollutants of non-antibiotic antimicrobial agents, including silver nanoparticles (AgNPs) and azoxystrobin. Results showed that AgNPs significantly inhibited the total expression of ARGs and VFs and decreased the number of pathogenic microorganisms expressing these genes. Azoxystrobin increased the total expression of ARGs and VFs, as well as the number of pathogens expressing VFs, but concomitantly reduced the number of pathogens expressing ARGs. Two tested pollutants dramatically changed the expression profiles of ARGs and VFs, with distinct patterns: AgNPs displayed a negative effect, while azoxystrobin showed a positive effect on their expression profiles. Our findings provided a systematical insight to demonstrate that non-antibiotic antimicrobial agents with different mechanisms of action showed various effects on ARGs and VFs, and therefore represented different ecological risks.

Isolation and Identification of Coliform Bacteria and Multidrug-Resistant Escherichia coli from Water Intended for Drug Compounding in Community Pharmacies in Jordan

(1) Background: Water is necessary for the preparation of some medicines found in pharmacies where the local water source does not meet the required purity. This study aimed to investigate the presence of coliform contamination in water used for drug reconstitution in community pharmacies in Jordan. (2) Methods: Two water samples from 50 randomly selected community pharmacies representing all Jordanian governorates were filtered and then cultured in plate count agars to determine total microbial count, and in m-Endo Agar Les and Eosin Methylene Blue (EMB) agar to cultivate Escherichia coli (E. coli). The presence of E. coli was further characterized with gram stains, biochemical tests, and Polymerase chain reaction (PCR). Antibiotic susceptibility of isolated E. coli was tested against a variety of standard antibiotics. (3) Results: Community pharmacies used droppers filled with water from coolers (62%), bottled water (20%), boiled tap water (16%) and tap water (2%). The majority of the sampled water contained coliform bacteria (88%), and E. coli was isolated from 26% of all samples. Statistical analysis showed no significant difference in the percentage of contaminated water samples based on its source location. Nonetheless, the results showed a tendency for higher proportions of contamination in droppers filled from boiled tap water (37.5%; SE: 17.1), followed by water from water coolers (25.8%; SE: 7.9), and then from bottled water (20%; SE: 12.7). All of the isolated E. coli were sensitive to gentamycin, ciprofloxacin and levofloxacin. The susceptibility of the isolates to ceftazidime, doxycycline, tetracycline, azithromycin and amoxicillin/clavulanic acid were 92%, 61%, 46%, 23% and 15%, respectively. (4) Conclusions: This study confirms the widespread presence of multidrug-resistant bacteria in water intended for reconstituting drugs in local pharmacies. These findings expose an alarming situation that needs special attention by the acting pharmacists and competent authorities. Higher levels of personal hygiene in the pharmacies coupled with regular inspection of water quality may reduce the risk of microbial contamination in compounded products, especially multidrug-resistant strains of E. coli and other index microorganisms.

Phenotypic and molecular characterization of extended-spectrum β-lactamase/AmpC- and carbapenemase-producing Klebsiella pneumoniae in Iran

BACKGROUND

The objective of the current study is to evaluate the phenotypic and molecular characterization of ESBL/AmpC- and carbapenemase-producing K. pneumoniae isolates in Iran.

METHODS

From October 2018 until the end of April 2020, different clinical samples were collected and K. pneumoniae isolates were identified using conventional biochemical tests and PCR assay. Antibiotic susceptibility pattern was determined using the Kirby-Bauer disk diffusion method. Modified Hedge Test (MHT) was applied to the identification of carbapenemase-producing K. pneumoniae. ESBL and AmpC-producing K. pneumoniae were detected using Double Disc Test (DDT) and Disc Potentiation Test (DPT), respectively. The presence of carbapenemase, ESBL, and AmpC encoding genes was screened by Polymerase Chain Reaction (PCR) assay.

RESULTS

A total of 100 K. pneumoniae isolates were collected. K. pneumoniae isolates had the highest resistance rate to cefazolin (66%) and cefotaxime (66%). Meropenem and amikacin with sensitivity rates of 76% and 69% were the most effective antimicrobial agents on K. pneumoniae isolates. It was found that 12 (12%), 27 (27%), and 9 (9%) K. pneumoniae isolates were positive in MHT, DDT, and DPT tests, respectively. Among the carbapenemase-encoding genes, bla_OXA-48 (24%) and bla_IMP (13%) genes had the highest frequency, while bla_KPC and bla_GIM genes were not detected among K. pneumoniae isolates. bla_TEM (48%) and bla_CMY (8%) genes had the highest frequency among ESBL and AmpC β-lactamase-encoding genes, respectively.

CONCLUSIONS

It is vital to adopt effective control strategies for K. pneumoniae infections and ensure rapid identification of antibiotic resistance profile.

Clonal and plasmid-mediated dissemination of environmental carbapenem-resistant Enterobacteriaceae in large animal breeding areas in northern China

The emergence and dissemination of carbapenem-resistant Enterobacteriaceae (CRE) constitute a major global health problem. The environment plays an important role in the dissemination of CRE, but large-scale studies on CRE in groundwater environments in animal breeding areas are scarce. The aim of this study was to investigate CRE occurrence and environmental transmission of carbapenem resistance genes in large animal breeding areas in northern China. In total, 280 well water and 102 animal feces samples in large animal breeding areas in six counties from the two provinces Inner Mongolia and Shandong in China, were screened for CRE. A total of 39 CRE were isolated and characterized with next-generation sequencing. 5.3% of well water samples were contaminated with CRE. The well water in chicken farms had the highest number of detections of CRE (15.9%). More than half of the isolates carried closely related, conjugative IncX3 plasmids with bla_NDM-genes from multiple geographic areas, indicating that this kind of plasmid plays an important role in dissemination of carbapenem resistance determinants. The clonal expansion of various CRE isolates in well water and animal feces were demonstrated; clonally related CRE were isolated from different wells within the same county, from different counties in the same province, and even from different provinces. In addition to harboring various ARGs, two closely related K. pneumoniae belonging to ST11 isolated from well water carried genetic hypervirulence determinants on a virulence plasmid, highlighting the potential health risk posed by further dissemination of this strain. These findings suggest that groundwater may be an underappreciated reservoir and source of dissemination of CRE, from which resistance genes may disseminate among different bacterial strains and over large geographic distances. Further research and multi-sectorial monitoring, with a "One health" perspective, is urgently needed to investigate the need for interventions aimed at preventing CRE dissemination.

The role of veterinarians in the One Health approach to antimicrobial resistance perspectives in Jordan

This study aims to evaluate the role of Jordanian veterinarians in terms of their knowledge, attitudes and common practices in combating antimicrobial resistance (AMR) and summarize the registered veterinary drugs between 2017 2020. Descriptive study data were collected using a standardized questionnaire that focused on the knowledge, attitudes, and practices of Jordanian veterinarians. The findings were analyzed descriptively; 84% of the participants agreed with the statement on the definition of AMR. The majority (95.65%) of participants agreed that AMR is a challenge for the veterinary sector in Jordan and that it should be prioritized over other zoonotic diseases. Approximately 69% of the participants believed that the misuse and overuse of antimicrobials by unqualified, fraudulent, or unauthorized practitioners is the primary reason for the rise of cases associated with AMR and the challenges that accompany these. The most common practice among the respondents in this study was to recommend clients (e.g., farmers and owners) to practice good animal husbandry (80.00%). The study also revealed that there was a significant difference (p = 0.015) between attendance at AMR training sessions and the professional sector (private, public, and academic) of the veterinarians. This study underscores the importance of implementing a continuous education program on AMR so as to enhance the all-round knowledge of veterinarians and improve their advisory skills. In addition, laws should be enacted to ensure that veterinarians prescribe the correct antimicrobials and to improve surveillance systems for monitoring the use of antimicrobials in veterinary medicine.

Molecular characterization of enterohemorrhagic Escherichia coli isolated from diarrhea samples from human, livestock, and ground beef in North Jordan

Background and Aim:

Enterohemorrhagic Escherichia coli (EHEC) is an important foodborne pathogen with worldwide distribution. Data regarding its presence, distribution, virulence, and antimicrobial susceptibility among various animal species and humans in Jordan are lacking. Therefore, the objectives of this study were to isolate and characterize EHEC from human and animal diarrhea fecal samples and ground beef samples.

Materials and Methods:

A total of 100 and 270 diarrhea fecal samples from humans and animals, respectively, were collected. In addition, 40 ground beef meat samples were collected from retail markets. EHEC was positively identified by detecting Shiga toxins (stx1 and stx2) genes using multiplex polymerase chain reaction (PCR). Antimicrobial susceptibility patterns were determined using the disk diffusion test. Beta-lactamase production was detected using the double disk diffusion test and the extended-spectrum beta-lactamases (ESBLs) were identified by detection of bla_TEM, bla_SHV, and OXA-1 genes using multiplex PCR. Pulsed-field gel electrophoresis (PFGE) was used to investigate the relatedness of EHEC isolates from different sources.

Results:

Out of 410 samples, 194 E. coli isolates were positively identified, of which 57 isolates (29%) were classified as EHEC. Thirty-five (61%) of EHEC isolates were serotyped as O157 (19: O157:H7 and 16: O157:NM). The stx1 gene was detected only among the sheep and goats isolates at a rate of 7.6% and 5.2%, respectively, while the stx2 gene was detected in only one ground beef meat sample. EHEC isolates showed high resistance patterns against amoxicillin, gentamycin, cephalexin, and doxycycline. Twenty-four out of 32 EHEC isolates were determined as ESBL producers, among which 14 isolates expressed the bla_SHVgene and 19 isolates expressed the bla_TEM while four expressed both genes. PFGE analysis revealed two clusters with high similarity (92%) originated from ground beef meat and cattle fecal samples. No similarities were found between human and animal E. coli isolates.

Conclusion:

Results of this study indicate widespread ESBL EHEC among humans, animals, and ground beef meat samples. These results represent an important alarm that requires the implementation of appropriate preventative measures by both human and animal health sectors to prevent the transmission of this important foodborne pathogen.

High prevalence of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae fecal carriage among children under five years in Addis Ababa, Ethiopia

Background

Extended-spectrum beta-lactamase (ESBL) producing bacteria present an ever-growing burden in the hospital and community settings. Data on the prevalence of ESBL fecal carriage remain scarce in Ethiopia. Therefore, this study aimed to determine the prevalence of ESBL producing Escherichia coli and Klebsiella pneumoniae fecal carriage among children under five years in Addis Ababa, Ethiopia.

Methods

A facility-based cross-sectional study was conducted from April to May 2017. A total of 269 fecal/rectal swab samples were cultured on MacConkey agar. All positive cultures were characterized by colony morphology, Gram stain, and standard biochemical tests. Further, bacteria identification, antimicrobial susceptibility testing, and phenotypic detection of ESBL production were performed using VITEK 2 Compact as per the instruction of the manufacturer. Socio-demographic and risk factors data were collected using questionnaires. Data were entered by EPI INFO version 7.2.1.0 and analyzed by SPSS version 20.

Results

The overall prevalence of ESBL-producing E. coli and K. pneumoniae was 17.1% (46/269; 95% CI: 12.9%–22.7%). A total of 47 isolates were ESBL-positive, of which, 83.0% were E. coli and 17.0% were K. pneumoniae. ESBL producing E. coli and K. pneumoniae isolates were also showed high levels of MDR (93.6%) and high rates of co-resistance to aminoglycosides, fluoroquinolones, and trimethoprim-sulfamethoxazole. However, all isolates were carbapenem susceptible. In the risk factors analysis, Children’s mothers who had lower educational level (primary school) (OR: 2.472, 95% CI: 1.323–4.618, P = 0.0062) and children who used tap water for drinking (OR: 1.714, 95% CI: 1.001–3.659, P = 0.048) were found to be significantly associated with higher ESBL fecal carriage.

Conclusions

In this study, the high prevalence rate of ESBL producing E. coli and K. pneumoniae fecal carriage and high level of multidrug resistance among ESBL producing E. coli and K. pneumoniae were demonstrated. This suggested that the necessity of routine screening of ESBL is crucial for the early detection and appropriate antibiotics selection for infection caused by ESBL producing pathogens.

Carbapenemase-producing Gram-negative bacteria in aquatic environments: a review

Antibiotic resistance is one of the greatest public-health challenges worldwide, especially with regard to Gram-negative bacteria (GNB). Carbapenems are the β-lactam antibiotics of choice with the broadest spectrum of activity and, in many cases, are the last-resort treatment for several bacterial infections. Carbapenemase-encoding genes, mainly carried by mobile genetic elements, are the main mechanism of resistance against carbapenems in GNB. These enzymes exhibit a versatile hydrolytic capacity and confer resistance to most β-lactam antibiotics. After being considered a clinical issue, increasing attention is being giving to the dissemination of such resistance mechanisms in the environment and especially through water. Aquatic environments are among the most significant microbial habitats on our planet, known as a favourable medium for antibiotic gene transfer, and they play a crucial role in the huge spread of drug resistance in the environment and the community. In this review, we present current knowledge regarding the spread of carbapenemase-producing isolates in different aquatic environments, which may help the implementation of control and prevention strategies against the spread of such dangerous resistant agents in the environment.

Spread Patterns of Antibiotic Resistance in Faecal Indicator Bacteria Contaminating an Urbanized Section of the Brda River

This paper presents the spatio-temporal distribution of faecal indicator bacteria (FIB) in the river section subject to anthropogenic stress and describes spread patterns of antibiotic resistance in the studied bacterial groups. The analysis involved 58 strains of Escherichia coli and 61 strains of enterococci. Antibiotic resistance profiles were prepared in accordance with the recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST). The results indicated a correlation between the location of a sampling site and the concentration of faecal bacteria. The highest average concentrations were recorded at the site located in the city centre, where the river is used mainly for recreation. Antibiotic resistance profiles showed that Escherichia coli had 100% sensitivity to tigecycline, levofloxacin and imipenem. The highest percentaage of strains (17%) were resistant to piperacillin. Enterococci were 100% sensitive to levofloxacin. No strains were vancomycin-resistant (VRE). The highest percentage of strains was resistant to imipenem (23%), and the lowest, to ampicillin (2%). The spatio-temporal distribution of antibiotic-resistant strains (ARS) indicated a high concentration of drug-resistant Escherichia coli (47%) in the summer season at the sampling site located in the last part of the river. At the same time, drug resistance in enterococci increased along the river course and was considerably higher in spring. There were no significant relationships between physico-chemical parameters of water and the levels of faecal bacteria. On the other hand, strong relationships were observed between the percentage of strains showing resistance to the applied antibiotics and physico-chemical and biological parameters of water. The percentage of antibiotic resistant strains of Escherichia coli was negatively correlated with dissolved oxygen concentration (r = - 0.9; p < 0.001) and BOD₅ (r = - 0.85; p < 0.05). The percentage of antibiotic resistant strains of enterococci was most strongly correlated with water pH (r = - 0.92; p < 0.001).

Detection and characterization of Enterobacteriaceae family members carried by commensal Rattus norvegicus from Tehran, Iran

Wild rats are known to carry different microorganisms and are considered a reservoir of zoonotic pathogens worldwide. The urban rats were collected from five districts of Tehran and Gram-negative bacteria (GNB) were isolated from fecal samples and were identified using classical biochemical tests. The antibiotic susceptibility patterns of isolated bacteria were determined by Kirby-Bauer disk diffusion method, the results of which were interpreted in line with CLSI guideline. The frequency of antibiotic-resistant genes was identified using multiplex-PCR. Moreover, PCR method was used to identify the frequency of Escherichia coli O157:H7 and main categories of diarrheagenic E. coli including EPEC, ETEC, EIEC, EAEC, and STEC pathotypes. A total of 100 Rattus norvegicus were trapped and fecal samples were collected. Overall, 72 fecal samples were positive for GNB. E. coli (n = 46/72) had the highest frequency among the isolated GNB. Among E. coli isolates, the highest and lowest resistance rates belonged to ampicillin (56.5%) and ceftriaxone (0%), respectively. Klebsiella spp. was 100% resistant to imipenem, and streptomycin (0%) was the most effective antimicrobial agent on Klebsiella spp. Among surveyed genes, bla_TEM (95.8%) and bla_aadA-1 (58.3%) had the highest frequency, while bla_KPC, and bla_CMY-2 were not detected among Enterobacteriaceae. Herein, O157: H7 serotype was not detected and aEPEC (87%) was the most common pathotype detected. Results suggested that rodents might be a reservoir of antimicrobial-resistant pathogens and rodent control along with implementation of surveillance programs should be considered as a critical priority for urban health.

Molecular characterization of antimicrobial resistance and virulence genes of Escherichia coli isolates from bovine mastitis

Background and Aim:

Mastitis is a common and economically important disease in dairy cattle. It remains one of the most common reasons for the extensive use of antimicrobials in dairy farms leading to the emergence of antimicrobial-resistant pathogens. The aim of this study was to determine the patterns of antimicrobial resistance of Escherichia coli isolates from bovine mastitis and to identify prominent antimicrobial resistance and virulence genes among isolated strains.

Materials and Methods:

Antimicrobial susceptibility testing against six antibiotic groups, including tetracyclines, aminoglycosides, beta-lactams, macrolides, sulfonamides, and fluoroquinolones was performed using the disk diffusion method. PCR was performed on resistant isolates to detect resistance and virulence genes using commercially available primers.

Results:

Out of 216 milk samples cultured, 14 samples yielded E. coli isolates. All isolates (100%) were resistant to ampicillin, amoxicillin, procaine penicillin, streptomycin, oxytetracycline, and sulfamethoxazole-trimethoprim. Only one isolate (7%) was sensitive to gentamicin, and all isolates (100%) were sensitive to enrofloxacin and ciprofloxacin. All isolates carried at least one resistance gene against one or more of the major antibiotic groups. All isolates carried the ereA, tetG, tetE, and tetB genes, followed by tetA (93%), ampC (86%), strA (86%), sul1 (78%), tetD (71%), tetC (57%), aadA (57%), and strB (36%). The lowest percentage of isolates carried bla1 (17%) and bla2 (12%) genes, and none of the isolates carried the qnrA gene. Most of the isolates (93%) carried the Shiga toxin 1 virulence gene, followed by complement resistance protein (79%), intimin (64%), Shiga toxin 2 (36%), cytotoxic necrotizing factor (35%), aerotaxis receptor (21%), and type 1 fimbriae (15%).

Conclusion:

Results of this study indicate that the high percentages of E. coli isolate from bovine mastitis are resistant to two or more of the major antibiotic groups, irrespective of the presence or absence of relevant resistance or virulence genes.

Waterborne diarrhoeal infection risk from multiple water sources and the impact of an earthquake

In the Kathmandu Valley of Nepal, locals depend on multiple water sources due to the limited access to safe water, which is a great global concern regarding its impact on human health. This study aimed to compare the infection risk of diarrhoea from multiple water sources with different concentrations of Escherichia coli among water supply areas and evaluate the impact of changing water sources due to the Gorkha earthquake on the infection risk. The concentration of enteropathogenic E. coli was estimated in samples of piped water, jar water, groundwater, and tanker water, which were collected in the Valley. The volume of each water ingestion was determined based on a questionnaire survey and considering drinking and bathing sources. The highest estimated risk was observed for households drinking groundwater from shallow dug wells, followed by tanker water. The estimated risk implied the regional disparity due to various water sources with different quality. After the earthquake, the ratio of households drinking only jar water increased, and the estimated risk decreased. The damage on piped water supply, the decrease of tanker water availability and the decrease of residents' trust in groundwater quality presumably enhanced the consumption of jar water despite its high price.

The role of the natural aquatic environment in the dissemination of extended spectrum beta-lactamase and carbapenemase encoding genes: A scoping review

The natural aquatic environment is a significant contributor to the development and circulation of clinically significant antibiotic resistance genes (ARGs). The potential for the aquatic environment to act as a reservoir for ARG accumulation in areas receiving anthropogenic contamination has been thoroughly researched. However, the emergence of novel ARGs in the absence of external influences, as well as the capacity of environmental bacteria to disseminate ARGs via mobile genetic elements remain relatively unchallenged. In order to address these knowledge gaps, this scoping literature review was established focusing on the detection of two important and readily mobile ARGs, namely, extended spectrum beta-lactamase (ESBL) and carbapenemase genes. This review included 41 studies from 19 different countries. A range of different water bodies including rivers (n = 26), seawaters (n = 6) and lakes (n = 3), amongst others, were analysed in the included studies. ESBL genes were reported in 29/41 (70.7%) studies, while carbapenemase genes were reported in 13/41 (31.7%), including joint reporting in 9 studies. The occurrence of mobile genetic elements was evaluated, which included the detection of integrons (n = 22), plasmids (n = 18), insertion sequences (n = 4) and transposons (n = 3). The ability of environmental bacteria to successfully transfer resistance genes via conjugation was also examined in 11 of the included studies. The findings of this scoping review expose the presence of clinically significant ARGs in the natural aquatic environment and highlights the potential ability of environmental isolates to disseminate these genes among different bacterial species. As such, the results presented demonstrate how anthropogenic point discharges may not act as the sole contributor to the development and spread of clinically significant antibiotic resistances. A number of critical knowledge gaps in current research were also identified. Key highlights include the limited number of studies focusing on antibiotic resistance in uncontaminated aquatic environments as well as the lack of standardisation among methodologies of reviewed investigations.

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

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.

Epidemiology of carbapenemase-producing Enterobacterales in the Middle East: a systematic review

Introduction: The Middle East is actually recognized as endemic for carbapenemases-producing Enterobacterales (CPE) including at least OXA-48-like and NDM-like.Areas covered: We performed a search of PubMed and Scopus using relevant keywords. We included peer-reviewed articles published only in English reporting any data on carbapenemase-producing bacteria from Middle East countries. The last literature search was performed on 26 October 2019. All studies describing carbapenemase-producing Enterobacterales isolated from humans, animals or environmental samples from the Middle East were included.Expert opinion: The Middle-East is considered an endemic region for CPE strains and the extensive international exchange could facilitate the spread of CPE from these countries to other parts of the Globe in which the prevalence of the CPE is low. The expansion of the Middle East conflict has been associated with the rapid collapse of the existing health care system of the concerned countries. Considering that Millions of refugees have fled their country, they could introduce these CPE strains in countries with low endemicity. In conclusion, the health care system actors should take in a count the endemicity of CPE in these countries and develop local surveillance programs to limit the spread of these MDR bacteria.