Byline: Madhu. Gupta, Gunjan. Didwal, Shruti. Bansal, Kanica. Kaushal, Nitya. Batra, Vikas. Gautam, Pallab. Ray
Background & objectives: Rampant use of [sz]-lactam antibiotics in both community and hospitals has transformed the human healthy intestinal gut flora into a reservoir of antibiotic-resistant organisms. This study was conducted to find the faecal presence of antibiotic-resistant Enterobacteriaceae in faecal samples in the community in north India. Methods: In this prospective study, 207 stool samples were collected from apparently healthy individuals residing in a semiurban community in Chandigarh, India, from August to October, 2015. Isolates belonging to family Enterobacteriaceae were identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and antibiotic susceptibility was determined using Clinical Laboratory Standard Institute disc diffusion method. Detection of extended spectrum [sz]-lactamases (TEM, SHV, OXA-1, CTXM 1, CTXM 2, CTXM 9 and CTXM 8/25), carbapenemases (IMP, VIM and KPC) and New Delhi metallo-[sz]-lactamase was done by multiplex PCR. Results: Of the population studied, 55.5 per cent were females and 60 per cent were illiterate or had only primary education; 43.4 per cent individuals were aged <20 yr. Overall, 70.5 per cent of stool samples had antibiotic-resistant isolates. Maximum resistance was seen for cephalosporins (60.4%) followed by fluoroquinolones (41.5%). The multidrug-resistant (MDR) isolates were 2.4 per cent. The most commonly detected genes were TEM, SHV, OXA-1, CTXM-1, CTXM-2, CTXM-9 and CTXM-8/25 [sz]-lactamases. Escherichia coli was the most common resistant isolate, and TEM was the most common gene detected. Interpretation & conclusions: Overall, 70.5 per cent members of Enterobacteriaceae had antibiotic resistance in the community and 2.4 per cent were MDR. Higher resistance rates were observed for most commonly used drugs such as cephalosporins and fluoroquinolones. High rate of antibiotic-resistant Enterobacteriaceae in gut of healthy individuals points towards the need for active screening and prevention of dissemination.
Inappropriate usage of antimicrobials has transformed the human healthy intestinal gut flora into a reservoir of antibiotic-resistant organisms, also called the gut resistome . This selection pressure-driven disruptive effect on the gut microbiome facilitates these organisms to behave as opportunistic pathogens. Mobile genetic elements-mediated resistance includes extended-spectrum [sz]-lactamases (ESBLs), AmpC [sz]-lactamases and carbapenemases, enabling easy dissemination among bacteria ,. The problem is intensified by increasing prevalence of these resistant bacteria in the community thereby increasing the risk of cross-transmission .
Rampant use of [sz]-lactam antibiotics in both community and hospitals is a grave concern, especially in resource-limited countries like India . As a consequence of ineffective antimicrobial stewardship in hospitals and lack of awareness in the community, an increase in resistance in pathogens among hospital-acquired infections escalates the problem compelling the usage of high-end drugs such as carbapenems and polymyxins . To tackle the menace of growing antimicrobial resistance in the country, National Action Plan was recently framed for India . The issue of resistant gut flora at the community level has yet not been addressed. The present study was planned to ascertain antimicrobial resistance among members of Enterobacteriaceae from the gut flora of healthy individuals at the community level.
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