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Background  Antibiotic-resistant  Enterobacteriaceae  in the gastrointestinal flora can lead to infections with limited therapeutic options. Also, the resistant bacteria can be transferred from colonized persons to others. The present study was conducted to search the fecal carriage rates of (i)  Enterobacteriaceae  that produce extended-spectrum β-lactamase (ESBL-E) and/or (ii) plasmid-mediated AmpC β-lactamase (pAmpC-E), (iii) ciprofloxacin-resistant  Enterobacteriaceae  (CIP-RE), and (iv) carbapenem-intermediate or -resistant  Enterobacteriaceae  (CIRE) in Northern Cyprus.    Methods  A total of 500 community-dwellers were recruited from consecutive admissions to the clinical laboratories of four hospitals. One rectal swab or stool sample was collected from each participant. A questionnaire was applied to evaluate possible risk factors associated with intestinal colonization of resistant bacteria. The samples were cultured on antibiotic containing media to screen for resistant bacteria colonization. The bacterial colonies that grew on the plates were subjected to further phenotypic tests to confirm the resistance.    Results  Of 500 volunteers, ESBL-E, pAmpC-E, CIP-RE and CIRE carriage were detected in 107 (21.4%), 15 (3.0%), 51 (10.2%) and six (1.2%) participants, respectively.  Escherichia coli  was the most commonly recovered species among  Enterobacteriaceae  isolates. A significant proportion of ESBL-producing  E. coli  isolates ( n  = 22/107; 20.6%) was found to be co-resistant to CIP ( p  = 0.000, OR 3.21, 95% CI 1.76–5.87). In this study, higher socioeconomic status (CIP-RE:  p  = 0.024, OR 1.96, 95% CI 1.09–3.53), presence of gastrointestinal symptoms (CIRE:  p  = 0.033; OR 6.79, 95% CI 1.34–34.39), antibiotic use (ESBL-E:  p  = 0.031; OR 1.67, 95% CI 1.04–2.67; and CIRE:  p  = 0.033; OR 6.40, 95% CI 1.16–35.39), and travelling abroad (pAmpC-E:  p  = 0.010; OR 4.12, 95% CI 1.45–11.66) were indentified as risk factors.    Conclusion  The study indicates that resistant  Enterobacteriaceae  isolates are carried by humans in the community. To prevent further spread of resistance, rational use of antibiotics should be encouraged, and antibiotic resistance should be carefully monitored in Northern Cyprus.

antimicrobial resistance and infection control

Extended-spectrum β-lactamase, plasmid-mediated AmpC β-lactamase, fluoroquinolone resistance, and decreased susceptibility to carbapenems in Enterobacteriaceae: fecal carriage rates and associated risk factors in the community of Northern Cyprus