Open AccessPrevalence of carbapenem-resistant Enterobacteriaceae and emergence of high rectal colonization rates of blaOXA-181-positive isolates in patients admitted to two major hospital intensive care units in Kuwait
Author(s) -
Amani H Al Fadhli,
Wafaa Jamal,
Vincent O. Rotimi
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0241971
Subject(s) - colistin , carbapenem resistant enterobacteriaceae , macconkey agar , meropenem , pulsed field gel electrophoresis , microbiology and biotechnology , intensive care , medicine , tigecycline , enterobacteriaceae , antibiotics , carriage , polymerase chain reaction , biology , antibiotic resistance , agar , gene , bacteria , intensive care medicine , genotype , escherichia coli , genetics , pathology , biochemistry
Background Fecal colonization by carbapenem-resistant Enterobacteriaceae (CRE) can be the main reservoir for transmission of these resistant organisms especially in the Intensive Care Units (ICUs). Aim This study was conducted to evaluate the rate of rectal carriage and molecular characterization of CRE in patients hospitalized in the ICUs of 2 major hospitals (Adan and Mubarak Al Kabeer Hospitals) in Kuwait. Materials and methods Rectal swabs were collected from all patients at admission, 48 h after admission and once weekly from April 2017- March 2018. Initial CRE screening was carried out on MacConkey agar on which meropenem disc 10μg was placed. Identification of isolates was by API 20E. Susceptibility testing was performed using the E-test method. Polymerase chain reaction (PCR) was used to detect the carbapenemase-encoding genes. Clonal relationship was investigated by pulsed-field electrophoresis (PFGE). Genes of bla OXA-181 and bla NDM-5 –carrying plasmids were detected in some strains. Results A total of 590 patients were recruited into the study. Of these, 58 were positive for CRE, giving a prevalence of 9.8%; 25/320 (7.8%) in Adan and 33/270 (12.2%) in Mubarak Al Kabeer Hospitals. All isolates were resistant to multiple antibiotics. Resistance rates to colistin and tigecycline were 17% and 83%, respectively. Single genes of bla OXA-181 were detected in isolates from 38 (65.5%) out of 58 patients and in 5 patients colonized by bla OXA-48 -positive CRE. A combination of 2 genes was detected in 12 isolates; 5 bla KPC-2 and bla OXA-181 , 4 bla VIM-1 and bla OXA-181 , and 3 bla NDM-5 and bla OXA-181 . PFGE showed an overall level of similarity of 38%. Southern hybridization studies localized the bla OXA-181 and bla NDM-5 genes to a large plasmid of 200kb in 3 K . pneumoniae isolates and a small plasmid of 80kb in 2 E . coli isolates, respectively. Conclusion The prevalence of CRE colonization in the 2 hospital ICUs was relatively high and the emergence of bla OXA-181 -mediated CRE is a cause for concern as there is the possibility of rapid horizontal spread among hospital patients in Kuwait. Active surveillance of CRE in the ICUs is highly recommended to stem its spread.