Plasmid-mediated quinolone resistance genes detected in Ciprofloxacin non-susceptible Escherichia coli and Klebsiella isolated from children under five years at hospital discharge, Kenya
Abstract Background The increasing spread of fluoroquinolone resistant enteric bacteria is a global public health concern. Children recently discharged from the hospital are at high risk of carriage of antimicrobial resistance (AMR) due to frequent exposure to antimicrobials during inpatient stays....
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BMC
2023-05-01
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| Series: | BMC Microbiology |
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| Online Access: | https://doi.org/10.1186/s12866-023-02849-2 |
| _version_ | 1797577772505235456 |
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| author | Kevin Kariuki Mame Mareme Diakhate Susan Musembi Stephanie N. Tornberg-Belanger Doreen Rwigi Timothy Mutuma Elizabeth Mutuku Kirkby D. Tickell Olusegun O. Soge Benson O. Singa Judd L. Walson Patricia B. Pavlinac Samuel Kariuki |
| author_facet | Kevin Kariuki Mame Mareme Diakhate Susan Musembi Stephanie N. Tornberg-Belanger Doreen Rwigi Timothy Mutuma Elizabeth Mutuku Kirkby D. Tickell Olusegun O. Soge Benson O. Singa Judd L. Walson Patricia B. Pavlinac Samuel Kariuki |
| author_sort | Kevin Kariuki |
| collection | DOAJ |
| description | Abstract Background The increasing spread of fluoroquinolone resistant enteric bacteria is a global public health concern. Children recently discharged from the hospital are at high risk of carriage of antimicrobial resistance (AMR) due to frequent exposure to antimicrobials during inpatient stays. This study aimed to determine the prevalence, correlates of ciprofloxacin (CIP) non-susceptibility, and distribution of plasmid-mediated quinolone resistance (PMQR) genes in Escherichia coli (E. coli) and Klebsiella spp isolated from children under five years being discharged from two Kenyan Hospitals. Methods E. coli and Klebsiella spp were isolated from fecal samples from children discharged from hospital and subjected to antimicrobial susceptibility testing (AST) by disc diffusion and E-test. CIP non-susceptible isolates were screened for seven PMQR genes using multiplex polymerase chain reaction (PCR). Poisson regression was used to determine the association between the carriage of CIP non-susceptible isolates and patient characteristics. Results Of the 280 CIP non-susceptible isolates: 188 E. coli and 92 Klebsiella spp isolates identified among 266 discharged children, 195 (68%) were CIP-non-susceptible with minimum inhibitory concentrations (MICs) of ≥ 1 µg/mL. Among these 195 isolates, 130 (67%) had high-level CIP MIC = ≥ 32 µg/mL). Over 80% of the isolates had at least one PMQR gene identified: aac(6’)lb-cr (60%), qnrB (24%), oqxAB (22%), qnrS (16%), and qepA (6%), however, qnrA was not identified in any isolates tested. Co-carriage of qnrB with acc(6’)-lb-cr was the most predominant accounting for 20% of all the isolates. Ceftriaxone use during hospital admission and the presence of extended spectrum beta-lactamase (ESBL) production were significantly associated with the carriage of CIP non-susceptible E. coli and Klebsiella spp. Conclusion CIP non-susceptibility is common among E. coli and Klebsiella spp isolated from hospital discharged children in Kenya. Carriage and co-carriage of PMQR, including the newly identified qepA gene, were frequently observed. These findings suggest that children leaving the hospital may serve as an important reservoir for transmission of resistant E. coli and Klebsiella spp to the community. Enhanced surveillance for AMR determinants is critical to inform interventions to control antimicrobial-resistant bacteria. |
| first_indexed | 2024-03-10T22:12:45Z |
| format | Article |
| id | doaj.art-c872f02fc5484664881e0d21df1d0428 |
| institution | Directory Open Access Journal |
| issn | 1471-2180 |
| language | English |
| last_indexed | 2024-03-10T22:12:45Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Microbiology |
| spelling | doaj.art-c872f02fc5484664881e0d21df1d04282023-11-19T12:32:54ZengBMCBMC Microbiology1471-21802023-05-0123111110.1186/s12866-023-02849-2Plasmid-mediated quinolone resistance genes detected in Ciprofloxacin non-susceptible Escherichia coli and Klebsiella isolated from children under five years at hospital discharge, KenyaKevin Kariuki0Mame Mareme Diakhate1Susan Musembi2Stephanie N. Tornberg-Belanger3Doreen Rwigi4Timothy Mutuma5Elizabeth Mutuku6Kirkby D. Tickell7Olusegun O. Soge8Benson O. Singa9Judd L. Walson10Patricia B. Pavlinac11Samuel Kariuki12Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI)Department of Global Health, University of WashingtonDepartment of Biochemistry, Microbiology and Biotechnology, Kenyatta UniversityInternal Medicine, (Infectious Diseases), Atrium Health Wake Forest Baptist HealthCentre for Microbiology Research, Kenya Medical Research Institute (KEMRI)Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI)Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI)Department of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonCentre for Microbiology Research, Kenya Medical Research Institute (KEMRI)Abstract Background The increasing spread of fluoroquinolone resistant enteric bacteria is a global public health concern. Children recently discharged from the hospital are at high risk of carriage of antimicrobial resistance (AMR) due to frequent exposure to antimicrobials during inpatient stays. This study aimed to determine the prevalence, correlates of ciprofloxacin (CIP) non-susceptibility, and distribution of plasmid-mediated quinolone resistance (PMQR) genes in Escherichia coli (E. coli) and Klebsiella spp isolated from children under five years being discharged from two Kenyan Hospitals. Methods E. coli and Klebsiella spp were isolated from fecal samples from children discharged from hospital and subjected to antimicrobial susceptibility testing (AST) by disc diffusion and E-test. CIP non-susceptible isolates were screened for seven PMQR genes using multiplex polymerase chain reaction (PCR). Poisson regression was used to determine the association between the carriage of CIP non-susceptible isolates and patient characteristics. Results Of the 280 CIP non-susceptible isolates: 188 E. coli and 92 Klebsiella spp isolates identified among 266 discharged children, 195 (68%) were CIP-non-susceptible with minimum inhibitory concentrations (MICs) of ≥ 1 µg/mL. Among these 195 isolates, 130 (67%) had high-level CIP MIC = ≥ 32 µg/mL). Over 80% of the isolates had at least one PMQR gene identified: aac(6’)lb-cr (60%), qnrB (24%), oqxAB (22%), qnrS (16%), and qepA (6%), however, qnrA was not identified in any isolates tested. Co-carriage of qnrB with acc(6’)-lb-cr was the most predominant accounting for 20% of all the isolates. Ceftriaxone use during hospital admission and the presence of extended spectrum beta-lactamase (ESBL) production were significantly associated with the carriage of CIP non-susceptible E. coli and Klebsiella spp. Conclusion CIP non-susceptibility is common among E. coli and Klebsiella spp isolated from hospital discharged children in Kenya. Carriage and co-carriage of PMQR, including the newly identified qepA gene, were frequently observed. These findings suggest that children leaving the hospital may serve as an important reservoir for transmission of resistant E. coli and Klebsiella spp to the community. Enhanced surveillance for AMR determinants is critical to inform interventions to control antimicrobial-resistant bacteria.https://doi.org/10.1186/s12866-023-02849-2CiprofloxacinEscherichia coliKlebsiella sppPost-hospital dischargeFluoroquinolonesAntimicrobial resistance |
| spellingShingle | Kevin Kariuki Mame Mareme Diakhate Susan Musembi Stephanie N. Tornberg-Belanger Doreen Rwigi Timothy Mutuma Elizabeth Mutuku Kirkby D. Tickell Olusegun O. Soge Benson O. Singa Judd L. Walson Patricia B. Pavlinac Samuel Kariuki Plasmid-mediated quinolone resistance genes detected in Ciprofloxacin non-susceptible Escherichia coli and Klebsiella isolated from children under five years at hospital discharge, Kenya BMC Microbiology Ciprofloxacin Escherichia coli Klebsiella spp Post-hospital discharge Fluoroquinolones Antimicrobial resistance |
| title | Plasmid-mediated quinolone resistance genes detected in Ciprofloxacin non-susceptible Escherichia coli and Klebsiella isolated from children under five years at hospital discharge, Kenya |
| title_full | Plasmid-mediated quinolone resistance genes detected in Ciprofloxacin non-susceptible Escherichia coli and Klebsiella isolated from children under five years at hospital discharge, Kenya |
| title_fullStr | Plasmid-mediated quinolone resistance genes detected in Ciprofloxacin non-susceptible Escherichia coli and Klebsiella isolated from children under five years at hospital discharge, Kenya |
| title_full_unstemmed | Plasmid-mediated quinolone resistance genes detected in Ciprofloxacin non-susceptible Escherichia coli and Klebsiella isolated from children under five years at hospital discharge, Kenya |
| title_short | Plasmid-mediated quinolone resistance genes detected in Ciprofloxacin non-susceptible Escherichia coli and Klebsiella isolated from children under five years at hospital discharge, Kenya |
| title_sort | plasmid mediated quinolone resistance genes detected in ciprofloxacin non susceptible escherichia coli and klebsiella isolated from children under five years at hospital discharge kenya |
| topic | Ciprofloxacin Escherichia coli Klebsiella spp Post-hospital discharge Fluoroquinolones Antimicrobial resistance |
| url | https://doi.org/10.1186/s12866-023-02849-2 |
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