Prevalence 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

• Published in: PloS one Vol. 15; no. 11; p. e0241971
• Main Authors: Al Fadhli, Amani H, Jamal, Wafaa Y, Rotimi, Vincent O
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 17-11-2020; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bacterial Proteins - genetics; beta-Lactamases - genetics; Biology and Life Sciences; Carbapenem-Resistant Enterobacteriaceae - drug effects; Carbapenem-Resistant Enterobacteriaceae - genetics; Carbapenem-Resistant Enterobacteriaceae - growth & development; Carbapenemase; Carbapenems - therapeutic use; Chronic obstructive pulmonary disease; Colistin; Colistin - therapeutic use; Colonization; Comorbidity; CRE bacteria; Disease control; E coli; Electrophoresis; Enterobacteriaceae; Epidemics; Escherichia coli - drug effects; Escherichia coli - genetics; Escherichia coli - growth & development; Ethics; Female; Genes; Hospitals; Humans; Hybridization; Infections; Intensive care; Intensive Care Units; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - genetics; Klebsiella pneumoniae - growth & development; Kuwait; Laboratories; Male; Medicine and Health Sciences; Meropenem; Microbial Sensitivity Tests - methods; Microbiology; Middle Aged; Patients; People and Places; Plasmids; Plasmids - genetics; Polymerase chain reaction; Prevalence; Rectum; Rectum - microbiology; Research parks; Tigecycline; Young Adult; Kuwait; France; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0241971

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).
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.
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 blaOXA-181 and blaNDM-5-carrying plasmids were detected in some strains.
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 blaOXA-181 were detected in isolates from 38 (65.5%) out of 58 patients and in 5 patients colonized by blaOXA-48-positive CRE. A combination of 2 genes was detected in 12 isolates; 5 blaKPC-2 and blaOXA-181, 4 blaVIM-1 and blaOXA-181, and 3 blaNDM-5 and blaOXA-181. PFGE showed an overall level of similarity of 38%. Southern hybridization studies localized the blaOXA-181 and blaNDM-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.
The prevalence of CRE colonization in the 2 hospital ICUs was relatively high and the emergence of blaOXA-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.