title: Community acquisition of β-lactamase producing Enterobacteriaceae in neonatal gut.
abstract: BACKGROUND
  Commensal flora constitutes a reservoir of antibiotic resistance. The increasing variety of β-lactamases and the emergence of Carbapenem resistant Enterobacteriaceae (CRE) in community, raise concerns regarding efficacy of β-lactams. It is important to know the exact load of antibiotic resistance in the absence of any antibiotic selection pressure including via food and water.In the present study gut colonization in neonates with no direct antibiotic pressure was used as a model to evaluate β-lactam resistance in the community.
  
  
  RESULTS
  In this prospective study, 75 healthy, vaginally delivered, antibiotic naive, breast fed neonates were studied for gut colonization by Extended spectrum β-lactamases (ESBL), AmpC β-lactamases hyperproducing Enterobacteriaceae and CRE on day 0, 21 and 60. Total 267 Enterobacteriaceae were isolated and E.coli was the predominant flora. ESBL, AmpC and coproduction was seen in 20.6%, 19.9% and 11.2% isolates respectively. ESBL carriage increased threefold from day 1 to 60 showing predominance of CTX-M group 15 (82.5%), ampC genes were heterogeneous. Colonization with CRE was rare, only one baby harboured Enterobacter sp positive for kpc-2. The reservoirs for these genes are likely to be mother and the environment.
  
  
  CONCLUSIONS
  Data strongly suggests that in absence of any antibiotic pressure there is tremendous load of antibiotic resistance to β-lactam drugs. Wide spread presence of ESBL and AmpC can drive rapid emergence and dissemination of CRE. This is the first report from India which depicts the smaller picture of true antibiotic pressure present in the Indian community.
authors.affiliation: Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi 110029, India.
authors.forename: Charu
authors.initials: C
authors.lastname: Kothari
authors.forename: Rajni
authors.initials: R
authors.lastname: Gaind
authors.forename: Laishram Chandreshwor
authors.initials: LC
authors.lastname: Singh
authors.forename: Anju
authors.initials: A
authors.lastname: Sinha
authors.forename: Vidya
authors.initials: V
authors.lastname: Kumari
authors.forename: Sugandha
authors.initials: S
authors.lastname: Arya
authors.forename: Harish
authors.initials: H
authors.lastname: Chellani
authors.forename: Sunita
authors.initials: S
authors.lastname: Saxena
authors.forename: Monorama
authors.initials: M
authors.lastname: Deb
mesh_terms: D002353:Carrier State / Q000382:microbiology*; D017714:Community-Acquired Infections / Q000382:microbiology*; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000382:microbiology*; D041981:Gastrointestinal Tract / Q000382:microbiology*; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D011446:Prospective Studies; D013997:Time Factors; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases