title: Faecal carriage rate of extended-spectrum β-lactamase-producing Enterobacteriaceae in hospitalised patients and healthy asymptomatic individuals coming for health check-up.
abstract: The prevalence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) in hospitalised and community patients is of significant public health concern. The aim of this study was to estimate the faecal carriage rate of ESBL-PE in hospitalised patients and healthy asymptomatic individuals coming for health check-up. Non-repetitive, consecutive stool samples from 480 adults (260 healthy individuals and 220 hospitalised patients) aged ≥18 years from November 2011 to July 2013 were screened using MacConkey agar supplemented with ceftazidime. All screen-positive isolates were identified to species level and were tested for ESBL production. Representative ESBL-PE isolates were subjected to susceptibility testing and multiplex ESBL PCR. The faecal carriage rate of ESBL-PE was found to be 62.7% among hospitalised patients and 33.8% among healthy asymptomatic individuals. The most common ESBL-PE was Escherichia coli (70.3% and 78.4% in hospitalised patients and healthy individuals, respectively), followed by Klebsiella pneumoniae (26.8% and 17.0%). ESBL-PE showed the highest sensitivity to carbapenems (85% and 100%, respectively), followed by amikacin (67.2% and 98%), cefoperazone/sulbactam (27.8% and 88.2%) and piperacillin/tazobactam (18% and 74.5%). Ciprofloxacin exhibited a high level of resistance among both groups. Molecular analysis for ESBL genes showed a predominance of the CTX-M gene. In conclusion, the faecal carriage rate of ESBL-PE among hospitalised patients was almost double that of healthy individuals. Carriage of carbapenem-resistant isolates is emerging among hospitalised patients. The spread of these organisms in the community merits radical measures to improve sanitation and implement antibiotic stewardship.
authors.affiliation: Department of Microbiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi 682041, Kerala, India.
authors.forename: Rachana
authors.initials: R
authors.lastname: Babu
authors.affiliation: Department of Microbiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi 682041, Kerala, India. Electronic address: vanilkumar@aims.amrita.edu.
authors.forename: Anil
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Microbiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi 682041, Kerala, India.
authors.forename: Shamsul
authors.initials: S
authors.lastname: Karim
authors.affiliation: Center for Nanoscience & Molecular Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, Kerala, India.
authors.forename: Sruthi
authors.initials: S
authors.lastname: Warrier
authors.affiliation: Department of Anesthesia and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, Kerala, India.
authors.forename: Suresh G
authors.initials: SG
authors.lastname: Nair
authors.affiliation: Department of Infection Control, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, Kerala, India.
authors.forename: Sanjeev K
authors.initials: SK
authors.lastname: Singh
authors.affiliation: Center for Nanoscience & Molecular Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara, Kochi, Kerala, India.
authors.forename: Raja
authors.initials: R
authors.lastname: Biswas
mesh_terms: D002353:Carrier State / Q000382:microbiology*; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics; D004756:Enterobacteriaceae Infections / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D001618:beta-Lactamases
keywords: Carbapenem; ESBL; Escherichia coli; Faecal carriage