Epidemiology of paediatric gastrointestinal colonisation by extended spectrum cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae isolates in north-west Cambodia


van Aartsen, JJ, Moore, CE, Parry, CM ORCID: 0000-0001-7563-7282, Turner, P, Phot, N, Mao, S, Suy, K, Davies, T, Giess, A, Sheppard, AE et al (show 5 more authors) (2019) Epidemiology of paediatric gastrointestinal colonisation by extended spectrum cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae isolates in north-west Cambodia. BMC MICROBIOLOGY, 19 (1). 59-.

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Abstract

<h4>Background</h4>Extended-spectrum cephalosporin resistance (ESC-R) in Escherichia coli and Klebsiella pneumoniae is a healthcare threat; high gastrointestinal carriage rates are reported from South-east Asia. Colonisation prevalence data in Cambodia are lacking. The aim of this study was to determine gastrointestinal colonisation prevalence of ESC-resistant E. coli (ESC-R-EC) and K. pneumoniae (ESC-R-KP) in Cambodian children/adolescents and associated socio-demographic risk factors; and to characterise relevant resistance genes, their genetic contexts, and the genetic relatedness of ESC-R strains using whole genome sequencing (WGS).<h4>Results</h4>Faeces and questionnaire data were obtained from individuals < 16 years in north-western Cambodia, 2012. WGS of cultured ESC-R-EC/KP was performed (Illumina). Maximum likelihood phylogenies were used to characterise relatedness of isolates; ESC-R-associated resistance genes and their genetic contexts were identified from de novo assemblies using BLASTn and automated/manual annotation. 82/148 (55%) of children/adolescents were ESC-R-EC/KP colonised; 12/148 (8%) were co-colonised with both species. Independent risk factors for colonisation were hospitalisation (OR: 3.12, 95% CI [1.52-6.38]) and intestinal parasites (OR: 3.11 [1.29-7.51]); school attendance conferred decreased risk (OR: 0.44 [0.21-0.92]. ESC-R strains were diverse; the commonest ESC-R mechanisms were bla<sub>CTX-M</sub> 1 and 9 sub-family variants. Structures flanking these genes were highly variable, and for bla<sub>CTX-M-15, - 55 and - 27</sub> frequently involved IS26. Chromosomal bla<sub>CTX-M</sub> integration was common in E. coli.<h4>Conclusions</h4>Gastrointestinal ESC-R-EC/KP colonisation is widespread in Cambodian children/adolescents; hospital admission and intestinal parasites are independent risk factors. The genetic contexts of bla<sub>CTX-M</sub> are highly mosaic, consistent with rapid horizontal exchange. Chromosomal integration of bla<sub>CTX-M</sub> may result in stable propagation in these community-associated pathogens.

Item Type: Article
Uncontrolled Keywords: Paediatric, ESBL, Carriage, Cambodia
Depositing User: Symplectic Admin
Date Deposited: 08 Apr 2019 11:17
Last Modified: 19 Jan 2023 00:55
DOI: 10.1186/s12866-019-1431-9
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3035999
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