Antony Sherly, Ravichandran Kandasamy, Kanungo Reba
Department of Microbiology, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India.
Department of Biostatistics, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry, India.
Indian J Med Microbiol. 2018 Oct-Dec;36(4):488-493. doi: 10.4103/ijmm.IJMM_18_388.
Multidrug-resistant (MDR) colonisers act as a reservoir for transmission of antibiotic resistance and are a source of infection. Exposure to antibiotics by the commensal flora renders them resistant. Antibiotic consumption and hospitalisation are two major factors influencing this. We studied, antibiotic-resistant bacteria colonising rural adult population who had restricted access to health care and presumably had low consumption of antibiotics.
Detection of multidrug resistance genes of extended spectrum β-lactamase (ESBL-CTX-M), AmpC β-Lactamase (CIT), Klebsiella pneumoniae carbapenemase (KPC) and New Delhi Metallo β-lactamase (NDM) in Enterobacteriaceae colonising the gut of adult population in a South Indian rural community.
Faecal samples of 154 healthy volunteers were screened for Enterobacteriaceae resistant to commonly used antibiotics by standard methods, followed by phenotypic detection of ESBL by double disk synergy method, AmpC by spot inoculation and carbapenemases by imipenem and ethylenediaminetetraacetic acid + imipenem combined E-test strips and modified Hodge test. Polymerase chain reaction was done to detect blablabla and bla genes coding for ESBL, AmpC, KPC and NDM, respectively.
Colonisation rate of enteric bacteria with MDR genes in the community was 30.1%. However, phenotypically, only ESBL (3.2%) and NDM (0.65%) were detected. While the genes coding for ESBL, AmpC and NDM were detected in 35.6%, 17.8% and 4.4% of the MDR isolates, respectively.
Carriage of MDR strains with a potential to express multidrug resistance poses a threat of dissemination in the community. Awareness for restricted use of antibiotics and proper sanitation can contain the spread of resistant bacteria.
多重耐药定植菌是抗生素耐药性传播的储存库，也是感染源。共生菌群接触抗生素会使其产生耐药性。抗生素使用和住院是影响这一情况的两个主要因素。我们研究了生活在农村、获得医疗保健机会有限且抗生素使用量可能较低的成年人群中定植的抗生素耐药菌。
检测印度南部农村社区成年人群肠道中肠杆菌科细菌的超广谱β-内酰胺酶（ESBL-CTX-M）、AmpCβ-内酰胺酶（CIT）、肺炎克雷伯菌碳青霉烯酶（KPC）和新德里金属β-内酰胺酶（NDM）等多重耐药基因。
采用标准方法对154名健康志愿者的粪便样本进行肠杆菌科对常用抗生素耐药性的筛查，随后通过双纸片协同试验进行ESBL的表型检测，通过点接种法进行AmpC检测，通过亚胺培南和乙二胺四乙酸+亚胺培南联合E试验条以及改良Hodge试验进行碳青霉烯酶检测。采用聚合酶链反应分别检测编码ESBL、AmpC、KPC和NDM的bla bla bla和bla基因。
该社区中携带多重耐药基因的肠道细菌定植率为30.1%。然而，在表型上，仅检测到ESBL（3.2%）和NDM（0.65%）。在多重耐药分离株中，分别有35.6%、17.8%和4.4%检测到编码ESBL、AmpC和NDM的基因。
携带可能表达多重耐药性的多重耐药菌株对社区传播构成威胁。对抗生素限制使用的意识和适当的卫生措施可遏制耐药菌的传播。
