Extended-spectrum β-lactamase, plasmid-mediated AmpC β-lactamase, fluoroquinolone resistance, and decreased susceptibility to carbapenems in : fecal carriage rates and associated risk factors in the community of Northern Cyprus.

BACKGROUND

Antibiotic-resistant in the gastrointestinal flora can lead to infections with limited therapeutic options. Also, the resistant bacteria can be transferred from colonized persons to others. The present study was conducted to search the fecal carriage rates of (i) that produce extended-spectrum β-lactamase (ESBL-E) and/or (ii) plasmid-mediated AmpC β-lactamase (pAmpC-E), (iii) ciprofloxacin-resistant (CIP-RE), and (iv) carbapenem-intermediate or -resistant (CIRE) in Northern Cyprus.

METHODS

A total of 500 community-dwellers were recruited from consecutive admissions to the clinical laboratories of four hospitals. One rectal swab or stool sample was collected from each participant. A questionnaire was applied to evaluate possible risk factors associated with intestinal colonization of resistant bacteria. The samples were cultured on antibiotic containing media to screen for resistant bacteria colonization. The bacterial colonies that grew on the plates were subjected to further phenotypic tests to confirm the resistance.

RESULTS

Of 500 volunteers, ESBL-E, pAmpC-E, CIP-RE and CIRE carriage were detected in 107 (21.4%), 15 (3.0%), 51 (10.2%) and six (1.2%) participants, respectively. was the most commonly recovered species among isolates. A significant proportion of ESBL-producing isolates ( = 22/107; 20.6%) was found to be co-resistant to CIP ( = 0.000, OR 3.21, 95% CI 1.76-5.87). In this study, higher socioeconomic status (CIP-RE:  = 0.024, OR 1.96, 95% CI 1.09-3.53), presence of gastrointestinal symptoms (CIRE:  = 0.033; OR 6.79, 95% CI 1.34-34.39), antibiotic use (ESBL-E:  = 0.031; OR 1.67, 95% CI 1.04-2.67; and CIRE:  = 0.033; OR 6.40, 95% CI 1.16-35.39), and travelling abroad (pAmpC-E:  = 0.010; OR 4.12, 95% CI 1.45-11.66) were indentified as risk factors.

CONCLUSION

The study indicates that resistant isolates are carried by humans in the community. To prevent further spread of resistance, rational use of antibiotics should be encouraged, and antibiotic resistance should be carefully monitored in Northern Cyprus.