Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
Department of Public Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
J Antimicrob Chemother. 2019 Oct 1;74(10):2880-2890. doi: 10.1093/jac/dkz296.
For low-income countries, data regarding the intestinal colonization with extended-spectrum cephalosporin-resistant (ESC-R) and colistin-resistant (CST-R) Enterobacteriaceae in the community are still scarce. Here, we investigated this phenomenon by analysing hotel employees in Zanzibar.
During June to July 2018, rectal swabs from 59 volunteers were screened implementing selective enrichments and agar plates. Species identification was achieved using MALDI-TOF MS. Strains were characterized using microdilution panels (MICs), microarray, PCRs for mcr-1/-8, repetitive extragenic palindromic-PCR (rep-PCR) and WGS.
Colonization prevalence with ESC-R-, CST-R- and mcr-1-positive Enterobacteriaceae were 91.5%, 66.1% and 18.6%, respectively (average: 2.2 strains per volunteer). Overall, 55 ESC-R Escherichia coli (3 also CST-R), 33 ESC-R Klebsiella pneumoniae (1 also CST-R), 17 CST-R E. coli and 21 CST-R K. pneumoniae were collected. The following main resistance genes were found: ESC-R E. coli (blaCTX-M-15-like, 51.0%), ESC-R K. pneumoniae (blaCTX-M-9-like, 42.9%), CST-R E. coli (mcr-1, 55%) and CST-R K. pneumoniae (D150G substitution in PhoQ). ESBL-producing E. coli mainly belonged to ST361, ST636 and ST131, whereas all those that were mcr-1 positive belonged to ST46 that carried mcr-1 in a 33 kb IncX4 plasmid. ESBL-producing K. pneumoniae mainly belonged to ST17, ST1741 and ST101, whereas CST-R strains belonged to ST11.
We recorded remarkably high colonization prevalence with ESC-R and/or CST-R Enterobacteriaceae in hotel staff. Further research in the local environment, livestock and food chain is warranted to understand this phenomenon. Moreover, as Zanzibar is a frequent holiday destination, attention should be paid to the risk of international travellers becoming colonized and thereby importing life-threatening pathogens into their low-prevalence countries.
对于低收入国家而言，有关社区中具有广谱头孢菌素耐药（ESC-R）和多粘菌素耐药（CST-R）肠杆菌科的肠道定植的数据仍然很少。在这里，我们通过分析桑给巴尔的酒店员工来研究这种现象。
在 2018 年 6 月至 7 月期间，对 59 名志愿者的直肠拭子进行了筛选，采用选择性增菌和琼脂平板进行了筛查。使用 MALDI-TOF MS 进行了种属鉴定。使用微量稀释板（MIC）、微阵列、mcr-1/-8 的 PCR、重复外回文重复 PCR（rep-PCR）和 WGS 对菌株进行了特征描述。
ESC-R-、CST-R-和 mcr-1 阳性肠杆菌科的定植率分别为 91.5%、66.1%和 18.6%（平均每个志愿者 2.2 株）。总体而言，共收集了 55 株 ESC-R 大肠埃希菌（3 株同时 CST-R）、33 株 ESC-R 肺炎克雷伯菌（1 株同时 CST-R）、17 株 CST-R 大肠埃希菌和 21 株 CST-R 肺炎克雷伯菌。发现了以下主要耐药基因：ESC-R 大肠埃希菌（blaCTX-M-15 样，51.0%）、ESC-R 肺炎克雷伯菌（blaCTX-M-9 样，42.9%）、CST-R 大肠埃希菌（mcr-1，55%）和 CST-R 肺炎克雷伯菌（PhoQ 中的 D150G 取代）。产 ESBL 的大肠埃希菌主要属于 ST361、ST636 和 ST131，而所有 mcr-1 阳性的均属于 ST46，其携带的 mcr-1 位于一个 33kb IncX4 质粒中。产 ESBL 的肺炎克雷伯菌主要属于 ST17、ST1741 和 ST101，而 CST-R 菌株属于 ST11。
我们记录了酒店员工中 ESC-R 和/或 CST-R 肠杆菌科的定植率非常高。需要对当地环境、牲畜和食物链进行进一步研究，以了解这一现象。此外，由于桑给巴尔是一个热门的度假目的地，应注意国际旅行者定植的风险，因为他们可能会将危及生命的病原体带入他们所在的低流行国家。
