Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait.
Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait.
J Glob Antimicrob Resist. 2021 Jun;25:370-376. doi: 10.1016/j.jgar.2021.04.009. Epub 2021 May 12.
Carbapenem-resistant Enterobacteriaceae (CRE) have become one of the most challenging problems in infectious diseases worldwide. Unrecognised personnel such as food handlers (FHs) colonised with CRE serve as a reservoir for transmission. This study assessed the prevalence and susceptibility patterns of CRE isolates from FHs working in commercial eateries in the community (CFHs) and healthcare settings (HCFHs) in Kuwait over the period 2016-2018.
Representative colonies from faecal samples were identified by API 20E and a VITEK®2 ID System. Susceptibility testing against 21 antibiotics was performed by Etest and agar dilution.
A total of 681 isolates of the family Enterobacteriaceae were isolated from 405 FHs, of which 425 (62.4%) were Escherichia coli and 126 (18.5%) were Klebsiella pneumoniae. The prevalence of CRE among FHs was 7.7% (31/405), comprising 32% CFHs (10/31) and 68% HCFHs (21/31). Ampicillin, tetracycline and cefalotin showed very poor activities against most isolates with resistance rates of 63.3%, 41.7% and 40.8%, respectively. The prevalence of multidrug-resistant (MDR) isolates was 30.5%, including 130 E. coli (30.6%) and 22 K. pneumoniae (17.5%). An alarming level of colistin resistance (11.3%) was noted. A significant proportion of FH isolates (13.2%) exhibited extended-spectrum β-lactamases (ESBL) phenotypes, including 80 E. coli (18.8%) and 5 K. pneumoniae (4.0%).
This study revealed that asymptomatic intestinal carriage of CRE, including MDR and ESBL isolates, was relatively common in our community. It is conceivable that FHs may pose a significant risk to consumers for the acquisition and spread of resistant strains.
耐碳青霉烯肠杆菌科（CRE）已成为全球传染病领域最具挑战性的问题之一。未被识别的人员，如携带 CRE 的食品处理人员（FHs），是传播的储源。本研究评估了 2016 年至 2018 年期间科威特社区商业餐饮（CFHs）和医疗保健环境（HCFHs）中从事 FH 的 CRE 分离株的流行率和药敏模式。
从粪便样本中分离出代表性的菌落，通过 API 20E 和 VITEK®2 ID 系统进行鉴定。采用 Etest 和琼脂稀释法对 21 种抗生素进行药敏试验。
从 405 名 FH 中分离出 681 株肠杆菌科，其中 425 株（62.4%）为大肠埃希菌，126 株（18.5%）为肺炎克雷伯菌。FH 中 CRE 的流行率为 7.7%（31/405），包括 32%的 CFHs（10/31）和 68%的 HCFHs（21/31）。氨苄西林、四环素和头孢噻吩对大多数分离株的活性较差，耐药率分别为 63.3%、41.7%和 40.8%。多药耐药（MDR）分离株的流行率为 30.5%，包括 130 株大肠埃希菌（30.6%）和 22 株肺炎克雷伯菌（17.5%）。令人震惊的是，出现了 11.3%的粘菌素耐药。相当比例的 FH 分离株（13.2%）表现出扩展谱β-内酰胺酶（ESBL）表型，包括 80 株大肠埃希菌（18.8%）和 5 株肺炎克雷伯菌（4.0%）。
本研究表明，无症状的肠道携带 CRE，包括 MDR 和 ESBL 分离株，在我们的社区中相当常见。可以想象，FH 可能对消费者获得和传播耐药菌株构成重大风险。
