Plasmid-Mediated Quinolone Resistance Genes Detected in Ciprofoxacin Non-Susceptible Escherichia Coli and Klebsiella Isolated from Children under Five Years at Hospital Discharge, Kenya
Loading...
Date
2023
Authors
Kariuki, Kevin
Diakhate, Mame Mareme
Musembi, Susan
Belanger, Stephanie N. Tornberg
Rwigi, Doreen
Mutuma, Timothy
Mutuku, Elizabeth
Tickell, Kirkby D
Soge, Olusegun O
Singa, Benson O
Journal Title
Journal ISSN
Volume Title
Publisher
Springer
Abstract
Background The increasing spread of fuoroquinolone resistant enteric bacteria is a global public health concern.
Children recently discharged from the hospital are at high risk of carriage of antimicrobial resistance (AMR) due to
frequent exposure to antimicrobials during inpatient stays. This study aimed to determine the prevalence, correlates
of ciprofoxacin (CIP) non-susceptibility, and distribution of plasmid-mediated quinolone resistance (PMQR) genes in
Escherichia coli (E. coli) and Klebsiella spp isolated from children under fve years being discharged from two Kenyan
Hospitals.
Methods E. coli and Klebsiella spp were isolated from fecal samples from children discharged from hospital and
subjected to antimicrobial susceptibility testing (AST) by disc difusion and E-test. CIP non-susceptible isolates were
screened for seven PMQR genes using multiplex polymerase chain reaction (PCR). Poisson regression was used to
determine the association between the carriage of CIP non-susceptible isolates and patient characteristics.
Results Of the 280 CIP non-susceptible isolates: 188 E. coli and 92 Klebsiella spp isolates identifed among 266 dis‑
charged children, 195 (68%) were CIP-non-susceptible with minimum inhibitory concentrations (MICs) of≥1 µg/mL.
Among these 195 isolates, 130 (67%) had high-level CIP MIC= ≥32 µg/mL). Over 80% of the isolates had at least one
PMQR gene identifed: aac(6’)lb-cr (60%), qnrB (24%), oqxAB (22%), qnrS (16%), and qepA (6%), however, qnrA was not
identifed in any isolates tested. Co-carriage of qnrB with acc(6’)-lb-cr was the most predominant accounting for 20%
of all the isolates. Ceftriaxone use during hospital admission and the presence of extended spectrum beta-lactamase
(ESBL) production were signifcantly associated with the carriage of CIP non-susceptible E. coli and Klebsiella spp.
Conclusion CIP non-susceptibility is common among E. coli and Klebsiella spp isolated from hospital discharged chil‑
dren in Kenya. Carriage and co-carriage of PMQR, including the newly identifed qepA gene, were frequently observed. These fndings suggest that children leaving the hospital may serve as an important reservoir for transmission of
resistant E. coli and Klebsiella spp to the community. Enhanced surveillance for AMR determinants is critical to inform
interventions to control antimicrobial-resistant bacteria
Description
Article
Keywords
Ciprofoxacin, Escherichia coli, Klebsiella spp, Post-hospital discharge, Fluoroquinolones, Antimicrobial resistance
Citation
Kariuki, K., Diakhate, M. M., Musembi, S., Tornberg-Belanger, S. N., Rwigi, D., Mutuma, T., ... & Kariuki, S. (2023). Plasmid-mediated quinolone resistance genes detected in Ciprofloxacin non-susceptible Escherichia coli and Klebsiella isolated from children under five years at hospital discharge, Kenya. BMC microbiology, 23(1), 129.