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. 2020 Nov 17;15(11):e0241971.
doi: 10.1371/journal.pone.0241971. eCollection 2020.

Prevalence of carbapenem-resistant Enterobacteriaceae and emergence of high rectal colonization rates of blaOXA-181-positive isolates in patients admitted to two major hospital intensive care units in Kuwait

Amani H Al Fadhli  1 , Wafaa Y Jamal  1 , Vincent O Rotimi  1
Affiliations

Prevalence of carbapenem-resistant Enterobacteriaceae and emergence of high rectal colonization rates of blaOXA-181-positive isolates in patients admitted to two major hospital intensive care units in Kuwait

Amani H Al Fadhli et al. PLoS One. .

Abstract

Background: Fecal colonization by carbapenem-resistant Enterobacteriaceae (CRE) can be the main reservoir for transmission of these resistant organisms especially in the Intensive Care Units (ICUs).

Aim: This study was conducted to evaluate the rate of rectal carriage and molecular characterization of CRE in patients hospitalized in the ICUs of 2 major hospitals (Adan and Mubarak Al Kabeer Hospitals) in Kuwait.

Materials and methods: Rectal swabs were collected from all patients at admission, 48 h after admission and once weekly from April 2017- March 2018. Initial CRE screening was carried out on MacConkey agar on which meropenem disc 10μg was placed. Identification of isolates was by API 20E. Susceptibility testing was performed using the E-test method. Polymerase chain reaction (PCR) was used to detect the carbapenemase-encoding genes. Clonal relationship was investigated by pulsed-field electrophoresis (PFGE). Genes of blaOXA-181 and blaNDM-5-carrying plasmids were detected in some strains.

Results: A total of 590 patients were recruited into the study. Of these, 58 were positive for CRE, giving a prevalence of 9.8%; 25/320 (7.8%) in Adan and 33/270 (12.2%) in Mubarak Al Kabeer Hospitals. All isolates were resistant to multiple antibiotics. Resistance rates to colistin and tigecycline were 17% and 83%, respectively. Single genes of blaOXA-181 were detected in isolates from 38 (65.5%) out of 58 patients and in 5 patients colonized by blaOXA-48-positive CRE. A combination of 2 genes was detected in 12 isolates; 5 blaKPC-2 and blaOXA-181, 4 blaVIM-1 and blaOXA-181, and 3 blaNDM-5 and blaOXA-181. PFGE showed an overall level of similarity of 38%. Southern hybridization studies localized the blaOXA-181 and blaNDM-5 genes to a large plasmid of 200kb in 3 K. pneumoniae isolates and a small plasmid of 80kb in 2 E. coli isolates, respectively.

Conclusion: The prevalence of CRE colonization in the 2 hospital ICUs was relatively high and the emergence of blaOXA-181-mediated CRE is a cause for concern as there is the possibility of rapid horizontal spread among hospital patients in Kuwait. Active surveillance of CRE in the ICUs is highly recommended to stem its spread.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Underlying comorbidity of patients colonized with CRE and their nationality.
Fig 2
Fig 2. Underlying comorbidity of patients colonized with CRE and their age group.
Fig 3
Fig 3. Prevalence of different carbapenemase genes harbored by CRE isolates from Adan and Mubarak Al Kabeer Hospitals.
Fig 4
Fig 4. Dendrogram based on UPGMA cluster analysis of Dice similarity values of PFGE fingerprint patterns of 50 carbapenemase-producing Enterobacteriaceae (CPE) isolates in Kuwait.
Band profiles of each strain are shown corresponding with the lines of the dendrogram. Seven pulsotypes (designated A, B, C, D, E, F, and G) diverging 85% criterion. The gene, isolate identification, and hospital are represented in the columns.
See this image and copyright information in PMC

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This work was supported by Kuwait University, Research Grant no. YM07/17. The funder had no rule in study design, data collection and analysis, decision to publish or preparing of the manuscript.