Intestinal carriage of colistin-resistant Enterobacteriaceae at Saint Georges Hospital in Lebanon

Tania Nawfal Dagher; Charbel Al-Bayssari; Selma Chabou; Sophie Baron; Linda Hadjadj; Seydina M Diene; Eid Azar; Jean-Marc Rolain

doi:10.1016/j.jgar.2019.12.001

Intestinal carriage of colistin-resistant Enterobacteriaceae at Saint Georges Hospital in Lebanon

J Glob Antimicrob Resist. 2020 Jun:21:386-390. doi: 10.1016/j.jgar.2019.12.001. Epub 2019 Dec 12.

Authors

Tania Nawfal Dagher¹, Charbel Al-Bayssari², Selma Chabou³, Sophie Baron³, Linda Hadjadj³, Seydina M Diene³, Eid Azar⁴, Jean-Marc Rolain⁵

Affiliations

¹ Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France, Faculté de Médecine et de Pharmacie, 19-21 Boulevard Jean Moulin, 13385 Marseille CEDEX 05, France; Saint George Hospital University Medical Center, Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon.
² Faculty of Sciences 3, Lebanese University, Michel Slayman Tripoli Campus, Ras Maska 1352, Lebanon.
³ Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France, Faculté de Médecine et de Pharmacie, 19-21 Boulevard Jean Moulin, 13385 Marseille CEDEX 05, France.
⁴ Saint George Hospital University Medical Center, Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon.
⁵ Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France, Faculté de Médecine et de Pharmacie, 19-21 Boulevard Jean Moulin, 13385 Marseille CEDEX 05, France. Electronic address: jean-marc.rolain@univ-amu.fr.

PMID: 31838239
DOI: 10.1016/j.jgar.2019.12.001

Abstract

Objectives: The increase in resistance to antibiotics has led to the revival of colistin as the last option for treatment, which automatically led to an increase of colistin-resistant, Gram-negative bacteria. In this study, we report the presence of clinical colistin-resistant Enterobacteriaceae isolated from a Lebanese hospital.

Methods: From 23 rectal swabs, eight colistin-resistant clinical strains (five Escherichia coli, two Enterobacter cloacae, and one Klebsiella pneumoniae) were isolated. Antibiotic susceptibility testing was performed using the disk diffusion method and Etest. The broth microdilution method was used to determine colistin susceptibility. Reverse transcription polymerase chain reaction (RT-PCR), standard PCR and sequencing were used to investigate genes encoding for extended-spectrum β-lactamases, carbapenemases and colistin resistance. Genotyping of these isolates was conducted by multilocus sequence typing (MLST).

Results: Results of antibiotic susceptibility testing revealed that all isolates were resistant to colistin. They had MICs for colistin that ranged from 8 to 32 mg/L. Real-time PCR results showed that five strains harboured bla_TEM-1 and one strain harboured bla_TEM-163. Moreover, four strains were positive for bla_CTX-M-15, bla_CTX-M-103 and bla_CTX-M-189, and K. pneumoniae harboured bla_SHV-1. Observed colistin resistance was linked to amino acid substitutions into protein sequences of pmrA/B, phoP/Q, and mgrB. Interestingly, we report here a mutation in the mgrB regulator and pmrA/B, phoP/Q in colistin-resistant E. cloacae and E. coli clinical isolates for the first time in Lebanon.

Conclusion: This study highlights the presence of colistin-resistant Gram-negative bacteria in a Lebanese hospital, which is worrisome. An urgent strategy needs to be adopted to avoid the spread of such bacteria.

Keywords: Gram-negative bacteria; Lebanon; colistin resistance; mgrB; phoPQ; pmrAB.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Carrier State / epidemiology*
Colistin* / pharmacology
Drug Resistance, Bacterial
Enterobacteriaceae* / genetics
Escherichia coli / genetics
Hospitals
Humans
Intestines / microbiology*
Lebanon
Multilocus Sequence Typing

Substances

Colistin