Epidemiology of extended-spectrum β-lactamase-producing Enterobacteriaceae among healthcare students, at the Portuguese Red Cross Health School of Lisbon, Portugal

Claudine Fournier; Marta Aires de Sousa; Begoña Fuster Escriva; Leila Sales; Patrice Nordmann; Laurent Poirel

doi:10.1016/j.jgar.2020.07.004

Epidemiology of extended-spectrum β-lactamase-producing Enterobacteriaceae among healthcare students, at the Portuguese Red Cross Health School of Lisbon, Portugal

J Glob Antimicrob Resist. 2020 Sep:22:733-737. doi: 10.1016/j.jgar.2020.07.004. Epub 2020 Jul 11.

Authors

Claudine Fournier¹, Marta Aires de Sousa², Begoña Fuster Escriva¹, Leila Sales³, Patrice Nordmann⁴, Laurent Poirel⁵

Affiliations

¹ Medical and Molecular Microbiology Unit, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.
² Escola Superior de Saúde da Cruz Vermelha Portuguesa (ESSCVP), Lisbon, Portugal; Laboratory of Molecular Genetics, Instituto de Tecnologia Quimica e Biológica (ITQB) António Xavier, Universidade Nova de Lisboa (UNL), Oeiras, Portugal.
³ Escola Superior de Saúde da Cruz Vermelha Portuguesa (ESSCVP), Lisbon, Portugal.
⁴ Medical and Molecular Microbiology Unit, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland; INSERM European Unit (IAME, France), University of Fribourg, Fribourg, Switzerland; Swiss National Reference Center for Emerging Antibiotic Resistance (NARA), University of Fribourg, Fribourg, Switzerland; Institute for Microbiology, University of Lausanne and University Hospital Centre, Lausanne, Switzerland.
⁵ Medical and Molecular Microbiology Unit, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland; INSERM European Unit (IAME, France), University of Fribourg, Fribourg, Switzerland; Swiss National Reference Center for Emerging Antibiotic Resistance (NARA), University of Fribourg, Fribourg, Switzerland. Electronic address: laurent.poirel@unifr.ch.

PMID: 32659506
DOI: 10.1016/j.jgar.2020.07.004

Abstract

Objective: The aim of the present study was to prospectively evaluate the prevalence of intestinal carriage by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae among Portuguese students attending a Bachelors' course in healthcare, and to determine the molecular features of ESBL-producing isolates.

Methods: One-hundred and eleven faecal samples recovered from Portuguese healthcare students were screened for either ESBL-producing, carbapenem-resistant, colistin-resistant or pan-aminoglycoside-resistant Enterobacteriaceae, using respective screening media. All recovered isolates were tested for antimicrobial susceptibility and characterised by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST).

Results: A total of 17 ESBL-producing Enterobacteriaceae (16 Escherichia coli and a single Klebsiella pneumoniae) were recovered from 16 students, representing a prevalence of 14.5%. The E. coli isolates were distributed into three sequence types (STs) and seven PFGE types. The most common ESBL identified was CTX-M-1 (n=13; 76%), followed by CTX-M-15 (n=3; 18%) and CTX-M-8 (n=1; 6%). The majority of the strains were resistant to sulfonamides (88%) and fosfomycin (71%). Resistance to aminoglycosides was observed at a low rate, that is 12% for both tobramycin and kanamycin. No colistin-, carbapenem- or pan-aminoglycoside-resistant isolates were recovered. A major clone, ST10-bla_CTX-M-1, included 12 E. coli isolates. The bla_CTX-M-1 gene was always located on an IncFIA/FIB plasmid type, co-harbouring genes encoding resistance to tetracycline, sulfonamides, trimethoprim-sulfamethoxazole and fosfomycin.

Conclusion: The most commonly identified ESBL gene in E. coli was bla_CTX-M-1, usually identified among ESBL-producing isolates recovered from animals. A high prevalence of faecal carriage of ESBL-producing E. coli was found among healthy healthcare students, underlying this population as an important reservoir.

Keywords: Carriage; ESBL; Enterobacteriaceae; Healtcare workers; Portugal.

Publication types

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

MeSH terms

Animals
Delivery of Health Care
Enterobacteriaceae / genetics
Escherichia coli* / genetics
Humans
Multilocus Sequence Typing
Portugal / epidemiology
Red Cross*
Schools
Students
beta-Lactamases / genetics

Substances

beta-Lactamases