Dissemination of carbapenemase-producing Enterobacterales in the community of Rawalpindi, Pakistan

PLoS One. 2022 Jul 8;17(7):e0270707. doi: 10.1371/journal.pone.0270707. eCollection 2022.

Abstract

Carbapenems are considered last-line beta-lactams for the treatment of infections caused by multidrug-resistant Gram-negative bacteria. However, their activity is compromised by the rising prevalence of carbapenemase-producing Enterobacterales (CPE), which are especially marked in the Indian subcontinent. In Pakistan, previous reports have warned about the possible spread of CPE in the community, but data are still partial. This study was carried out to analyse the prevalence of CPE, the genetic characterisation, and phylogenetic links among the spreading CPE in the community. In this cohort study, we collected 306 rectal swabs from patients visiting Benazir Bhutto hospital, Rawalpindi. CPEs were screened by using ertapenem-supplemented MacConkey agar. Identification was performed by using conventional biochemical tests, and genomes were sequenced using Illumina chemistry. Antibiotic resistance genes, plasmid incompatibility groups, and Escherichia coli phylogroups were determined in silico. Sequence types were determined by using MLST tool. The prevalence of CPE carriage observed was 14.4% (44/306 samples). The most common carbapenemase-encoding gene was bla-NDM-5 (n = 58) followed by blaNDM-1 (n = 7), blaNDM (non-assigned variant, n = 4), blaOXA-181 (n = 3), blaOXA-232 (n = 3) and blaNDM-7 (n = 1). Most of the CPE were E. coli (55/64, 86%), and the genomic analysis revealed a pauciclonal diffusion of E. coli with ST167 (n = 14), 405 (n = 10), 940 (n = 8), 648 (n = 6) and 617 (n = 5). We obtained a second sample from 94 patients during their hospital stay in whom carriage was negative at admission and found that 7 (7.4%) acquired a CPE. Our results indicate that the prevalence of CPE carriage in the Pakistani urban community was high and driven by the dissemination of some E. coli clones, with ST167 being the most frequent. The high CPE carriage in the community poses a serious public health threat and calls for implementation of adequate preventive measures.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Bacterial Proteins / genetics
  • Cohort Studies
  • Enterobacteriaceae Infections* / microbiology
  • Enterobacteriaceae* / enzymology
  • Escherichia coli* / genetics
  • Humans
  • Microbial Sensitivity Tests
  • Multilocus Sequence Typing
  • Pakistan / epidemiology
  • Phylogeny
  • beta-Lactamases / genetics

Substances

  • Anti-Bacterial Agents
  • Bacterial Proteins
  • beta-Lactamases
  • carbapenemase

Grants and funding

This work was partially supported by the “Fondation pour la Recherche Médicale” (Equipe FRM 2016, grant 325 number DEQ20161136698); the Direction Générale des Armées (project FastGeneII); the Programme Hubert Curien “Peridot” (Ministère des Affaires Etrangères, France) and by the Higher Education Commission, Pakistan under Pak-France Joint Grant (PERIDOT) to RZ and ER, National Research Program for Universities (NRPU - Project 9755) to RZ, International Research Support Initiative Program (IRSIP) (PIN: 43 BMS 16) to AH.