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A role for arthropods as vectors of multidrug-resistant Enterobacterales in surgical site infections from South Asia.

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Ijaz, Muhammad 
Khan, Asadullah 
Serfas, Georgios-Ion 


Understanding how multidrug-resistant Enterobacterales (MDRE) are transmitted in low- and middle-income countries (LMICs) is critical for implementing robust policies to curb the increasing burden of antimicrobial resistance (AMR). Here, we analysed samples from surgical site infections (SSIs), hospital surfaces (HSs) and arthropods (summer and winter 2016) to investigate the incidence and transmission of MDRE in a public hospital in Pakistan. We investigated Enterobacterales containing resistance genes (blaCTX-M-15, blaNDM and blaOXA-48-like) for identification, antimicrobial susceptibility testing and whole-genome sequencing. Genotypes, phylogenetic relationships and transmission events for isolates from different sources were investigated using single-nucleotide polymorphism (SNP) analysis with a cut-off of ≤20 SNPs. Escherichia coli (14.3%), Klebsiella pneumoniae (10.9%) and Enterobacter cloacae (16.3%) were the main MDRE species isolated. The carbapenemase gene blaNDM was most commonly detected, with 15.5%, 15.1% and 13.3% of samples positive in SSIs, HSs and arthropods, respectively. SNP (≤20) and spatiotemporal analysis revealed linkages in bacteria between SSIs, HSs and arthropods supporting the One Health approach to underpin infection control policies across LMICs and control AMR.



Animals, Anti-Bacterial Agents, Arthropod Vectors, Bacterial Proteins, Drug Resistance, Multiple, Bacterial, Enterobacteriaceae, Enterobacteriaceae Infections, Environmental Microbiology, Genetic Variation, Hospitals, Humans, Microbial Sensitivity Tests, Pakistan, Phylogeny, Plasmids, Prevalence, Seasons, Surgical Wound Infection, beta-Lactamases

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Nat Microbiol

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Springer Science and Business Media LLC
MRC (via Cardiff University) (MR/S013768/1)
Medical Research Council (MR/S013768/2)