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

Accepted version
Peer-reviewed

Type

Article

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Authors

Ijaz, Muhammad 
Khan, Asadullah 
Serfas, Georgios-Ion 

Abstract

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.

Description

Keywords

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

Journal Title

Nat Microbiol

Conference Name

Journal ISSN

2058-5276
2058-5276

Volume Title

6

Publisher

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