Klebsiella pneumoniae carriage in low-income countries: antimicrobial resistance, genomic diversity and risk factors

被引:49
|
作者
Huynh, Bich-Tram [1 ]
Passet, Virginie [2 ]
Rakotondrasoa, Andriniaina [3 ]
Diallo, Thierno [4 ]
Kerleguer, Alexandra [5 ]
Hennart, Melanie [2 ]
De Lauzanne, Agathe [6 ]
Herindrainy, Perlinot [7 ]
Seck, Abdoulaye [4 ]
Bercion, Raymond [4 ]
Borand, Laurence [6 ]
de la Gandara, Maria Pardos [8 ]
Delarocque-Astagneau, Elisabeth [1 ]
Guillemot, Didier [1 ]
Vray, Muriel [9 ]
Garin, Benoit [3 ]
Collard, Jean-Marc [3 ]
Rodrigues, Carla [2 ]
Brisse, Sylvain [2 ]
机构
[1] Univ Versailles St Quentin, Inst Pasteur, Biostat Biomath Pharmacoepidemiol & Infect Dis B2, INSERM,UMR 1181, Versailles, France
[2] Inst Pasteur, Biodivers & Epidemiol Bacterial Pathogens, 28 Rue Docteur Roux, F-75724 Paris, France
[3] Inst Pasteur Madagascar, Expt Bacteriol Unit, Antananarivo, Madagascar
[4] Inst Pasteur, Lab Med Biol, Dakar, Senegal
[5] Inst Pasteur Cambodge, Med Biol Unit, Phnom Penh, Cambodia
[6] Inst Pasteur Cambodge, Epidemiol & Publ Hlth Unit, Phnom Penh, Cambodia
[7] Inst Pasteur Madagascar, Epidemiol & Clin Res Unit, Antananarivo, Madagascar
[8] Inst Pasteur, Ctr Natl Reference Escherichia Coli Shigella & Sa, Paris, France
[9] Inst Pasteur, Epidemiol & Publ Hlth Unit, Dakar, Senegal
基金
欧盟地平线“2020”;
关键词
Klebsiella pneumoniae; carriage; antibiotic resistance; genomic diversity; community; low-income countries; BETA-LACTAMASE; FECAL CARRIAGE; ENTEROBACTERIACEAE; VIRULENCE; RESERVOIR; OXYTOCA; GENES;
D O I
10.1080/19490976.2020.1748257
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background Klebsiella pneumoniae (hereafter, Kp) is a major public health threat responsible for high levels of multidrug resistant (MDR) human infections. Besides, Kp also causes severe infections in the community, especially in Asia and Africa. Although most Kp infections are caused by endogenous intestinal carriage, little is known about the prevalence and microbiological characteristics of Kp in asymptomatic human carriage, and attached risk factors including environmental sources exposure. Methods Here, 911 pregnant women from communities in Madagascar, Cambodia, and Senegal were screened for gut colonization by Kp. Characteristics of Kp strains (antimicrobial susceptibility, genomic diversity, virulence, and resistance genes) were defined, and associated risk factors were investigated. Results Kp carriage rate was 55.9%, and Kp populations were highly heterogeneous (6 phylogroups, 325 sequence types, Simpson index 99.6%). One third of Kp isolates had acquired antimicrobial resistance genes. MDR-Kp (11.7% to 39.7%) and extended spectrum beta-lactamase (ESBL)-producing Kp (0.7% to 14.7%) varied among countries. Isolates with virulence genes were detected (14.5%). Environmental exposure factors including food, animal contacts, or hospitalization of household members were associated with carriage of Kp, antimicrobial resistance and hypervirulence. However, risk factors were country-specific and Kp subpopulation-specific. Conclusion This large-scale multicenter study uncovers the huge diversity of Kp in human gut carriage, demonstrates that antimicrobial resistance is widespread in communities of three low-income countries, and underlines the challenges posed by Kp colonization to the control of antimicrobial resistance.
引用
收藏
页码:1287 / 1299
页数:13
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