Preliminary screening of ESBL-producing Escherichia coli and Klebsiella pneumoniae carriage among migrant communities in Klang Valley, Malaysia

Abstract

Economic migrant workers are crucial for a country's development but may also contribute to transboundary transmission of antimicrobial resistance (AMR). This study aimed to investigate the silent carriage of ESBL-producing Escherichia coli (ESBLEC) and Klebsiella pneumoniae (ESBLKP) among economic migrants from Indonesia, Bangladesh and Nepal residing in Klang Valley, Malaysia. Between December 2023 and May 2024, 263 study participants of Indonesian, Bangladeshi, and Nepalese migrant communities were recruited and rectal swabs collected. Swabs were then cultured on CHROMagar™ ESBL; presumptive ESBL-positive strains were confirmed and antimicrobial susceptibility-tested using a VITEK 2 system. ESBL genotyping was also performed on confirmed isolates. A total of 67 and five strains were confirmed as ESBLEC and ESBLKP, respectively. Both ESBLEC and ESBLKP strains showed similar resistance to penicillin and 3rd generation cephalosporins, though more ESBLKP strains were resistant to 4th generation cephalosporins. More ESBLEC strains were resistant to ciprofloxacin. No carbapenem-resistant strains were detected. The bla_CTX-M-1 gene family was predominantly found in ESBLEC strains from all three nationalities, while ESBLKP strains frequently harboured bla_TEM, bla_CTX-M, and bla_SHV genes. The prevalence of ESBL-producing strains was highest among Bangladeshi participants (n = 16, 31.4 %), followed by Indonesians (n = 47, 29.7 %) and Nepalis (n = 9, 19.1 %) working in domestic or manufacturing sectors. These findings highlight the public health risks of high ESBLEC and ESBLKP carriage in healthy migrant workers, which may impact recruitment and retention, leading to labour shortages and higher costs. Screening and increased awareness are crucial to limit the spread of these pathogens.