High-level Colonization With Antibiotic-Resistant Enterobacterales Among Individuals in a Semi-Urban Setting in South India: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study.

C P Girish Kumar, Tarun Bhatnagar, G Sathya Narayanan, S S Swathi, V Sindhuja, Valan A Siromany, Daniel VanderEnde, Paul Malpiedi, Rachel M Smith, Susan Bollinger, Ahmed Babiker, Ashley Styczynski
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Abstract

Background: Antimicrobial resistance poses a significant threat to public health globally. We studied the prevalence of colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE), carbapenem-resistant Enterobacterales (CRE), and colistin-resistant Enterobacterales (Col-RE) in hospitals and the surrounding community in South India.

Methods: Adults from 2 hospitals and the catchment community who consented to provide stool specimens were enrolled. Stools were plated on CHROMagar selective for ESCrE, CRE, and Col-RE. Bacterial identification and antibiotic susceptibility testing were done using Vitek 2 Compact and disc diffusion testing. Colistin broth microdilution was performed for a subset of isolates. Prevalence estimates were calculated with 95% confidence intervals (CIs), and differences were compared across populations using the Pearson χ  2 or Fisher exact test.

Results: Between November 2020 and March 2022, 757 adults in the community and 556 hospitalized adults were enrolled. ESCrE colonization prevalence was 71.5% (95% CI, 68.1%-74.6%) in the community and 81.8% (95% CI, 78.4%-84.8%) in the hospital, whereas CRE colonization prevalence was 15.1% (95% CI, 12.7%-17.8%) in the community and 22.7% (95% CI, 19.4%-26.3%) in the hospital. Col-RE colonization prevalence was estimated to be 1.1% (95% CI, .5%-2.1%) in the community and 0.5% (95% CI, .2%-1.6%) in the hospital. ESCrE and CRE colonization in hospital participants was significantly higher compared with community participants (P < .001 for both).

Conclusions: High levels of colonization with antibiotic-resistant Enterobacterales were found in both community and hospital settings. This study highlights the importance of surveillance of colonization in these settings for understanding the burden of antimicrobial resistance.

印度南部半城市环境中耐药肠杆菌的高水平定植:社区和医院的抗生素耐药性研究》(ARCH)。
背景:抗菌药耐药性对全球公共卫生构成重大威胁。我们研究了南印度医院和周边社区中耐药扩展谱头孢菌素肠杆菌(ESCRE)、耐碳青霉烯类肠杆菌(CRE)和耐可乐定肠杆菌(Col-RE)的定植率:方法:从两家医院和周边社区同意提供粪便标本的成年人中选取样本。将粪便培养在对 ESCrE、CRE 和 Col-RE 有选择性的 CHROMagar 上。使用 Vitek 2 Compact 和圆盘扩散试验进行细菌鉴定和抗生素药敏试验。对部分分离物进行了秋水仙素肉汤微量稀释。计算流行率估计值及 95% 置信区间(CIs),并使用 Pearson χ 2 或 Fisher 精确检验比较不同人群之间的差异:2020 年 11 月至 2022 年 3 月期间,757 名社区成人和 556 名住院成人参加了调查。ESCrE在社区的定植率为71.5%(95% CI,68.1%-74.6%),在医院的定植率为81.8%(95% CI,78.4%-84.8%),而CRE在社区的定植率为15.1%(95% CI,12.7%-17.8%),在医院的定植率为22.7%(95% CI,19.4%-26.3%)。Col-RE定植率在社区估计为1.1%(95% CI,0.5%-2.1%),在医院为0.5%(95% CI,0.2%-1.6%)。与社区参与者相比,医院参与者的ESCrE和CRE定植率明显更高(两者的P < .001):结论:抗生素耐药肠杆菌在社区和医院环境中的定植率都很高。这项研究强调了在这些环境中监测定植情况对了解抗菌药耐药性负担的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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