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Open Access Highly Accessed Research article

Community acquisition of β-lactamase producing Enterobacteriaceae in neonatal gut

Charu Kothari1, Rajni Gaind1*, Laishram Chandreshwor Singh2, Anju Sinha3, Vidya Kumari4, Sugandha Arya4, Harish Chellani4, Sunita Saxena2 and Monorama Deb1

Author Affiliations

1 Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi 110029, India

2 National Institute of Pathology, Indian Council of Medical Research, New Delhi 110029, India

3 Indian Council of Medical Research, New Delhi 110029, India

4 Department of Paediatrics, VMMC and Safdarjung Hospital, New Delhi 110029, India

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BMC Microbiology 2013, 13:136  doi:10.1186/1471-2180-13-136

Published: 17 June 2013

Abstract

Background

Commensal flora constitutes a reservoir of antibiotic resistance. The increasing variety of β-lactamases and the emergence of Carbapenem resistant Enterobacteriaceae (CRE) in community, raise concerns regarding efficacy of β-lactams. It is important to know the exact load of antibiotic resistance in the absence of any antibiotic selection pressure including via food and water.

In the present study gut colonization in neonates with no direct antibiotic pressure was used as a model to evaluate β-lactam resistance in the community.

Results

In this prospective study, 75 healthy, vaginally delivered, antibiotic naive, breast fed neonates were studied for gut colonization by Extended spectrum β-lactamases (ESBL), AmpC β-lactamases hyperproducing Enterobacteriaceae and CRE on day 0, 21 and 60. Total 267 Enterobacteriaceae were isolated and E.coli was the predominant flora. ESBL, AmpC and coproduction was seen in 20.6%, 19.9% and 11.2% isolates respectively. ESBL carriage increased threefold from day 1 to 60 showing predominance of CTX-M group 15 (82.5%), ampC genes were heterogeneous. Colonization with CRE was rare, only one baby harboured Enterobacter sp positive for kpc-2. The reservoirs for these genes are likely to be mother and the environment.

Conclusions

Data strongly suggests that in absence of any antibiotic pressure there is tremendous load of antibiotic resistance to β-lactam drugs. Wide spread presence of ESBL and AmpC can drive rapid emergence and dissemination of CRE. This is the first report from India which depicts the smaller picture of true antibiotic pressure present in the Indian community.

Keywords:
ESBL; AmpC; Carbapenemases; Neonates; Antibiotic resistance; Enterobacteriaceae; Fecal carriage; Gut colonization