Introduction / objectives
In this study we investigated a multi-drug resistant E.coli recovered from ascetic fluid of a haemodialysis patient with community-onset urinary tract infection from Al-Amiri hospital in Kuwait. The patient was suffering from advanced liver disease with portal hypertension and multiple current inter abdominal abscesses.
Antimicrobial susceptibility was determined by Vitek2, Microscan, disc diffusion, E-test & double disc method against antibiotics. PCR& sequencing were performed forO25pabBspe,pabB, trpA, chuA, yjaA TSPE4, blaSHV, blaTEM, blaCTX-M15, blaOXA-1-like, aac(6′)-Ib-cr, tet(A), tet(B), gyrA, parC, plasmid mediated qnrA, qnrB, qnrS, IMP, SPM, VIM, OXA-48, NDM, KPC and classes 1and 2 integrons.
The isolate was confirmed as E. coli O25b-sequence type (ST) 131 clone of B2 phylogenetic group. The isolate was resistant to all antibiotics tested except sulfamethoxazole, trimethoprim and nitrofurantoin and E-test confirmed that it is highly resistant to meropenem, imipenem, ciprofloxacin, cefotaxime and ceftazidime with MIC values of >16 mg/l, 32 mg/l, >64 mg/l, 32 mg/l & >32mg/l respectively. PCR detected the expected sizes of the amplified resistance genes, and DNA sequencing confirmed that TEM-1, the novel SHV-122 GeneBank (GQ290211), CTX-M-15, OXA-1, variant aac(6′)-Ib-cr, tet(A) genes, VIM and KPC were present and it was found to carry a class 1 integron. No mutation was found in gyrA but in ParC a mutation at 520 G to C, with amino acid change 174 Val (GTC) to Leu (CTC) was detected. QnrA, B, S and integron 2 were not present.
This is the first report of the emergence and the detection of a multiple antibiotic resistant E. coli O25b-sequence type (ST)131 containing 2 carbapenemase genes in Kuwait.
Disclosure of interest