AUTHOR=Moghnia Ola H. , Rotimi Vincent O. , Al-Sweih Noura A. 

TITLE=Preponderance of blaKPC-Carrying Carbapenem-Resistant Enterobacterales Among Fecal Isolates From Community Food Handlers in Kuwait

JOURNAL=Frontiers in Microbiology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2021.737828

DOI=10.3389/fmicb.2021.737828

ISSN=1664-302X

ABSTRACT=<p>Carbapenem-resistant Enterobacterales (CRE) are pathogens that have been found in several countries, with a significant public health concern. Characterizing the mode of resistance and determining the prevailing clones are vital to the epidemiology of CRE in our community. This study was conducted to characterize the molecular mode of resistance and to determine the clonality of the CRE fecal isolates among community food handlers (FHs) vs. infected control patients (ICPs) in Kuwait. Fecal CRE isolates obtained from FHs and ICPs from September 2016 to September 2018 were analyzed for their resistance genes. Gene characterization was carried out by polymerase chain reaction (PCR) assays and sequencing. Clonality of isolates was established by multilocus sequence typing (MLST). Of the 681 and 95 isolates of the family Enterobacterales isolated from FHs and ICPs, 425 (62.4%) and 16 (16.8%) were <italic>Escherichia coli</italic>, and 18 (2.6%) and 69 (72.6%) were <italic>Klebsiella pneumoniae</italic>, respectively. A total of 36 isolates were CRE with a prevalence of 5.3% among FH isolates and 87 (91.6%) among the ICPs. Of these, carbapenemase genes were detected in 22 (61.1%) and 65 (74.7%) isolates, respectively (<italic>p</italic> &lt; 0.05). The detected specific genes among FHs and ICPs were positive for <italic>bla</italic><sub>KPC</sub> 19 (86.4%) and 35 (40.2%), and <italic>bla</italic><sub>OXA</sub> 10 (45.5%) and 59 (67.8%), in addition to <italic>bla</italic><sub>NDM</sub> 2 (9.1%) and 32 (36.8%), respectively. MLST assays of the <italic>E. coli</italic> and <italic>K. pneumoniae</italic> isolates revealed considerable genetic diversity and polyclonality as well as demonstrated multiple known ST types and eight novel sequence types. The study revealed a relatively high number of CRE harboring predominantly <italic>bla</italic><sub>KPC</sub>-mediated CRE among the community FH isolates vs. predominant <italic>bla</italic><sub>OXA</sub> genes among the ICPs. Those heterogeneous CRE isolates raise concerns and mandate more efforts toward molecular surveillance. A multinational study is recommended to monitor the spread of genes mediating CRE in the community of Arabian Peninsula countries.</p>