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Abstract

The emergence of resistance amongst commensal flora is a serious threat to the community. However, there is paucity of data regarding antibiotic resistance in commensals in the absence of antibiotic pressure.

Altogether, 100 vaginally delivered antibiotic naïve exclusively breastfed neonates were selected. Stool samples collected on day (D)1, D21 and D60 of birth were cultured. isolates were screened for nalidixic acid (NA) and ciprofloxacin susceptibility as per CLSI guidelines. In 28 randomly selected neonates, isolates (=92) resistant to NA and ciprofloxacin were characterized for the presence of plasmid-mediated quinolone resistance (PMQR) genes (, and , and ) and mutations in the quinolone resistance determining region (QRDR) of and genes by specific primers and confirmed by sequencing.

A total of 343 were isolated from 100 neonates. On D1, 58 % of neonates were colonized with at least one predominantly Overall resistance to NA was 60 % but ciprofloxacin resistance increased significantly from 15 % (14/96) on D1 to 38 % (50/132) on D60 (-value <0.001). The predominant mechanism of fluoroquinolone resistance was mutation in gyrA (=49) with or without PMQR. PMQR carrying isolates increased more than fivefold from D1 to D60.

A high level of fluoroquinolone resistance in gut flora of antibiotic naïve and exclusively breastfed neonates suggests a rampant rise of resistance in the community. The source of resistance genes on D1 is probably maternal flora acquired at birth. High load of PMQR genes in commensal flora are a potential source of spread to pathogenic organisms.

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2018-04-01
2024-11-11
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References

  1. Chau TT, Campbell JI, Galindo CM, van Minh Hoang N, Diep TS et al. Antimicrobial drug resistance of Salmonella enterica serovar Typhi in Asia and molecular mechanism of reduced susceptibility to the fluoroquinolones. Antimicrob Agents Chemother 2007; 51:4315–4323 [View Article][PubMed]
    [Google Scholar]
  2. Strahilevitz J, Engelstein D, Adler A, Temper V, Moses AE et al. Changes in qnr prevalence and fluoroquinolone resistance in clinical isolates of Klebsiella pneumonia and Enterobacter spp. collected from 1990 to 2005. Antimicrob Agents Chemother 2007; 51:3001–3003 [View Article][PubMed]
    [Google Scholar]
  3. Saksena R, Nayyar C, Manchanda V. Six-year susceptibility trends and effect of revised Clinical Laboratory Standards Institute breakpoints on ciprofloxacin susceptibility reporting in typhoidal Salmonellae in a tertiary care paediatric hospital in Northern India. Indian J Med Microbiol 2016; 34:520–525 [View Article][PubMed]
    [Google Scholar]
  4. Higgins PG, Fluit AC, Schmitz FJ. Fluoroquinolones: structure and target sites. Curr Drug Targets 2003; 4:181–190 [View Article][PubMed]
    [Google Scholar]
  5. Jacoby GA. Mechanisms of resistance to quinolones. Clin Infect Dis 2005; 41:S120–S126 [View Article]
    [Google Scholar]
  6. Jacoby G, Cattoir V, Hooper D, Martínez-Martínez L, Nordmann P et al. qnr gene nomenclature. Antimicrob Agents Chemother 2008; 52:2297–2299 [View Article][PubMed]
    [Google Scholar]
  7. Ruiz E, Ocampo-Sosa AA, Alcoba-Flórez J, Román E, Arlet G et al. Changes in ciprofloxacin resistance levels in Enterobacter aerogenes isolates associated with variable expression of the aac(6')-Ib-cr gene. Antimicrob Agents Chemother 2012; 56:1097–1100 [View Article][PubMed]
    [Google Scholar]
  8. Périchon B, Courvalin P, Galimand M. Transferable resistance to aminoglycosides by methylation of G1405 in 16S rRNA and to hydrophilic fluoroquinolones by QepA-mediated efflux in Escherichia coli. Antimicrob Agents Chemother 2007; 51:2464–2469 [View Article][PubMed]
    [Google Scholar]
  9. Hawkey PM, Jones AM. The changing epidemiology of resistance. J Antimicrob Chemother 2009; 64:i3–i10 [View Article][PubMed]
    [Google Scholar]
  10. Macpherson AJ, Harris NL. Interactions between commensal intestinal bacteria and the immune system. Nat Rev Immunol 2004; 4:478–485 [View Article][PubMed]
    [Google Scholar]
  11. Grady R. Safety profile of quinolone antibiotics in the pediatric population. Pediatr Infect Dis J 2003; 22:1128–1132 [View Article][PubMed]
    [Google Scholar]
  12. Sinha A, Gupta SS, Chellani H, Maliye C, Kumari V et al. Role of probiotics VSL#3 in prevention of suspected sepsis in low birthweight infants in India: a randomised controlled trial. BMJ Open 2015; 5:e006564 [View Article][PubMed]
    [Google Scholar]
  13. Kothari C, Gaind R, Singh LC, Sinha A, Kumari V et al. Community acquisition of β-lactamase producing Enterobacteriaceae in neonatal gut. BMC Microbiol 2013; 13:136 [View Article][PubMed]
    [Google Scholar]
  14. CLSI Performance of Standards for Antimicrobial Susceptibility Testing; Twenty-first Information supplement M100- S25 Wayne, PA: Clinical and Laboratory Standard Institute; 2015
    [Google Scholar]
  15. Pérez-Pérez FJ, Hanson ND. Detection of plasmid-mediated AmpC β-lactamase genes in clinical isolates by using multiplex PCR. J Clin Microbiol 2002; 40:2153–2162 [View Article][PubMed]
    [Google Scholar]
  16. Qin X, Razia Y, Johnson JR, Stapp JR, Boster DR et al. Ciprofloxacin-resistant gram-negative bacilli in the fecal microflora of children. Antimicrob Agents Chemother 2006; 50:3325–3329 [View Article][PubMed]
    [Google Scholar]
  17. Gurnee EA, Ndao IM, Johnson JR, Johnston BD, Gonzalez MD et al. Gut colonization of healthy children and their mothers with pathogenic ciprofloxacin-resistant Escherichia coli. J Infect Dis 2015; 212:1862–1868 [View Article][PubMed]
    [Google Scholar]
  18. Zaidi MB, Zamora E, Diaz P, Tollefson L, Fedorka-Cray PJ et al. Risk factors for fecal quinolone-resistant Escherichia coli in Mexican children. Antimicrob Agents Chemother 2003; 47:1999–2001 [View Article][PubMed]
    [Google Scholar]
  19. Kalter HD, Gilman RH, Moulton LH, Cullotta AR, Cabrera L et al. Risk factors for antibiotic-resistant Escherichia coli carriage in young children in Peru: community-based cross-sectional prevalence study. Am J Trop Med Hyg 2010; 82:879–888 [View Article][PubMed]
    [Google Scholar]
  20. Gritz EC, Bhandari V. The human neonatal gut microbiome: a brief review. Front Pediatr 2010; 3:17
    [Google Scholar]
  21. Aagaard K, Ma J, Antony KM, Ganu R, Petrosino J et al. The placenta harbors a unique microbiome. Sci Transl Med 2014; 237:ra65
    [Google Scholar]
  22. Latuga MS, Stuebe A, Seed PC. A review of the source and function of microbiota in breast milk. Semin Reprod Med 2014; 32:68–73 [View Article][PubMed]
    [Google Scholar]
  23. Azad MB, Konya T, Maughan H, Guttman DS, Field CJ et al. Infant gut microbiota and the hygiene hypothesis of allergic disease: impact of household pets and siblings on microbiota composition and diversity. Allergy Asthma Clin Immunol 2013; 9:15 [View Article][PubMed]
    [Google Scholar]
  24. Rath S, Padhy RN. Prevalence of fluoroquinolone resistance in Escherichia coli in an Indian teaching hospital and adjoining communities. J Taibah Univ Med Sci 2015; 10:504–508 [View Article]
    [Google Scholar]
  25. Sethi S, Golparian D, Bala M, Dorji D, Ibrahim M et al. Antimicrobial susceptibility and genetic characteristics of Neisseria gonorrhoeae isolates from India, Pakistan and Bhutan in 2007-2011. BMC Infect Dis 2013; 13:35 [View Article][PubMed]
    [Google Scholar]
  26. Singhal S, Purnapatre KP, Kalia V, Dube S, Nair D et al. Ciprofloxacin-resistant Neisseria meningitidis, Delhi, India. Emerg Infect Dis 2007; 13:1614–1616 [View Article][PubMed]
    [Google Scholar]
  27. Verma JS, Nair D, Rawat D, Manzoor N. Assessment of trends of ofloxacin resistance in Mycobacterium tuberculosis. Indian J Med Microbiol 2011; 29:280–282 [View Article][PubMed]
    [Google Scholar]
  28. Vellinga A, Murphy AW, Hanahoe B, Bennett K, Cormican M. A multilevel analysis of trimethoprim and ciprofloxacin prescribing and resistance of uropathogenic Escherichia coli in general practice. J Antimicrob Chemother 2010; 65:1514–1520 [View Article][PubMed]
    [Google Scholar]
  29. Johnson L, Sabel A, Burman WJ, Everhart RM, Rome M et al. Emergence of fluoroquinolone resistance in outpatient urinary Escherichia coli isolates. Am J Med 2008; 121:876–884 [View Article][PubMed]
    [Google Scholar]
  30. Center for Disease Dynamics, Economics & Policy State of the World’s Antibiotics, 2015 vol. 34 Washington, DC: CDDEP; 2015 p. 26 Available from https://cddep.org/sites/default/files/swa_2015_final.pdf
    [Google Scholar]
  31. Kotwani A, Holloway K. Trends in antibiotic use among outpatients in New Delhi, India. BMC Infect Dis 2011; 11:99 [View Article][PubMed]
    [Google Scholar]
  32. NVBDCP National Framework for Malaria Elimination in India Delhi: Directorate of National Vector Borne Disease Control Programme; 2015
    [Google Scholar]
  33. Davidson RJ, Davis I, Willey BM, Rizg K, Bolotin S et al. Antimalarial therapy selection for quinolone resistance among Escherichia coli in the absence of quinolone exposure, in tropical South America. PLoS One 2008; 3:e2727 [View Article][PubMed]
    [Google Scholar]
  34. Robicsek A, Jacoby GA, Hooper DC. The worldwide emergence of plasmid-mediated quinolone resistance. Lancet Infect Dis 2006; 6:629–640 [View Article][PubMed]
    [Google Scholar]
  35. Jeong HS, Bae IK, Shin JH, Jung HJ, Kim SH et al. Prevalence of plasmid-mediated quinolone resistance and its association with extended-spectrum beta-lactamase and AmpC beta-lactamase in Enterobacteriaceae. Korean J Lab Med 2011; 31:257–264 [View Article][PubMed]
    [Google Scholar]
  36. Shaw AG, Sim K, Randell P, Cox MJ, McClure ZE et al. Late-onset bloodstream infection and perturbed maturation of the gastrointestinal microbiota in premature infants. PLoS One 2015; 10:e0132923 [View Article][PubMed]
    [Google Scholar]
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