Carriage of quinolone-resistant Escherichia coli among healthy Israeli Arab children attending daycare centres in northern Israel

Abstract number: 1732_23

Athamna A., Muhsen K., Athamna M., Roth D., Spungin-Bialik A., Halperin T., Cohen D.

Objectives: To determine the rate, characteristics and risk factors of intestinal carriage of nalidixic acid (NA) resistant E. coli (E. coli NAR) in healthy children who have never received quinolones as antibiotic treatment.

Methods: Two consecutive surveys, 10 months apart, were carried out to determine the prevalence of E. coli NAR in a cohort of healthy children aged 3–5 years from 9 Day Care Centers (DCC) in 3 Arab villages of northern Israel. Parents were interviewed on demographic and socioeconomic characteristics and medical history of the children and their families. Stool samples obtained from the cohort of children and from a sub-sample of siblings and mothers were inoculated onto MacConkey agar plates, containing NA (32mg/mL). The NA Minimal Inhibitory Concentration (MIC) was determined by the broth microdilution technique. The E. coli NAR strains were examined for ciprofloxacin resistance. Selected strains were evaluated for efflux pumps activity and for point mutations in the gyrA and parC genes. Uni- and multivariable analyses were used to identify risk factors of E. coli NAR carriage.

Results: We found that 17.2% (34/198) of the children carried E. coli NAR in the first survey and 42.3 (85/208) in the second. Among the children examined in both surveys (n = 147), 9.4% harboured E. coli NAR in the first survey but became negative in the second while 38.5% children found negative in the first survey carried E. coli NAR in the second. E. coli NAR were isolated in both screenings among 11 (9.4%) children. 21% and 34% of the E. coli NAR strains were also resistant to ciprofloxacin in the first and second surveys, respectively. Persistent resistance to NA was associated with an increase in MIC, number of mutations in the gyrA and parC genes and presence of efflux pumps. Acquisition of resistance to NA was significantly higher in two of the DCCs located in one of the 3 villages. The carriage of E. coli NAR was not associated with the child's age or gender, use of antibiotics, or carriage of E. coli NAR among mothers and siblings.

Conclusions: The lack of evidence for intra-familiar spread of E. coli NAR and the significant acquisition of E. coli NAR in 2 specific DCCs suggest that other means of transmission such as the food or waterborne routs may explain the high carriage rate of E. coli NAR. Persistent carriage of E. coli NAR is of concern in view of the association with an increase in both phenotypic and genetic markers of resistance to quinolones.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Location: ICC, Munich, Germany
Presentation type:
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