Prevalence and associated factors for carriage of Multi-Drug Resistant Organisms in the Community: A cross-sectional study in Hong Kong
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AbstractBackground: Imprudent use of antimicrobials in various societal sectors render contemporary antimicrobials ineffective against infections, posing public health challenge to human beings. Despite evidence of multidrug resistant organisms (MDROs) in the general population, their carriage prevalence and epidemiology has not been studied on a community basis in Hong Kong. Therefore, we conducted this cross-sectional study to: (i) estimate the population carriage prevalence of selected MDROs in Hong Kong, including extended spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E), Methicillin Resistant Staphylococcus aureus (MRSA) and carbapenem resistant Enterobacteriaceae (CRE); (ii) characterize the carriers of such carriage and (iii) identify genotypes of these MDRO carriage.

Method: From March 2017 to April 2017, nasal, handprint and stool samples were obtained from subjects recruited from established population-based cohorts. Molecular methods were used to characterize the isolates. Prevalence was defined as the proportion of subjects with positive specimens. To adjust for subjects from the same household, multivariable regression methods were conducted in generalized estimating equation framework to identify associated factors for ESBL-E carriage.

Result: We recruited 197 subjects from 140 households. The prevalence of ESBL-E, MRSA and CRE were 52.8% (104/197), 2.5% (5/197) and 0.5% (1/197) respectively. Of the ESBL-E isolates, 85.6% (113/132) were Escherichia Coli, followed by 6.8% (9/132) being Klebsiella pneumoniae. Most ESBL genes belonged to CTX-M Group 9 (68.9%; 91/132), followed by TEM (53.0%; 70/132) and CTX-M Group 1 (25.8%; 34/132). Increasing self-reported antibiotic consumption from two courses in the past six months (adjust OR: 4.26-5.19) was independently associated with ESBL-E carriage.

Conclusion: Alarming community acquired MDRO carriage prevalence was observed in our study in particular high prevalence of ESBL-E. Healthcare related risk factors, except antibiotic use, were not associated with ESBL-E carriage in the community. Detection of consistent CTX-M isolates from ESBL-Es in our study with other previous community studies in neighbouring areas in mainland China and Thailand highlighted the possible role of travellers importing MDRO. Despite the low prevalence, the detection of MRSA and CRE suggested that they may have evolved from nosocomial pathogens to community ones. Besides, the isolation of MRSA from more than one household members may imply the potential household transmission of MRSA. The identification of characteristics associated with study MDROs’ carriage in the community will help the health authorities formulate specific infection control policies.
Acceptance Date29/11/2018
All Author(s) ListKin On Kwok, Emily Chan, Arthur Tang, Vivian Wei, Chendi Zhu, Steven Riley, Margaret Ip
Name of ConferenceAntimicrobial Resistance - Genomes, Big data and Emerging Technologies
Start Date of Conference27/11/2018
End Date of Conference29/11/2018
Place of ConferenceCambridge
Country/Region of ConferenceGreat Britain
Year2018
Month11
LanguagesEnglish-United Kingdom

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