Indian Journal of Animal Research

  • Chief EditorM. R. Saseendranath

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Molecular Characterization and Antimicrobial Resistance Profiling of Carbapenemase Producing E. coli and Klebsiella spp. Isolates of  Bovine Origin in Awadh Region of Uttar Pradesh

V. Yadav1,*, R.K. Joshi1, Namita Joshi2, S.V. Singh3, D.P. Srivastva4, D. Yadav3
1Department of Veterinary Microbiology, College of Veterinary Science and Animal Husbandry, Acharya Narendra Deva University of Agriculture and Technology, Kumarganj, Ayodhya-224 229, Uttar Pradesh, India.
2Department of Veterinary Public Health and Epidemiology, College of Veterinary Science and Animal Husbandry, Acharya Narendra Deva University of Agriculture and Technology, Kumarganj, Ayodhya-224 229, Uttar Pradesh, India.
3Department of Veterinary Medicine, College of Veterinary Science and Animal Husbandry, Acharya Narendra Deva University of Agriculture and Technology, Kumarganj, Ayodhya-224 229, Uttar Pradesh, India.
4Department of Veterinary Pathology, College of Veterinary Science and Animal Husbandry, Acharya Narendra Deva University of Agriculture and Technology, Kumarganj, Ayodhya-224 229, Uttar Pradesh, India.

Background: Carbapenems are used as last resort of antibiotics to treat infection caused by multi-drug resistant pathogens of human, hence resulting into emergence and dissemination of Carbapenem-resistant Enterobacteriaceae (CRE). The occurrence of CRE among livestock is of great concern as these can be transferred to human and animals through adulterated food, water and environment. Therefore a specific study on the occurrence of CRE and their AMR profiling is warranted with regard to therapeutic options.

Methods: Total 240 faecal samples were collected from Ayodhya and Sultanpur districts of Awadh region of Uttar Pradesh (India). The E. coli and Klebsiella spp. isolates were confirmed by PCR analysis using species specific uidA and 16S rRNA genes respectively. Carbapenemase producing isolates were confirmed by DDST, MBL E-strip and PCR analysis by targeting bla-NDM, bla-KPC and bla-OXA-48 genes. Antibiotic resistance profiling was performed against 20 antibiotics of 12 different classes.

Result: In this study, PCR analysis revealed 90.80% confirmed isolates including 71.67% E. coli and 19.16% Klebsiella spp., out of which 36/218 (16.51%) and 28/218 (12.84%) isolates were confirmed as carbapenemase producer by DDST and MBL E-strip test respectively. Carbapenemase genes were detected in 17/218 (7.80%) isolates and among them bla-KPC gene was detected in both isolates while bla-NDM and bla-OXA-48 were detected only in E. coli and Klebsiella spp. respectively. All phenotypically confirmed carbapenemase positive isolates of E. coli and Klebsiella spp. were found 100% sensitive to aminoglycosides, polypeptides and 85-100% resistance against carbapenem, 3rd and 4th generation cephalosporines, monobactams and penicillin class of antibiotics.

The emergence of antimicrobial resistance (AMR) particularly in reference to Enterobacteriaceae has been expanding rapidly and become more problematic as it possess serious threat to both human and animals. The major contributors of AMR are Extended-spectrum β-lactamase (ESBL) and Carbapenemase producing Enterobacteriaceae (CPE) (Mustafai et al., 2023). Nowadays Carbapenem resistance is one of the latest challenges faced by scientific community across the world because it is one of the latest groups of antibiotics which are used as last resort for treating the infections caused by multidrug-resistant gram negative bacilli. The most common mechanism of resistance is the production of carbapenem-hydrolysing enzymes that hydrolyse most β-lactam antibiotics (Tarashi et al., 2016). Among CRE plasmid mediated horizontal transmission of carbapenem encoding resistance genes occur most commonly between inter and intra-species (Diene and Rolain, 2014). The major public health threat is because of transmissible carbapenemases, which not only increase the rate of mortality but also limit the choice of appropriate antibiotic therapy (Bush et al., 2013). The transmissible enzymes are acquired randomly by important nosocomial pathogens such as Pseudomonas aeruginosa, Acinetobacter baumannii and members of the family Enterobacteriaceae (Thomson, 2010). The most serious form of carbapenem resistance is mediated by carbapenem-hydrolyzing β-lactamases, including metallo-β-lactamases (MBLs), such as imipenemase (IMP), Verona imipenemase (VIM), New Delhi metallo-β-lactamase (NDM), Ambler class A Klebsiella pneumoniae Carbapenemase (KPC) and class D oxacillinase-48 (OXA-48) (Iraz et al., 2015). The CPE among livestock are of great social hygiene concern as these can be transferred to human and animal through adulterated food, water and environment. The research work on CPE in bovines including India and abroad is very limited and the incidence in animals is of most concern due to risk of transfer to human via food-chain, contact or environment.
               
Keeping in view the above facts, the present study was design to detect the Carbapenem resistant genes in E. coli and Klebsiella spp. Since, no in-depth study has been done on Carbapenemase producing enterobacteria in bovines in Awadh region of U.P. It will help the researchers, field veterinarians and policy makers to develop appropriate control strategy for the farmers of this region.
Study area
 
The study was carried out in the Department of Veterinary Microbiology, C.V.Sc. and A.H. Kumarganj, Ayodhya. The samples were collected from Ayodhya and Sultanpur district of Eastern Plain Zone of Uttar Pradesh, India. The study was conducted between August 2020 and March 2021. The research work was duly permitted by Institutional Animal Ethical Committee (IAEC) as per letter no. IAEC/C.V.Sc./2019/34 dated 10/12/2019.
 
Sample collection
 
In present study, total 240 faecal samples (160 normal and 80 diarrhoeic) of cattle and buffaloes were collected from 5 tehsils of Ayodhya and 3 tehsils of Sultanpur district.Sampling was done randomly and consisted of 10 apparently normal and 5 diarrhoeic faecal samples from each of the animal from total eight tehsils. The samples were collected aseptically and transported to laboratory under cold condition.
 
Isolation and identification
 
Samples were enriched with 2 ml nutrient broth and incubated at 37oC for 24 hrs. A loopful of inoculum was taken and directly streaked on MacConkey agar (MLA) plates added with 1mg/L imipenem and incubated at 37oC for 24 hours (Cruickshank et al., 1975). Lactose fermenting colonies were picked up and streaked on Eosine Methylene Blue (EMB) agar plates. The colonies showing specific characteristics were identified by the method of Cruickshank et al., (1975). Further identification of the isolates was done by various biochemical and sugar fermentation reaction as per the method of Edward and Ewing (1972).
 
Extraction of genomic DNA
 
The DNA templates were prepared by using snap-chill method as described by Franco et al., (2008).
 
Confirmation of E. coli and Klebsiella spp. by PCR analysis
 
All presumptively positive E. coli and Klebsiella spp. isolates were confirmed by PCR amplification using spp. specific uidA and bacteria specific 16S rRNA gene as per method described by Anbazhagan et al., (2010) and Andersson et al., (2008) respectively (Table 1). PCR reaction was carried out in 25 µl volume consisted of 12.5 µl of 2X EmeraldAmp GT Master Mix, 8.5 µl nuclease free water, 1 µl mixture of the forward and reverse primers (0.5 µl each primer) and 3.0 µl of template DNA. Amplification was performed using thermal cycler (Bio-Rad, USA). The cycling conditions of PCR are mentioned in Table 1. Amplicons of PCR were stored at 4oC until electrophoresis.

Table 1: Detail of primer sequences used for molecular characterization of E. coli and Klebsiella spp.


 
Screening of carbapenemase producing isolates
 
All confirmed isolates of E. coli and Klebsiella spp. were subjected to screening test using imipenem and meropenem disc with 10 µg conc. (Hi-Media, India) disk diffusion method (Bauer et al., 1966). The results were interpreted as per Clinical and Laboratory Standards Institute (2019) guidelines. The isolates showing reduced susceptibility to any one of these antibiotic disc were further confirmed by phenotypic tests.
 
Confirmation of carbapenemase positive isolates
 
Confirmation of carbapenemase producing isolates was done by using phenotypic methods.
 
Double disc synergy test (DDST)
 
The test was performed by placing the commercially available imipenem disc (10 µg) and combination of imipenem+EDTA (10/750 µg) discs (HiMedia, India) at 25 mm apart on Muller Hinton agar (MHA) (HiMedia) plate seeded with 1.5x108 organisms/ml and incubated at 37oC for 24 hrs (Fig 1). The results were interpreted as per Clinical and Laboratory Standards Institute (2019).

Fig 1: Double disc synergy test (DDST).


 
Minimum inhibitory concentration (MIC) MBL E-test
 
This test was performed by placing MBL E-strip on MHA plate seeded with 1.5x108 organisms/ml and incubated at 37oC for 24 hrs. Results were interpreted as per Clinical and Laboratory Standards Institute (2019) (Fig 2).

Fig 2: MIC MBL E-strip test.


 
Detection of carbapenemase genes by PCR assay

Isolation of plasmid DNA
 
Single pure colony of each isolate was inoculated into 10 ml Luria-Bertani (LB) broth medium (HiMedia, India) and incubated at 37oC for 12-15 hrs in shaking incubator. The pellet was prepared by centrifugation of bacterial suspension at 10,000 rpm for 3 min. Plasmid DNA was isolated using the GeneJet plasmid Miniprep kit (Cat No. #K0503,Thermo Scientific) as per the instruction of the manufacturers.
 
Detection of bla-NDM, bla-KPC and bla-OXA-48 genes by PCR analysis
 
Genotypic analysis of phenotypically confirmed Carbapenemase producing isolates was performed by targeting bla-NDM, bla-KPC and bla-OXA-48 genes. PCR reaction was carried out in a total reaction volume of 25 µl as per method described by Mushi et al., (2014), Jones et al., (2009) and Dallenne et al., (2010) for bla-NDM, bla-KPC and bla-OXA-48 genes respectively. The primer sequence of targeted genes and amplicon sizes are listed in table 2. Visualization of PCR product was done by mixing 5 µl of amplified products with 3 µl of bromophenol blue dye (6X) and electrophorased in 0.8% agarose gel in 1X TAE buffer mixed with ethidium bromide 1 µl (5µg/ml) in 60 ml and run slowly at 80-100V, 60-70 mA for 1 hrs and the gels were visualized using the UV illuminator (GeNei Bangalore, India). Ladder DNA of 1kb (Thermo Scientific # SM 0311) was used as a marker for band interpretation.

Table 2: Detail of primers used for Molecular characterization of carbapenemase genes.


 
Study of antibiotic resistance profiling
 
All phenotypically confirmed Carbapenemase isolates of E. coli and Klebsiella spp. were subjected to antimicrobial resistance (AMR) profiling against 20 antibiotics of 12 different classes (Hi-Media) mentioned in table 7. The AMR profiling was performed by disk diffusion method on MHA (Hi-Media) plates seeded with 1.5 x108organisms/ml and incubated at 37oC for 24 hrs and isolates were classified as susceptible and resistant as per interpretation criteria of Clinical and Laboratory Standards Institute (2019).
In present study, total 240 samples comprising 160 normal and 80 diarrhoeic faecal samples were processed for isolation and confirmation of E. coli and Klebsiella spp. The presumptive positive isolates of E. coli and Klebsiella spp. on the basis of their morphology, growth, cultural and biochemical characteristics were found 91.25% and 26.25% respectively (Table 3). Further PCR analysis revealed total 90.80% confirmed isolates comprising 71.67% E. coli and 19.16% Klebsiella spp. (Fig 3, 4 and Table 3). Similar findings have been also reported by Yadav et al., (2024) and Gupta et al., (2019). The isolation rate of E. coli was found much higher than Klebsiella spp. in both cattle and buffaloes which may be attributed to high prevalence of E. coli in GIT of ruminants as compared to other members of family Enterobacteriaceae.

Table 3: Isolation rate of E. coli and Klebsiella spp. in normal and diarrhoeic bovine faecal samples.



Fig 3: PCR amplification of uidA gene (556 bp).



Fig 4: PCR amplification of 16S rRNA (265 bp).


       
The present study also aimed to detect the occurrence of carbapenemase producing isolates among the clinical and apparently healthy animal isolates. Total 218 isolates (172E. coli and 46 Klebsiella spp.) were subjected to screening and confirmatory phenotypic tests. Out of 218 confirmed isolates, 21.55% (47/218), 16.51% (36/218) and 12.84% (28/218) presumed as carbapenemase producer by screening test, DDST and MBL-E strip test respectively (Table 4). There was little difference in the sensitivity of both phenotypic confirmatory test used for detection of carbapenemase producers and this observation corroborated with the findings of Bora et al., (2014) and Yadav et al., (2021). Phenotypic confirmatory method revealed the occurrence of 8.75% (3.75% E. coli and 5.0% Klebsiella spp.) in normal faecal 12.5% (7.50% E. coli and 5.0% Klebsiella spp.) in diarrhoeic faecal, 11.25% (5.0% E. coli and 6.25% Klebsiella spp.) in normal faecal and 17.50% (7.50% E. coli and 10.0% Klebsiella spp) in diarrhoeic faecal samples of cattle and buffaloes respectively (Table 5). Similar to our finding, low percentage of carbapenemase positive E. coli has also been reported by Braun et al., (2016), Webb et al., (2016), Nirupama et al., (2018) from faecal samples of different spp. and Yadav et al. (2021) from milk samples of bovine. However some of the workers have reported higher occurrence of carbapenemase producers among faecal samples ranging from 21.64% to 29.03% from various parts of India (Gupta et al., 2019; Murugan et al., 2019; Pruthvishree et al., 2017). These differences in the findings of various co-workers may be attributed to variations in source and animal husbandry practices in geographical locations.

Table 4: Distribution of carbapenemase producing isolates according to various phenotypic confirmatory tests.



Table 5: Occurrence of carbapenemase producing of E. coli and Klebsiella spp. among various sources.


       
Confirmation of carbapenemase producing isolates was done by PCR analysis by targeting bla-NDM, bla-KPC and bla-OXA-48genes (Fig 5, 6, 7), which revealed 17/218 (7.80%) carbapenemase positive isolates comprising 7/172(4.07%) E. coli and 10/46(31.25%) Klebsiella spp. (Table 6). The overall gene distribution study showed 30.77% occurrence of bla-NDM and 23.07% bla-KPC in E. coli isolates while 53.33% of bla-KPC and 13.33% bla-OXA-48 genes in Klebsiella spp. It was notable under this study that bla-KPC gene was reported both in E. coli and Klebsiella spp where as bla-NDM was only reported in E. coli and bla-OXA-48 only in Klebsiella spp. (table-6). The occurrence of bla-OXA-48 was found very low but it is very significant from public health point of view, as it is increasingly being reported from nosocomial infections in which Klebsiella spp. is most commonly implicated and in best of my knowledge, this is the first report of bla-KPC and bla-OXA-48 gene detection in faecal samples of bovine in India. Similar to our finding these carbapenemase genes have been also reported from various parts of India and abroad in previous studies like bla-NDM-1 and bla-OXA-48 genes in piglets (Pruthvishree et al., 2017; Nirupama et al., 2018), bla-VIM in calves (Murugan et al., 2019), bla-OXA-48 in cattle faeces (Braun et al., 2016) and in milk (Diab et al., 2017; Yadav et al., 2021). The occurrence of such genes in faecal samples of bovine is of great significant as can be transferred to human and animal horizontally through contaminated food, water and environment leading to various food-borne diseases.

Fig 5: PCR amplification of bla-NDM gene (521 bp).



Fig 6: PCR amplification of bla-KPC gene (892 bp).



Fig 7: PCR amplification of bla-OXA-48 gene (281 bp).



Table 6: Distribution of carbapenemase genes according to various sources and organisms.


               
Nowadays antimicrobial resistance is of great concern globally and a matter of serious threat to humanity which has received the attention of policy makers along with scientific community. In present study all E. coli and Klebsiella spp. isolates were 100% sensitive to aminogycosides, polypeptides and chloramphenicol whereas 84.61% to 100% resistant against carbapenems, 3rd and 4th generation cephalosporines, monobactams and penicillin group of antibiotics (Table 7). Both E. coli and Klebsiella spp. isolates showed resistance 26.67% to 80.0% against non-β-lactam group of antibiotics. There are several evidences that corroborate with these findings in India and abroad for both E. coli and Klebsiella spp. isolated from bovine (Gupta et al., 2019; Ibrahim et al., 2018; Yadav et al., 2022). The plausible factors showing extreme level of resistance to several groups of antibiotic may be due to irrational and over use of these antibiotics without performing antibiotic sensitivity testing for treatment and in feed additives.  

@table7
The findings of the present study are noteworthy with facts that carbapenems are not in use for treating the animals in this area; even though the isolates revealed complete resistance against these antibiotics, which is very threatening to public health point of view. It may be attributed to horizontal transfer of resistance genes between human and animal in community settings. This type of transfer of pathogens or genes from one species to another is likely to occur in ours populated country. This is important to consider in view of emergence of carbapenem resistance that the practice of routine carbapenem testing along with conventional antibiogram would be beneficial in all cases which will help appropriate selection of antibiotics along with prevention of further development of AMR. Therefore routine monitoring of resistance genes against carbapenem antibiotics in animal husbandry is warranted.
The author is thankful to Dean, College of Veterinary Sciences and Animal Husbandry, Kumarganj and livestock owners of the Ayodhya and Sultanpur districts for their kind support during collection of samples.
The authors declare that there is no conflict of interest.

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