AUTHOR=Huang Yu-Shan , Lai Liang-Chuan , Chen Yu-An , Lin Kuan-Yin , Chou Yi-Hsuan , Chen Hsiu-Chi , Wang Shu-Sheng , Wang Jann-Tay , Chang Shan-Chwen 

TITLE=Colonization With Multidrug-Resistant Organisms Among Healthy Adults in the Community Setting: Prevalence, Risk Factors, and Composition of Gut Microbiome

JOURNAL=Frontiers in Microbiology

VOLUME=11

YEAR=2020

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2020.01402

DOI=10.3389/fmicb.2020.01402

ISSN=1664-302X

ABSTRACT=<sec><title>Background</title><p>The prevalence of colonization with multidrug-resistant organisms (MDROs) among healthy adults in the community is largely unknown. This study investigated the colonization rate of multidrug-resistant <italic>Enterobacteriaceae</italic>, methicillin-resistant <italic>Staphylococcus aureus</italic> (MRSA), and vancomycin-resistant enterococci (VRE) in the community in Taiwan, and compared the gut microbiota between MDRO carriers and non-carriers.</p></sec><sec><title>Methods</title><p>This prospective cohort study was conducted from March 2017 to February 2018 at the Hsin-Chu and Jin-Shan branches of National Taiwan University Hospital. Nasal swabs and stool samples were obtained from healthy adults attending a health examination to screen for MDROs. Bacteria isolates of MDROs were tested for antibiotic susceptibility and resistant genes. Relevant data were collected using a standardized questionnaire to evaluate the risk factors for MDROs carriage, and 16S rRNA metagenomics sequencing was performed to analyze gut microbiota.</p></sec><sec><title>Results</title><p>Among 187 participants, 4.6% (8/174) carried MRSA and 41.4% (77/186) carried third-generation cephalosporin-resistant (3GC-R) <italic>Escherichia coli</italic> or <italic>Klebsiella pneumoniae</italic>. The carriage rate of AmpC beta-lactamases and ESBL-producing strains were 16.1 and 27.4%, respectively. No carbapenem-resistant <italic>Enterobacteriaceae</italic> (CRE) or VRE were detected. The dominant resistant gene of <italic>E. coli</italic> isolates was CTX-M-type (73%), while that of <italic>K. pneumoniae</italic> was AmpC beta-lactamases (80%). In the multivariate analysis, the significant risk factors for carrying 3GC-R <italic>E. coli</italic> or <italic>K. pneumoniae</italic> were being an employee of technology company A [adjusted odds ratio (aOR) 4.127; 95% confidence interval (CI) 1.824–9.336; <italic>p</italic> = 0.001], and traveling to Southeast Asia in the past year (aOR 6.545; 95% CI 1.071–40.001; <italic>p</italic> = 0.042). The gut microbiota analysis showed that the phylum <italic>Proteobacteria</italic> and the family <italic>Enterobacteriaceae</italic> were significantly more abundant in 3GC-R <italic>E. coli</italic> and <italic>K. pneumoniae</italic> carriers.</p></sec><sec><title>Conclusion</title><p>A high rate of Taiwanese adults in the community carried 3GC-R <italic>Enterobacteriaceae</italic>, while no CRE or VRE colonization was noted. Compared with non-carriers, an expansion of <italic>Enterobacteriaceae</italic> in gut microbiota was found among 3GC-R <italic>Enterobacteriaceae</italic> carriers.</p></sec>