Extended-Spectrum Beta-Lactamase-Producing Escherichia coli in Drinking Water Samples From a Forcibly Displaced, Densely Populated Community Setting in Bangladesh

Abstract

<b>Introduction:</b> Community-acquired infections due to extended-spectrum beta-lactamase (ESBL) producing <i>Escherichia coli</i> are rising worldwide, resulting in increased morbidity, mortality, and healthcare costs, especially where poor sanitation and inadequate hygienic practices are very common. <b>Objective:</b> This study was conducted to investigate the prevalence and characterization of multidrug-resistant (MDR) and ESBL-producing <i>E. coli</i> in drinking water samples collected from Rohingya camps, Bangladesh. <b>Methods:</b> A total of 384 <i>E. coli</i> isolates were analyzed in this study, of which 203 were from household or point-of-use (POU) water samples, and 181 were from source water samples. The isolates were tested for virulence genes, ESBL-producing genes, antimicrobial susceptibility by VITEK 2 assay, plasmid profiling, and conjugal transfer of AMR genes. <b>Results:</b> Of the 384 <i>E. coli</i> isolates tested, 17% (66/384) were found to be ESBL producers. The abundance of ESBL-producers in source water contaminated with <i>E. coli</i> was observed to be 14% (27/181), whereas, 19% (39/203) ESBL producers was found in household POU water samples contaminated with <i>E. coli</i>. We detected 71% (47/66) ESBL<i>-E. coli</i> to be MDR. Among these 47 MDR isolates, 20 were resistant to three classes, and 27 were resistant to four different classes of antibiotics. Sixty-four percent (42/66) of the ESBL producing <i>E. coli</i> carried 1 to 7 plasmids ranging from 1 to 103 MDa. Only large plasmids with antibiotic resistance properties were found transferrable via conjugation. Moreover, around 7% (29/384) of <i>E. coli</i> isolates harbored at least one of 10 virulence factors belonging to different <i>E. coli</i> pathotypes. <b>Conclusions:</b> The findings of this study suggest that the drinking water samples analyzed herein could serve as an important source for exposure and dissemination of MDR, ESBL-producing and pathogenic <i>E. coli</i> lineages, which therewith pose a health risk to the displaced Rohingya people residing in the densely populated camps of Bangladesh.