Faecal Carriage of Gram-Negative Multidrug-Resistant Bacteria among Patients Hospitalized in Two Centres in Ulaanbaatar, Mongolia

<div><p>Gram-negative multidrug-resistant organisms (GN-MDRO) producing β-lactamases (ESBL, plasmid-mediated AmpC β-lactamases and carbapenemases) are increasingly reported throughout Asia. The aim of this surveillance study was to determine the rate of bacterial colonization in patients from two hospitals in the Mongolian capital Ulaanbaatar. Rectal swabs were obtained from patients referred to the National Traumatology and Orthopaedics Research Centre (NTORC) or the Burn Treatment Centre (BTC) between July and September 2014, on admission and again after 14 days. Bacteria growing on selective chromogenic media (CHROMagar ESBL/KPC) were identified by MALDI-ToF MS. We performed susceptibility testing by disk diffusion and PCR (<i>bla</i>_IMP-1, <i>bla</i>_VIM, <i>bla</i>_GES, <i>bla</i>_NDM, <i>bla</i>_KPC, <i>bla</i>_OXA-48, <i>bla</i>_GIM-1, <i>bla</i>_OXA-23, <i>bla</i>_OXA-24/40, <i>bla</i>_OXA-51, <i>bla</i>_OXA-58, <i>bla</i>_OXA-143, <i>bla</i>_OXA-235, <i>bla</i>_CTX-M, <i>bla</i>_SHV <i>bla</i>_TEM and plasmid-mediated <i>bla</i>_AmpC). Carbapenemase-producing isolates were additionally genotyped by PFGE and MLST. During the study period 985 patients in the NTORC and 65 patients in the BTC were screened on admission. The prevalence of GN-MDRO-carriage was 42.4% and 69.2% respectively (<i>p</i><0.001). Due to the different medical specialities the two study populations differed significantly in age (<i>p<</i>0.029<i>)</i> and gender (<i>p</i><0.001) with younger and more female patients in the burn centre (BTC). We did not observe a significant difference in colonization rate in the respective age groups in the total study population. In both centres most carriers were colonized with CTX-M-producing <i>E</i>. <i>coli</i>, followed by CTX-M-producing <i>K</i>. <i>pneumoniae</i> and CTX-M-producing <i>E</i>. <i>cloacae</i>. 158 patients from the NTORC were re-screened after 14 days of whom 99 had acquired a new GN-MDRO (<i>p</i><0.001). Carbapenemases were detected in both centres in four OXA-58-producing <i>A</i>. <i>baumannii</i> isolates (ST642) and six VIM-2-producing <i>P</i>. <i>aeruginosa</i> isolates (ST235). This study shows a high overall prevalence of GN-MDRO in the study population and highlights the importance of routine surveillance, appropriate infection control practice and antibiotic prescribing policies to prevent further spread especially of carbapenemases.</p></div

Effect of <i>Mycoplasma hominis</i> and cytomegalovirus infection on pregnancy outcome: A prospective study of 200 Mongolian women and their newborns

<div><p>In Mongolia, diagnostic tests for the detection of the sexually transmitted mycoplasmas, ureaplasmas, Herpes simplex virus (HSV), and cytomegalovirus (CMV) are currently not routinely used in clinical settings and the frequency of these STIs are enigmatic. The prevalence of these STI pathogens were prospectively evaluated among 200 Mongolian pregnant women and their newborns and correlated with pregnancy outcome. TaqMan PCRs were used to detect bacterial and viral STI pathogens in pre-birth vaginal swabs of the pregnant women and in oral swabs of their newborns. A standardized questionnaire concerning former and present pregnancies was developed and linear regression analysis was used to correlate pathogen detection with pregnancy outcome. Ureaplasmas were the most prevalent of the tested pathogens (positive in 90.5% positive women and 47.5% newborns), followed by mycoplasmas (32.5% and 7.5%), chlamydia (14.5% and 7.5%), trichomonas (8.5% and 4.0%) and gonococcus (0.5% and 0%). CMV was found in 46.5% of the pregnant women and in 10.5% of their newborns, whereas HSV-2 was detected in only two mothers. Multiple regression analyses indicate that colonization of the mothers with <i>U</i>. <i>urealyticum</i>, <i>M</i>. <i>hominis</i>, <i>T</i>. <i>vaginalis</i> or CMV is associated with transmission to newborns and that transmission of <i>M</i>. <i>hominis</i> or CMV from Mongolian pregnant women to offspring is associated with reduced neonatal length and gestational age. Thus, diagnostic tests for their detection should be implemented in the clinical settings in Mongolia.</p></div

Patient characteristics of the study population with univariable analysis of the two study sites.

<p>Patient characteristics of the study population with univariable analysis of the two study sites.</p

Correlation of pathogen load and pregnancy outcome.

<p>Correlation of pathogen load and pregnancy outcome.</p

Resistance rates of relevant Gram-negative multidrug-resistant bacteria.

<p>Resistance rates of relevant Gram-negative multidrug-resistant bacteria.</p

GN-MDRO grouped by species and resistance mechanisms at the two sampling sites.

<p>GN-MDRO grouped by species and resistance mechanisms at the two sampling sites.</p

Characteristics of 200 pregnant women from Mongolia, Ulaanbaatar.

<p>Characteristics of 200 pregnant women from Mongolia, Ulaanbaatar.</p

Co-localizing STI pathogens.

<p>Stacked bar charts indicate the decreasing number of specimens (with respect to the maternal colonization; from left) with detected pathogens and pathogen-communities in the 200 maternal vaginal specimens (Mothers) and 200 neonatal oral specimens (Newborns). Abbreviations indicate the respective microorganisms: Up, <i>U</i>. <i>parvum</i>, Uu, <i>U</i>. <i>urealyticum</i>; Mh, <i>M</i>. <i>hominis</i>; Mg, <i>M</i>. <i>genitalium</i>; Ct, <i>C</i>. <i>trachomatis</i>, Tv, <i>T</i>.<i>vaginalis</i>; and CM, CMV.</p

Quantities of <i>M</i>. <i>hominis</i>, CMV and <i>U</i>. <i>parvum</i> with respect to gestational age.

<p>Column scatter plots indicate the mean genome equivalents of <i>M</i>. <i>hominis</i>, CMV and <i>U</i>. <i>parvum</i> in maternal and neonatal specimens, normalized to 10⁶ GAPDH genome equivalents, in 2 GA -weeks intervals from 35–36 to 39–40. Statistically significant differences were assessed by Kruskal-Wallis test between GA-groups 35–36 and 38–39 or 39–40, respectively (p-values < 0,05).</p