Antibiotic Susceptibility Profile of ‘Vibrio Cholerae O1 Biotype El Tor Serotype Ogawa’ Outbreak in North Delhi, India

Abstract

Background Cholera remains a public health issue, especially in developing countries. We report a cholera outbreak in North Delhi.

Objective To report the causative agent of outbreak and to characterize, biotype, and analyze antimicrobial resistance pattern of V. cholerae isolated from cholera patients admitted to our hospital. The outbreak occurred from July 2016 to August 2016.

Materials and Methods A total of 179 stool samples from pediatrics department were received and processed according to the current Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results Out of 179 stool samples received by the laboratory, 26 samples grew Vibrio cholerae O1 Biotype El Tor. Cefotaxime and ceftriaxone were the most sensitive drugs. All isolates were resistant to cotrimoxazole followed by tetracycline.

Conclusion According to the World Health Organization (WHO), cholera is becoming endemic in Delhi. Emergence of multiple antibiotic-resistant cholera isolates is a concern. Prompt identification and notification of cholera are the key measures to avert cholera outbreak. Clean water supply and improved sanitation measures should be taken for prevention of cholera.

Keywords

cholera - antibiotic resistance - public health - outbreak - North Delhi

• References

• 1 Cholera, facts sheet, updated October 2016. Available at: http://www.who.int/mediacentre/factsheets/fs107/en/ . Accessed January 5, 2017
• 2 Ali M, Nelson AR, Lopez AL, Sack DA. Updated global burden of cholera in endemic countries. PLoS Negl Trop Dis 2015; 9 (06) e0003832 . doi: 10.1371/journal.pntd.0003832
• 3 Almagro-Moreno S, Taylor RK. Cholera: Environmental reservoirs and impact on disease transmission. Microbiol Spectr 2013; 1 (02) OH-0003-OH-2012
• 4 Diarrhoeal disease. Available at: http://www.who.int/mediacentre/factsheets/fs330/en/ . Accessed December 26, 2016
• 5 Speer BS, Shoemaker NB, Salyers AA. Bacterial resistance to tetracycline: mechanisms, transfer, and clinical significance. Clin Microbiol Rev 1992; 5 (04) 387-399
• 6 Collee JG, Fraser AG, Marmion BP, Simmons A. Mackie and McCartney – Practical Medical Microbiology. 14th ed. New Delhi: Churchill Livingstone; 2006: 425-428
• 7 Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. 26th ed. Pennsylvania: Clinical and Laboratory Standards Institute; 2016: M100S
• 8 WHO. http://conflict.lshtm.ac.uk/page_76.htm . Accessed December 26, 2016
• 9 Garg P, Chakraborty S, Basu I. , et al. Expanding multiple antibiotic resistance among clinical strains of Vibrio cholerae isolated from 1992-7 in Calcutta, India. Epidemiol Infect 2000; 124 (03) 393-399
• 10 Garg P, Sinha S, Chakraborty R. , et al. Emergence of fluoroquinolone-resistant strains of Vibrio cholerae O1 biotype El Tor among hospitalized patients with cholera in Calcutta, India. Antimicrob Agents Chemother 2001; 45 (05) 1605-1606
• 11 Gupta N, Dewan S, Saini S. Resurgence of Vibrio cholerae O139 in Rohtak. Indian J Med Res 2005; 121 (02) 128-130
• 12 Faruque ASG, Alam K, Malek MA. , et al. Emergence of multidrug-resistant strain of Vibrio cholerae O1 in Bangladesh and reversal of their susceptibility to tetracycline after two years. J Health Popul Nutr 2007; 25 (02) 241-243
• 13 Roychowdhury A, Pan A, Dutta D. , et al. Emergence of tetracycline-resistant Vibrio cholerae O1 serotype Inaba, in Kolkata, India. Jpn J Infect Dis 2008; 61 (02) 128-129
• 14 Pal BB, Khuntia HK, Samal SK, Das SS, Chhotray GP. Emergence of Vibrio cholerae O1 biotype El Tor serotype Inaba causing outbreaks of cholera in Orissa, India. Jpn J Infect Dis 2006; 59 (04) 266-269
• 15 Bhattacharya K, Kanungo S, Sur D. , et al. Tetracycline-resistant Vibrio cholerae O1, Kolkata, India. Emerg Infect Dis 2011; 17 (03) 568-569
• 16 Das S, Choudhry S, Saha R, Ramachandran VG, Kaur K, Sarkar BL. Emergence of multiple drug resistance Vibrio cholerae O1 in East Delhi. J Infect Dev Ctries 2011; 5 (04) 294-298
• 17 Roy S, Parande MV, Mantur BG. , et al. Multidrug-resistant Vibrio cholerae O1 in Belgaum, south India. J Med Microbiol 2012; 61 (Pt 11): 1574-1579
• 18 Jain M, Kumar P, Goel AK. Emergence of tetracycline resistant Vibrio cholerae O1 biotype El Tor serotype Ogawa with classical ctxB gene from a cholera outbreak in Odisha, Eastern India. J Pathog 2016. doi: https://doi.org/10.1155/2016/1695410
• 19 Nandimath VA, Nandimath SA, Swamy CS, Ukrande AR. Epidemiological study of drug resistant cholera in and around Miraj, India. Int J Community Med Public Health 2016; 3 (08) 2058-2063
• 20 Mishra M, Kurhade A, Thakar Y, Kurhade G, Vaillant AJ, Lakhdive S. Occurrence of a cholera outbreak in central India. Am J Infect Dis Microbiol 2015; 3 (05) 141-143
• 21 Kar SK, Pal BB, Khuntia HK, Achary KG, Khuntia CP. Emergence and spread of tetracycline resistant Vibrio cholerae O1 El Tor variant during 2010 cholera epidemic in the tribal areas of Odisha, India. Int J Infect Dis 2015; 33: 45-49
• 22 Gupta PK, Pant ND, Bhandari R, Shrestha P. Cholera outbreak caused by drug resistant Vibrio cholerae serogroup O1 biotype ElTor serotype Ogawa in Nepal; a cross-sectional study. Antimicrob Resist Infect Control 2016; 5: 23
• 23 Glass RI, Huq I, Alim AR, Yunus M. Emergence of multiply antibiotic-resistant Vibrio cholerae in Bangladesh. J Infect Dis 1980; 142 (06) 939-942
• 24 Dengo-Baloi LC, Semá-Baltazar CA, Manhique LV, Chitio JE, Inguane DL, Langa JP. Antibiotics resistance in El Tor Vibrio cholerae 01 isolated during cholera outbreaks in Mozambique from 2012 to 2015. PLoS One 2017; 12 (08) e0181496
• 25 Thapa Shrestha U, Adhikari N, Maharjan R. , et al. Multidrug resistant Vibrio cholerae O1 from clinical and environmental samples in Kathmandu city. BMC Infect Dis 2015; 15: 104
• 26 Wozniak RA, Fouts DE, Spagnoletti M. , et al. Comparative ICE genomics: insights into the evolution of the SXT/R391 family of ICEs. PLoS Genet 2009; 5 (12) e1000786
• 27 Waldor MK, Tschäpe H, Mekalanos JJ. A new type of conjugative transposon encodes resistance to sulfamethoxazole, trimethoprim, and streptomycin in Vibrio cholerae O139. J Bacteriol 1996; 178 (14) 4157-4165
• 28 Sjölund-Karlsson M, Reimer A, Folster JP. , et al. Drug-resistance mechanisms in Vibrio cholerae O1 outbreak strain, Haiti. Emerg Infect Dis 2011; 17 (11) 2151-2154
• 29 Burrus V, Marrero J, Waldor MK. The current ICE age: biology and evolution of SXT-related integrating conjugative elements. Plasmid 2006; 55 (03) 173-183
• 30 Fonseca EL, Dos Santos Freitas F, Vieira VV, Vicente AC. New qnr gene cassettes associated with superintegron repeats in Vibrio cholerae O1. Emerg Infect Dis 2008; 14 (07) 1129-1131
• 31 Kim HB, Wang M, Ahmed S. , et al. Transferable quinolone resistance in Vibrio cholerae. Antimicrob Agents Chemother 2010; 54 (02) 799-803
• 32 Mandal S, Mandal MD, Pal NK. Cholera: a great global concern. Asian Pac J Trop Med 2011; 4 (07) 573-580
• 33 Ghosh A, Ramamurthy T. Antimicrobials & cholera: are we stranded?. Indian J Med Res 2011; 133 (February): 225-231
• 34 Mandal J, Sangeetha V, Ganesan V. , et al. Third-generation cephalosporin-resistant Vibrio cholerae, India. Emerg Infect Dis 2012; 18 (08) 1326-1328
• 35 Walther-Rasmussen J, Høiby N. Cefotaximases (CTX-M-ases), an expanding family of extended-spectrum beta-lactamases. Can J Microbiol 2004; 50 (03) 137-165
• 36 Smith JM, Feil EJ, Smith NH. Population structure and evolutionary dynamics of pathogenic bacteria. BioEssays 2000; 22 (12) 1115-1122
• 37 Karlsson SL, Thomson N, Mutreja A. , et al. Retrospective analysis of serotype switching of Vibrio cholerae O1 in a cholera endemic region shows it is a non-random process. PLoS Negl Trop Dis 2016; 10 (10) e0005044
• 38 Siddique AK, Nair GB, Alam M. , et al. El Tor cholera with severe disease: a new threat to Asia and beyond. Epidemiol Infect 2010; 138 (03) 347-352
• 39 De R, Ghosh JB, Sen Gupta S, Takeda Y, Nair GB. The role of Vibrio cholerae genotyping in Africa. J Infect Dis 2013; 208 (01) (Suppl. 01) S32-S38
• 40 Azarian T, Ali A, Johnson JA. , et al. Non-toxigenic environmental Vibrio cholerae O1 strain from Haiti provides evidence of pre-pandemic cholera in Hispaniola. Sci Rep 2016; 6: 36115
• 41 Mandell D. Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: 2807
• 42 Progress on drinking-water and sanitation: 2012 update. Geneva, World Health Organization/UNICEF Joint Monitoring Programme on Water Supply and Sanitation, 2012. Available at: http://whqlibdoc. who.int/publications/2012/9789280646320_eng_full_text.pdf . Accessed December 26, 2016
• 43 Khanna KK, Dhanvijay A, Riley LW, Sehgal S, Kumari S. Cholera outbreak in Delhi -1988. J Commun Dis 1990; 22 (01) 35-38
• 44 Ali M, Sen Gupta S, Arora N. , et al. Identification of burden hotspots and risk factors for cholera in India: an observational study. PLoS One 2017; 12 (08) e0183100
• 45 Cholera cases on the rise in Delhi. Available at: http://www.thehindu.com/news/cities/Delhi/cholera-cases-on-the-rise-indelhi/article6195994.ece . Accessed December 26, 2016
• 46 Kanungo S, Sah BK, Lopez AL, Sung JS, Paisley AM. Cholera in India: an analysis of reports, 1997-2006. Bulletin of the World Health Organization. . Available at: http://www.who.int/bulletin/volumes/88/3/09-073460/en/ . Accessed December 26, 2016
• 47 Cholera Symptoms and causes: Overview. Mayo Clinic. . Available at: https://www.mayoclinic.org/diseases-conditions/cholera/symptomscauses/syc-20355287 . Accessed 12 March 2018
• 48 Raychoudhuri A, Mukhopadhyay AK, Ramamurthy T, Nandy RK, Takeda Y, Nair GB. Biotyping of Vibrio cholerae O1: time to redefine the scheme. Indian J Med Res 2008; 128 (06) 695-698