Molecular Characterization of Multidrug-Resistant Enterobacter spp. Isolated from Powdered Infant Formula and children with Gastroenteritis

Background: Enterobacter species causes many serious and life-threatening infections. Enterobacter species may be the cause of diarrhea in children. Multidrug-resistant (MDR) Enterobacter species limits treatment options. Powdered Infant Formula (PIF) was epidemiologically linked to diseases in infants caused by Enterobacter spp. Objectives: Our study aimed to detect the frequency and antimicrobial resistance profile, both phenotypically and genotypically of MDR Enterobacter isolated from powdered infant formula (PIF) and stools of children suffering from gastroenteritis who needed hospitalization and determine if there is a link between the presence of Enterobacter spp. in contaminated PIF & its presence in the stool of infants. Methodology: Isolation of Enterobacter spp. from Powdered Infant Formula and Stool of Infants, Antimicrobial susceptibility test of Enterobacter spp. isolates to antimicrobial agents, genotypic test by polymerase chain reaction (PCR) for five genes: 16S rDNA, blaSHV, blaTEM, aac(6′)-Ib-cr, and qnrB1 genes, and molecular identification of multidrug-resistant of Enterobacter strains which will be isolated from infant formula and stools. Results: Frequency of multidrug-resistant Enterobacter spp. isolates from PIF were 3 isolates positive for four resistant genes in three antibiotics classes (β-Lactam, Aminoglycoside, and Fluoroquinolones) with a percentage of 27.3%, and the genotypic frequency of multidrug-resistant Enterobacter spp. isolates from infants' stool were 2 isolates positive for four resistant genes in three antibiotics classes (β-Lactam, Aminoglycosides, and Fluoroquinolones) with a percentage of 13.3%. Conclusion: MDR Enterobacter was isolated from young aged (less than 24 months) children and PIF, more than one resistance gene: blaSHV, blaTEM, aac(6′)-Ib-cr, and qnrB1 genes were detected in isolates. The presence of MDR strains is risky at a young age as it limits treatment options. Drug-resistant genes may be transmitted to a child through a carrier mother or PIF or cross-infection from the hospital.