Prevalence and antibiotic susceptibility of colistin-resistance gene (mcr-1) positive Enterobacteriaceae in stool specimens of patients attending a tertiary care hospital in Singapore.

• Unexpected high prevalence of mcr-1 in stool specimens of patients attending a tertiary care hospital. • Variable antibioltic-susceptibility profiles of mcr-1 positive Enterobacteriaceae isolates. • No detection of mcr-1 positive carbapenem-resistant Enterobacteriaceae. • First report of the prevalence of human faecal carriage of mcr- 1 in Singapore. The aim of this study was to determine the prevalence of the colistin-resistance gene (mcr-1) and the antibiotic-susceptibility profile of mcr-1 positive, colistin-resistant isolates in stool specimens of patients attending a tertiary care hospital in Singapore. 201 diarrheal stool specimens of patients attending the Changi General Hospital between May to August 2017 were collected and screened for the presence of mcr-1 by culture and molecular methods. Antibiotic-susceptibility profile of mcr -1 positive isolates was determined using the polymyxin B and colistin E-tests and the VITEK 2 system. We observed an unexpectedly high prevalence of mcr-1 in patients attending a tertiary care hospital in Singapore, i.e 6.0% and 8.0% estimated by stool culture and direct stool PCR, respectively. The mcr-1 gene was detected predominantly in Escherichia coli. Antibiotic-susceptibility testing on 12 mcr-1 positive Enterobacteriaceae isolates revealed variable susceptibility profiles with no detection of carbapenem-resistant Enterobacteriaceae. This is the first report of the prevalence of human faecal carriage of mcr- 1 in Singapore. Our findings highlight the potential risk of mcr- 1 spread among our patient cohort. The mcr-1 gene detection combined with the detection of other resistance gene targets of clinical importance is recommended to pre-empt the spread mcr-1 in our patients. [ABSTRACT FROM AUTHOR]