Spreading Patterns of NDM-Producing Enterobacteriaceae in Clinical and Environmental Settings in Yangon, Myanmar.

The spread of carbapenemase-producing Enterobacteriaceae (CPE), contributing to widespread carbapenem resistance, has become a global concern. However, the specific dissemination patterns of carbapenemase genes have not been intensively investigated in developing countries, including Myanmar, where NDM-type carbapenemases are spreading in clinical settings. In the present study, we phenotypically and genetically characterized 91 CPE isolates obtained from clinical (n = 77) and environmental (n = 14) samples in Yangon, Myanmar. We determined the dissemination of plasmids harboring genes encoding NDM-1 and its variants using whole-genome sequencing and plasmid analysis. IncFII plasmids harboring blaNDM-5 and IncX3 plasmids harboring blaNDM-4 or blaNDM-7 were the most prevalent plasmid types identified among the isolates. The IncFII plasmids were predominantly carried by clinical isolates of Escherichia coli, and their clonal expansion was observed within the same ward of a hospital. In contrast, the IncX3 plasmids were found in phylogenetically divergent isolates from clinical and environmental samples classified into nine species, suggesting widespread dissemination of plasmids via horizontal transfer. Half of the environmental isolates were found to possess IncX3 plasmids, and this type of plasmid was confirmed to transfer more effectively to recipient organisms at a relatively low temperature (25°C) compared to the IncFII plasmid. Moreover, various other plasmid types were identified harboring blaNDM-1, including IncFIB, IncFII, IncL/M, and IncA/C2, among clinical isolates of Klebsiella pneumoniae or Enterobacter cloacae complex. Overall, our results highlight three distinct patterns of the dissemination of blaNDM-harboring plasmids among CPE isolates in Myanmar, contributing to a better understanding of their molecular epidemiology and dissemination in a setting of endemicity.

Sexually transmitted infections among male highway coach drivers in Myanmar.

A cross sectional descriptive study was conducted from February 2008 to December 2009 at the largest Highway Terminal, Yangon, Myanmar to determine the prevalence of curable STIs (syphilis, gonorrhea, chlamydial infections, and trichomoniasis), to find out the associated factors for STIs, and to determine the antibiotic susceptibility pattern of gonococcal infection among highway drivers. Urine and blood specimens were collected from 601 male highway coach drivers after an interview about their behavior. Standard laboratory tests were carried out to detect STIs. Multivariate analysis was used to ascertain potential risk factors for STIs. The prevalence rates of syphilis, gonorrhea, chlamydial infections, and trichomoniasis were 4.8, 4.3, 5.7, and 9.8%, respectively. One hundred and two (17.0%) were infected with at least one of the tested four STIs, and 34 (5.7%) had STI co-infections (2STIs). Those who had multiple sexual contacts were likely to be infected with at least one STI, and those who had a history of inconsistent condom use within past two weeks and multiple sexual contacts were more likely to have STI co-infections (p < 0.05). Antimicrobial susceptibility of 21 Neisseria gonorrhoeae isolates showed that 85.7% were susceptible to azithromycin, 80.9% to spectinomycin, 66.7% to cefixime, 61.9% to ceftriaxone, and 38.1% to ciprofloxacin. The high prevalence of STIs in this study and the decreased susceptibility of Neisseria gonorrhoeae to cephalosporin and fluoroquinolone highlighted the role of periodic screening in early diagnosis and effective treatment of STIs among high-risk populations.

blaOXA -731 , a new chromosome-encoded blaOXA -48 -like variant in Shewanella sp. from the aquatic environment in Myanmar.

Shewanella sp., the progenitors of blaOXA-48 -like genes are increasingly reported with the possession of different blaOXA-48 -like variants. This study aims to characterize blaOXA-731 , a new variant of a blaOXA-48 -like gene identified in Shewanella sp. isolated from the aquatic environment in Myanmar. Phylogenetic analysis of the blaOXA-731 sequence with other blaOXA-48 -like variants showed that it has the highest nucleotide identity of 86.09% with blaOXA-48 . However, the active site motifs in OXA-731 were 100% identical to that in OXA-48. Whole-genome sequencing analysis showed that blaOXA-731 is not surrounded by any mobile genetic elements. The genetic context of blaOXA-731 was found as similar to other blaOXA-48 -like genes previously identified in Shewanella sp. S1 nuclease pulsed-field gel electrophoresis followed by Southern blotting confirmed the location of blaOXA-731 in the chromosome of the Shewanella genome. Cloning and expression studies showed that OXA-731 has ß-lactamase activity similar to OXA-48 and OXA-181, but it has no significant carbapenemase activity. Our results showed the significance of blaOXA-48 -like-carrying Shewanella sp. in the spreading of blaOXA-48 -like genes in the community.

Prevalence of household drinking-water contamination and of acute diarrhoeal illness in a periurban community in Myanmar.

BACKGROUND: A major health consequence of rapid population growth in urban areas is the increased pressure on existing overstretched water and sanitation services. This study of an expanding periurban neighbourhood of Yangon Region, Myanmar, aimed to ascertain the prevalence of acute diarrhoea in children under 5 years; to identify household sources of drinking-water; to describe purification and storage practices; and to assess drinking-water contamination at point-of-use. METHODS: A survey of the prevalence of acute diarrhoea in children under 5 years was done in 211 households in February 2013; demographic data were also collected, along with data and details of sources of drinking water, water purification, storage practices and waste disposal. During March-August, a subset of 112 households was revisited to collect drinking water samples. The samples were analysed by the multiple tube fermentation method to count thermotolerant (faecal) coliforms and there was a qualitative determination of the presence of Escherichia coli. RESULTS: Acute diarrhoea in children under 5 years was reported in 4.74% (10/211, 95% CI: 3.0-9.0) of households within the past two weeks. More than half of the households used insanitary pit latrines and 36% disposed of their waste into nearby streams and ponds. Improved sources of drinking water were used, mainly the unchlorinated ward reservoir, a chlorinated tube well or purified bottled water. Nearly a quarter of households never used any method for drinking-water purification. Ninety-four per cent (105/112) of water samples were contaminated with thermotolerant (faecal) coliforms, ranging from 2.2 colony-forming units (CFU)/100 mL (21.4%) to more than 1000 CFU/100 mL (60.7%). Of faecal (thermotolerant)-coliform-positive water samples, 70% (47/68) grew E. coli. CONCLUSION: The prevalence of acute diarrhoea reported for children under 5 years was high and a high level of drinking-water contamination was detected, though it was unclear whether this was due to contamination at source or at point-of-use. Maintenance of drinking-water quality in study households is complex. Further research is crucial to prove the cost effectiveness in quality improvement of drinking water at point-of-use in resource-limited settings. In addition, empowerment of householders to use measures of treating water by boiling, filtration or chlorination, and safe storage with proper handling is essential.