Speaker
Description
Carbapenem-resistant Escherichia coli (CREC) is a global public health threat, yet its emergence in neglected tropical disease (NTD) settings remains underexplored. Lymphatic filariasis (LF), characterized by chronic lymphedema and wounds, may create the conditions that pressure-select for antimicrobial resistance. We performed whole-genome sequencing of six (6) CREC isolates from LF patients in endemic communities in Ghana. Genomic analysis revealed resistance mechanisms, virulence factors, mobile genetic elements, and clonal structure. All 6 selected isolates exhibited phenotypic carbapenem resistance but lacked canonical carbapenemase genes. Resistance was linked with the presence of multiple efflux systems (e.g. acrAB, medtEF, emrKY), outer membrane modification genes (eptA, pmrF, ugd), polymyxin tolerance and variable β-lactamase profiles. Notably, virulence factors ompA, astA, and ybt co-occurred with resistance genes on plasmids and genomic islands. Core-genome phylogeny showed multiple lineage origins and isolate-specific accessory genomes. These findings challenge healthcare-centric AMR surveillance paradigms and highlight the need to include NTD populations in the global AMR surveillance efforts.