Virulence and Antibiotic Resistance of Vibrio parahaemolyticus Isolates from Seafood from Three Developing Countries and of Worldwide Environmental, Seafood, and Clinical Isolates from 2000 to 2017

Abstract
Vibrio parahaemolyticus is a leading cause of seafood-associated illness. This study investigated the prevalence, virulence, and antibiotic resistance of V. parahaemolyticus in three low- and middle-income countries. Freshly caught fish samples (n = 330) imported to Jordan from Yemen, India, and Egypt were tested. The overall prevalence of V. parahaemolyticus was 15% (95% confidence interval: 11 to 19%). Three isolates (6%) were positive for the thermostable direct hemolysin–related (trh) gene, and all isolates was negative for the thermostable direct hemolysin (tdh) gene. All isolates were resistant to colistin sulfate, neomycin, and kanamycin, and 51 and 43% of isolates were resistant to tetracycline and ampicillin, respectively. Only 4% of the isolates were resistant to cefotaxime and chloramphenicol, and no isolates were resistant to sulfamethoxazole-trimethoprim, streptomycin, gentamicin, ciprofloxacin, and nalidixic acid. All isolates were resistant to two classes of antibiotics, and 86% were multidrug resistant (resistant to at least one drug in three or more classes of antibiotics). A literature review of clinical, seafood, and environmental V. parahaemolyticus isolates worldwide revealed high rates of gentamicin and ampicillin resistance, emerging resistance to third-generation cephalosporins, and limited resistance to sulfamethoxazole-trimethoprim, ciprofloxacin, nalidixic acid, and chloramphenicol. Thus, last-resort antibiotics could be ineffective for treating V. parahaemolyticus infections. Several global reports also documented illness outbreaks in humans caused by trh- and tdh-negative V. parahaemolyticus strains. More research is needed to determine whether the presence of these genes is sufficient to classify the strains as virulent.

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