Diversity of aminoglycoside resistance in Enterobacter cloacae in Greece

Dynamics and removal mechanisms of antibiotic and antibiotic resistance genes during the fermentation process of spectinomycin mycelial dregs: An integrated meta-omics study

Antibiotic mycelial dregs (AMDs) have been listed as industrial hazardous wastes. With the aim of reducing the environmental risk, the integrated-omics and qPCR approaches were used to reveal the dynamics and removal mechanisms of antibiotic and antibiotic resistance genes (ARGs) during the fermentation of different spectinomycin mycelial dregs (SMDs). The results showed that the removal efficiency of antibiotic in the fermentation of high moisture SMDs reached up to 98%. The high abundance of aadA1 gene encoded by Streptomyces, Lactobacillus, and Pseudomonas was associated with the efficient degradation of spectinomycin, and the inactivating enzymes secreted by degradative bacteria were identified. Furthermore, the dominant microbiota was impacted by moisture content significantly under high temperature environments. In the fermentation of low moisture SMDs, Saccharopolyspora was the dominant microbiota which secreted S8 endopeptidase, M14, M15, S10, S13 carboxypeptidases, M1, M28, S15 aminopeptidases, and antioxidant enzymes, while in the fermentation of high moisture SMDs, Bacillus and Cerasibacillus were dominant genera which mainly secreted S8 endopeptidase and antioxidant enzymes. The abundance of ARGs and mobile genetic elements decreased significantly at thermophilic phase, with maximum drops of 93.7% and 99.9%, respectively. Maintaining moisture content below 30% at the end phase could prevent the transmission of ARGs effectively.

Bacterial effluxome as a barrier against antimicrobial agents: structural biology aspects and drug targeting

Antimicrobial resistance (AMR) is fast becoming a medical crisis affecting the entire global population. The bacterial membrane is the first layer of defense for the bacteria against antimicrobial agents (AMA), specifically transporters in the membrane efflux these AMA out of the bacteria and plays a significant role in the AMR development. Understanding the structure and the functions of these efflux transporters is essential to overcome AMR. This review discusses efflux transporters (primary, secondary, and tripartite), their domain architectures, substrate specificities, and efflux pump inhibitors (EPI). Special emphasis on nosocomial ESKAPEE (Enterococcus faecium., Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp. and Escherichia coli) pathogens, their multidrug efflux targets and inhibitors are discussed. Deep knowledge about the functioning of efflux pumps and their structural aspects will open up opportunities for developing new EPI, which could be used along with AMA as combination therapy to overcome the emerging AMR crisis.

Prevalent mechanisms of resistance among common enterobacterial isolates in Greek hospitals

The recent data concerning antibiotic resistance of the enterobacteria isolated in Greek hospitals are reviewed. A variety of mechanisms of resistance, clustered in most of the cases, was observed. Epidemics of plasmids were responsible for dissemination of third-generation cephalosporins, aminoglycosides, and trimethoprim resistance among Klebsiella pneumoniae and, to a lesser extent, Escherichia coli isolates. Stable depression of the expression of chromosomal cephalosporinase is the main cause of resistance to third-generation cephalosporins observed at high frequencies in Enterobacter spp. strains.

Bacterial resistance to ciprofloxacin in Greece: results from the National Electronic Surveillance System. Greek Network for the Surveillance of Antimicrobial Resistance

According to 1997 susceptibility data from the National Electronic System for the Surveillance of Antimicrobial Resistance, Greece has high rates of ciprofloxacin resistance. For most species, the frequency of ciprofloxacin-resistant isolates (from highest to lowest, by patient setting) was as follows: intensive care unit > surgical > medical > outpatient. Most ciprofloxacin-resistant strains were multidrug resistant.

Risk factors for nosocomial infections caused by gram-negative bacilli. The Hellenic Antibiotic Resistance Study Group

Two hundred and ninety-nine Gram-negative hospital-acquired infections from 257 patients, consecutively identified during one month (November 1992) in five hospitals in the greater Athens area, were divided into four groups on the basis of the bacterium isolated: Group 1 (Escherichia coli group) included infections owing to E. coli, Group 2 (Proteus group) consisted of infections owing to Proteus spp. and Providencia spp., Group 3 (Kiebsiella/Enterobacter group) involved infections owing to Kiebsiella spp., Enterobacter spp., Citrobacter spp. and Serratia spp. Infections owing to Pseudomonas spp. and other non-fermenters were allocated into Group 4 (non-fermenters group). The four groups were studied in relation to risk factors including the duration of hospitalization, type of ward, underlying disease, history of operation, medical procedures/devices and antimicrobial therapy. A stepwise multiple logistic regression technique (SPSS Inc) was used to analyse the data, and the three groups (the Proteus group, the Klebsiella/Enterobacter group and the non-fermenters group) were analysed separately against the E. coli group. Infections with the Kiebsiella/Enterobacter group were associated with: (a) length of hospital stay before the infection, (b) treatment with newer antibiotics, and (c) hospitalization in an intensivecare unit (ICU). Infections with non-fermenters were associated with: (a) length of hospital stay before infection, (b) a urinary catheter, (c) type of disease (chronic infection being negatively associated), (d) treatment with newer antibiotics and (e) hospitalization in an ICU. Proteus group infections were associated with (a) length of hospital stay before infection, (b) treatment with newer antibiotics and (c) operation during present hospitalization (negative association). Interestingly, no specific hospitals were identified as risk factors. Identification of patients at risk for acquiring an infection owing to a nosocomial pathogen is vital in the development of a preventive strategy for hospital-acquired infections.

Generation of DNA probes for detection of microorganisms by polymerase chain reaction fingerprinting

Identification of medically relevant microorganisms is important for diagnosis, treatment and prevention of infectious diseases. This has initiated the development of a large number of identification and typing techniques based on phenotypic and genetic characteristics. In general, these last mentioned nucleic acid-mediated techniques provide more detailed and consistent information on strain-specific characteristics. However, the development of clinically useful microbial DNA/RNA probes requires nucleotide sequence information and a set of well defined reference organisms for test validation in comparison with the current gold standard. This is a requirement for the development of accurate nucleic acid hybridisation and/or amplification tests. Recently, it has been demonstrated that polymerase chain reaction (PCR)-mediated genetic typing of microorganisms can lead to the immediate isolation of species-specific DNA probes by comparison of DNA fingerprints. This combines the sensitivity of PCR with the specificity of DNA probing without the need to generate nucleic acid sequence information prior to probe development. The implications of this procedure for clinical microbiology and epidemiological surveillance will be discussed. It is shown that specific probes can be developed for various taxonomic levels and that detection and identification can be combined into a single, fast procedure. The versatility and widely applicable principles of this procedure will be highlighted and exemplified by some newly developed tests and a review of the current literature.

In vitro activity of cefpirome against selected clinical enterobacterial isolates with beta-lactamase-mediated resistance

Previous studies have shown that there is a high incidence of resistance to cephalosporins among enterobacteria isolated in Greek hospitals. This resistance is mainly due to either the derepression of chromosomal cephalosporinases or the acquisition of plasmids coding for SHV-5 type beta-lactamase. In the present study the activity of cefpirome against a number of enterobacteria (Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Enterobacter aerogenes and Serratia marcescens) possessing the mechanisms mentioned above was examined. Cefpirome was found active against all the strains characterized by stable derepression of chromosomal class-C enzymes. The antibiotic was less potent against strains expressing SHV-5 type beta-lactamase due to its hydrolysis by the enzyme. Also cefpirome exhibited good activity against E. aerogenes strains with reduced susceptibility to imipenem. These in vitro data suggest that cefpirome might be useful in treating infections caused by these resistant microorganisms that are frequently encountered in Greek hospitals.

Biotyping, phage typing, and O-serotyping of clinical isolates of Enterobacter cloacae

The purpose of this study was to make an independent evaluation of the methods of bio-, phage-, and O-serotyping which had been used only in the laboratory of origin, and to assess the extent of possible cross-infection of Enterobacter cloacae in a Danish university hospital. The material consisted of 237 clinical isolates of E. cloacae from the clinical microbiology laboratory at Hvidovre Hospital. The typability of bio-, phage-, and serotyping was 100%, 83%, and 85%, respectively. Reproducibility of serotyping was 90% and of phage typing 96% if two major differences were allowed to differentiate between patterns. O-serotyping had the highest discriminatory power and combination of all typing methods further increased discrimination. Outbreaks of E. cloacae were not evident in clinical departments, but cross-infections from one department to another could not be completely ruled out. We concluded that the combination of bio-, phage- and O-serotyping is sufficiently discriminating and will be satisfactory in the majority of clinical situations.