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Herrmann J, Burgener-Gasser AV, Goldenberger D, Roth J, Weisser M, Tamma PD, Tschudin-Sutter S. Cefepime versus carbapenems for treatment of AmpC beta-lactamase-producing Enterobacterales bloodstream infections. Eur J Clin Microbiol Infect Dis 2024; 43:213-221. [PMID: 37993680 PMCID: PMC10821988 DOI: 10.1007/s10096-023-04715-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Cefepime is recommended for treating infections caused by AmpC beta-lactamase-producing Enterobacterales (AmpC-PE), though supporting evidence is limited. Therefore, this study compared outcomes associated with cefepime versus carbapenem therapy for bloodstream infections (BSIs) caused by AmpC-PE after phenotypic exclusion of ESBL-co-producing isolates. METHODS This retrospective cohort study compared definite cefepime versus carbapenem treatment for AmpC-PE BSI in hospitalized patients of the University Hospital Basel, Switzerland, between 01/2015 and 07/2020. Primary outcomes included in-hospital death, renal impairment and neurologic adverse events; secondary outcomes included length of hospital stay and recurrent infection. RESULTS Two hundred and seventy episodes of AmpC-PE BSI were included, 162, 77 and 31 were treated with a carbapenem, cefepime and other antibiotics, respectively. Patients treated with carbapenems were more likely to be transferred to the ICU on admission and more frequently had central venous catheter as a source of infection. In uni- and multivariable analyses, primary and secondary outcomes did not differ between the two treatment groups, except for more frequent occurrence of neurological adverse events among patients treated with carbapenems and shorter length of hospital stay among survivors treated with cefepime. CONCLUSION After excluding isolates with phenotypic ESBL-co-production, cefepime was not associated with adverse outcomes compared to carbapenems when used to treat BSIs caused by AmpC-PE. Our study provides evidence to support the use of cefepime as a safe treatment strategy for AmpC-PE BSI, particularly in clinically stable patients without initial renal impairment or increased susceptibility to neurological adverse events.
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Affiliation(s)
- Julia Herrmann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Petersgraben 4, CH-4031, Basel, Switzerland
| | - Anne-Valérie Burgener-Gasser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Petersgraben 4, CH-4031, Basel, Switzerland
| | - Daniel Goldenberger
- Division of Clinical Bacteriology and Mycology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jan Roth
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Petersgraben 4, CH-4031, Basel, Switzerland
| | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Petersgraben 4, CH-4031, Basel, Switzerland
| | - Pranita D Tamma
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Petersgraben 4, CH-4031, Basel, Switzerland.
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Tavares-Carreon F, De Anda-Mora K, Rojas-Barrera IC, Andrade A. Serratia marcescens antibiotic resistance mechanisms of an opportunistic pathogen: a literature review. PeerJ 2023; 11:e14399. [PMID: 36627920 PMCID: PMC9826615 DOI: 10.7717/peerj.14399] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/25/2022] [Indexed: 01/07/2023] Open
Abstract
Serratia marcescens is a ubiquitous bacterium from order Enterobacterales displaying a high genetic plasticity that allows it to adapt and persist in multiple niches including soil, water, plants, and nosocomial environments. Recently, S. marcescens has gained attention as an emerging pathogen worldwide, provoking infections and outbreaks in debilitated individuals, particularly newborns and patients in intensive care units. S. marcescens isolates recovered from clinical settings are frequently described as multidrug resistant. High levels of antibiotic resistance across Serratia species are a consequence of the combined activity of intrinsic, acquired, and adaptive resistance elements. In this review, we will discuss recent advances in the understanding of mechanisms guiding resistance in this opportunistic pathogen.
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Affiliation(s)
- Faviola Tavares-Carreon
- Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Karla De Anda-Mora
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Idalia C. Rojas-Barrera
- Environmental Genomics Group, Max Planck Institute for Evolutionary Biology, Plön, Germany,Christian-Albrechts-University Kiel, Kiel, Germany
| | - Angel Andrade
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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Shin SR, Noh SM, Jung WK, Shin S, Park YK, Moon DC, Lim SK, Park YH, Park KT. Characterization of Extended-Spectrum β-Lactamase-Producing and AmpC β-Lactamase-Producing Enterobacterales Isolated from Companion Animals in Korea. Antibiotics (Basel) 2021; 10:antibiotics10030249. [PMID: 33802246 PMCID: PMC8001212 DOI: 10.3390/antibiotics10030249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 11/16/2022] Open
Abstract
The emergence of extended-spectrum cephalosporin (ESC)-resistant Gram-negative bacteria is of great concern in both human and veterinary medicine. The aim of this study was to investigate ESC-resistant bacterial isolates from companion animals in South Korea between 2017 and 2019. Isolates with ESC resistance genes, which were identified by PCR, were assessed for genetic relatedness by multi-locus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). In total, 91 ESC-resistant Escherichia coli, Klebsiella spp., Serratia spp., and Enterobacter cloacae isolates harbored the blaTEM gene. Among other ESC resistance genes, blaCTX-M-15, blaCIT, and blaCTX-M-55 were predominantly detected in E. coli isolates, whereas blaSHV and blaDHA were more frequently detected in Klebsiella pneumoniae isolates. In addition, all blaEBC-positive isolates were classified as E. cloacae. From the MLST results, blaCTX-M-9-carrying ST131, blaCIT-carrying ST405, and blaCTX-M-1-carrying ST3285 strains were dominant among E. coli isolates. ST273 and ST275 strains harboring blaSHV were frequently detected in K. pneumoniae isolates. Various sequence types were obtained in E. cloacae and Klebsiella oxytoca isolates. All isolates demonstrated unique PFGE profiles (<57–98% similarity) and were unlikely to be derived from a single clone. The present study reveals the presence and wide genetic distribution of ESC-resistant bacterial species in South Korean companion animals.
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Affiliation(s)
- Se Ra Shin
- Department of Pathobiology and Preventive Medicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Korea; (S.R.S.); (S.M.N.); (S.S.); (Y.K.P.); (Y.H.P.)
- BK21 PLUS Creative Veterinary Research Center, Seoul National University, Seoul 08826, Korea
| | - Seong Mi Noh
- Department of Pathobiology and Preventive Medicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Korea; (S.R.S.); (S.M.N.); (S.S.); (Y.K.P.); (Y.H.P.)
- BK21 PLUS Creative Veterinary Research Center, Seoul National University, Seoul 08826, Korea
| | - Woo Kyung Jung
- Department of Pathobiology and Preventive Medicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Korea; (S.R.S.); (S.M.N.); (S.S.); (Y.K.P.); (Y.H.P.)
- Correspondence: (W.K.J.); (K.T.P.)
| | - Sook Shin
- Department of Pathobiology and Preventive Medicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Korea; (S.R.S.); (S.M.N.); (S.S.); (Y.K.P.); (Y.H.P.)
| | - Young Kyung Park
- Department of Pathobiology and Preventive Medicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Korea; (S.R.S.); (S.M.N.); (S.S.); (Y.K.P.); (Y.H.P.)
| | - Dong Chan Moon
- Bacterial Disease Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Korea; (D.C.M.); (S.-K.L.)
| | - Suk-Kyung Lim
- Bacterial Disease Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Korea; (D.C.M.); (S.-K.L.)
| | - Yong Ho Park
- Department of Pathobiology and Preventive Medicine, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul 08826, Korea; (S.R.S.); (S.M.N.); (S.S.); (Y.K.P.); (Y.H.P.)
| | - Kun Taek Park
- Department of Biotechnology, Inje University, Gimhae 50834, Korea
- Correspondence: (W.K.J.); (K.T.P.)
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Thomas SG, Abajorga M, Glover MA, Wengert PC, Parthasarathy A, Savka MA, Wadsworth CB, Shipman PA, Hudson AO. Aeromonas hydrophila RIT668 and Citrobacter portucalensis RIT669-Potential Zoonotic Pathogens Isolated from Spotted Turtles. Microorganisms 2020; 8:microorganisms8111805. [PMID: 33212916 PMCID: PMC7698337 DOI: 10.3390/microorganisms8111805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/06/2020] [Accepted: 11/13/2020] [Indexed: 11/16/2022] Open
Abstract
Antimicrobial resistance (AMR) is one of the biggest challenges of the 21st century, and biofilm formation enables bacteria to resist antibiotic at much higher concentrations than planktonic cells. Earlier, we showed that the Gram-negative Aeromonas hydrophila RIT668 and Citrobacter portucalensis RIT669 (closely related to C. freundii NBRC 12681) from infected spotted turtles (Clemmys guttata), formed biofilms and upregulated toxin expression on plastic surfaces, and were predicted to possess multiple antibiotic resistance genes. Here, we show that they each resist several antibiotics in the planktonic phase, but were susceptible to neomycin, and high concentrations of tetracycline and cotrimoxazole. The susceptibility of their biofilms to neomycin and cotrimoxazole was tested using the Calgary device. For A. hydrophila, the minimum inhibitory concentration (MIC) = 500-1000, and the minimum biofilm eradication concentration (MBEC) > 1000 μg/mL, using cotrimoxazole, and MIC = 32.3-62.5, and MBEC > 1000 μg/mL, using neomycin. For C. freundii MIC = 7.8-15.6, and, MBEC > 1000 μg/mL, using cotrimoxazole, and MIC = 7.8, and MBEC > 1000 μg/mL, using neomycin. Both A. hydrophila and C. portucalensis activated an acyl homoserine lactone (AHL) dependent biosensor, suggesting that quorum sensing could mediate biofilm formation. Their multidrug resistance in the planktonic form, and weak biofilm eradication even with neomycin and cotrimoxazole, indicate that A. hydrophila and C. portucalensis are potential zoonotic pathogens, with risks for patients living with implants.
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Tamma PD, Doi Y, Bonomo RA, Johnson JK, Simner PJ. A Primer on AmpC β-Lactamases: Necessary Knowledge for an Increasingly Multidrug-resistant World. Clin Infect Dis 2020; 69:1446-1455. [PMID: 30838380 DOI: 10.1093/cid/ciz173] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/26/2019] [Indexed: 12/13/2022] Open
Abstract
Understanding the nuances of AmpC β-lactamase-mediated resistance can be challenging, even for the infectious diseases specialist. AmpC resistance can be classified into 3 categories: (1) inducible chromosomal resistance that emerges in the setting of a β-lactam compound, (2) stable derepression due to mutations in ampC regulatory genes, or (3) the presence of plasmid-mediated ampC genes. This review will mainly focus on inducible AmpC resistance in Enterobacteriaceae. Although several observational studies have explored optimal treatment for AmpC producers, few provide reliable insights into effective management approaches. Heterogeneity within the data and inherent selection bias make inferences on effective β-lactam choices problematic. Most experts agree it is prudent to avoid expanded-spectrum (ie, third-generation) cephalosporins for the treatment of organisms posing the greatest risk of ampC induction, which has best been described in the context of Enterobacter cloacae infections. The role of other broad-spectrum β-lactams and the likelihood of ampC induction by other Enterobacteriaceae are less clear. We will review the mechanisms of resistance and triggers resulting in AmpC expression, the species-specific epidemiology of AmpC production, approaches to the detection of AmpC production, and treatment options for AmpC-producing infections.
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Affiliation(s)
- Pranita D Tamma
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yohei Doi
- Department of Medicine, University of Pittsburgh, School of Medicine, Pennsylvania
| | - Robert A Bonomo
- Department of Medicine, The Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Case Western Reserve University, Ohio
| | - J Kristie Johnson
- Department of Pathology, University of Maryland School of Medicine, Baltimore
| | - Patricia J Simner
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Expression of a Shiga-Like Toxin during Plastic Colonization by Two Multidrug-Resistant Bacteria, Aeromonas hydrophila RIT668 and Citrobacter freundii RIT669, Isolated from Endangered Turtles ( Clemmys guttata). Microorganisms 2020; 8:microorganisms8081172. [PMID: 32752245 PMCID: PMC7465454 DOI: 10.3390/microorganisms8081172] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 12/12/2022] Open
Abstract
Aeromonas hydrophila RIT668 and Citrobacter freundii RIT669 were isolated from endangered spotted turtles (Clemmys guttata). Whole-genome sequencing, annotation and phylogenetic analyses of the genomes revealed that the closest relative of RIT668 is A. hydrophila ATCC 7966 and Citrobacter portucalensis A60 for RIT669. Resistome analysis showed that A. hydrophila and C. freundii harbor six and 19 different antibiotic resistance genes, respectively. Both bacteria colonize polyethylene and polypropylene, which are common plastics, found in the environment and are used to fabricate medical devices. The expression of six biofilm-related genes—biofilm peroxide resistance protein (bsmA), biofilm formation regulatory protein subunit R (bssR), biofilm formation regulatory protein subunit S (bssS), biofilm formation regulator (hmsP), toxin-antitoxin biofilm protein (tabA) and transcriptional activator of curli operon (csgD)—and two virulence factors—Vi antigen-related gene (viaB) and Shiga-like toxin (slt-II)—was investigated by RT-PCR. A. hydrophila displayed a > 2-fold increase in slt-II expression in cells adhering to both polymers, C. freundii adhering on polyethylene displayed a > 2-fold, and on polypropylene a > 6-fold upregulation of slt-II. Thus, the two new isolates are potential pathogens owing to their drug resistance, surface colonization and upregulation of a slt-II-type diarrheal toxin on polymer surfaces.
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Liu L, Qin L, Hao S, Lan R, Xu B, Guo Y, Jiang R, Sun H, Chen X, LV X, Xu J, Zhao C. Lineage, Antimicrobial Resistance and Virulence of Citrobacter spp. Pathogens 2020; 9:pathogens9030195. [PMID: 32155802 PMCID: PMC7157202 DOI: 10.3390/pathogens9030195] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 01/31/2023] Open
Abstract
Citrobacter spp. are opportunistic human pathogens which can cause nosocomial infections, sporadic infections and outbreaks. In order to determine the genetic diversity, in vitro virulence properties and antimicrobial resistance profiles of Citrobacter spp., 128 Citrobacter isolates obtained from human diarrheal patients, foods and environment were assessed by multilocus sequence typing (MLST), antimicrobial susceptibility testing and adhesion and cytotoxicity testing to HEp-2 cells. The 128 Citrobacter isolates were typed into 123 sequence types (STs) of which 101 were novel STs, and these STs were divided into five lineages. Lineages I and II contained C. freundii isolates; Lineage III contained all C. braakii isolates, while Lineage IV and V contained C. youngae isolates. Lineages II and V contained more adhesive and cytotoxic isolates than Lineages I, III, and IV. Fifty-one of the 128 isolates were found to be multidrug-resistant (MDR, ≥3) and mainly distributed in Lineages I, II, and III. The prevalence of quinolone resistance varied with Lineage III (C. braakii) having the highest proportion of resistant isolates (52.6%), followed by Lineage I (C. freundii) with 23.7%. Seven qnrB variants, including two new alleles (qnrB93 and qnrB94) were found with Lineage I being the main reservoir. In summary, highly cytotoxic MDR isolates from diarrheal patients may increase the risk of severe disease.
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Affiliation(s)
- Liyun Liu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (H.S.); (X.C.); (J.X.)
- Correspondence: (L.L.); (C.Z.)
| | - Liyun Qin
- Shijiazhuang Center for Disease Control and Prevention, Shijiazhuang 050011, China; (L.Q.); (B.X.); (Y.G.); (R.J.); (X.L.)
| | - Shuai Hao
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Engineering and Technology Research Center of Food Additives, Beijing Technology and Business University, Beijing 100048, China;
| | - Ruiting Lan
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Baohong Xu
- Shijiazhuang Center for Disease Control and Prevention, Shijiazhuang 050011, China; (L.Q.); (B.X.); (Y.G.); (R.J.); (X.L.)
| | - Yumei Guo
- Shijiazhuang Center for Disease Control and Prevention, Shijiazhuang 050011, China; (L.Q.); (B.X.); (Y.G.); (R.J.); (X.L.)
| | - Ruiping Jiang
- Shijiazhuang Center for Disease Control and Prevention, Shijiazhuang 050011, China; (L.Q.); (B.X.); (Y.G.); (R.J.); (X.L.)
| | - Hui Sun
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (H.S.); (X.C.); (J.X.)
| | - Xiaoping Chen
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (H.S.); (X.C.); (J.X.)
| | - Xinchao LV
- Shijiazhuang Center for Disease Control and Prevention, Shijiazhuang 050011, China; (L.Q.); (B.X.); (Y.G.); (R.J.); (X.L.)
| | - Jianguo Xu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (H.S.); (X.C.); (J.X.)
| | - Chuan Zhao
- Shijiazhuang Center for Disease Control and Prevention, Shijiazhuang 050011, China; (L.Q.); (B.X.); (Y.G.); (R.J.); (X.L.)
- Correspondence: (L.L.); (C.Z.)
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Characterization of Antimicrobial Resistance in Serratia spp. and Citrobacter spp. Isolates from Companion Animals in Japan: Nosocomial Dissemination of Extended-Spectrum Cephalosporin-Resistant Citrobacter freundii. Microorganisms 2019; 7:microorganisms7030064. [PMID: 30823419 PMCID: PMC6462910 DOI: 10.3390/microorganisms7030064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 01/28/2023] Open
Abstract
In many countries including Japan, the status of emerging antimicrobial resistance among Serratia spp. and Citrobacter spp. in companion animals remains unknown because these genera are rarely isolated from animals. In this study, 30 Serratia spp. and 23 Citrobacter spp. isolates from companion animals underwent susceptibility testing for 10 antimicrobials. Phenotypic and genetic approaches were used to identify the mechanisms of extended-spectrum cephalosporins (ESC). Subsequently, ESC-resistant Citrobacter spp. strains underwent multilocus sequence typing and pulsed-field gel electrophoresis (PFGE). A significantly higher rate (34.8%) of ESC resistance was observed in Citrobacter spp. isolates than in Serratia spp. isolates (0%). ESC resistance was detected in five C. freundii strains, two C. portucalensis strains, and one C. koseri strain. All of the ESC-resistant Citrobacter spp. strains harbored CMY-type and/or DHA-type AmpC β-lactamases. Three C. freundii strains harbored the CTX-M-3-type extended-spectrum β-lactamases. Notably, the three blaCTX-3-producing and two blaCMY-117-bearing C. freundii strains (obtained from different patients in one hospital) had the same sequence type (ST156 and ST18, respectively) and similar PFGE profiles. We believe that ESC-resistant Citrobacter spp. are important nosocomial pathogens in veterinary medicine. Therefore, infection control in animal hospitals is essential to prevent dissemination of these resistant pathogens.
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Lépesová K, Kraková L, Pangallo D, Medveďová A, Olejníková P, Mackuľak T, Tichý J, Grabic R, Birošová L. Prevalence of antibiotic-resistant coliform bacteria, Enterococcus spp. and Staphylococcus spp. in wastewater sewerage biofilm. J Glob Antimicrob Resist 2018; 14:145-151. [DOI: 10.1016/j.jgar.2018.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 03/19/2018] [Accepted: 03/21/2018] [Indexed: 11/28/2022] Open
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Liu L, Chen D, Liu L, Lan R, Hao S, Jin W, Sun H, Wang Y, Liang Y, Xu J. Genetic Diversity, Multidrug Resistance, and Virulence of Citrobacter freundii From Diarrheal Patients and Healthy Individuals. Front Cell Infect Microbiol 2018; 8:233. [PMID: 30050870 PMCID: PMC6052900 DOI: 10.3389/fcimb.2018.00233] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/19/2018] [Indexed: 12/11/2022] Open
Abstract
Objectives:Citrobacter freundii is a frequent cause of nosocomial infections and a known cause of diarrheal infections, and has increasingly become multidrug resistant (MDR). In this study, we aimed to determine the genetic diversity, the antimicrobial resistance profiles and in vitro virulence properties of C. freundii from diarrheal patients and healthy individuals. Methods: 82 C. freundii isolates were obtained from human diarrheal outpatients and healthy individuals. Multilocus Sequence Typing (MLST) of seven housekeeping genes was performed. Antimicrobial susceptibility testing was carried out using the disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) recommendations. Adhesion and cytotoxicity to HEp-2 cells were assessed. PCR and sequencing were used to identify blaCTX-M, blaSHV, blaTEM, qnrA, qnrB, qnrS, qnrC, qnrD, aac(6')-Ib-cr, and qepA genes. Results: The 82 C. freundii isolates were divided into 76 sequence types (STs) with 65 STs being novel, displaying high genetic diversity. Phylogenetic analysis divided the 82 isolates into 5 clusters. All 82 isolates were sensitive to imipenem (IPM), but resistant to one or more other 16 antibiotics tested. Twenty-six isolates (31.7%) were multidrug resistant to three or more antibiotic classes out of the 10 distinct antibiotic classes tested. Five MDR isolates, all of which were isolated from 2014, harbored one or more of the resistance genes, blaTEM-1, blaCTX-M-9, aac(6')-Ib-cr, qnrS1, qnrB9, and qnrB13. All 11 qnrB-carrying C. freundii isolates belonged to cluster 1, and one C. freundii isolate carried a new qnrB gene (qnrB92). Six isolates showed strong cytotoxicity to HEp-2 cells, one of which was multidrug resistant. Conclusions:C. freundii isolates from human diarrheal outpatients and healthy individuals were diverse with variation in sequence types, antibiotic resistance profiles and virulence properties.
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Affiliation(s)
- Liyun Liu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang, China
| | - Daoli Chen
- Maanshan Center for Disease Control and Prevention, Ma'anshan, China
| | - Liqin Liu
- School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing, China
| | - Ruiting Lan
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Shuai Hao
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, Beijing Engineering and Technology Research Center of Food Additives, Beijing Technology and Business University, Beijing, China
| | - Wenjie Jin
- School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing, China
| | - Hui Sun
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yiting Wang
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ying Liang
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianguo Xu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang, China
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Torkar KG, Ivić S. Surveillance of bacterial colonisation on contact surfaces in different medical wards. Arh Hig Rada Toksikol 2018; 68:116-126. [PMID: 28665797 DOI: 10.1515/aiht-2017-68-2892] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 05/01/2017] [Indexed: 11/15/2022] Open
Abstract
This study was conducted to determine the bacterial colonization of some bacterial groups, including extended-spectrum β-lactamase (ESBLs) producers and methicillin-resistant Staphylococcus aureus (MRSA), on surfaces of the equipment and instruments in patient rooms and other workspaces in three different medical wards. The number of microorganisms on swabs was determined with the colony count method on selective microbiological mediums. The aerobic mesophylic microorganisms were found in 73.5 % out of 102 samples, with the average and maximum values of 2.6 × 102 and 4.6 × 103 colony forming units (CFU) 100 cm-2, respectively. Members of the family Enterobacteriaceae, coagulase positive staphylococci, coagulase-negative staphylococci, and enterococci were detected in 23.4, 31.4, 53.2, and 2.9 % of samples, respectively. The differences in bacterial counts on the surfaces of the psychiatric, oncology, and paediatric wards were statistically significant (P<0.001). About 40 % out of 19 isolates from the family Enterobacteriaceae showed multiple resistance to three or more different groups of tested antibiotics, while ESBL was confirmed for only one strain. Staphylococci isolates were mostly resistant to penicillin. MRSA was confirmed in 5.2 % of the tested S. aureus isolates. Greater attention should be paid to cleaning and the appropriate choice of disinfectants, especially in the psychiatric ward. Employees should be informed about the prevention of the spreading of nosocomial infections. Routine application of rapid methods for hygiene control of surfaces is highly recommended.
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Zhou X, Friedrich AW, Bathoorn E. Diagnostic Evasion of Highly-Resistant Microorganisms: A Critical Factor in Nosocomial Outbreaks. Front Microbiol 2017; 8:2128. [PMID: 29163416 PMCID: PMC5675861 DOI: 10.3389/fmicb.2017.02128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 10/18/2017] [Indexed: 12/13/2022] Open
Abstract
Highly resistant microorganisms (HRMOs) may evade screening strategies used in routine diagnostics. Bacteria that have evolved to evade diagnostic tests may have a selective advantage in the nosocomial environment. Evasion of resistance detection can result from the following mechanisms: low-level expression of resistance genes not resulting in detectable resistance, slow growing variants, mimicry of wild-type-resistance, and resistance mechanisms that are only detected if induced by antibiotic pressure. We reviewed reports on hospital outbreaks in the Netherlands over the past 5 years. Remarkably, many outbreaks including major nation-wide outbreaks were caused by microorganisms able to evade resistance detection by diagnostic screening tests. We describe various examples of diagnostic evasion by several HRMOs and discuss this in a broad and international perspective. The epidemiology of hospital-associated bacteria may strongly be affected by diagnostic screening strategies. This may result in an increasing reservoir of resistance genes in hospital populations that is unnoticed. The resistance elements may horizontally transfer to hosts with systems for high-level expression, resulting in a clinically significant resistance problem. We advise to communicate the identification of HRMOs that evade diagnostics within national and regional networks. Such signaling networks may prevent inter-hospital outbreaks, and allow collaborative development of adapted diagnostic tests.
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Affiliation(s)
- Xuewei Zhou
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Alexander W Friedrich
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Erik Bathoorn
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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13
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Liu L, Lan R, Liu L, Wang Y, Zhang Y, Wang Y, Xu J. Antimicrobial Resistance and Cytotoxicity of Citrobacter spp. in Maanshan Anhui Province, China. Front Microbiol 2017; 8:1357. [PMID: 28775715 PMCID: PMC5518651 DOI: 10.3389/fmicb.2017.01357] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/04/2017] [Indexed: 11/23/2022] Open
Abstract
Objectives:Citrobacter spp. especially Citrobacter freundii, is frequently causing nosocomial infections, and increasingly becoming multi-drug resistant (MDR). In this study, we aimed to determine the genetic diversity and relationships of Citrobacter spp. from diarrheal patients and food sources, their antimicrobial resistance profiles and in vitro virulence properties. Methods: Sixty two Citrobacter isolates, including 13 C. freundii, 41 C. youngae and eight C. braakii isolates, were obtained from human diarrheal patients and food sources. Multilocus Sequence Typing (MLST) of seven housekeeping genes and antimicrobial susceptibility testing using the broth microdilution method according to CLSI recommendations were carried out. Adhesion and cytotoxicity to HEp-2 cells were performed. PCR and sequencing were used to identify blaCTX−M, blaSHV, blaTEM and qnr genes. Results: The 62 isolates were divided into 53 sequence types (STs) with all STs being novel, displaying high genetic diversity. ST39 was a predominant ST shared by 5 C. youngae strains isolated from four foods and a diarrheal patient. All isolates were resistant to cefoxitin, and sensitive to imipenem, meropenem and amikacin. The majority of Citrobacter isolates (61.3%) were MDR of three or more antibiotics out of the 22 antibiotics tested. Two C. freundii isolates each carried the blaTEM−1 gene and a variant of qnrB77. Three Citrobacter isolates each carried qnrS1 and aac(6')-Ib-cr genes. Seven isolates that showed strong cytotoxicity to HEp-2 cells were MDR. Conclusions:Citrobacter spp. from human and food sources are diverse with variation in virulence properties and antibiotic resistance profiles. Food may be an important source of Citrobacter species in transmission to humans. C. freundii and C. youngae are potential foodborne pathogens.
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Affiliation(s)
- Liyun Liu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and PreventionBeijing, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious DiseasesZhejiang, China
| | - Ruiting Lan
- School of Biotechnology and Biomolecular Sciences, University of New South WalesSydney, NSW, Australia
| | - Liqin Liu
- Department of Biological Science and Engineering, School of Chemistry and Biological Engineering, University of Science and Technology BeijingBeijing, China
| | - Yonglu Wang
- Maanshan Center for Disease Control and PreventionMaanshan, China
| | - Yushi Zhang
- Department of Biological Science and Engineering, School of Chemistry and Biological Engineering, University of Science and Technology BeijingBeijing, China
| | - Yiting Wang
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and PreventionBeijing, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious DiseasesZhejiang, China
| | - Jianguo Xu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and PreventionBeijing, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious DiseasesZhejiang, China
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Park KH, Chong YP, Kim SH, Lee SO, Lee MS, Sung H, Kim MN, Kim YS, Woo JH, Choi SH. Impact of Revised Broad-Spectrum Cephalosporin Clinical and Laboratory Standards Institute Breakpoints on Susceptibility in Enterobacteriaceae Producing AmpC β-Lactamase. Infect Chemother 2017; 49:62-67. [PMID: 28271652 PMCID: PMC5382052 DOI: 10.3947/ic.2017.49.1.62] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 01/10/2017] [Indexed: 12/05/2022] Open
Abstract
We evaluated the impact of revised Clinical and Laboratory Standards Institute (CLSI) breakpoints for broad-spectrum cephalosporins (BSCs) on the susceptibilities of 1,742 isolates of Enterobacter species, Serratia marcescens, Citrobacter freundii, and Morganella morganii. The 2011 CLSI criteria for cefotaxime and ceftazidime reduced the rates of susceptibility by 2.9% and 5.9%, respectively. The 2014 CLSI criteria for cefepime reduced the rate of susceptibility by 13.9%, and categorized 11.8% isolates as susceptible-dose dependent (SDD) for cefepime. Among 183 isolates with extended-spectrum ß-lactamase (ESBL) phenotype, implementation of the new criteria reduced the rates of susceptibility to cefotaxime, ceftazidime, and cefepime by 2.8%, 14.8%, and 53.6%, respectively. The proportion of ESBL phenotype among BSC-susceptible isolates was low (0.9% for cefotaxime, 3.0% for ceftazidime, and 3.3% for cefepime). In summary, implementation of new CLSI criteria led to little change in susceptibility to cefotaxime and ceftazidime but a substantial change in susceptibility to cefepime. The recognition of revised CLSI criteria for BSC and SDD will help clinicians to select the optimal antibiotic and dosing regimen.
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Affiliation(s)
- Ki Ho Park
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Suk Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Na Kim
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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15
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Kim SJ, Park KH, Chung JW, Sung H, Choi SH, Choi SH. Prevalence and impact of extended-spectrum β-lactamase production on clinical outcomes in cancer patients with Enterobacter species bacteremia. Korean J Intern Med 2014; 29:637-46. [PMID: 25228840 PMCID: PMC4164728 DOI: 10.3904/kjim.2014.29.5.637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 04/17/2014] [Accepted: 05/22/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS We examined the prevalence of extended-spectrum β-lactamase (ESBL) production and the impact of ESBL on clinical outcomes in cancer patients with Enterobacter spp. bacteremia. METHODS Using prospective cohort data on Enterobacter bacteremia obtained between January 2005 and November 2008 from a tertiary care center, the prevalence and clinical impact of ESBL production were evaluated. RESULTS Two-hundred and three episodes of Enterobacter spp. bacteremia were identified. Thirty-one blood isolates (15.3%, 31/203) scored positive by the double-disk synergy test. Among 17 isolates in which ESBL genes were detected by polymerase chain reaction and sequencing, CTX-M (n = 12), SHV-12 (n = 11), and TEM (n = 4) were the most prevalent ESBL types. Prior usage of antimicrobial agents (77.4% vs. 54.0%, p = 0.02) and inappropriate empirical antimicrobial therapy (22.6% vs. 3.0%, p < 0.001) were more commonly encountered in the ESBL-positive group than in the extended-spectrum cephalosporin-susceptible ESBL-negative group, respectively. Clinical outcomes did not differ significantly between the two groups (30-day mortality rate, 19.4% vs. 17.0%, p = 0.76; median length of hospital stay, 24.0 days vs. 30.5 days, p = 0.97). Initial presentation of severe sepsis/septic shock, pneumonia, and intra-abdominal infection were independently associated with 30-day mortality. CONCLUSIONS The prevalence of ESBL-producing isolates was 15.3% in cancer patients with Enterobacter bacteremia. Although inappropriate empirical therapy was more common in the ESBL-positive group, ESBL production was not associated with poorer outcomes.
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Affiliation(s)
- Sun Jong Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Ki-Ho Park
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Jin-Won Chung
- Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong-Ho Choi
- Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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16
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Mezzatesta ML, Gona F, Stefani S. Enterobacter cloacae complex: clinical impact and emerging antibiotic resistance. Future Microbiol 2014; 7:887-902. [PMID: 22827309 DOI: 10.2217/fmb.12.61] [Citation(s) in RCA: 296] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Species of the Enterobacter cloacae complex are widely encountered in nature, but they can act as pathogens. The biochemical and molecular studies on E. cloacae have shown genomic heterogeneity, comprising six species: Enterobacter cloacae, Enterobacter asburiae, Enterobacter hormaechei, Enterobacter kobei, Enterobacter ludwigii and Enterobacter nimipressuralis, E. cloacae and E. hormaechei are the most frequently isolated in human clinical specimens. Phenotypic identification of all species belonging to this taxon is usually difficult and not always reliable; therefore, molecular methods are often used. Although the E. cloacae complex strains are among the most common Enterobacter spp. causing nosocomial bloodstream infections in the last decade, little is known about their virulence-associated properties. By contrast, much has been published on the antibiotic-resistance features of these microorganisms. In fact, they are capable of overproducing AmpC β-lactamases by derepression of a chromosomal gene or by the acquisition of a transferable ampC gene on plasmids conferring the antibiotic resistance. Many other resistance determinants that are able to render ineffective almost all antibiotic families have been recently acquired. Most studies on antimicrobial susceptibility are focused on E. cloacae, E. hormaechei and E. asburiae; these studies reported small variations between the species, and the only significant differences had no discriminating features.
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Affiliation(s)
- Maria Lina Mezzatesta
- Department of Bio-Medical Sciences, Section of Microbiology, University of Catania, Via Androne 81, 95124 Catania, Italy.
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17
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Gomi H, Solomkin JS, Takada T, Strasberg SM, Pitt HA, Yoshida M, Kusachi S, Mayumi T, Miura F, Kiriyama S, Yokoe M, Kimura Y, Higuchi R, Windsor JA, Dervenis C, Liau KH, Kim MH. TG13 antimicrobial therapy for acute cholangitis and cholecystitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 20:60-70. [DOI: 10.1007/s00534-012-0572-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Harumi Gomi
- Center for Clinical Infectious Diseases; Jichi Medical University; 3311-1, Yakushiji, Shimotsuke Tochigi 329-0431 Japan
| | - Joseph S. Solomkin
- Department of Surgery; University of Cincinnati College of Medicine; Cincinnati OH USA
| | - Tadahiro Takada
- Department of Surgery; Teikyo University School of Medicine; Tokyo Japan
| | - Steven M. Strasberg
- Section of Hepatobiliary and Pancreatic Surgery; Washington University in Saint Louis School of Medicine; Saint Louis MO USA
| | - Henry A. Pitt
- Department of Surgery; Indiana University School of Medicine; Indianapolis IN USA
| | - Masahiro Yoshida
- Clinical Research Center Kaken Hospital; International University of Health and Welfare; Ichikawa Japan
| | - Shinya Kusachi
- Department of Surgery; Toho University Medical Center Ohashi Hospital; Tokyo Japan
| | - Toshihiko Mayumi
- Department of Emergency and Critical Care Medicine; Ichinomiya Municipal Hospital; Ichinomiya Japan
| | - Fumihiko Miura
- Department of Surgery; Teikyo University School of Medicine; Tokyo Japan
| | - Seiki Kiriyama
- Department of Gastroenterology; Ogaki Municipal Hospital; Ogaki Japan
| | - Masamichi Yokoe
- General Internal Medicine, Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Yasutoshi Kimura
- Department of Surgical Oncology and Gastroenterological Surgery; Sapporo Medical University School of Medicine; Sapporo Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology; Tokyo Women's Medical University; Tokyo Japan
| | - John A. Windsor
- Department of Surgery; The University of Auckland; Auckland New Zealand
| | | | - Kui-Hin Liau
- Hepatobiliary and Pancreatic Surgery, Nexus Surgical Associates; Mount Elizabeth Hospital; Singapore Singapore
| | - Myung-Hwan Kim
- Department of Internal Medicine, Asan Medical Center; University of Ulsan; Seoul Korea
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18
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English G, Trunk K, Rao VA, Srikannathasan V, Hunter WN, Coulthurst SJ. New secreted toxins and immunity proteins encoded within the Type VI secretion system gene cluster of Serratia marcescens. Mol Microbiol 2012; 86:921-36. [PMID: 22957938 PMCID: PMC3533786 DOI: 10.1111/mmi.12028] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2012] [Indexed: 12/29/2022]
Abstract
Protein secretion systems are critical to bacterial virulence and interactions with other organisms. The Type VI secretion system (T6SS) is found in many bacterial species and is used to target either eukaryotic cells or competitor bacteria. However, T6SS-secreted proteins have proven surprisingly elusive. Here, we identified two secreted substrates of the antibacterial T6SS from the opportunistic human pathogen, Serratia marcescens. Ssp1 and Ssp2, both encoded within the T6SS gene cluster, were confirmed as antibacterial toxins delivered by the T6SS. Four related proteins encoded around the Ssp proteins (‘Rap’ proteins) included two specifically conferring self-resistance (‘immunity’) against T6SS-dependent Ssp1 or Ssp2 toxicity. Biochemical characterization revealed specific, tight binding between cognate Ssp–Rap pairs, forming complexes of 2:2 stoichiometry. The atomic structures of two Rap proteins were solved, revealing a novel helical fold, dependent on a structural disulphide bond, a structural feature consistent with their functional localization. Homologues of the Serratia Ssp and Rap proteins are found encoded together within other T6SS gene clusters, thus they represent founder members of new families of T6SS-secreted and cognate immunity proteins. We suggest that Ssp proteins are the original substrates of the S. marcescens T6SS, before horizontal acquisition of other T6SS-secreted toxins. Molecular insight has been provided into how pathogens utilize antibacterial T6SSs to overcome competitors and succeed in polymicrobial niches.
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Affiliation(s)
- Grant English
- Division of Molecular Microbiology, College of Life Sciences, University of Dundee, Dundee, UK
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19
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Zhao WH, Hu ZQ. Epidemiology and genetics of CTX-M extended-spectrum β-lactamases in Gram-negative bacteria. Crit Rev Microbiol 2012; 39:79-101. [PMID: 22697133 PMCID: PMC4086240 DOI: 10.3109/1040841x.2012.691460] [Citation(s) in RCA: 203] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CTX-M enzymes, the plasmid-mediated cefotaximases, constitute a rapidly growing family of extended-spectrum β-lactamases (ESBLs) with significant clinical impact. CTX-Ms are found in at least 26 bacterial species, particularly in Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis. At least 109 members in CTX-M family are identified and can be divided into seven clusters based on their phylogeny. CTX-M-15 and CTX-M-14 are the most dominant variants. Chromosome-encoded intrinsic cefotaximases in Kluyvera spp. are proposed to be the progenitors of CTX-Ms, while ISEcp1, ISCR1 and plasmid are closely associated with their mobilization and dissemination.
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Affiliation(s)
- Wei-Hua Zhao
- Department of Microbiology and Immunology, Showa University School of Medicine, Tokyo, Japan.
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20
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O'Neal CS, O'Neal HR, Daniels TL, Talbot TR. Treatment outcomes in patients with third-generation cephalosporin-resistant Enterobacter bacteremia. ACTA ACUST UNITED AC 2012; 44:726-32. [PMID: 22681412 DOI: 10.3109/00365548.2012.681694] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Infections with resistant Enterobacter spp. are increasingly described, yet data on outcomes associated with these infections are limited. METHODS A retrospective cohort study was conducted to investigate outcomes of hospitalized patients with third-generation cephalosporin-resistant (CR) Enterobacter bacteremia. Cephalosporin resistance was detected using cefotaxime and cefpodoxime. Patients with Enterobacter spp. bacteremia from January 2006 through February 2008 defined the population. We defined cases as those with CR isolates; controls were patients with bacteremia due to non-CR isolates. Treatment failure was defined as persistence of the presenting signs of infection 72 h after initial culture collection. RESULTS Of the 95 Enterobacter cases identified, 31 (33%) were CR. CR cases were significantly associated with treatment failure (odds ratio (OR) 2.81, 95% confidence interval (CI) 1.14-6.94). This association was not seen after adjustment for age, simplified acute physiology score (SAPS II), and inappropriate empiric antibiotic therapy. Inappropriate empiric therapy (adjusted OR 3.86, 95% CI 1.32-11.31) and SAPS II score (adjusted OR 1.09, 95% CI 1.02-1.16) were significantly associated with treatment failure in the multivariate analysis. CONCLUSIONS Third-generation cephalosporin-resistant Enterobacter bacteremia is associated with treatment failure due to receipt of inappropriate empiric antibiotic therapy and severity of illness.
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Affiliation(s)
- Catherine S O'Neal
- Department of Medicine, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana 70805, USA.
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21
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Abstract
Serratia species, in particular Serratia marcescens, are significant human pathogens. S. marcescens has a long and interesting taxonomic, medical experimentation, military experimentation, and human clinical infection history. The organisms in this genus, particularly S. marcescens, were long thought to be nonpathogenic. Because S. marcescens was thought to be a nonpathogen and is usually red pigmented, the U.S. military conducted experiments that attempted to ascertain the spread of this organism released over large areas. In the process, members of both the public and the military were exposed to S. marcescens, and this was uncovered by the press in the 1970s, leading to U.S. congressional hearings. S. marcescens was found to be a certain human pathogen by the mid-1960s. S. marcescens and S. liquefaciens have been isolated as causative agents of numerous outbreaks and opportunistic infections, and the association of these organisms with point sources such as medical devices and various solutions given to hospitalized patients is striking. Serratia species appear to be common environmental organisms, and this helps to explain the large number of nosocomial infections due to these bacteria. Since many nosocomial infections are caused by multiply antibiotic-resistant strains of S. marcescens, this increases the danger to hospitalized patients, and hospital personnel should be vigilant in preventing nosocomial outbreaks due to this organism. S. marcescens, and probably other species in the genus, carries several antibiotic resistance determinants and is also capable of acquiring resistance genes. S. marcescens and S. liquefaciens are usually identified well in the clinical laboratory, but the other species are rare enough that laboratory technologists may not recognize them. 16S rRNA gene sequencing may enable better identification of some of the less common Serratia species.
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Cheong HS, Ko KS, Kang CI, Chung DR, Peck KR, Song JH. Clinical significance of infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae blood isolates with inducible AmpC β-lactamase. Microb Drug Resist 2012; 18:446-52. [PMID: 22409779 DOI: 10.1089/mdr.2011.0126] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Few studies have investigated the clinical features and outcomes for extended-spectrum β-lactamase (ESBL)-producing Enterobacter spp., Citrobacter spp., Serratia spp., and Morganella morganii (ECSM) bloodstream infections. This study was performed to investigate the clinical features and outcomes for ESBL-producing ECSM bloodstream infections. Patients with ECSM bloodstream infection were enrolled from October 2006 to March 2008. Of 124 patients with ECSM bacteremia, 30 cases (24.2%) were ESBL-producing isolates. Immunosuppressive drugs use within 30 days (p=0.028), indwelling device at the time of bacteremia (p=0.042) and antibiotics use within 3 months (p=0.022) were independently associated with ESBL production in multivariate analysis. Overall 30-day mortality rate was 19.4% (24/124). When the 30-day mortality rate was evaluated, no significant difference was found between the ESBL group (16.6%; 5/30) and non-ESBL group (20.2%; 19/94). Hospitalization was longer in the ESBL group than in the non-ESBL group (65.4±92.8 vs. 32.9±37.8 days, respectively; p=0.007). The recent use of antibiotics (especially broad-spectrum cephalosporins and other β-lactam antibiotics) was an important risk factor for ESBL among ECSM bacteremia. ESBL production of ECSM isolates was not significantly associated with mortality but ESBL-producing organisms have an important impact on the duration of hospital stay and subsequent medical cost.
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Affiliation(s)
- Hae Suk Cheong
- Division of Infectious Diseases, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Republic of Korea
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Coton M, Delbés-Paus C, Irlinger F, Desmasures N, Le Fleche A, Stahl V, Montel MC, Coton E. Diversity and assessment of potential risk factors of Gram-negative isolates associated with French cheeses. Food Microbiol 2012; 29:88-98. [DOI: 10.1016/j.fm.2011.08.020] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 08/14/2011] [Accepted: 08/26/2011] [Indexed: 11/24/2022]
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24
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Kang CI, Chung DR, Ko KS, Peck KR, Song JH. Clinical predictors of Enterobacter bacteremia among patients admitted to the ED. Am J Emerg Med 2012; 30:165-9. [DOI: 10.1016/j.ajem.2010.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 09/04/2010] [Accepted: 09/05/2010] [Indexed: 11/28/2022] Open
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25
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Nijhuis RHT, van Zwet AA, Savelkoul PHM, Roovers EA, Bosboom RW, Postma B, van Griethuysen AJ. Distribution of extended-spectrum beta-lactamase genes using a commercial DNA micro-array system. J Hosp Infect 2011; 79:349-53. [PMID: 21962834 DOI: 10.1016/j.jhin.2011.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 08/12/2011] [Indexed: 11/25/2022]
Abstract
Extended-spectrum beta-lactamase (ESBL) genes are distributed worldwide and their epidemiology is complex. Using the Check-ESBL assay, the distribution of class A ESBL genes in clinical isolates of aerobic Gram-negative bacilli from three laboratories in the East of The Netherlands was determined. Four patient categories were distinguished: (i) patients admitted to an intensive care unit (ICU); (ii) non-ICU inpatients; (iii) outpatients admitted less than a year before collection of the isolate, (<1); (iv) outpatients admitted more than one-year prior to isolate collection or who had never been hospitalized (>1). From February 2009 until March 2010, out of 491 putative ESBL-positive isolates detected by the Vitek2 or Phoenix automated sensitivity testing systems, ESBL genes were detected in 247 (50.3%) by the Check-ESBL assay. Of these, 116 were from hospitalized patients (35 ICU, 81 non-ICU) and 131 were from outpatients (43 <1, 88 >1). In all, 274 ESBL genes were identified in these 247 isolates: 153 CTX-M-1 group (predominantly in E. coli and K. pneumoniae, 70.4% and 51.6% respectively), 67 CTX-M-9 group (predominantly in E. cloacae, 57.9%), 32 SHV, 14 TEM and 8 CTX-M-2 group. ESBL-producing E. cloacae were significantly more common in hospitalized patients than in outpatients, 20.7% and 3.8% respectively (P=0.001). CTX-M-9 group ESBLs were significantly more prevalent in ICU patients (P=0.003), whereas SHV ESBLs were more common in hospitalized patients than in outpatients (P<0.001). There was no significant difference in distribution of ESBL genes between the two outpatient groups.
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Affiliation(s)
- R H T Nijhuis
- Department of Medical Microbiology and Medical Immunology, Rijnstate, Velp, The Netherlands.
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The opportunistic pathogen Serratia marcescens utilizes type VI secretion to target bacterial competitors. J Bacteriol 2011; 193:6057-69. [PMID: 21890705 DOI: 10.1128/jb.05671-11] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The type VI secretion system (T6SS) is the most recently described and least understood of the protein secretion systems of Gram-negative bacteria. It is widely distributed and has been implicated in the virulence of various pathogens, but its mechanism and exact mode of action remain to be defined. Additionally there have been several very recent reports that some T6SSs can target bacteria rather than eukaryotic cells. Serratia marcescens is an opportunistic enteric pathogen, a class of bacteria responsible for a significant proportion of hospital-acquired infections. We describe the identification of a functional T6SS in S. marcescens strain Db10, the first report of type VI secretion by an opportunist enteric bacterium. The T6SS of S. marcescens Db10 is active, with secretion of Hcp to the culture medium readily detected, and is expressed constitutively under normal growth conditions from a large transcriptional unit. Expression of the T6SS genes did not appear to be dependent on the integrity of the T6SS. The S. marcescens Db10 T6SS is not required for virulence in three nonmammalian virulence models. It does, however, exhibit dramatic antibacterial killing activity against several other bacterial species and is required for S. marcescens to persist in a mixed culture with another opportunist pathogen, Enterobacter cloacae. Importantly, this antibacterial killing activity is highly strain specific, with the S. marcescens Db10 T6SS being highly effective against another strain of S. marcescens with a very similar and active T6SS. We conclude that type VI secretion plays a crucial role in the competitiveness, and thus indirectly the virulence, of S. marcescens and other opportunistic bacterial pathogens.
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Kanamori H, Yano H, Hirakata Y, Endo S, Arai K, Ogawa M, Shimojima M, Aoyagi T, Hatta M, Yamada M, Nishimaki K, Kitagawa M, Kunishima H, Kaku M. High prevalence of extended-spectrum β-lactamases and qnr determinants in Citrobacter species from Japan: dissemination of CTX-M-2. J Antimicrob Chemother 2011; 66:2255-62. [PMID: 21733965 DOI: 10.1093/jac/dkr283] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Extended-spectrum β-lactamases (ESBLs) have become a problem among AmpC-producing Enterobacteriaceae and the emergence of concomitant quinolone resistance in β-lactamase-producing isolates poses a global threat. In this study we investigated the prevalence and regional variation of ESBLs in Japanese clinical isolates of Citrobacter spp. and analysed plasmid-mediated quinolone resistance (PMQR) determinants in ESBL-producing Citrobacter spp. METHODS A total of 348 clinical isolates of Citrobacter spp. collected throughout Japan were studied. Screening and the boronic acid disc test were performed to detect ESBLs in Citrobacter spp. with chromosomal AmpC β-lactamases. PCR and sequencing were done to identify ESBL and PMQR genes. For ESBL-producing Citrobacter spp., PFGE was performed using the SfiI restriction enzyme. RESULTS The number of ESBL-producing isolates confirmed phenotypically was 67 (19.3%). The prevalence of ESBL-producing Citrobacter koseri was significantly higher (32.1%) than that of ESBL-producing Citrobacter freundii (4.6%) (P < 0.01). Moreover, the prevalence of ESBLs was notably higher among C. koseri from southern Japan (60.0%). CTX-M-2 was predominant in C. koseri. Of the ESBL-producing C. koseri analysed, 23.2% possessed PMQR determinants, and there was a significant association between qnrB4 and bla(SHV-12). The 57 ESBL-producing Citrobacter spp. possessing bla(CTX-M), bla(SHV) or bla(TEM) were divided into 18 unique PFGE types. CONCLUSIONS This is the first report about the prevalence of PMQR determinants among ESBL-producing Citrobacter spp. from Japan. Our data suggest that ESBLs and PMQR determinants are spreading among C. koseri in Japan.
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Affiliation(s)
- Hajime Kanamori
- Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.
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Abstract
PURPOSE OF REVIEW Multiresistant Gram-negative infections are an increasing problem in hospitals and healthcare facilities worldwide. While much attention has been paid to Gram-positive pathogens such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus lately, the importance of Gram-negative nosocomial infections has also been recognized globally. RECENT FINDINGS Recent reports have described the spread of carbapenemase-producing Klebsiella pneumoniae across North America. In addition, many strains of Pseudomonas and Acinetobacter in Asia are resistant to all known antibiotics. The global epidemiology of multiresistant Gram-negative pathogens seems to vary by continent. There are very few existing agents which can be used for these pathogens and there are limited options on the horizon. This limited therapeutic armamentarium has been an impetus for novel approaches including combination therapies and increased attention to infection control and prevention efforts. SUMMARY Clinicians need to be aware of the rising problem of resistance in nosocomial and community-acquired Gram-negative pathogens. Novel agents are urgently needed to combat these infections and innovative infection control strategies need to be devised to protect our vulnerable patients.
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Bacteremia due to extended-spectrum-beta-lactamase-producing Enterobacter cloacae: role of carbapenem therapy. Antimicrob Agents Chemother 2010; 54:3551-6. [PMID: 20547798 DOI: 10.1128/aac.00055-10] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Enterobacter cloacae is an important nosocomial pathogen. However, few studies specifically dealing with the clinical characteristics and outcome of extended-spectrum beta-lactamase (ESBL)-producing E. cloacae infections have been published. During an 8-year period in a medical center, of 610 E. cloacae bacteremic isolates, 138 (22.6%) with ESBL genes were designated the ESBL group, and 120 (19.6%) cefotaxime-nonsusceptible isolates without the ESBL phenotype and genes were designated the control group. Of the former group of isolates, 133 (96.3%) carried the bla(SHV-12) gene, 3 (2.1%) had bla(CTX-M3), and 2 (1.4%) had both the bla(SHV-12) and bla(CTX-M3) genes. After patients under the age of 18 years were excluded, there were 206 adults with E. cloacae bacteremia, and these consisted of 121 patients in the ESBL group and 85 in the control group. More episodes of hospital-onset and polymicrobial bacteremia, increased severity of illness, more cases of bacteremia onset in intensive care units (ICUs), and longer stays in the hospital and ICU after bacteremia onset were noted in the ESBL group. However, the crude and sepsis-related mortality rates in two groups were similar. Of the ESBL group, the in-hospital sepsis-related mortality rate of patients definitively treated by a carbapenem was lower than that of those treated by noncarbapenem beta-lactams (5/53, or 9.4%, versus 13/44, or 29.5%; P = 0.01) though the difference was not significant in the hierarchical multivariate analysis (P = 0.46). Among 62 patients with follow-up blood cultures within 14 days of bacteremia onset, breakthrough bacteremia was more common in those treated by a noncarbapenem beta-lactam agent than in those treated by a carbapenem (18/31, or 58.0%, versus 3/31, or 9.6%; P < 0.001). Thus, carbapenem therapy for ESBL-producing E. cloacae that cause bacteremia may provide therapeutic benefits.
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Song EH, Park KH, Jang EY, Lee EJ, Chong YP, Cho OH, Kim SH, Lee SO, Sung H, Kim MN, Jeong JY, Kim YS, Woo JH, Choi SH. Comparison of the clinical and microbiologic characteristics of patients with Enterobacter cloacae and Enterobacter aerogenes bacteremia: a prospective observation study. Diagn Microbiol Infect Dis 2010; 66:436-40. [PMID: 20071128 DOI: 10.1016/j.diagmicrobio.2009.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Revised: 10/26/2009] [Accepted: 11/14/2009] [Indexed: 11/25/2022]
Abstract
We compared the characteristics and outcomes of 172 Enterobacter cloacae bacteremia and 67 Enterobacter aerogenes bacteremia (EAB) cases. Antimicrobial resistance rates to E. cloacae were higher than those to E. aerogenes. However, EAB more frequently presented as septic shock and was associated with poorer outcomes.
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Affiliation(s)
- Eun Hee Song
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea
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Cheong HS, Ko KS, Kang CI, Chung DR, Peck KR, Song JH. Prevalence of Extended-spectrum β-lactamase among Enterobacteriacae Blood Isolates with Inducible AmpC β-lactamase. Infect Chemother 2010. [DOI: 10.3947/ic.2010.42.5.280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hae Suk Cheong
- Division of Infectious Diseases, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Korea
| | - Kwan Soo Ko
- Department of Molecular Cell Biology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol-In Kang
- Division of Infectious Disease, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo Ryeon Chung
- Division of Infectious Disease, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyong Ran Peck
- Division of Infectious Disease, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Hoon Song
- Division of Infectious Disease, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Extended Spectrum beta-Lactamases among Gram-Negative Bacterial Isolates from Clinical Specimens in Three Major Hospitals in Northern Jordan. Int J Microbiol 2009; 2009:513874. [PMID: 19936109 PMCID: PMC2777014 DOI: 10.1155/2009/513874] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 07/25/2009] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives. Extended spectrum β-lactamase (ESBL) production is increasing all over the world, and organisms other than E. coli and K. pneumoniae are acquiring this character. ESBL production is detectable by automation, E-test, double disk diffusion (DDD), and PCR. This study aimed to determine the prevalence of ESBL production among clinical isolates of gram-negative rods, and to evaluate the effectiveness of augmentation of clavunate with Cefotaxime, Ceftazoxime, Aztreonam, Ceftriaxone, and Cefpodoxime in detecting ESBL production.
Methods. 472 clinical gram-negative isolates identified by standard methods were tested for ESBL-production by (DDD) method using six cephalosporins and amoxicillin-clavulinate discs.
Results. 108/472 (22.9%) of the isolates were ESBL producers, and were prevalent in tertiary care hospitals. 88.2% of E. cloacae, 71.4% of K. pneumoniae, 28.6% of K. oxytoca, 12.5% of C. freundii, 11.1% of A. calcoacceticus, and 10.8% of E. coli were ESBL producers. The DDD test demonstrated some variations in the efficacy of the different cephalosporins in detecting all the ESBL producers. The inclusion of ceftizoxime discs increased the efficacy of the test. It is concluded that ESBL-producing bacteria were prevalent among our hospitalized patients, and involved genera other than Klebsiella and Escherichia, and the inclusion of ceftizoxime increased the efficacy of ESBL detection by the DDD test.
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Emergence of high levels of extended-spectrum-beta-lactamase-producing gram-negative bacilli in the Asia-Pacific region: data from the Study for Monitoring Antimicrobial Resistance Trends (SMART) program, 2007. Antimicrob Agents Chemother 2009; 53:3280-4. [PMID: 19506060 DOI: 10.1128/aac.00426-09] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Of 3,004 gram-negative bacilli collected from intra-abdominal infections in the Asia-Pacific region during 2007, 42.2% and 35.8% of Escherichia coli and Klebsiella spp., respectively, were extended-spectrum beta-lactamase (ESBL) positive. Moreover ESBL rates in India for E. coli, Klebsiella pneumoniae, and Klebsiella oxytoca were 79.0%, 69.4%, and 100%, respectively. ESBL-positive E. coli rates were also relatively high in China (55.0%) and Thailand (50.8%). Ertapenem and imipenem were the most active drugs tested, inhibiting over 90% of all species, including ESBL-positive isolates with the exception of Pseudomonas aeruginosa isolates (<90% susceptible to all study drugs) and ESBL-positive Klebsiella pneumoniae isolates (<90% susceptible to all study drugs except imipenem). Quinolones achieved 90% inhibition levels only against ESBL-negative K. pneumoniae and ESBL-negative K. oxytoca. A decline in ampicillin-sulbactam activity was noted, with only 34.5% of all Enterobacteriaceae inhibited in this study.
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Nicasio AM, Kuti JL, Nicolau DP. The current state of multidrug-resistant gram-negative bacilli in North America. Pharmacotherapy 2008; 28:235-49. [PMID: 18225969 DOI: 10.1592/phco.28.2.235] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Although much of today's media focuses on multidrug-resistant gram-positive bacteria such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus, resistance within gram-negative bacilli continues to rise, occasionally creating situations in which few or no antibiotics that retain activity are available. Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella sp are emerging threats nationally. Although carbapenems are considered the antibiotic class of choice to treat ESBL-producing Enterobacteriaceae, the ability of these organisms to produce carbapenemases has now become apparent in some regions throughout the United States. Although still rare, Klebsiella sp that produce KPC-2 retain susceptibility only to tigecycline, polymyxins, and occasionally aminoglycosides. Multidrug resistance among Pseudomonas aeruginosa and Acinetobacter sp has always been apparent across many hospitals in the United States. Recent surveillance indicates increasing resistance to all currently available antibiotics, including carbapenems, cephalosporins, penicillins, fluoroquinolones, and aminoglycosides. Against many strains, only polymyxins retain activity; however, resistance has also been reported to these agents. Fortunately, resistance mechanisms such as metallo-beta-lactamases are still rare in the United States. As no new antibiotics with novel mechanisms against many of these gram-negative bacilli are expected to be developed in the foreseeable future, careful and conservative use of agents combined with good infection control practices is required.
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Affiliation(s)
- Anthony M Nicasio
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA
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