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Fernández-Caso B, Lumbreras-Iglesias P, Rodicio MR, Fernández J, Rodríguez-Lucas C. Usefulness of inclusion of ertapenem and temocillin screening breakpoints in the EUCAST rapid antimicrobial susceptibility testing (RAST) for rapid detection of OXA-48-producing Klebsiella pneumoniae directly from positive blood cultures. J Antimicrob Chemother 2024; 79:462-466. [PMID: 38153116 DOI: 10.1093/jac/dkad406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/07/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVES The aims of this study were: (i) to assess the ability of the meropenem screening breakpoint as part of the screening rapid antimicrobial susceptibility testing (sRAST) of EUCAST for the detection of OXA-48 carbapenemase-producing Klebsiella pneumoniae directly from positive blood cultures (BCs); and (ii) to evaluate the inclusion of ertapenem and temocillin discs into the sRAST to enhance the detection of OXA-48-producing isolates. METHODS BC bottles were spiked with a total of 117 K. pneumoniae isolates, including 77 previously characterized OXA-48 producers and 40 non-OXA-48 producers. Disc diffusion assays were directly performed from positive BCs with meropenem (10 µg), ertapenem (10 µg) and temocillin (30 µg) discs, and inhibition zones were manually measured after 4, 6 and 8 h of incubation. The screening cut-off values of sRAST were applied to evaluate their capability in detecting OXA-48-producing isolates. Receiver operating characteristic curves were constructed to illustrate the performance efficacy of the disc diffusion assays to detect OXA-48 producers. RESULTS The meropenem cut-off values of sRAST only detected 90.91% of the OXA-48-producing isolates after 6 and 8 h of incubation. With the proposed cut-off points for ertapenem [<19 mm (4/6 h) and <20 mm (8 h)] and temocillin [<10 mm (4 h) and <11 mm (6/8 h)], all OXA-48-positive isolates were detected without any false-positive results at any reading time. CONCLUSIONS In healthcare settings with a high prevalence of OXA-48 producers, the inclusion of ertapenem and temocillin discs in the sRAST procedure may improve the detection of OXA-48-producing K. pneumoniae isolates directly from positive BCs, providing reliable results after only a 4 h incubation period.
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Affiliation(s)
- Belén Fernández-Caso
- Servicio de Microbiología, Hospital Valle del Nalón, Langreo, Spain
- Servicio de Microbiología, Hospital Universitario de Cabueñes, Gijón, Spain
| | - Pilar Lumbreras-Iglesias
- Grupo de Neoplasias Hematológicas, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Grupo de Microbiología Traslacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - M Rosario Rodicio
- Grupo de Microbiología Traslacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Departamento de Biología Funcional, Área de Microbiología, Universidad de Oviedo, Oviedo, Spain
| | - Javier Fernández
- Grupo de Microbiología Traslacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Servicio de Microbiología, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
- Research & Innovation, Artificial Intelligence and Statistical Department, Pragmatech, Oviedo, Spain
| | - Carlos Rodríguez-Lucas
- Grupo de Microbiología Traslacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Servicio de Microbiología, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
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Lumbreras-Iglesias P, Rodrigo-Arrazola E, López-Amor L, Fernández-Suárez J, Rodicio MR, Fernández J. Clinical and Microbiological Risk Factors for 30-Day Mortality of Bloodstream Infections Caused by OXA-48-Producing Klebsiella pneumoniae. Pathogens 2023; 13:11. [PMID: 38276157 PMCID: PMC10819929 DOI: 10.3390/pathogens13010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Bloodstream infections (BSI) caused by carbapenem-resistant Klebsiella pneumoniae are associated with high morbidity and mortality, and the therapy options available for their treatment are frequently scarce. The aim of this study was to analyze risk factors for 30-day mortality in patients with BSI caused by OXA-48-producing K. pneumoniae. The clinical and treatment features of the patients, who attended a single hospital over a five-year period, were retrospectively reviewed. The microbiological features, including the sequence types (ST) and the somatic (O) and capsular (K) antigens, as well as their resistance properties, comprising phenotypes and genetic background, were also considered. To identify the risk factors for 30-day mortality, uni- and multivariate statistical analyses were performed. The univariate analysis revealed statistically significant correlations for age, male gender, lower respiratory system infection, infection by ST147 isolates, and infection by isolates expressing the K64 antigen. The multivariate analysis, applied to variables yielding p-values close to or lower than 0.05 in the univariate analysis, confirmed gender, lower respiratory system infection, and infection with ST147 isolates, but not age or infection with K64 isolates, as risk factors for 30-day mortality. Moreover, the multivariate analysis showed that patients suffering from hematological malignancies or having been treated with inappropriate therapy, both having p-values slightly higher than 0.05 in the univariate analysis, exhibited significantly poorer outcomes in the multivariant analysis. The association of the ST147 clone with an increased risk of mortality is a novel finding that deserves further attention. Studies like the one presented here can certainly benefit the management of patients with nosocomial BSI caused by carbapenemase-producing K. pneumoniae.
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Affiliation(s)
- Pilar Lumbreras-Iglesias
- Traslational Microbiology Group, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain; (P.L.-I.); (J.F.-S.)
- Department of Clinical Microbiology, Central University Hospital of Asturias (HUCA), 33011 Oviedo, Spain;
- Hematological Malignancies Group, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Edurne Rodrigo-Arrazola
- Department of Clinical Microbiology, Central University Hospital of Asturias (HUCA), 33011 Oviedo, Spain;
| | - Lucía López-Amor
- Department of Intensive Care Medicine, San Agustín University Hospital (HUSA), 33401 Avilés, Spain;
| | - Jonathan Fernández-Suárez
- Traslational Microbiology Group, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain; (P.L.-I.); (J.F.-S.)
- Department of Clinical Microbiology, Central University Hospital of Asturias (HUCA), 33011 Oviedo, Spain;
| | - María Rosario Rodicio
- Traslational Microbiology Group, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain; (P.L.-I.); (J.F.-S.)
- Department of Functional Biology, Microbiology Area, University of Oviedo, 33006 Oviedo, Spain
| | - Javier Fernández
- Traslational Microbiology Group, Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain; (P.L.-I.); (J.F.-S.)
- Department of Clinical Microbiology, Central University Hospital of Asturias (HUCA), 33011 Oviedo, Spain;
- Department of Functional Biology, Microbiology Area, University of Oviedo, 33006 Oviedo, Spain
- Research & Innovation, Artificial Intelligence and Statistical Department, Pragmatech AI Solutions, 33001 Oviedo, Spain
- Biomedical Research Networking Center—Respiratory Diseases, 28029 Madrid, Spain
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Lumbreras-Iglesias P, de Toro M, Vázquez X, García-Carús E, Rodicio MR, Fernández J. High-risk international clones ST66, ST171 and ST78 of Enterobacter cloacae complex causing blood stream infections in Spain and carrying bla OXA-48 with or without mcr-9. J Infect Public Health 2023; 16:272-279. [PMID: 36621205 DOI: 10.1016/j.jiph.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/01/2022] [Accepted: 12/21/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In the last years, Enterobacter cloacae complex has become an important threat associated with nosocomial infections (including bacteraemia). These bacteria have the ability to acquire mobile genetic elements with antimicrobial resistance genes, reducing the number of therapies available for treatment of the infections they cause. Multidrug resistant isolates of the E. cloacae complex have been causing blood stream infections in a hospital in northern Spain. The aim of this study was to report the spread of E. cloacae complex isolates carrying blaOXA-48 with or without mcr-9 which were involved in blood stream infections, in a Spanish hospital. METHODS All Enterobacter spp. isolates recovered from blood cultures of patients admitted to a tertiary Spanish hospital, over a five-year period were recovered. Of those, OXA-48-producing isolates were selected for further analysis (19 E. xiangfangensis isolates and a single E. hoffmannii). Bacterial identification, antimicrobial susceptibility, DNA sequencing, molecular typing, resistome analysis and plasmid characterization was performed. RESULTS 20 isolates were positive for blaOXA-48, harbored by IncL/M plasmids. They belonged to the international high-risk clones ST66, ST171 and ST78. They produced the extended-spectrum β-lactamases CTX-M-15 and/or CTX-M-9 and 40 % of them (n = 8) also carried the mcr-9 gene, located on IncHI2 plasmids. However, they were susceptible to colistin. CONCLUSION The presence of blaOXA-48, together with at least one blaCTX-M gene in our multidrug resistant high-risk E. cloacae complex clones is worrisome. Also, the additional presence of mcr-9 in some of them is of concern as it could potentially be transferred into other hosts or acquire mutations that might led to emerging colistin resistance. Surveillance systems are essential to detect these difficult-to-treat bacteria which, apart from causing live-threatening infections, can spread important resistance threats.
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Affiliation(s)
- Pilar Lumbreras-Iglesias
- Department of Clinical Microbiology, Hospital Universitario Central de Asturias, Oviedo, Spain; Traslational Microbiology Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - María de Toro
- Genomics and Bioinformatics Core Facility, Center for Biomedical Research of La Rioja (CIBIR), Logroño, Spain
| | - Xenia Vázquez
- Traslational Microbiology Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Department of Functional Biology, Microbiology Area, University of Oviedo, Oviedo, Spain
| | - Enrique García-Carús
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - M Rosario Rodicio
- Traslational Microbiology Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Department of Functional Biology, Microbiology Area, University of Oviedo, Oviedo, Spain
| | - Javier Fernández
- Department of Clinical Microbiology, Hospital Universitario Central de Asturias, Oviedo, Spain; Traslational Microbiology Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Research & Innovation, Artificial Intelligence and Statistical Department, Pragmatech AI Solutions, Oviedo, Spain; Centro de Investigación Biomédica en Red-Enfermedades Respiratorias, Madrid, Spain.
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Lumbreras-Iglesias P, Rodicio MR, Valledor P, Suárez-Zarracina T, Fernández J. High-Level Carbapenem Resistance among OXA-48-Producing Klebsiellapneumoniae with Functional OmpK36 Alterations: Maintenance of Ceftazidime/Avibactam Susceptibility. Antibiotics (Basel) 2021; 10:antibiotics10101174. [PMID: 34680754 PMCID: PMC8532661 DOI: 10.3390/antibiotics10101174] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022] Open
Abstract
The aim of this work was to analyze outer membrane porin-encoding genes (ompK35 and ompK36) in a collection of OXA-48 producing Klebsiella pneumoniae, to assess the effect of porin alterations on the susceptibility to ceftazidime/avibactam, and to describe a screening methodology for phenotypic detection of OXA-48-producing K. pneumoniae with disrupted porins. Antimicrobial susceptibility was tested by Microscan and Etest. The genomes of 81 OXA-48-producing K. pneumoniae were sequenced. MLST, detection of antimicrobial resistance genes, and analysis of ompK35 and ompK36 were performed in silico. Tridimensional structures of the OmpK36 variants were assessed. Receiver operating characteristics curves were built to visualize the performance ability of a disk diffusion assay using carbapenems and cefoxitin to detect OmpK36 functional alterations. A wide variety of OmpK36 alterations were detected in 17 OXA-48-producing K. pneumoniae isolates. All displayed a high-level meropenem resistance (MIC ≥ 8 mg/L), and some belonged to high-risk clones, such as ST15 and ST147. Alterations in ompK35 were also observed, but they did not correlate with high-level meropenem resistance. All isolates were susceptible to ceftazidime/avibactam and porin alterations did not affect the MICs of the latter combination. Cefoxitin together with ertapenem/meropenem low inhibition zone diameters (equal or lower than 16 mm) could strongly suggest alterations affecting OmpK36 in OXA-48-producing K. pneumoniae. OXA-48-producing K. pneumoniae with porin disruptions are a cause of concern; ceftazidime/avibactam showed good in vitro activity against them, so this combination could be positioned as the choice therapy to combat the infections caused by this difficult-to-treat isolates.
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Affiliation(s)
- Pilar Lumbreras-Iglesias
- Department of Clinical Microbiology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
- Traslational Microbiology Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
| | - María Rosario Rodicio
- Traslational Microbiology Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Department of Functional Biology, Microbiology Area, University of Oviedo, 33006 Oviedo, Spain
| | - Pablo Valledor
- Research & Innovation, Artificial Intelligence and Statistical Department, Pragmatech AI Solutions, 33003 Oviedo, Spain;
| | - Tomás Suárez-Zarracina
- Department of Internal Medicine, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
| | - Javier Fernández
- Department of Clinical Microbiology, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
- Traslational Microbiology Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain;
- Research & Innovation, Artificial Intelligence and Statistical Department, Pragmatech AI Solutions, 33003 Oviedo, Spain;
- Correspondence:
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Lengliz S, Benlabidi S, Raddaoui A, Cheriet S, Ben Chehida N, Najar T, Abbassi MS. High occurrence of carbapenem-resistant Escherichia coli isolates from healthy rabbits (Oryctolagus cuniculus): first report of bla IMI and bla VIM type genes from livestock in Tunisia. Lett Appl Microbiol 2021; 73:708-717. [PMID: 34487562 DOI: 10.1111/lam.13558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/06/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022]
Abstract
We aimed to study the antibiotic susceptibility and possible occurrence of extended-spectrum beta-lactamases (ESBL)/carbapenemase-producing Escherichia coli isolates collected from rabbits in Tunisia. In all, 35 faecal samples from healthy rabbits were collected from one farm and E. coli were isolated from three media: antibiotic-free TBX agar, TBX+2 mg l-1 cefotaxime and TBX+1 mg l-1 imipenem. In total, 39 E. coli isolates were recovered; the majority showed resistance to at least one antibiotic and none was ESBL producer. Carbapenem resistance was detected in 16 isolates from either selective or un-selective media. Phenotypic methods used to detect carbapenemase production showed two positive isolates by Modified Hodge Test, six metallo-carbapenemase producers (Imipenem disc+EDTA) and all were temocillin resistant (possible OXA-48 carbapenemase). blaVIM and blaIMP type genes were detected in two and one isolates, respectively; one of them harboured both genes. Isolates contained common genes encoding resistance to sulphonamides (sul1, sul2), tetracycline (tetA, tetB, tetC) and fluoroquinolones (qnrS, aac(6')-Ib-cr). Class 1 and 2 integrons were detected in five and four isolates, respectively. These findings highlight the importance of rabbit production as reservoir of carbapenem-resistant E. coli and argument the first report of blaVIM and blaIMP genes in livestock in Tunisia.
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Affiliation(s)
- S Lengliz
- Institute of Veterinary Research of Tunisia, University of Tunis El Manar, Tunis, Tunisia.,Laboratory of Materials, Molecules and Application, Preparatory Institute for Scientific and Technical Studies LR11ES22, University of Carthage, Tunis, Tunisia
| | - S Benlabidi
- Institute of Veterinary Research of Tunisia, University of Tunis El Manar, Tunis, Tunisia
| | - A Raddaoui
- Laboratory Ward, National Bone Marrow Transplant Center, Tunis, Tunisia.,LR18ES39, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - S Cheriet
- Institute of Veterinary Research of Tunisia, University of Tunis El Manar, Tunis, Tunisia
| | - N Ben Chehida
- Institute of Veterinary Research of Tunisia, University of Tunis El Manar, Tunis, Tunisia
| | - T Najar
- Laboratory of Materials, Molecules and Application, Preparatory Institute for Scientific and Technical Studies LR11ES22, University of Carthage, Tunis, Tunisia.,Department of Animal Sciences, National Institute of Agronomy of Tunisia, University of Carthage, Tunis, Tunisia
| | - M S Abbassi
- Institute of Veterinary Research of Tunisia, University of Tunis El Manar, Tunis, Tunisia.,Faculty of Medicine of Tunis, Research Laboratory «Antimicrobial Resistance» LR99ES09, University of Tunis El Manar, Tunis, Tunisia
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Hortaç İştar E, Alışkan HE, Göçmen JS. Diverse efficacy of CarbaNP test among OXA-48 carbapenemase producing Enterobacterales in an endemic region. Acta Microbiol Immunol Hung 2021; 68:34-39. [PMID: 33661134 DOI: 10.1556/030.2021.01220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/26/2020] [Indexed: 11/19/2022]
Abstract
After the first description of OXA-48 type carbapenemase, it has become endemic in Europe, Mediterranean and North African countries in a short time. OXA-48 carbapenemase is the most difficult type to determine and accurate diagnosis is crucial especially in endemic areas.The CarbaNP test was described as a rapid phenotypic evaluation method of carbapenemases activity. Sensitivity and specifity of this test were high within all carbapenemases genes. In our study, we evaluated the efficacy of CarbaNP test in routine laboratories located in an endemic area of OXA-48 producing Enterobacterales.A total of 53 Enterobacterales isolates were included in this study. Antimicrobial susceptibility of the isolates to imipenem, meropenem and ertapenem was determined. Polymerase Chain Reaction (PCR) was carried out for the detection of carbapenemases genes (blaKPC, blaNDM, blaBIC, blaIMP, blaVIM, blaSPM, blaAIM, blaDIM, blaGIM, blaSIM, and blaOXA-48). The Carba NP test was performed as in the protocol described previously.Altogether 31 isolates (58.4%) were blaOXA-48 positive (18 Klebsiella pneumoniae, 8 Escherichia coli, 2 Serratia marcescens, 1 Enterobacter aerogenes, 1 Pantoea agglomerans and 1 Morganella morganii). Among these isolates 3 (5.6%) and 2 (3.7%) isolates were also positive for blaVIM and blaSPM, respectively.The sensitivity and specifity of CarbaNP test were found 64.5, and 68.2% respectively. It was observed that determination of positive isolates is hard to distinguish and subjective.The CarbaNP test has suboptimal results and low of sensitivity and specifity for detection of OXA-48 producing Enterobacterales, and not suitable for detection of blaOXA-48 positive isolates in routine laboratories in endemic areas.
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Affiliation(s)
- Elvan Hortaç İştar
- 1Central Laboratory, Republic of Turkey Minister of Health Beytepe Murat Erdi Eker State Hospital, Ankara, Turkey
| | - Hikmet Eda Alışkan
- 2Department of Medical Microbiology, Baskent University Faculty of Medicine, Adana, Turkey
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