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Freiberg JA, Tao L, Manuel C, Mike LA, Nelson GE, Harris BD, Mathers AJ, Talbot TR, Skaar EP, Humphries RM. A multi-species outbreak of VIM-producing carbapenem-resistant bacteria in a burn unit and subsequent investigation of rapid development of cefiderocol resistance. Antimicrob Agents Chemother 2024; 68:e0150723. [PMID: 38376188 PMCID: PMC10989021 DOI: 10.1128/aac.01507-23] [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: 11/14/2023] [Accepted: 01/25/2024] [Indexed: 02/21/2024] Open
Abstract
Carbapenem resistance due to metallo-β-lactamases (MBLs) such as the Verona integron-encoded metallo-β-lactamase (VIM) is particularly problematic due to the limited treatment options. We describe a case series of bacterial infections in a tertiary care hospital due to multi-species acquisition of a VIM gene along with our experience using novel β-lactam antibiotics and antibiotic combinations to treat these infections. Four patients were treated with the combination of ceftazidime-avibactam and aztreonam, with no resistance to the combination detected. However, cefiderocol-resistant Klebsiella pneumoniae isolates were detected in two out of the five patients who received cefiderocol within 3 weeks of having started the antibiotic. Strain pairs of sequential susceptible and resistant isolates from both patients were analyzed using whole-genome sequencing. This analysis revealed that the pairs of isolates independently acquired point mutations in both the cirA and fiu genes, which encode siderophore receptors. These point mutations were remade in a laboratory strain of K. pneumoniae and resulted in a significant increase in the MIC of cefiderocol, even in the absence of a beta-lactamase enzyme or a penicillin-binding protein 3 (PBP3) mutation. While newer β-lactam antibiotics remain an exciting addition to the antibiotic armamentarium, their use must be accompanied by diligent monitoring for the rapid development of resistance.
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Affiliation(s)
- Jeffrey A. Freiberg
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Institute for Infection, Immunology and Inflammation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lili Tao
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carmila Manuel
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura A. Mike
- Medical Microbiology and Immunology, University of Toledo, Toledo, Ohio, USA
| | - George E. Nelson
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bryan D. Harris
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amy J. Mathers
- Department of Medicine and Pathology, University of Virginia, Charlottesville, Virginia, USA
| | - Thomas R. Talbot
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric P. Skaar
- Vanderbilt Institute for Infection, Immunology and Inflammation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Romney M. Humphries
- Vanderbilt Institute for Infection, Immunology and Inflammation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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2
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Schachner-Groehs I, Koller M, Leopold M, Kolm C, Linke RB, Jakwerth S, Kolarević S, Kračun-Kolarević M, Kandler W, Sulyok M, Vierheilig J, Toumi M, Farkas R, Toth E, Kittinger C, Zarfel G, Farnleitner AH, Kirschner AKT. Linking antibiotic resistance gene patterns with advanced faecal pollution assessment and environmental key parameters along 2300 km of the Danube River. WATER RESEARCH 2024; 252:121244. [PMID: 38340455 DOI: 10.1016/j.watres.2024.121244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/19/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
The global spread of antimicrobial resistance (AMR) in the environment is a growing health threat. Large rivers are of particular concern as they are highly impacted by wastewater discharge while being vital lifelines serving various human needs. A comprehensive understanding of occurrence, spread and key drivers of AMR along whole river courses is largely lacking. We provide a holistic approach by studying spatiotemporal patterns and hotspots of antibiotic resistance genes (ARGs) along 2311 km of the navigable Danube River, combining a longitudinal and temporal monitoring campaign. The integration of advanced faecal pollution diagnostics and environmental and chemical key parameters allowed linking ARG concentrations to the major pollution sources and explaining the observed patterns. Nine AMR markers, including genes conferring resistance to five different antibiotic classes of clinical and environmental relevance, and one integrase gene were determined by probe-based qPCR. All AMR targets could be quantified in Danube River water, with intI1 and sul1 being ubiquitously abundant, qnrS, tetM, blaTEM with intermediate abundance and blaOXA-48like, blaCTX-M-1 group, blaCTX-M-9 group and blaKPC genes with rare occurrence. Human faecal pollution from municipal wastewater discharges was the dominant factor shaping ARG patterns along the Danube River. Other significant correlations of specific ARGs were observed with discharge, certain metals and pesticides. In contrast, intI1 was not associated with wastewater but was already established in the water microbiome. Animal contamination was detected only sporadically and was correlated with ARGs only in the temporal sampling set. During temporal monitoring, an extraordinary hotspot was identified emphasizing the variability within natural waters. This study provides the first comprehensive baseline concentrations of ARGs in the Danube River and lays the foundation for monitoring future trends and evaluating potential reduction measures. The applided holistic approach proved to be a valuable methodological contribution towards a better understanding of the environmental occurrence of AMR.
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Affiliation(s)
- Iris Schachner-Groehs
- Institute of Hygiene and Applied Immunology - Water Microbiology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, Vienna 1090, Austria
| | - Michael Koller
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University Graz, Neue Stiftingtalstraße 6, Graz 8010, Austria
| | - Melanie Leopold
- Division Water Quality and Health, Department Pharmacology, Physiology and Microbiology, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, Krems an der Donau 3500, Austria
| | - Claudia Kolm
- Division Water Quality and Health, Department Pharmacology, Physiology and Microbiology, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, Krems an der Donau 3500, Austria; Institute of Chemical, Environmental and Bioscience Engineering, Research Group Microbiology and Molecular Diagnostics, Technische Universität Wien, Gumpendorfer Straße 1A/166, Vienna 1060, Austria
| | - Rita B Linke
- Institute of Chemical, Environmental and Bioscience Engineering, Research Group Microbiology and Molecular Diagnostics, Technische Universität Wien, Gumpendorfer Straße 1A/166, Vienna 1060, Austria
| | - Stefan Jakwerth
- Institute of Hygiene and Applied Immunology - Water Microbiology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, Vienna 1090, Austria
| | - Stoimir Kolarević
- Department of Hydroecology and Water Protection, Institute for Biological Research ¨Siniša Stanković¨, National Institute of the Republic of Serbia, University of Belgrade, Bulevar despota Stefana 142, Belgrade 11060, Serbia
| | - Margareta Kračun-Kolarević
- Department of Hydroecology and Water Protection, Institute for Biological Research ¨Siniša Stanković¨, National Institute of the Republic of Serbia, University of Belgrade, Bulevar despota Stefana 142, Belgrade 11060, Serbia
| | - Wolfgang Kandler
- Department of Agrotechnology (IFA-Tulln), Institute of Bioanalytics and Agro-Metabolomics, University of Natural Resources and Life Sciences, Konrad-Lorenz-Straße 20, Tulln an der Donau 3430, Austria
| | - Michael Sulyok
- Department of Agrotechnology (IFA-Tulln), Institute of Bioanalytics and Agro-Metabolomics, University of Natural Resources and Life Sciences, Konrad-Lorenz-Straße 20, Tulln an der Donau 3430, Austria
| | - Julia Vierheilig
- Institute of Water Quality and Resource Management, Technische Universität Wien, Karlsplatz 13/226-1, Wien 1040, Austria
| | - Marwene Toumi
- Department of Microbiology, Eötvös Loránd University, Pázmány Péter sétány 1/C., H-1117, Budapest, Hungary
| | - Rózsa Farkas
- Department of Microbiology, Eötvös Loránd University, Pázmány Péter sétány 1/C., H-1117, Budapest, Hungary
| | - Erika Toth
- Department of Microbiology, Eötvös Loránd University, Pázmány Péter sétány 1/C., H-1117, Budapest, Hungary
| | - Clemens Kittinger
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University Graz, Neue Stiftingtalstraße 6, Graz 8010, Austria
| | - Gernot Zarfel
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University Graz, Neue Stiftingtalstraße 6, Graz 8010, Austria
| | - Andreas H Farnleitner
- Division Water Quality and Health, Department Pharmacology, Physiology and Microbiology, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, Krems an der Donau 3500, Austria; Institute of Chemical, Environmental and Bioscience Engineering, Research Group Microbiology and Molecular Diagnostics, Technische Universität Wien, Gumpendorfer Straße 1A/166, Vienna 1060, Austria.
| | - A K T Kirschner
- Institute of Hygiene and Applied Immunology - Water Microbiology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, Vienna 1090, Austria; Division Water Quality and Health, Department Pharmacology, Physiology and Microbiology, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, Krems an der Donau 3500, Austria.
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Ajayi AO, Odeyemi AT, Akinjogunla OJ, Adeyeye AB, Ayo-ajayi I. Review of antibiotic-resistant bacteria and antibiotic resistance genes within the one health framework. Infect Ecol Epidemiol 2024; 14:2312953. [PMID: 38371518 PMCID: PMC10868463 DOI: 10.1080/20008686.2024.2312953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/29/2024] [Indexed: 02/20/2024] Open
Abstract
Background: The interdisciplinary One Health (OH) approach recognizes that human, animal, and environmental health are all interconnected. Its ultimate goal is to promote optimal health for all through the exploration of these relationships. Antibiotic resistance (AR) is a public health challenge that has been primarily addressed within the context of human health and clinical settings. However, it has become increasingly evident that antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs) that confer resistance are transmitted and circulated within humans, animals, and the environment. Therefore, to effectively address this issue, antibiotic resistance must also be considered an environmental and livestock/wildlife problem. Objective: This review was carried out to provide a broad overview of the existence of ARB and ARGs in One Health settings. Methods: Relevant studies that placed emphasis on ARB and ARGs were reviewed and key findings were accessed that illustrate the importance of One Health as a measure to tackle growing public and environmental threats. Results: In this review, we delve into the complex interplay of the three components of OH in relation to ARB and ARGs. Antibiotics used in animal husbandry and plants to promote growth, treat, and prevent infectious diseases lead to the development of antibiotic-resistant bacteria in animals. These bacteria are transmitted from animals to humans through food and environmental exposure. The environment plays a critical role in the circulation and persistence of antibiotic-resistant bacteria and genes, posing a significant threat to human and animal health. This article also highlights how ARGs are spread in the environment through the transfer of genetic material between bacteria. This transfer can occur naturally or through human activities such as the use of antibiotics in agriculture and waste management practices. Conclusion: It is important to integrate the One Health approach into the public health system to effectively tackle the emergence and spread of ARB and genes that code for resistance to different antibiotics.
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Affiliation(s)
| | - Adebowale Toba Odeyemi
- Department of Microbiology, Landmark University SDG Groups 2 and 3, Omu-Aran, Kwara State, Nigeria
| | | | | | - Ibiwumi Ayo-ajayi
- Department of Computer Science, Afe Babalola University, Ado Ekiti, Ekiti State, Nigeria
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Sudhakari PA, Ramisetty BCM. Resistome Diversity in Escherichia coli Isolates of Global Wastewaters. Microb Drug Resist 2024; 30:37-49. [PMID: 38150178 DOI: 10.1089/mdr.2022.0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
Antimicrobial resistance (AMR) is a global health threat requiring urgent attention and effective strategies for containment. AMR is fueled by wastewater mismanagement and global mobility, disseminating multidrug-resistant (MDR) strains worldwide. While global estimates of AMR burden have been informative, community-level understanding has received little attention despite reports of high AMR prevalence in healthy communities. We assessed the "invasion" of antibiotic resistance genes (ARGs) into the normal human flora by characterizing AMR Escherichia coli in local wastewaters contributed by a healthy youth population. This study estimated 26% (out of 300 isolates) resistant and 59% plasmid-bearing E. coli in local wastewater. Of the 78 AMR isolates, the frequency of mono-resistance was higher against tetracycline (32%), followed by kanamycin (17%) and chloramphenicol (9%). Five isolates were potentially MDR. We further sequenced four MDRs and four sensitive strains to comprehend the genome and resistome diversity in comparison to the global wastewater E. coli (genomes from the PATRIC database). The whole-genome analysis revealed extensive genome similarity among global isolates, suggesting global dissemination and colonization of E. coli. Global wastewater resistome majorly comprised ARGs against aminoglycosides (26%), beta-lactam (17%), sulfonamide (11%), and trimethoprim (8%). Resistance to colistin, a last-resort antibiotic, was prevalent in MDRs of European and South Asian isolates. A systems approach is required to address the AMR crisis on a global scale, reduce antibiotic usage, and increase the efficiency of wastewater management and disinfection.
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Affiliation(s)
- Pavithra Anantharaman Sudhakari
- Laboratory of Molecular Biology and Evolution, 312@ASK1, School of Chemical and Biotechnology, SASTRA Deemed University, Thanjavur, India
| | - Bhaskar Chandra Mohan Ramisetty
- Laboratory of Molecular Biology and Evolution, 312@ASK1, School of Chemical and Biotechnology, SASTRA Deemed University, Thanjavur, India
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Walsh TR, Gales AC, Laxminarayan R, Dodd PC. Antimicrobial Resistance: Addressing a Global Threat to Humanity. PLoS Med 2023; 20:e1004264. [PMID: 37399216 DOI: 10.1371/journal.pmed.1004264] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Affiliation(s)
- Timothy R Walsh
- Ineos Oxford Institute for Antimicrobial Resistance, Department of Zoology, Oxford, United Kingdom
| | - Ana C Gales
- Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Ramanan Laxminarayan
- Princeton University, Princeton, New Jersey, United States of America; One Health Trust, Bengaluru, India
| | - Philippa C Dodd
- Public Library of Science, San Francisco, United States of America and Cambridge, United Kingdom
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