1
|
Imran H, Saleem F, Gull S, Khan Z. Uncovering the growing burden of enteric fever: A molecular analysis of Salmonella Typhi antimicrobial resistance. Microb Pathog 2024; 191:106676. [PMID: 38710290 DOI: 10.1016/j.micpath.2024.106676] [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] [Received: 12/11/2023] [Revised: 01/24/2024] [Accepted: 05/01/2024] [Indexed: 05/08/2024]
Abstract
Enteric fever, a persistent public health challenge in developing regions, is exacerbated by suboptimal socioeconomic conditions, contaminated water and food sources, and insufficient sanitation. This study delves into the antimicrobial susceptibility of Salmonella Typhi, uncovering the genetic underpinnings of its resistance. Analyzing 897 suspected cases, we identified a significant prevalence of typhoid fever, predominantly in males (58.3 %) and younger demographics. Alarmingly, our data reveals an escalation in resistance to both primary and secondary antibiotics, with cases of multi-drug resistant (MDR) and extensively drug-resistant (XDR) S. Typhi reaching 14.7 % and 43.4 %, respectively, in 2021. The Multiple Antibiotic Resistance (MAR) index exceeded 0.2 in over half of the isolates, signaling widespread antibiotic misuse. The study discerned 47 unique antibiotic resistance patterns and pinpointed carbapenem and macrolide antibiotics as the remaining effective treatments against XDR strains, underlining the critical need to preserve these drugs for severe cases. Molecular examinations identified blaTEM, blaSHV, and blaCTX-M genes in ceftriaxone-resistant strains, while qnrS was specific to ciprofloxacin-resistant variants. Notably, all examined strains exhibited a singular mutation in the gyrA gene, maintaining wild-type gyrB and parC genes. The erm(B) gene emerged as the primary determinant of azithromycin resistance. Furthermore, a distressing increase in resistance genes was observed over three years, with erm(B), blaTEM and qnrS showing significant upward trends. These findings are a clarion call for robust antimicrobial stewardship programs to curtail inappropriate antibiotic use and forestall the burgeoning threat of antibiotic resistance in S. Typhi.
Collapse
Affiliation(s)
- Hassan Imran
- University Institute of Medical Laboratory Technology, Faculty of Allied Health Sciences, The University of Lahore, Pakistan
| | - Fiza Saleem
- University Institute of Medical Laboratory Technology, Faculty of Allied Health Sciences, The University of Lahore, Pakistan
| | - Sidra Gull
- University Institute of Medical Laboratory Technology, Faculty of Allied Health Sciences, The University of Lahore, Pakistan
| | - Zaman Khan
- University Institute of Medical Laboratory Technology, Faculty of Allied Health Sciences, The University of Lahore, Pakistan; Department of Microbiology, Faculty of Science, Emerson University Multan, Pakistan.
| |
Collapse
|
2
|
Wu Y, Mao W, Shao J, He X, Bao D, Yue M, Wang J, Shen W, Qiang X, Jia H, He F, Ruan Z. Monitoring the long-term spatiotemporal transmission dynamics and ecological surveillance of multidrug-resistant Salmonella enterica serovar Goldcoast: A multicenter genomic epidemiology study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:169116. [PMID: 38065491 DOI: 10.1016/j.scitotenv.2023.169116] [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: 08/06/2023] [Revised: 12/02/2023] [Accepted: 12/03/2023] [Indexed: 12/17/2023]
Abstract
The emergence of multidrug-resistant Salmonella enterica serovar Goldcoast poses a significant threat to the effective treatment and control of salmonellosis within the ecological environment. Here, we conducted a genomic epidemiological study delineate the global dissemination scenarios of the multidrug-resistant S. Goldcoast originated from 11 countries for over 20 years. The population structure and evolutionary history of multidrug-resistant S. Goldcoast was investigated through phylogenomic and long-term spatiotemporal transmission dynamic analysis. ST358 and ST2529 are the predominant lineages of S. Goldcoast. Multidrug-resistant S. Goldcoast strains have mainly been identified in the ST358 lineage from human and the ST2529 lineage from livestock. ST358 S. Goldcoast was estimated to have emerged in the United Kingdom in 1969, and then spread to China, with both countries serve as centers for the global dissemination of the ST358 lineage. After its emergence and subsequent spread in Chinese clinical and environmental samples, occasional instances of this lineage have been reported in Canada, the United Kingdom, and Ireland. Clonal transmission of ST358 and ST2529 S. Goldcoast have occurred not only on an international and intercontinental scale but also among clinical, environmental and livestock samples. These data indicated that international circulation and local transmission of S. Goldcoast have occurred for over a decade. Continued surveillance of multidrug-resistant S. Goldcoast from a global "One Health" perspective is urgently needed to facilitate monitoring the spread of the antimicrobial resistant high-risk clones.
Collapse
Affiliation(s)
- Yuye Wu
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Weifang Mao
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; Department of Clinical Laboratory, Shaoxing University Affiliated Hospital, Shaoxing 312000, China
| | - Jiayu Shao
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; Department of Clinical Laboratory, The Third People's Hospital of Xiaoshan District, Hangzhou 311251, China
| | - Xianhong He
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; Department of Clinical Laboratory, The Third People's Hospital of Xiaoshan District, Hangzhou 311251, China
| | - Danni Bao
- Department of Clinical Laboratory, Sanmen People's Hospital, Taizhou 317199, China
| | - Meina Yue
- Department of Clinical Laboratory, Hangzhou Children's Hospital, Hangzhou 310005, China
| | - Jinyue Wang
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Weiwei Shen
- Taizhou Center for Disease Control and Prevention, Taizhou 318000, China
| | - Xinhua Qiang
- Department of Clinical Laboratory, The First People's Hospital of Huzhou, Huzhou 313000, China
| | - Huiqiong Jia
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
| | - Fang He
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou 314408, China
| | - Zhi Ruan
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Hangzhou 310016, China.
| |
Collapse
|
3
|
Srednik ME, Morningstar-Shaw BR, Hicks JA, Tong C, Mackie TA, Schlater LK. Whole-genome sequencing and phylogenetic analysis capture the emergence of a multi-drug resistant Salmonella enterica serovar Infantis clone from diagnostic animal samples in the United States. Front Microbiol 2023; 14:1166908. [PMID: 37333652 PMCID: PMC10272548 DOI: 10.3389/fmicb.2023.1166908] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/20/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Salmonella enterica is a major cause of foodborne illness in the United States. A multi-drug resistant (MDR) emergent Salmonella Infantis (ESI) with a megaplasmid (pESI) was first identified in Israel and Italy and subsequently reported worldwide. The ESI clone carrying an extended spectrum β-lactamase blaCTX-M-65 on a pESI-like plasmid and a mutation in the gyrA gene has recently been found in the United States in poultry meat. Methods We analyzed the phenotypic and genotypic antimicrobial resistance, genomics and phylogeny of 200 S. infantis isolates from animal diagnostic samples. Results Of these, 33.5% were resistant to at least one antimicrobial and 19.5% were multi-drug resistant (MDR). Eleven isolates from different animal sources were phenotypically and genetically similar to the ESI clone. These isolates had a D87Y mutation in the gyrA gene conferring reduced susceptibility to ciprofloxacin and harbored a combination of 6-10 resistance genes: blaCTX-M-65, aac(3)-IVa, aadA1, aph(4)-Ia, aph(3')-Ia, floR, sul1, dfrA14, tetA, and fosA. These 11 isolates carried class I and class II integrons and three virulence genes: sinH, involved in adhesion and invasion, ybtQ and ybtP, associated with iron transport. These isolates were also closely related to each other (separated by 7 to 27 SNPs) and phylogenetically related to the ESI clone recently found in the U.S. Discussion This dataset captured the emergence of the MDR ESI clone in multiple animal species and the first report of a pESI-like plasmid in isolates from horses in the U.S.
Collapse
Affiliation(s)
- Mariela E. Srednik
- National Veterinary Services Laboratories, Animal and Plant Health Inspection Service, U.S. Department of Agriculture, Ames, IA, United States
| | - Brenda R. Morningstar-Shaw
- National Veterinary Services Laboratories, Animal and Plant Health Inspection Service, U.S. Department of Agriculture, Ames, IA, United States
| | - Jessica A. Hicks
- National Veterinary Services Laboratories, Animal and Plant Health Inspection Service, U.S. Department of Agriculture, Ames, IA, United States
| | - Christopher Tong
- Center for Veterinary Biologics, Animal and Plant Health Inspection Service, U.S. Department of Agriculture, Ames, IA, United States
| | - Tonya A. Mackie
- National Veterinary Services Laboratories, Animal and Plant Health Inspection Service, U.S. Department of Agriculture, Ames, IA, United States
| | - Linda K. Schlater
- National Veterinary Services Laboratories, Animal and Plant Health Inspection Service, U.S. Department of Agriculture, Ames, IA, United States
| |
Collapse
|
4
|
Hu Y, He Y, Nguyen SV, Liu C, Liu C, Gan X, Wang W, Dong Y, Xu J, Li F, Fanning S. Antimicrobial resistance of Salmonella Indiana from retail chickens in China and emergence of an mcr-1-harboring isolate with concurrent resistance to ciprofloxacin, cefotaxime, and colistin. Front Microbiol 2022; 13:955827. [PMID: 36160190 PMCID: PMC9493365 DOI: 10.3389/fmicb.2022.955827] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022] Open
Abstract
Salmonella enterica serotype Indiana (S. Indiana) in Chinese poultry meat has aroused widespread concern because of its high prevalence and strong antimicrobial resistance. In consideration of the relationship in our previous study between S. Indiana and co-resistance to ciprofloxacin and cefotaxime (CIP-CTX), which were the first-line drug which were used in Salmonella infection in clinical, the antimicrobial resistance (AMR) of 224 CIP-CTX co-resistant S. Indiana isolated from retail chicken samples in China were investigated, with the aim of characterizing the AMR profiles and related resistance mechanisms to ciprofloxacin and cefotaxime among these CIP-CTX co-resistant S. Indiana isolates, all of which showed multi-drug-resistant (MDR) phenotypes. GyrA (S83F and D87N/G) with ParC (T57S and S80R) were the dominant amino acid substitution types, with oqxA, oqxB, and aac (6′)-Ib-cr identified as common plasmid-mediated quinolone resistance (PMQR)-encoding genes. Five blaCTX-M gene subtypes were identified with blaCTX-M-65 ranking at the top. Equally important, we obtained one isolate CFSA664 harboring the mcr-1 gene was ESBL producer with co-resistance to nine in ten classes of tested drugs inclduing colistin. A single circular chromosome and 3 circular plasmids were found in its genome. Among the 26 AMR genes identified, 24 were located on plasmid pCFSA664-1, including three ESBL genes, while plasmid pCFSA664-3 owning only the mcr-1 gene and sharing the same backbone structure with plasmids from Enterobacteriaceae. No insertion sequences were found near the mcr-1 gene but a relaxase-encoding gene in the flank, which could transfer into E. coli J53 at a relatively high frequency. S. Indiana in this study exhibited highly drug-resistant phenotypes, contributing to the acceleration of the dissemination and emergence of this pathogen among different sources. Surveillance and a One Health strategy are needed to limit the emergence of S. Indiana along the food chain.
Collapse
Affiliation(s)
- Yujie Hu
- NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, China
- UCD-Centre for Food Safety, School of Public Health, Physiotherapy and Population Science, University College Dublin, Belfield, Dublin, Ireland
| | - Yingying He
- NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, China
| | - Scott V. Nguyen
- UCD-Centre for Food Safety, School of Public Health, Physiotherapy and Population Science, University College Dublin, Belfield, Dublin, Ireland
- Public Health Laboratory, District of Columbia Department of Forensic Sciences, Washington, DC, United States
| | - Chang Liu
- Department of Microbiological Laboratory Technology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chang Liu
- Food Science and Engineering College, Beijing University of Agriculture, Beijing, China
| | - Xin Gan
- NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, China
| | - Wei Wang
- NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, China
| | - Yinping Dong
- NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, China
- UCD-Centre for Food Safety, School of Public Health, Physiotherapy and Population Science, University College Dublin, Belfield, Dublin, Ireland
| | - Jin Xu
- NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, China
| | - Fengqin Li
- NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, China
- *Correspondence: Fengqin Li,
| | - Séamus Fanning
- NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, China
- UCD-Centre for Food Safety, School of Public Health, Physiotherapy and Population Science, University College Dublin, Belfield, Dublin, Ireland
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, United Kingdom
- Séamus Fanning,
| |
Collapse
|
5
|
Rai S, Shukla U, Kapil A, Dahiya S, Sharma P. Ceftriaxone treatment failure in two cases of Enteric Fever caused by CTX-M15 positive Salmonella Typhi and its gastrointestinal carriage. Indian J Med Microbiol 2022; 40:459-461. [PMID: 35483998 DOI: 10.1016/j.ijmmb.2022.04.001] [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: 01/11/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/05/2022]
Abstract
We report two cases of culture positive typhoid fever caused by ceftriaxone resistant Salmonella Typhi. Bacterial isolates from both the cases were positive for ESBL by phenotypic methods. Both patients didn't respond to ceftriaxone and were finally treated with meropenem. Screening of family members of one patient isolated a similar strain from a healthy carrier with the same antibiogram pattern. All isolates were subjected to PCR, which confirmed the presence of blaCTX-M15 ESBL gene. These two cases confirm emergence of ESBL-producing Salmonella Typhi causing Enteric Fever in India and also their presence in the gut flora of healthy carriers.
Collapse
Affiliation(s)
- Sumit Rai
- Department of Clinical Microbiology and Infectious Diseases, All India Institute of Medical Sciences, Mangalagiri (AP), India.
| | - Umesh Shukla
- Department of Paediatric Gastroenterology, Post Graduate Institute of Child Health, NOIDA, India.
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Sushila Dahiya
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Priyanka Sharma
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India.
| |
Collapse
|
6
|
Genotypic Diversity of Ciprofloxacin Nonsusceptibility and Its Relationship with Minimum Inhibitory Concentrations in Nontyphoidal Salmonella Clinical Isolates in Taiwan. Antibiotics (Basel) 2021; 10:antibiotics10111383. [PMID: 34827321 PMCID: PMC8614936 DOI: 10.3390/antibiotics10111383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022] Open
Abstract
This study analyzed the genetic diversity of ciprofloxacin (CIP) nonsusceptibility and the relationship between two major mechanisms and minimum inhibitory concentrations (MICs) of CIP in nontyphoidal Salmonella (NTS). Chromosomal mutations in quinolone resistance-determining regions (QRDRs) and plasmid-mediated quinolone resistance (PMQR) genes were searched from ResFinder, ARG-ANNOT, and PubMed for designing the sequencing regions in gyrA, gyrB, parC, and parE, and the 13 polymerase chain reactions for PMQR genes. We found that QRDR mutations were detected in gyrA (82.1%), parC (59.0%), and parE (20.5%) but not in gyrB among the 39 isolates. Five of the 13 PMQR genes were identified, including oqxA (28.2%), oqxB (28.2%), qnrS (18.0%), aac(6′)-Ib-cr (10.3%), and qnrB (5.1%), which correlated with the MICs of CIP within 0.25–2 μg/mL, and it was found that oxqAB contributed more than qnr genes to increase the MICs. All the isolates contained either QRDR mutations (53.8%), PMQR genes (15.4%), or both (30.8%). QRDR mutations (84.6%) were more commonly detected than PMQR genes (46.2%). QRDR mutation numbers were significantly associated with MICs (p < 0.001). Double mutations in gyrA and parC determined high CIP resistance (MICs ≥ 4 μg/mL). PMQR genes contributed to intermediate to low CIP resistance (MICs 0.25–2 μg/mL), thus providing insights into mechanisms underlying CIP resistance.
Collapse
|
7
|
Kim C, Latif I, Neupane DP, Lee GY, Kwon RS, Batool A, Ahmed Q, Qamar MU, Song J. The molecular basis of extensively drug-resistant Salmonella Typhi isolates from pediatric septicemia patients. PLoS One 2021; 16:e0257744. [PMID: 34582469 PMCID: PMC8478237 DOI: 10.1371/journal.pone.0257744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/08/2021] [Indexed: 12/02/2022] Open
Abstract
Sepsis is a syndromic response to infections and is becoming an emerging threat to the public health sector, particularly in developing countries. Salmonella Typhi (S. Typhi), the cause of typhoid fever, is one primary cause of pediatric sepsis in typhoid endemic areas. Extensively drug-resistant (XDR) S. Typhi is more common among pediatric patients, which is responsible for over 90% of the reported XDR typhoid cases, but the majority of antibiotic resistance studies available have been carried out using S. Typhi isolates from adult patients. Here, we characterized antibiotic-resistance profiles of XDR S. Typhi isolates from a medium size cohort of pediatric typhoid patients (n = 45, 68.89% male and 31.11% female) and determined antibiotic-resistance-related gene signatures associated with common treatment options to typhoid fever patients of 18 XDR S. Typhi representing all 45 isolates. Their ages were 1–13 years old: toddlers aging 1–2 years old (n = 9, 20%), pre-schoolers aging 3–5 years old (n = 17, 37.78%), school-age children aging 6–12 years old (n = 17, 37.78%), and adolescents aging 13–18 years old (n = 2, 4.44%). Through analyzing blaTEM1, dhfR7, sul1, and catA1genes for multidrug-resistance, qnrS, gyrA, gyrB, parC, and parE for fluoroquinolone-resistance, blaCTX-M-15 for XDR, and macAB and acrAB efflux pump system-associated genes, we showed the phenotype of the XDR S. Typhi isolates matches with their genotypes featured by the acquisitions of the genes blaTEM1, dhfR7, sul1, catA1, qnrS, and blaCTX-M-15 and a point mutation on gyrA. This study informs the molecular basis of antibiotic-resistance among recent S. Typhi isolates from pediatric septicemia patients, therefore providing insights into the development of molecular detection methods and treatment strategies for XDR S. Typhi.
Collapse
Affiliation(s)
- Chanmi Kim
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America
| | - Iqra Latif
- Faculty of Life Sciences, Department of Microbiology, Government College University Faisalabad, Faisalabad, Pakistan
| | - Durga P. Neupane
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America
| | - Gi Young Lee
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America
| | - Ryan S. Kwon
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America
| | - Alia Batool
- Department of Pathology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Qasim Ahmed
- Department of Pathology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Muhammad Usman Qamar
- Faculty of Life Sciences, Department of Microbiology, Government College University Faisalabad, Faisalabad, Pakistan
- * E-mail: (JS); (MUQ)
| | - Jeongmin Song
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America
- * E-mail: (JS); (MUQ)
| |
Collapse
|
8
|
Chattaway MA, Gentle A, Nair S, Tingley L, Day M, Mohamed I, Jenkins C, Godbole G. Phylogenomics and antimicrobial resistance of Salmonella Typhi and Paratyphi A, B and C in England, 2016-2019. Microb Genom 2021; 7. [PMID: 34370659 PMCID: PMC8549371 DOI: 10.1099/mgen.0.000633] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The emergence of antimicrobial resistance (AMR) to first- and second-line treatment regimens of enteric fever is a global public-health problem, and routine genomic surveillance to inform clinical and public-health management guidance is essential. Here, we present the prospective analysis of genomic data to monitor trends in incidence, AMR and travel, and assess hierarchical clustering (HierCC) methodology of 1742 isolates of typhoidal salmonellae. Trend analysis of Salmonella Typhi and S. Paratyphi A cases per year increased 48 and 17.3%, respectively, between 2016 and 2019 in England, mainly associated with travel to South Asia. S. Paratyphi B cases have remained stable and are mainly associated with travel to the Middle East and South America. There has been an increase in the number of S. Typhi exhibiting a multidrug-resistant (MDR) profile and the emergence of extensively drug resistant (XDR) profiles. HierCC was a robust method to categorize clonal groups into clades and clusters associated with travel and AMR profiles. The majority of cases that had XDR S. Typhi reported recent travel to Pakistan (94 %) and belonged to a subpopulation of the 4.3.1 (H58) clone (HC5_1452). The phenotypic and genotypic AMR results showed high concordance for S. Typhi and S. Paratyphi A, B and C, with 99.99 % concordance and only three (0.01 %) discordant results out of a possible 23 178 isolate/antibiotic combinations. Genomic surveillance of enteric fever has shown the recent emergence and increase of MDR and XDR S. Typhi strains, resulting in a review of clinical guidelines to improve management of imported infections.
Collapse
Affiliation(s)
- Marie Anne Chattaway
- Gastrointestinal Bacteria Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Amy Gentle
- Gastrointestinal Bacteria Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Satheesh Nair
- Gastrointestinal Bacteria Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Laura Tingley
- Gastrointestinal Bacteria Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Martin Day
- Gastrointestinal Bacteria Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Iman Mohamed
- Travel Health and IHR, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Claire Jenkins
- Gastrointestinal Bacteria Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Gauri Godbole
- Gastrointestinal Bacteria Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| |
Collapse
|
9
|
Li Z, Cai Z, Cai Z, Zhang Y, Fu T, Jin Y, Cheng Z, Jin S, Wu W, Yang L, Bai F. Molecular genetic analysis of an XDR Pseudomonas aeruginosa ST664 clone carrying multiple conjugal plasmids. J Antimicrob Chemother 2021; 75:1443-1452. [PMID: 32129854 DOI: 10.1093/jac/dkaa063] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES A group of ST664 XDR Pseudomonas aeruginosa strains have been isolated from a burn clinic. Here we decipher their resistomes and likely mechanisms of resistance acquisition. METHODS The complete nucleotide sequences of representative isolates were determined, by PacBio and Illumina MiSeq sequencing, and analysed for antimicrobial resistance (AMR) genes as well as sequence variations. S1-PFGE was used to determine the sizes and numbers of plasmids harboured by the isolates. Purified plasmid DNA was further sequenced by PacBio technology, closed manually and annotated by RAST. The mobility of plasmids was determined by conjugation assays. RESULTS The XDR P. aeruginosa ST664 clone carries 11 AMR genes, including a blaKPC-2 gene that confers resistance to carbapenems. Most of the ST664 isolates carry three coexisting plasmids. blaKPC-2 and a cluster of three AMR genes (aadB-cmlA1-sul1) are encoded on a 475 kb megaplasmid pNK546a, which codes for an IncP-3-like replication and partitioning mechanism, but has lost the conjugative transfer system. Interestingly, however, pNK546a is mobilizable and can be transferred to P. aeruginosa PAO1 with the help of a co-residing IncP-7 conjugative plasmid. The blaKPC-2 gene is carried by an IS6100-ISKpn27-blaKPC-2-ΔISKpn6-Tn1403 mobile element, which might be brought into the ST664 clone by another co-resident IncP-1α plasmid, which is inclined to be lost. Moreover, pNK546a harbours multiple heavy metal (mercury, tellurite and silver) resistance modules. CONCLUSIONS To the best of our knowledge, pNK546a is the first fully sequenced blaKPC-2-carrying megaplasmid from P. aeruginosa. These results give new insights into bacterial adaptation and evolution during nosocomial infections.
Collapse
Affiliation(s)
- Zhenpeng Li
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Molecular Microbiology and Technology of the Ministry of Education, College of Life Sciences, Nankai University, Tianjin, China
| | - Zhao Cai
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, 60 Nanyang Drive, Singapore
| | - Zeqiong Cai
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Molecular Microbiology and Technology of the Ministry of Education, College of Life Sciences, Nankai University, Tianjin, China
| | - Yanhong Zhang
- Affiliated Hospital of Nankai University, Tianjin, China
| | - Tongtong Fu
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Molecular Microbiology and Technology of the Ministry of Education, College of Life Sciences, Nankai University, Tianjin, China
| | - Yongxin Jin
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Molecular Microbiology and Technology of the Ministry of Education, College of Life Sciences, Nankai University, Tianjin, China
| | - Zhihui Cheng
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Molecular Microbiology and Technology of the Ministry of Education, College of Life Sciences, Nankai University, Tianjin, China
| | - Shouguang Jin
- Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, FL, USA
| | - Weihui Wu
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Molecular Microbiology and Technology of the Ministry of Education, College of Life Sciences, Nankai University, Tianjin, China
| | - Liang Yang
- School of Medicine, Southern University of Science and Technology (SUSTech), Shenzhen, China
| | - Fang Bai
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Molecular Microbiology and Technology of the Ministry of Education, College of Life Sciences, Nankai University, Tianjin, China
| |
Collapse
|
10
|
Chang MX, Zhang JF, Sun YH, Li RS, Lin XL, Yang L, Webber MA, Jiang HX. Contribution of Different Mechanisms to Ciprofloxacin Resistance in Salmonella spp. Front Microbiol 2021; 12:663731. [PMID: 34025618 PMCID: PMC8137344 DOI: 10.3389/fmicb.2021.663731] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/09/2021] [Indexed: 11/28/2022] Open
Abstract
Development of fluoroquinolone resistance can involve several mechanisms that include chromosomal mutations in genes (gyrAB and parCE) encoding the target bacterial topoisomerase enzymes, increased expression of the AcrAB-TolC efflux system, and acquisition of transmissible quinolone-resistance genes. In this study, 176 Salmonella isolates from animals with a broad range of ciprofloxacin MICs were collected to analyze the contribution of these different mechanisms to different phenotypes. All isolates were classified according to their ciprofloxacin susceptibility pattern into five groups as follows: highly resistant (HR), resistant (R), intermediate (I), reduced susceptibility (RS), and susceptible (S). We found that the ParC T57S substitution was common in strains exhibiting lowest MICs of ciprofloxacin while increased MICs depended on the type of GyrA mutation. The ParC T57S substitution appeared to incur little cost to bacterial fitness on its own. The presence of PMQR genes represented an route for resistance development in the absence of target-site mutations. Switching of the plasmid-mediated quinolone resistance (PMQR) gene location from a plasmid to the chromosome was observed and resulted in decreased ciprofloxacin susceptibility; this also correlated with increased fitness and a stable resistance phenotype. The overexpression of AcrAB-TolC played an important role in isolates with small decreases in susceptibility and expression was upregulated by MarA more often than by RamA. This study increases our understanding of the relative importance of several resistance mechanisms in the development of fluoroquinolone resistance in Salmonella from the food chain.
Collapse
Affiliation(s)
- Man-Xia Chang
- Guangdong Key Laboratory of Veterinary Drug Development and Safety Evaluation, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China.,Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou, China
| | - Jin-Fei Zhang
- Guangdong Key Laboratory of Veterinary Drug Development and Safety Evaluation, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Yin-Huan Sun
- Guangdong Key Laboratory of Veterinary Drug Development and Safety Evaluation, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Rong-Sheng Li
- Guangdong Key Laboratory of Veterinary Drug Development and Safety Evaluation, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Xiao-Ling Lin
- Guangdong Key Laboratory of Veterinary Drug Development and Safety Evaluation, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Ling Yang
- Guangdong Key Laboratory of Veterinary Drug Development and Safety Evaluation, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Mark A Webber
- Quadram Institute Bioscience, Norwich Research Park, Norwich, United Kingdom.,Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Hong-Xia Jiang
- Guangdong Key Laboratory of Veterinary Drug Development and Safety Evaluation, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China.,Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou, China
| |
Collapse
|
11
|
Skarżyńska M, Zaja C M, Bomba A, Bocian Ł, Kozdruń W, Polak M, Wia Cek J, Wasyl D. Antimicrobial Resistance Glides in the Sky-Free-Living Birds as a Reservoir of Resistant Escherichia coli With Zoonotic Potential. Front Microbiol 2021; 12:656223. [PMID: 33897669 PMCID: PMC8062882 DOI: 10.3389/fmicb.2021.656223] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/05/2021] [Indexed: 12/15/2022] Open
Abstract
Antimicrobial resistance (AMR) is one of the most important global health concerns; therefore, the identification of AMR reservoirs and vectors is essential. Attention should be paid to the recognition of potential hazards associated with wildlife as this field still seems to be incompletely explored. In this context, the role of free-living birds as AMR carriers is noteworthy. Therefore, we applied methods used in AMR monitoring, supplemented by colistin resistance screening, to investigate the AMR status of Escherichia coli from free-living birds coming from natural habitats and rescue centers. Whole-genome sequencing (WGS) of strains enabled to determine resistance mechanisms and investigate their epidemiological relationships and virulence potential. As far as we know, this study is one of the few that applied WGS of that number (n = 71) of strains coming from a wild avian reservoir. The primary concerns arising from our study relate to resistance and its determinants toward antimicrobial classes of the highest priority for the treatment of critical infections in people, e.g., cephalosporins, quinolones, polymyxins, and aminoglycosides, as well as fosfomycin. Among the numerous determinants, bla CTX-M-15, bla CMY-2, bla SHV-12, bla TEM-1B, qnrS1, qnrB19, mcr-1, fosA7, aac(3)-IIa, ant(3")-Ia, and aph(6)-Id and chromosomal gyrA, parC, and parE mutations were identified. Fifty-two sequence types (STs) noted among 71 E. coli included the global lineages ST131, ST10, and ST224 as well as the three novel STs 11104, 11105, and 11194. Numerous virulence factors were noted with the prevailing terC, gad, ompT, iss, traT, lpfA, and sitA. Single E. coli was Shiga toxin-producing. Our study shows that the clonal spread of E. coli lineages of public and animal health relevance is a serious avian-associated hazard.
Collapse
Affiliation(s)
- Magdalena Skarżyńska
- Department of Microbiology, National Veterinary Research Institute, Puławy, Poland
| | - Magdalena Zaja C
- Department of Microbiology, National Veterinary Research Institute, Puławy, Poland
| | - Arkadiusz Bomba
- Department of Omics Analyses, National Veterinary Research Institute, Puławy, Poland
| | - Łukasz Bocian
- Department of Epidemiology and Risk Assessment, National Veterinary Research Institute, Puławy, Poland
| | - Wojciech Kozdruń
- Department of Poultry Diseases, National Veterinary Research Institute, Puławy, Poland
| | - Marcin Polak
- Department of Zoology and Nature Protection, Institute of Biological Sciences, Maria Curie-Skłodowska University, Lublin, Poland
| | - Jarosław Wia Cek
- Department of Zoology and Nature Protection, Institute of Biological Sciences, Maria Curie-Skłodowska University, Lublin, Poland
| | - Dariusz Wasyl
- Department of Microbiology, National Veterinary Research Institute, Puławy, Poland.,Department of Omics Analyses, National Veterinary Research Institute, Puławy, Poland
| |
Collapse
|
12
|
Whole-Genome Sequencing Reveals the Presence of the blaCTX-M-65 Gene in Extended-Spectrum β-Lactamase-Producing and Multi-Drug-Resistant Clones of Salmonella Serovar Infantis Isolated from Broiler Chicken Environments in the Galapagos Islands. Antibiotics (Basel) 2021; 10:antibiotics10030267. [PMID: 33807748 PMCID: PMC8000398 DOI: 10.3390/antibiotics10030267] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/19/2021] [Accepted: 02/25/2021] [Indexed: 12/24/2022] Open
Abstract
Salmonella Infantis, a common contaminant of poultry products, is known to harbor mobile genetic elements that confer multi-drug resistance (MDR) and have been detected in many continents. Here, we report four MDR S. Infantis strains recovered from poultry house environments in Santa Cruz Island of the Galapagos showing extended-spectrum β-lactamase (ESBL) resistance and reduced fluoroquinolone susceptibility. Whole-genome sequencing (WGS) revealed the presence of the ESBL-conferring blaCTX-M-65 gene in an IncFIB-like plasmid in three S. Infantis isolates. Multi-locus sequence typing (MLST) and single nucleotide variant/polymorphism (SNP) SNVPhyl analysis showed that the S. Infantis isolates belong to sequence type ST32, likely share a common ancestor, and are closely related (1–3 SNP difference) to blaCTX-M-65-containing clinical and veterinary S. Infantis isolates from the United States and Latin America. Furthermore, phylogenetic analysis of SNPs following core-genome alignment (i.e., ParSNP) inferred close relatedness between the S. Infantis isolates from Galapagos and the United States. Prophage typing confirmed the close relationship among the Galapagos S. Infantis and was useful in distinguishing them from the United States isolates. This is the first report of MDR blaCTX-M-65-containing S. Infantis in the Galapagos Islands and highlights the need for increased monitoring and surveillance programs to determine prevalence, sources, and reservoirs of MDR pathogens.
Collapse
|
13
|
Jamilah J, Hatta M, Natzir R, Umar F, Sjahril R, Agus R, Junita AR, Dwiyanti R, Primaguna MR, Sabir M. Analysis of existence of multidrug-resistant H58 gene in Salmonella enterica serovar Typhi isolated from typhoid fever patients in Makassar, Indonesia. New Microbes New Infect 2020; 38:100793. [PMID: 33294191 PMCID: PMC7695904 DOI: 10.1016/j.nmni.2020.100793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/02/2022] Open
Abstract
The surveillance of multidrug-resistant (MDR) H58 typhoid is highly important, especially in endemic areas. MDR strain detection is needed by using a simple PCR technique that only uses a pair of primers. This is conducted considering the detection of Salmonella Typhi strains that have been carried out so far are only using antimicrobial sensitivity tests to determine microbial resistance phenotypically and to determine genotypically using complex molecular techniques. We aimed to analyse the existence of Salmonella Typhi MDR H58 in patients with typhoid fever in Makassar, Indonesia. A total of 367 blood samples of typhoid fever patients were collected from April 2018 until April 2019. The blood sample was cultured, then confirmed via simple PCR. All of the confirmed samples were tested for susceptibility against antibiotics and molecularly analysed for MDR H58 existence using a simple PCR technique. We found 7% (27/367) of the samples to be positive by both blood culture and PCR. All 27 isolates were found to be sensitive to sulfamethoxazole/trimethoprim. The lowest drug sensitivities were to amoxicillin, at one (3.7%) of 27 isolates, and ampicillin, at 13 (48.1%) of 27 isolates. Salmonella Typhi H58 PCR results showed that one (3.7%) of 27 isolates carried a positive fragment of 993 bp that led to the H58 strain, since the deletion flanks this fragment. The isolate was also found to be resistant to amoxicillin and fluoroquinolone according to a sensitivity test. Further molecular analysis needs to be conducted to examine the single isolate that carried the 933 bp fragment.
Collapse
Affiliation(s)
- J Jamilah
- Alauddin State Islamic University, Makassar, Indonesia.,Postgraduate Program of Medical Science, Indonesia
| | - M Hatta
- Molecular Biology and Immunology Laboratory, Indonesia
| | - R Natzir
- Department of Biochemistry, Indonesia
| | - F Umar
- Postgraduate Program of Medical Science, Indonesia.,Makassar Medical State Laboratory, Indonesian Ministry of Health, Makassar, Indonesia
| | - R Sjahril
- Department of Medical Microbiology, Indonesia
| | - R Agus
- Laboratory of Genetics, Department of Biology, Faculty of Science, University of Hasanuddin, Makassar, Indonesia
| | - A R Junita
- Molecular Biology and Immunology Laboratory, Indonesia
| | - R Dwiyanti
- Department of Medical Microbiology, Faculty of Medicine, Tadulako University, Palu, Indonesia
| | - M R Primaguna
- Department of Internal Medicine, Faculty of Medicine, Indonesia
| | - M Sabir
- Department of Medical Microbiology, Faculty of Medicine, Tadulako University, Palu, Indonesia
| |
Collapse
|
14
|
Garzón V, Bustos RH, G. Pinacho D. Personalized Medicine for Antibiotics: The Role of Nanobiosensors in Therapeutic Drug Monitoring. J Pers Med 2020; 10:E147. [PMID: 32993004 PMCID: PMC7712907 DOI: 10.3390/jpm10040147] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 01/01/2023] Open
Abstract
Due to the high bacterial resistance to antibiotics (AB), it has become necessary to adjust the dose aimed at personalized medicine by means of therapeutic drug monitoring (TDM). TDM is a fundamental tool for measuring the concentration of drugs that have a limited or highly toxic dose in different body fluids, such as blood, plasma, serum, and urine, among others. Using different techniques that allow for the pharmacokinetic (PK) and pharmacodynamic (PD) analysis of the drug, TDM can reduce the risks inherent in treatment. Among these techniques, nanotechnology focused on biosensors, which are relevant due to their versatility, sensitivity, specificity, and low cost. They provide results in real time, using an element for biological recognition coupled to a signal transducer. This review describes recent advances in the quantification of AB using biosensors with a focus on TDM as a fundamental aspect of personalized medicine.
Collapse
Affiliation(s)
- Vivian Garzón
- PhD Biosciences Program, Universidad de La Sabana, Chía 140013, Colombia;
| | - Rosa-Helena Bustos
- Therapeutical Evidence Group, Clinical Pharmacology, Universidad de La Sabana, Chía 140013, Colombia;
| | - Daniel G. Pinacho
- Therapeutical Evidence Group, Clinical Pharmacology, Universidad de La Sabana, Chía 140013, Colombia;
| |
Collapse
|
15
|
Dong N, Li Y, Zhao J, Ma H, Wang J, Liang B, Du X, Wu F, Xia S, Yang X, Liu H, Yang C, Qiu S, Song H, Jia L, Li Y, Sun Y. The phenotypic and molecular characteristics of antimicrobial resistance of Salmonella enterica subsp. enterica serovar Typhimurium in Henan Province, China. BMC Infect Dis 2020; 20:511. [PMID: 32669095 PMCID: PMC7362628 DOI: 10.1186/s12879-020-05203-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/29/2020] [Indexed: 02/07/2023] Open
Abstract
Background Salmonella enterica subsp. enterica serovar Typhimurium infections continue to be a significant public health threat worldwide. The aim of this study was to investigate antibiotic resistance among 147 S. Typhimurium isolates collected from patients in Henan, China from 2006 to 2015. Methods 147 S. Typhimurium isolates were collected from March 2006 to November 2015 in Henan Province, China. Antimicrobial susceptibility testing was performed, and the resistant genes of ciprofloxacin, cephalosporins (ceftriaxone and cefoxitin) and azithromycin were detected and sequenced. Clonal relationships were assessed by multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). Results Of the 147 isolates, 91.1% were multidrug resistant (MDR), with 4.1% being resistant to all antibiotic classes tested. Of concern, 13 MDR isolates were co-resistant to the first-line treatments cephalosporins and ciprofloxacin, while three were also resistant to azithromycin. Seven PFGE patterns were identified among the 13 isolates. All of the isolates could be assigned to one of four main groups, with a similarity value of 89%. MLST assigned the 147 isolates into five STs, including two dominant STs (ST19 and ST34). Of the 43 ciprofloxacin-resistant isolates, 39 carried double gyrA mutations (Ser83Phe, Asp87Asn/Tyr/Gly) and a single parC (Ser80Arg) mutation, including 1 isolate with four mutations (gyrA: Ser83Phe, Asp87Gly; parC: Ser80Arg; parE: Ser458Pro). In addition, 12 isolates not only carried mutations in gyrA and parC but also had at least one plasmid-mediated quinolone resistance (PMQR) gene. Among the 32 cephalosporin-resistant isolates, the most common extended-spectrum β-lactamase (ESBL) gene was blaOXA-1, followed by blaCTX-M, blaTEM-1, and blaCMY-2. Moreover, the mphA gene was identified in 5 of the 15 azithromycin-resistant isolates. Four MDR isolates contained ESBL and PMQR genes, and one of them also carried mphA in addition. Conclusion The high level of antibiotic resistance observed in S. Typhimurium poses a great danger to public health, so continuous surveillance of changes in antibiotic resistance is necessary.
Collapse
Affiliation(s)
- Nian Dong
- Chinese PLA Center for Disease Control and Prevention, 20th Dongda Street, Beijing, 100071, Fengtai District, China.,Xingcheng Special Service Recuperation Center of PLA Strategic Support Force, 210th Xinghai South Road, Xingcheng, 125100, China
| | - Yongrui Li
- Luoyang No.1 Hospital of TCM, 7th Jiudu Road, Luoyang, 471000, China.,The Key laboratory of Pharmacology and Molecular Biology, Medical College, Henan University of Science and Technology, 263th Kaiyuan Street, Luolong District, Luoyang, 471023, China
| | - Jiayong Zhao
- Institute for Infectious Disease Control and Prevention, Henan Center for Disease Control and Prevention, Zhengzhou, China
| | - Hui Ma
- The Health Bureau of Logistical Support Department, Central Military Commission of China, 22 Fuxing Road, Beijing, 100036, Haidian District, China
| | - Jinyan Wang
- Chinese PLA Center for Disease Control and Prevention, 20th Dongda Street, Beijing, 100071, Fengtai District, China
| | - Beibei Liang
- Chinese PLA Center for Disease Control and Prevention, 20th Dongda Street, Beijing, 100071, Fengtai District, China
| | - Xinying Du
- Chinese PLA Center for Disease Control and Prevention, 20th Dongda Street, Beijing, 100071, Fengtai District, China
| | - Fuli Wu
- Chinese PLA Center for Disease Control and Prevention, 20th Dongda Street, Beijing, 100071, Fengtai District, China
| | - Shengli Xia
- Institute for Infectious Disease Control and Prevention, Henan Center for Disease Control and Prevention, Zhengzhou, China
| | - Xiaoxia Yang
- Chinese PLA Center for Disease Control and Prevention, 20th Dongda Street, Beijing, 100071, Fengtai District, China
| | - Hongbo Liu
- Chinese PLA Center for Disease Control and Prevention, 20th Dongda Street, Beijing, 100071, Fengtai District, China
| | - Chaojie Yang
- Chinese PLA Center for Disease Control and Prevention, 20th Dongda Street, Beijing, 100071, Fengtai District, China
| | - Shaofu Qiu
- Chinese PLA Center for Disease Control and Prevention, 20th Dongda Street, Beijing, 100071, Fengtai District, China
| | - Hongbin Song
- Chinese PLA Center for Disease Control and Prevention, 20th Dongda Street, Beijing, 100071, Fengtai District, China
| | - Leili Jia
- Chinese PLA Center for Disease Control and Prevention, 20th Dongda Street, Beijing, 100071, Fengtai District, China.
| | - Yan Li
- The Key laboratory of Pharmacology and Molecular Biology, Medical College, Henan University of Science and Technology, 263th Kaiyuan Street, Luolong District, Luoyang, 471023, China.
| | - Yansong Sun
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, 20 Dongda Street, Beijing, 100071, Fengtai District, China.
| |
Collapse
|
16
|
Wang W, Zhao L, Hu Y, Dottorini T, Fanning S, Xu J, Li F. Epidemiological Study on Prevalence, Serovar Diversity, Multidrug Resistance, and CTX-M-Type Extended-Spectrum β-Lactamases of Salmonella spp. from Patients with Diarrhea, Food of Animal Origin, and Pets in Several Provinces of China. Antimicrob Agents Chemother 2020; 64:e00092-20. [PMID: 32312775 PMCID: PMC7318004 DOI: 10.1128/aac.00092-20] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/14/2020] [Indexed: 12/19/2022] Open
Abstract
A total of 2,283 Salmonella isolates were recovered from 18,334 samples, including samples from patients with diarrhea, food of animal origin, and pets, across 5 provinces of China. The highest prevalence of Salmonella spp. was detected in chicken meats (39.3%, 486/1,237). Fifteen serogroups and 66 serovars were identified, with Salmonella enterica serovars Typhimurium and Enteritidis being the most dominant. Most (85.5%, 1,952/2,283) isolates exhibited resistance to ≥1 antimicrobial, and 56.4% were multidrug resistant (MDR). A total of 222 isolates harbored extended-spectrum β-lactamases (ESBLs), and 200 of these were of the CTX-M type and were mostly detected in isolates from chicken meat and turtle fecal samples. Overall, eight blaCTX-M genes were identified, with blaCTX-M-65, blaCTX-M-123, blaCTX-M-14, blaCTX-M-79, and blaCTX-M-130 being the most prevalent. In total, 166 of the 222 ESBL-producing isolates had amino acid substitutions in GyrA (S83Y, S83F, D87G, D87N, and D87Y) and ParC (S80I), while the plasmid-mediated quinolone resistance (PMQR)-encoding genes oqxA, oqxB, qepA, qnrB, and qnrS were detected in almost all isolates. Of the 15 sequence types (STs) identified in the 222 ESBLs, ST17, ST11, ST34, and ST26 ranked among the top 5 in number of isolates. Our study revealed considerable serovar diversity and a high prevalence of the co-occurrence of MDR determinants, including CTX-M-type ESBLs, quinolone resistance-determining region (QRDR) mutations, and PMQR genes. This is the first report of CTX-M-130 Salmonella spp. from patients with diarrhea and QRDR mutations from turtle fecal samples. Our study emphasizes the importance of actions, both in health care settings and in the veterinary medicine sector, to control the dissemination of MDR, especially the CTX-M-type ESBL-harboring Salmonella isolates.
Collapse
Affiliation(s)
- Wei Wang
- NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, China
| | - Li Zhao
- School of Public Health, Shandong University, Jinan, China
| | - Yujie Hu
- NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, China
| | - Tania Dottorini
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, United Kingdom
| | - Séamus Fanning
- NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, China
- UCD-Centre for Food Safety, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - Jin Xu
- NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, China
| | - Fengqin Li
- NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, China
| |
Collapse
|
17
|
Sheng H, Huang J, Han Z, Liu M, Lü Z, Zhang Q, Zhang J, Yang J, Cui S, Yang B. Genes and Proteomes Associated With Increased Mutation Frequency and Multidrug Resistance of Naturally Occurring Mismatch Repair-Deficient Salmonella Hypermutators. Front Microbiol 2020; 11:770. [PMID: 32457709 PMCID: PMC7225559 DOI: 10.3389/fmicb.2020.00770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/31/2020] [Indexed: 11/23/2022] Open
Abstract
The emergence of antibiotic-resistant Salmonella through mutations led to mismatch repair (MMR) deficiency that represents a potential hazard to public health. Here, four representative MMR-deficient Salmonella hypermutator strains and Salmonella Typhimurium LT2 were used to comprehensively reveal the influence of MMR deficiency on antibiotic resistance among Salmonella. Our results indicated that the mutation frequency ranged from 3.39 × 10–4 to 5.46 × 10–2 in the hypermutator. Mutation sites in MutS, MutL, MutT, and UvrD of the four hypermutators were all located in the essential and core functional regions. Mutation frequency of the hypermutator was most highly correlated with the extent of mutation in MutS. Mutations in MMR genes (mutS, mutT, mutL, and uvrD) were correlated with increased mutation in antibiotic resistance genes, and the extent of antibiotic resistance was significantly correlated with the number of mutation sites in MutL and in ParC. The number of mutation sites in MMR genes and antibiotic resistance genes exhibited a significant positive correlation with the number of antibiotics resisted and with expression levels of mutS, mutT, and mutL. Compared to Salmonella Typhimurium LT2, a total of 137 differentially expressed and 110 specifically expressed proteins were identified in the four hypermutators. Functional enrichment analysis indicated that the proteins significantly overexpressed in the hypermutators primarily associated with translation and stress response. Interaction network analysis revealed that the ribosome pathway might be a critical factor for high mutation frequency and multidrug resistance in MMR-deficient Salmonella hypermutators. These results help elucidate the mutational dynamics that lead to hypermutation, antibiotic resistance, and activation of stress response pathways in Salmonella.
Collapse
Affiliation(s)
- Huanjing Sheng
- College of Food Science and Engineering, Northwest A&F University, Xianyang, China
| | - Jinling Huang
- College of Food Science and Engineering, Northwest A&F University, Xianyang, China
| | - Zhaoyu Han
- School of Pharmaceutical Sciences, Jiangnan University, Wuxi, China
| | - Mi Liu
- College of Food Science and Engineering, Northwest A&F University, Xianyang, China
| | - Zexun Lü
- College of Food Science and Engineering, Northwest A&F University, Xianyang, China
| | - Qian Zhang
- College of Food Science and Engineering, Northwest A&F University, Xianyang, China
| | - Jinlei Zhang
- College of Food Science and Engineering, Northwest A&F University, Xianyang, China
| | - Jun Yang
- College of Food Science and Engineering, Northwest A&F University, Xianyang, China
| | - Shenghui Cui
- National Institutes for Food and Drug Control, Beijing, China
| | - Baowei Yang
- College of Food Science and Engineering, Northwest A&F University, Xianyang, China
| |
Collapse
|
18
|
Five Closed Salmonella enterica Genome Sequences from a 2017-2018 Multistrain, Multistate Kratom Outbreak. Microbiol Resour Announc 2020; 9:9/3/e01395-19. [PMID: 31948965 PMCID: PMC6965583 DOI: 10.1128/mra.01395-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We report here the closed genomes of Salmonella enterica strains from the 2017–2018 multistrain, multistate kratom outbreak using single-molecule real-time DNA sequencing. Four of the genomes consist of one circular chromosome, and the fifth has a circular chromosome and a single plasmid. We report here the closed genomes of Salmonella enterica strains from the 2017–2018 multistrain, multistate kratom outbreak using single-molecule real-time DNA sequencing. Four of the genomes consist of one circular chromosome, and the fifth has a circular chromosome and a single plasmid.
Collapse
|
19
|
Acheampong G, Owusu M, Owusu-Ofori A, Osei I, Sarpong N, Sylverken A, Kung HJ, Cho ST, Kuo CH, Park SE, Marks F, Adu-Sarkodie Y, Owusu-Dabo E. Chromosomal and plasmid-mediated fluoroquinolone resistance in human Salmonella enterica infection in Ghana. BMC Infect Dis 2019; 19:898. [PMID: 31660876 PMCID: PMC6819380 DOI: 10.1186/s12879-019-4522-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/30/2019] [Indexed: 11/19/2022] Open
Abstract
Background Salmonella infection poses significant public health threat globally, especially in resource-limited countries. Emergence and spread of antibiotic resistant strains to fluoroquinolones have led to treatment failures and increased mortality in Salmonella infection. However, there is dearth of information regarding mechanisms of resistance to fluoroquinolones in Ghana. This study therefore sought to identify chromosomal mutations and plasmid-mediated resistance as possible mechanisms of fluoroquinolone resistance from clinical isolates in Ghana. Methods This was a retrospective study of archived isolates biobanked at Kumasi Centre for Collaborative Research in Tropical Medicine, Ghana. Isolates were obtained from blood, stool and oropharynx samples at two hospitals, between May, 2016 and January, 2018. Salmonella identification was done using standard microbiological protocols and antibiotic susceptibility testing performed by Kirby-Bauer disc diffusion method. Isolates with intermediate susceptibility and/or resistance to nalidixic acid and/or ciprofloxacin were selected and examined for chromosomal mutations by Sanger sequencing and plasmid-mediated resistance by PCR. Results Of 133 biobanked isolates cultured, 68 (51.1%) and 16 (12%) were identified as Salmonella Typhi and non-typhoidal Salmonella (NTS), respectively. Sequence analysis of gyrA gene revealed the presence of 5 different nonsynonymous mutations, with the most frequent mutation (Ile203Ser) occurring in 12 out of 13 isolates tested. Gyrase B (gyrB) gene had 1 nonsynonymous mutation in 3 out of 13 isolates, substituting phenylalanine with leucine at codon 601 (Phe601Leu). No mutation was observed in parC and parE genes. Two NTS isolates were found to harbour qnrS plasmid-mediated resistant gene of molecular size 550 bp with high ciprofloxacin MIC of 0.5 μg/ml. Conclusion This study reports for the first time in Ghana plasmid-mediated fluoroquinolone resistant gene qnrS in Salmonella clinical isolates. Nonsynonymous mutations of gyrA and gyrB genes likely to confer Salmonella reduced susceptibility to ciprofloxacin were also reported.
Collapse
Affiliation(s)
- Godfred Acheampong
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Michael Owusu
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana.,Department of Medical Laboratory Technology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Alex Owusu-Ofori
- Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Isaac Osei
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | | | - Augustina Sylverken
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana.,Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Hung-Jui Kung
- Institute of Plant and Microbial Biology, Academia Sinica, Taipei, Taiwan
| | - Shu-Ting Cho
- Institute of Plant and Microbial Biology, Academia Sinica, Taipei, Taiwan
| | - Chih-Horng Kuo
- Institute of Plant and Microbial Biology, Academia Sinica, Taipei, Taiwan
| | - Se Eun Park
- Department of Epidemiology, International Vaccine Institute, Seoul, South Korea.,Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, Quant 5, Ho Chi Minh City, Vietnam
| | - Florian Marks
- Department of Epidemiology, International Vaccine Institute, Seoul, South Korea
| | - Yaw Adu-Sarkodie
- Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ellis Owusu-Dabo
- Department of Global and International Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| |
Collapse
|
20
|
Koide K, Kongsoi S, Nakajima C, Suzuki Y. WQ-3810 exerts high inhibitory effect on quinolone-resistant DNA gyrase of Salmonella Typhimurium. Biosci Biotechnol Biochem 2019; 83:2249-2256. [PMID: 31382821 DOI: 10.1080/09168451.2019.1650634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The inhibitory effect of WQ-3810 on DNA gyrase was assayed to evaluate the potential of WQ-3810 as a candidate drug for the treatment of quinolone resistant Salmonella Typhymurium infection. The inhibitory effect of WQ-3810, ciprofloxacin and nalidixic acid was compared by accessing the drug concentration that halves the enzyme activity (IC50) of purified S. Typhimurium wildtype and mutant DNA gyrase with amino acid substitution at position 83 or/and 87 in subunit A (GyrA) causing quinolone resistance. As a result, WQ-3810 reduced the enzyme activity of both wildtype and mutant DNA gyrase at a lower concentration than ciprofloxacin and nalidixic acid. Remarkably, WQ-3810 showed a higher inhibitory effect on DNA gyrase with amino acid substitutions at position 87 than with that at position 83 in GyrA. This study revealed that WQ-3810 could be an effective therapeutic agent, especially against quinolone resistant Salmonella enterica having amino acid substitution at position 87.
Collapse
Affiliation(s)
- Kentaro Koide
- Division of Bioresources, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
| | - Siriporn Kongsoi
- Department of Veterinary Public Health, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
| | - Chie Nakajima
- Division of Bioresources, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan.,Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
| | - Yasuhiko Suzuki
- Division of Bioresources, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan.,Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
| |
Collapse
|
21
|
Salmonella enterica subsp. enterica Serovar Heidelberg Food Isolates Associated with a Salmonellosis Outbreak Have Enhanced Stress Tolerance Capabilities. Appl Environ Microbiol 2019; 85:AEM.01065-19. [PMID: 31175193 DOI: 10.1128/aem.01065-19] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/03/2019] [Indexed: 11/20/2022] Open
Abstract
Salmonella enterica serovar Heidelberg is currently the 12th most common serovar of Salmonella enterica causing salmonellosis in the United States and results in twice the average incidence of blood infections caused by nontyphoidal salmonellae. Multiple outbreaks of salmonellosis caused by Salmonella Heidelberg resulted from the same poultry processor, which infected 634 people during 2013 and 2014. The hospitalization and invasive illness rates were 38% and 15%, respectively. We hypothesized that the outbreak strains of Salmonella Heidelberg had enhanced stress tolerance and virulence capabilities. We sourced nine food isolates collected during the outbreak investigation and three reference isolates to assess their tolerance to heat and sanitizers, ability to attach to abiotic surfaces, and invasiveness in vitro We performed RNA sequencing on three isolates (two outbreak-associated isolates and a reference Salmonella Heidelberg strain) with various levels of heat tolerance to gain insight into the mechanism behind the isolates' enhanced heat tolerance. We also performed genomic analyses to determine the genetic relationships among the outbreak isolates. Ultimately, we determined that (i) six Salmonella Heidelberg isolates associated with the foodborne outbreak had enhanced heat tolerance, (ii) one outbreak isolate with enhanced heat tolerance also had an enhanced biofilm-forming ability under stressful conditions, (iii) exposure to heat stress increased the expression of Salmonella Heidelberg multidrug efflux and virulence genes, and (iv) outbreak-associated isolates were likely transcriptionally primed to better survive processing stresses and, potentially, to cause illness.IMPORTANCE This study provides a deep analysis of the intrinsic stress tolerance and virulence capabilities of Salmonella Heidelberg that may have contributed to the length and severity of a recent salmonellosis outbreak. Additionally, this study provides a comprehensive analysis of the transcriptomic response of S. enterica strains to heat stress conditions and compares baseline stationary-phase gene expression among outbreak- and non-outbreak-associated Salmonella Heidelberg isolates. These data can be used in assay development to screen isolates for stress tolerance and subsequent survival. This study adds to our understanding of the strains associated with the outbreak and informs ongoing regulatory discussions on Salmonella in poultry.
Collapse
|
22
|
Yang Y, Feye KM, Shi Z, Pavlidis HO, Kogut M, J Ashworth A, Ricke SC. A Historical Review on Antibiotic Resistance of Foodborne Campylobacter. Front Microbiol 2019; 10:1509. [PMID: 31402900 PMCID: PMC6676416 DOI: 10.3389/fmicb.2019.01509] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/17/2019] [Indexed: 01/06/2023] Open
Abstract
Campylobacter is one of the most commonly reported foodborne human bacterial gastrointestinal pathogens. Campylobacter is the etiological agent of campylobacteriosis, which is generally a self-limited illness and therefore does not require treatment. However, when patients are immunocompromised or have other co-morbidities, antimicrobial treatment may be necessary for clinical treatment of campylobacteriosis, macrolides and fluoroquinolones are the drugs of choices. However, the increase in antimicrobial resistance of Campylobacter to clinically important antibiotics may become insurmountable. Because of the transmission between poultry and humans, the poultry industry must now allocate resources to address the problem by reducing Campylobacter as well as antimicrobial use, which may reduce resistance. This review will focus on the incidence of antibiotic-resistant Campylobacter in poultry, the clinical consequences of this resistance, and the mechanisms of antibiotic resistance associated with Campylobacter.
Collapse
Affiliation(s)
- Yichao Yang
- Department of Poultry Science, University of Arkansas Fayetteville, Fayetteville, AR, United States
| | - Kristina M Feye
- Southern Plains Agricultural Research Center, Agricultural Research Service, United States Department of Agriculture, College Station, TX, United States
| | - Zhaohao Shi
- Center of Food Safety, Department of Food Science, University of Arkansas, Fayetteville, AR, United States
| | | | - Michael Kogut
- Southern Plains Agricultural Research Center, Agricultural Research Service, United States Department of Agriculture, College Station, TX, United States
| | - Amanda J Ashworth
- Poultry Production and Product Safety Research Unit (USDA-ARS), Fayetteville, AR, United States
| | - Steven C Ricke
- Southern Plains Agricultural Research Center, Agricultural Research Service, United States Department of Agriculture, College Station, TX, United States
| |
Collapse
|
23
|
Devanga Ragupathi NK, Muthuirulandi Sethuvel DP, Gajendran R, Anandan S, Walia K, Veeraraghavan B. Horizontal Transfer of Antimicrobial Resistance Determinants Among Enteric Pathogens Through Bacterial Conjugation. Curr Microbiol 2019; 76:666-672. [PMID: 30941540 DOI: 10.1007/s00284-019-01676-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 03/22/2019] [Indexed: 11/25/2022]
Abstract
Multi-drug resistance and transfer of mobile genetic elements among enteric pathogens is being reported to have increased rapidly. Commensal Escherichia coli was previously known to acquire mobile genetic elements from other genus/species. E. coli is also capable of disseminating these elements containing antimicrobial resistance determinants through horizontal transfer. Similarly, for Shigellae the antimicrobial resistance are on rise for fluoroquinolones and cephalosporins due to accumulation of mobile elements. Thus the study was hypothesized to investigate the role of transferable plasmids in commensal MDR E. coli vs Salmonella spp, and MDR Shigella flexneri vs Salmonella spp. pKP3-A plasmid containing qnrS1 was successfully transferred from E. coli to Salmonella spp. Similarly, a plasmid containing qnrS1 and blaCTX-M-15 was transferred from Shigella to Salmonella spp. However, blaCTX-M-15 was not transferred from E. coli as it was integrated into chromosome that was revealed by next-generation sequencing. This might be a reason that fluoroquinolone-resistant determinants are more frequently transferred than the cephalosporin resistant determinants. Findings from the study emphasize that mobile elements with AMR determinants are significant public health concern that has potential to rapidly disseminate.
Collapse
Affiliation(s)
| | | | - Revathi Gajendran
- Department of Clinical Microbiology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India
| | - Shalini Anandan
- Department of Clinical Microbiology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India
| | - Kamini Walia
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, 110 029, India
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India.
| |
Collapse
|
24
|
Day MR, Doumith M, Do Nascimento V, Nair S, Ashton PM, Jenkins C, Dallman TJ, Stevens FJ, Freedman J, Hopkins KL, Woodford N, De Pinna EM, Godbole G. Comparison of phenotypic and WGS-derived antimicrobial resistance profiles of Salmonella enterica serovars Typhi and Paratyphi. J Antimicrob Chemother 2019; 73:365-372. [PMID: 29216342 DOI: 10.1093/jac/dkx379] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/19/2017] [Indexed: 01/12/2023] Open
Abstract
Objectives Surveillance of antimicrobial resistance (AMR) in Salmonella enterica serovars Typhi and Paratyphi is essential to provide an evidence base for empirical treatment protocols and to monitor emerging AMR. We sought to compare phenotypic and WGS-based genotypic methods for the detection of AMR in Salmonella Typhi and Salmonella Paratyphi. Methods WGS data from 603 isolates of Salmonella Typhi (n = 332) and Salmonella Paratyphi (n = 271) were mapped to genes or chromosomal mutations known to be associated with phenotypic AMR and compared with phenotypic susceptibility data interpreted using breakpoints recommended by EUCAST. Results There were two (0.03%) discordant interpretations out of a possible 6030 isolate/antimicrobial class combinations. MDR (resistant to three or more classes of antimicrobial) was detected in 83/332 (25.0%) Salmonella Typhi isolates, but was not detected in Salmonella Paratyphi. Thirty-six (10.8%) isolates of Salmonella Typhi were resistant to ciprofloxacin (MIC >0.5 mg/L), with 33 (9.9%) of 332 exhibiting mutations in gyrA and parC, and 244 (73.5%) isolates had reduced susceptibility to ciprofloxacin (MIC 0.06-0.25 mg/L). In comparison, 209/227 (92.1%) isolates of Salmonella Paratyphi A exhibited resistance to ciprofloxacin (MIC >0.5 mg/L). No resistance to azithromycin or the third-generation cephalosporins was detected. Conclusions WGS data provided a robust and informative approach for monitoring MDR and emerging resistance to ciprofloxacin in Salmonella Typhi and Salmonella Paratyphi. Phenotypic antimicrobial susceptibility testing continues to be performed to guide targeted individual patient treatment, but inferred AMR profiles from WGS data may be used for surveillance and to guide empirical therapy.
Collapse
Affiliation(s)
- Martin R Day
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Michel Doumith
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Vivienne Do Nascimento
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Satheesh Nair
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Philip M Ashton
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Claire Jenkins
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Timothy J Dallman
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Flora J Stevens
- Travel and Migrant Health Section, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Joanne Freedman
- Travel and Migrant Health Section, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Katie L Hopkins
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Neil Woodford
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Elizabeth M De Pinna
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Gauri Godbole
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| |
Collapse
|
25
|
Koide K, Kongsoi S, Ouchi Y, Yamaguchi T, Nakajima C, Suzuki Y. Antibacterial Activity of DC-159a AgainstSalmonellaTyphimurium. Microb Drug Resist 2019; 25:14-22. [DOI: 10.1089/mdr.2018.0078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Kentaro Koide
- Division of Bioresources, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
| | - Siriporn Kongsoi
- Division of Bioresources, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
- Department of Veterinary Public Health, Faculty of Veterinary Medicine, Kasetsart University, Nakhon Pathom, Thailand
| | - Yuki Ouchi
- Division of Bioresources, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
| | - Tomoyuki Yamaguchi
- Division of Bioresources, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
| | - Chie Nakajima
- Division of Bioresources, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
| | - Yasuhiko Suzuki
- Division of Bioresources, Hokkaido University Research Center for Zoonosis Control, Sapporo, Japan
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo, Japan
| |
Collapse
|
26
|
Chowdhury SR, Majumder HK. DNA Topoisomerases in Unicellular Pathogens: Structure, Function, and Druggability. Trends Biochem Sci 2019; 44:415-432. [PMID: 30609953 DOI: 10.1016/j.tibs.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/20/2018] [Accepted: 12/03/2018] [Indexed: 02/06/2023]
Abstract
All organisms, including unicellular pathogens, compulsorily possess DNA topoisomerases for successful nucleic acid metabolism. But particular subtypes of topoisomerases exist, in all prokaryotes and in some unicellular eukaryotes, that are absent in higher eukaryotes. Moreover, topoisomerases from pathogenic members of a niche possess some unique molecular architecture and functionalities completely distinct from their nonpathogenic colleagues. This review will highlight the unique attributes associated with the structures and functions of topoisomerases from the unicellular pathogens, with special reference to bacteria and protozoan parasites. It will also summarise the progress made in the domain pertaining to the druggability of these topoisomerases, upon which a future platform for therapeutic development can be successfully constructed.
Collapse
Affiliation(s)
- Somenath Roy Chowdhury
- Laboratory of Molecular Parasitology, Infectious Diseases and Immunology Division, CSIR-Indian Institute of Chemical Biology, Kolkata 700 032, India
| | - Hemanta K Majumder
- Laboratory of Molecular Parasitology, Infectious Diseases and Immunology Division, CSIR-Indian Institute of Chemical Biology, Kolkata 700 032, India.
| |
Collapse
|
27
|
Subedi D, Vijay AK, Kohli GS, Rice SA, Willcox M. Association between possession of ExoU and antibiotic resistance in Pseudomonas aeruginosa. PLoS One 2018; 13:e0204936. [PMID: 30265709 PMCID: PMC6161911 DOI: 10.1371/journal.pone.0204936] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/17/2018] [Indexed: 12/22/2022] Open
Abstract
Virulent strains of Pseudomonas aeruginosa are often associated with an acquired cytotoxic protein, exoenzyme U (ExoU) that rapidly destroys the cell membranes of host cells by its phospholipase activity. Strains possessing the exoU gene are predominant in eye infections and are more resistant to antibiotics. Thus, it is essential to understand treatment options for these strains. Here, we have investigated the resistance profiles and genes associated with resistance for fluoroquinolone and beta-lactams. A total of 22 strains of P. aeruginosa from anterior eye infections, microbial keratitis (MK), and the lungs of cystic fibrosis (CF) patients were used. Based on whole genome sequencing, the prevalence of the exoU gene was 61.5% in MK isolates whereas none of the CF isolates possessed this gene. Overall, higher antibiotic resistance was observed in the isolates possessing exoU. Of the exoU strains, all except one were resistant to fluoroquinolones, 100% were resistant to beta-lactams. 75% had mutations in quinolone resistance determining regions (T81I gyrA and/or S87L parC) which correlated with fluoroquinolone resistance. In addition, exoU strains had mutations at K76Q, A110T, and V126E in ampC, Q155I and V356I in ampR and E114A, G283E, and M288R in mexR genes that are associated with higher beta-lactamase and efflux pump activities. In contrast, such mutations were not observed in the strains lacking exoU. The expression of the ampC gene increased by up to nine-fold in all eight exoU strains and the ampR was upregulated in seven exoU strains compared to PAO1. The expression of mexR gene was 1.4 to 3.6 fold lower in 75% of exoU strains. This study highlights the association between virulence traits and antibiotic resistance in pathogenic P. aeruginosa.
Collapse
Affiliation(s)
- Dinesh Subedi
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- * E-mail:
| | - Ajay Kumar Vijay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Gurjeet Singh Kohli
- The Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore
| | - Scott A. Rice
- The Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore
- The School of Biological Sciences, Nanyang Technological University, Singapore
- The ithree institute, The University of Technology Sydney, Sydney NSW Australia
| | - Mark Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| |
Collapse
|
28
|
Kuang D, Zhang J, Xu X, Shi W, Chen S, Yang X, Su X, Shi X, Meng J. Emerging high-level ciprofloxacin resistance and molecular basis of resistance in Salmonella enterica from humans, food and animals. Int J Food Microbiol 2018; 280:1-9. [DOI: 10.1016/j.ijfoodmicro.2018.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/31/2018] [Accepted: 05/01/2018] [Indexed: 10/17/2022]
|
29
|
Mąka Ł, Maćkiw E, Stasiak M, Wołkowicz T, Kowalska J, Postupolski J, Popowska M. Ciprofloxacin and nalidixic acid resistance of Salmonella spp. isolated from retail food in Poland. Int J Food Microbiol 2018; 276:1-4. [DOI: 10.1016/j.ijfoodmicro.2018.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/12/2018] [Accepted: 03/16/2018] [Indexed: 11/16/2022]
|
30
|
Srisanga S, Angkititrakul S, Sringam P, Le Ho PT, T Vo AT, Chuanchuen R. Phenotypic and genotypic antimicrobial resistance and virulence genes of Salmonella enterica isolated from pet dogs and cats. J Vet Sci 2018; 18:273-281. [PMID: 27586467 PMCID: PMC5639079 DOI: 10.4142/jvs.2017.18.3.273] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/05/2016] [Accepted: 08/26/2016] [Indexed: 12/13/2022] Open
Abstract
Salmonella enterica isolates (n = 122), including 32 serotypes from 113 dogs and 9 cats, were obtained from household dogs (n = 250) and cats (n = 50) during 2012-2015. The isolates were characterized by serotyping, antimicrobial resistance phenotyping and genotyping, and virulence gene screening. Serovars Weltevreden (15.6%) and Typhimurium (13.9%) were the most common. The majority (43%) of the isolates were multidrug resistant. The dog isolates (12.3%) harbored class 1 integrons, of which the dfrA12-aadA2 cassette was most frequent (66.7%). The only class integron in serovar Albany was located on a conjugative plasmid. Two ESBL-producing isolates (i.e., a serovar Krefeld and a serovar Enteritridis) carried blaTEM and blaCTX-M, and the blaTEM gene in both was horizontally transferred. Of the plasmid-mediated quinolone resistance genes tested, only qnrS (4.9%) was detected. Most Salmonella isolates harbored invA (100%), prgH (91.8%), and sipB (91%). Positive associations between resistance and virulence genes were observed for blaPSE-1/orgA, cmlA/span, tolC, and sul1/tolC (p < 0.05). The results suggest that companion dogs and cats are potential sources of S. enterica strains that carry resistance and virulence genes and that antimicrobial use in companion animals may select for the examined Salmonella virulence factors.
Collapse
Affiliation(s)
- Songsak Srisanga
- Research Unit in Microbial Food Safety and Antimicrobial Resistance, Department of Veterinary Public Health, Chulalongkorn University, Bangkok 10330, Thailand.,Center for Antimicrobial Resistance Monitoring in Foodborne Pathogens (in cooperation with WHO), Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand
| | - Sunpetch Angkititrakul
- Research Group for Prevention Technology in Livestock, Faculty of Veterinary Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Patcharee Sringam
- Research Group for Prevention Technology in Livestock, Faculty of Veterinary Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Phuong T Le Ho
- Research Unit in Microbial Food Safety and Antimicrobial Resistance, Department of Veterinary Public Health, Chulalongkorn University, Bangkok 10330, Thailand.,Department of Veterinary Biosciences, Faculty of Animal Sciences and Veterinary Medicine, Nong Lam University, Ho Chi Minh 70000, Vietnam
| | - An T T Vo
- Department of Veterinary Biosciences, Faculty of Animal Sciences and Veterinary Medicine, Nong Lam University, Ho Chi Minh 70000, Vietnam
| | - Rungtip Chuanchuen
- Research Unit in Microbial Food Safety and Antimicrobial Resistance, Department of Veterinary Public Health, Chulalongkorn University, Bangkok 10330, Thailand.,Center for Antimicrobial Resistance Monitoring in Foodborne Pathogens (in cooperation with WHO), Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand
| |
Collapse
|
31
|
Macías-Farrera GP, de Oca Jiménez RM, Varela-Guerrero J, Tenorio-Borroto E, Rivera-Ramírez F, Monroy-Salazar HG, Yong-Angel G. Antibiotics susceptibility of quinolones against Salmonella spp. strains isolated and molecularly sequenced for gyrA gene. Microb Pathog 2018; 114:286-290. [DOI: 10.1016/j.micpath.2017.11.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 02/04/2023]
|
32
|
Zhang WH, Zhang CZ, Liu ZJ, Gu XX, Li W, Yang L, Liu YH, Zeng ZL, Jiang HX. In VitroDevelopment of Ciprofloxacin Resistance ofSalmonella entericaSerovars Typhimurium, Enteritidis, and Indiana Isolates from Food Animals. Microb Drug Resist 2017; 23:687-694. [DOI: 10.1089/mdr.2016.0119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wen-Hui Zhang
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria, College of Veterinary Medicine, South China Agricultural University (SCAU), Guangzhou, China
| | - Chuan-Zhen Zhang
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria, College of Veterinary Medicine, South China Agricultural University (SCAU), Guangzhou, China
| | - Zhi-Jie Liu
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria, College of Veterinary Medicine, South China Agricultural University (SCAU), Guangzhou, China
| | - Xi-Xi Gu
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria, College of Veterinary Medicine, South China Agricultural University (SCAU), Guangzhou, China
| | - Wan Li
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria, College of Veterinary Medicine, South China Agricultural University (SCAU), Guangzhou, China
| | - Ling Yang
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria, College of Veterinary Medicine, South China Agricultural University (SCAU), Guangzhou, China
| | - Ya-Hong Liu
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria, College of Veterinary Medicine, South China Agricultural University (SCAU), Guangzhou, China
| | - Zhen-Ling Zeng
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria, College of Veterinary Medicine, South China Agricultural University (SCAU), Guangzhou, China
| | - Hong-Xia Jiang
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria, College of Veterinary Medicine, South China Agricultural University (SCAU), Guangzhou, China
| |
Collapse
|
33
|
Santhosh KS, Deekshit VK, Venugopal MN, Karunasagar I, Karunasagar I. Multiple Antimicrobial Resistance and Novel Point Mutation in Fluoroquinolone-Resistant Escherichia coli Isolates from Mangalore, India. Microb Drug Resist 2017; 23:994-1001. [PMID: 28445079 DOI: 10.1089/mdr.2016.0142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Fluoroquinolone resistance in bacteria is usually associated with mutations in the topoisomerase regions. We report a novel point mutation in fluoroquinolone-resistant Escherichia coli strains. E. coli isolated from the environment in and around Mangalore, India, were examined for their antimicrobial resistance profile to 12 antibiotics and for the antibiotic resistance genes by polymerase chain reaction. Of the 67 E. coli isolated, 24 (35.8%) were sensitive to all antibiotics and 43 (64.2%) showed resistance to at least one of the 12 antibiotics used in the study. One isolate (EC10) was resistant to nine of the 12 antibiotics used. Resistance to nalidixic acid was the most common (34.32%), followed by nitrofurantoin (26.86%), tetracycline (22.38%), ampicillin (20.89%), cotrimoxazole (13.43%), ciprofloxacin (11.94%), gentamicin (10.44%), piperacillin/tazobactam (7.46%), chloramphenicol (7.46%), and cefotaxime (4.47%). Least resistance was observed for meropenem (1.49%) and none of the isolates showed resistance to imipenem. All the isolates harbored resistance genes corresponding to their antimicrobial resistance. Few quinolone-resistant isolates carried single point mutation (ser83Leu) and some had double point mutation (Ser83Leu and Asp87Asn) in gyrA. A third novel point mutation was also observed at position 50 with the change in the amino acid from tyrosine to cysteine (Tyr50Cys) in gyrA region. The study throws light on a novel point mutation in fluoroquinolone-resistant isolates. While the study helps to understand the risk and occurrence of antibiotic resistance among gram-negative bacteria from the environment, the alarming rate of antibiotic-resistant bacteria is a cause of concern in addressing infections.
Collapse
Affiliation(s)
- Kogaluru Shivakumaraswamy Santhosh
- 1 Department of Fisheries Microbiology, Karnataka Veterinary, Animal and Fisheries Sciences University , College of Fisheries, Mangalore, India
| | - Vijaya Kumar Deekshit
- 2 UNESCO MIRCEN for Marine Biotechnology, Nitte University Center for Science Education and Research, University Enclave , Medical Sciences Complex, Deralakatte, Mangalore, India
| | - Moleyuru Nagarajappa Venugopal
- 1 Department of Fisheries Microbiology, Karnataka Veterinary, Animal and Fisheries Sciences University , College of Fisheries, Mangalore, India
| | - Iddya Karunasagar
- 3 Senior International Food Safety Consultant , Subba-Meena, Jayanagar, Mangalore, India
| | - Indrani Karunasagar
- 2 UNESCO MIRCEN for Marine Biotechnology, Nitte University Center for Science Education and Research, University Enclave , Medical Sciences Complex, Deralakatte, Mangalore, India
| |
Collapse
|
34
|
Wang J, Li Y, Xu X, Liang B, Wu F, Yang X, Ma Q, Yang C, Hu X, Liu H, Li H, Sheng C, Xie J, Du X, Hao R, Qiu S, Song H. Antimicrobial Resistance of Salmonella enterica Serovar Typhimurium in Shanghai, China. Front Microbiol 2017; 8:510. [PMID: 28400764 PMCID: PMC5368216 DOI: 10.3389/fmicb.2017.00510] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/13/2017] [Indexed: 11/13/2022] Open
Abstract
We aimed to analyze the antimicrobial resistance phenotypes and to elucidate the molecular mechanisms underlying resistance to cephalosporins, ciprofloxacin, and azithromycin in Salmonella enterica serovar Typhimurium isolates identified from patients with diarrhea in Shanghai. The isolates showed high rates of resistance to traditional antimicrobials, and 20.6, 12.7, and 5.5% of them exhibited decreased susceptibility to cephalosporins, ciprofloxacin, and azithromycin, respectively. Notably, 473 (84.6%) isolates exhibited multidrug resistance (MDR), including 161 (28.8%) isolates that showed an ACSSuT profile. Twenty-two MDR isolates concurrently exhibited decreased susceptibility to cephalosporins and ciprofloxacin, and six of them were co-resistant to azithromycin. Of all the 71 isolates with decreased susceptibility to ciprofloxacin, 65 showed at least one mutation (D87Y, D87N, or D87G) in gyrA, among which seven isolates simultaneously had mutations of parC (S80R) (n = 6) or parC (T57S/S80R) (n = 1), while 49 isolates with either zero or one mutation in gyrA contained plasmid-mediated quinolone resistance (PMQR) genes including qnrB, qnrS, and aac(6')-Ib-cr. Among the 115 cephalosporin-resistant isolates, the most common ESBL gene was blaCTX-M, followed by blaTEM-1, blaOXA-1, and blaSHV -12. Eight subtypes of blaCTX-M were identified and blaCTX-M-14 (n = 22) and blaCTX-M-55 (n = 31) were found to be dominant. To the best of our knowledge, this is the first report of the presence of blaCTX-M-123 and blaCTX-M-125 in S. Typhimurium. Besides, mphA gene was identified in 15 of the 31 azithromycin-resistant isolates. Among the 22 isolates with reduced susceptibility to cephalosporins and ciprofloxacin, 15 contained ESBL and PMQR genes. Coexistence of these genes lead to the emergence of MDR and the transmission of them will pose great difficulties in S. Typhimurium treatments. Therefore, surveillance for these MDR isolates should be enhanced.
Collapse
Affiliation(s)
- Jinyan Wang
- Institute of Disease Control and Prevention, Academy of Military Medical SciencesBeijing, China; Western Theater CommandTianshui, China
| | - Yongrui Li
- Institute of Disease Control and Prevention, Academy of Military Medical SciencesBeijing, China; The Key laboratory of Pharmacology and Molecular Biology, Medical College, Henan University of Science and TechnologyLuoyang, China
| | - Xuebin Xu
- Shanghai Municipal Center for Disease Control and Prevention Shanghai, China
| | - Beibei Liang
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences Beijing, China
| | - Fuli Wu
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences Beijing, China
| | - Xiaoxia Yang
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences Beijing, China
| | - Qiuxia Ma
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences Beijing, China
| | - Chaojie Yang
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences Beijing, China
| | - Xiaofeng Hu
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences Beijing, China
| | - Hongbo Liu
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences Beijing, China
| | - Hao Li
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences Beijing, China
| | - Chunyu Sheng
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences Beijing, China
| | - Jing Xie
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences Beijing, China
| | - Xinying Du
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences Beijing, China
| | - Rongzhang Hao
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences Beijing, China
| | - Shaofu Qiu
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences Beijing, China
| | - Hongbin Song
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences Beijing, China
| |
Collapse
|
35
|
Utrarachkij F, Nakajima C, Changkwanyeun R, Siripanichgon K, Kongsoi S, Pornruangwong S, Changkaew K, Tsunoda R, Tamura Y, Suthienkul O, Suzuki Y. Quinolone Resistance Determinants of Clinical Salmonella Enteritidis in Thailand. Microb Drug Resist 2017; 23:885-894. [PMID: 28437229 DOI: 10.1089/mdr.2015.0234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Salmonella Enteritidis has emerged as a global concern regarding quinolone resistance and invasive potential. Although quinolone-resistant S. Enteritidis has been observed with high frequency in Thailand, information on the mechanism of resistance acquisition is limited. To elucidate the mechanism, a total of 158 clinical isolates of nalidixic acid (NAL)-resistant S. Enteritidis were collected throughout Thailand, and the quinolone resistance determinants were investigated in the context of resistance levels to NAL, norfloxacin (NOR), and ciprofloxacin (CIP). The analysis of point mutations in type II topoisomerase genes and the detection of plasmid-mediated quinolone resistance genes showed that all but two harbored a gyrA mutation, the qnrS1 gene, or both. The most commonly affected codon in mutant gyrA was 87, followed by 83. Double codon mutation in gyrA was found in an isolate with high-level resistance to NAL, NOR, and CIP. A new mutation causing serine to isoleucine substitution at codon 83 was identified in eight isolates. In addition to eighteen qnrS1-carrying isolates showing nontypical quinolone resistance, one carrying both the qnrS1 gene and a gyrA mutation also showed a high level of resistance. Genotyping by multilocus variable number of tandem repeat analysis suggested a possible clonal expansion of NAL-resistant strains nationwide. Our data suggested that NAL-resistant isolates with single quinolone resistance determinant may potentially become fluoroquinolone resistant by acquiring secondary determinants. Restricted therapeutic and farming usage of quinolones is strongly recommended to prevent the emergence of fluoroquinolone-resistant isolates.
Collapse
Affiliation(s)
- Fuangfa Utrarachkij
- 1 Department of Microbiology, Faculty of Public Health, Mahidol University , Bangkok, Thailand
| | - Chie Nakajima
- 2 Division of Bioresources, Hokkaido University Research Center for Zoonosis Control , Sapporo, Japan .,3 Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University , Sapporo, Japan
| | - Ruchirada Changkwanyeun
- 2 Division of Bioresources, Hokkaido University Research Center for Zoonosis Control , Sapporo, Japan
| | - Kanokrat Siripanichgon
- 1 Department of Microbiology, Faculty of Public Health, Mahidol University , Bangkok, Thailand
| | - Siriporn Kongsoi
- 2 Division of Bioresources, Hokkaido University Research Center for Zoonosis Control , Sapporo, Japan
| | - Srirat Pornruangwong
- 4 National Institute of Health , Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Kanjana Changkaew
- 5 Faculty of Public Health, Thammasat University , Bangkok, Thailand
| | - Risa Tsunoda
- 6 Laboratory of Food Microbiology and Food Safety, Department of Health and Environmental Sciences, School of Veterinary Medicine, Rakuno Gakuen University , Ebetsu, Japan
| | - Yutaka Tamura
- 6 Laboratory of Food Microbiology and Food Safety, Department of Health and Environmental Sciences, School of Veterinary Medicine, Rakuno Gakuen University , Ebetsu, Japan
| | - Orasa Suthienkul
- 1 Department of Microbiology, Faculty of Public Health, Mahidol University , Bangkok, Thailand .,5 Faculty of Public Health, Thammasat University , Bangkok, Thailand
| | - Yasuhiko Suzuki
- 2 Division of Bioresources, Hokkaido University Research Center for Zoonosis Control , Sapporo, Japan .,3 Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University , Sapporo, Japan
| |
Collapse
|
36
|
Biglari S, Hanafiah A, Mohd Puzi S, Ramli R, Rahman M, Lopes BS. Antimicrobial Resistance Mechanisms and Genetic Diversity of Multidrug-Resistant Acinetobacter baumannii Isolated from a Teaching Hospital in Malaysia. Microb Drug Resist 2016; 23:545-555. [PMID: 27854165 DOI: 10.1089/mdr.2016.0130] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Multidrug-resistant (MDR) Acinetobacter baumannii has increasingly emerged as an important nosocomial pathogen. The aim of this study was to determine the resistance profiles and genetic diversity in A. baumannii clinical isolates in a tertiary medical center in Malaysia. The minimum inhibitory concentrations of carbapenems (imipenem and meropenem), cephalosporins (ceftazidime and cefepime), and ciprofloxacin were determined by E-test. PCR and sequencing were carried out for the detection of antibiotic resistance genes and mutations. Clonal relatedness among A. baumannii isolates was determined by REP-PCR. Sequence-based typing of OXA-51 and multilocus sequence typing were performed. One hundred twenty-five of 162 (77.2%) A. baumannii isolates had MDR phenotype. From the 162 A. baumannii isolates, 20 strain types were identified and majority of A. baumannii isolates (66%, n = 107) were classified as strain type 1 and were positive for ISAba1-blaOXA-23 and ISAba1-blaADC and had mutations in both gyrA and parC genes at positions, 83 and 80, resulting in serine-to-leucine conversion. REP-PCR analysis showed 129 REP types that generated 31 clones with a 90% similarity cutoff value. OXA-66 variant of the blaOXA-51-like genes was predominantly detected among our A. baumannii clinical isolates belonging to ST195 (found in six clones: 1, 8, 9, 19, 27, and 30) and ST208 (found in clone 21). The study helps us in understanding the genetic diversity of A. baumannii isolates in our setting and confirms that international clone II is the most widely distributed clone in Universiti Kebangsaan Malaysia Medical Centre, Malaysia.
Collapse
Affiliation(s)
- Shirin Biglari
- 1 Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre , Kuala Lumpur, Malaysia
| | - Alfizah Hanafiah
- 1 Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre , Kuala Lumpur, Malaysia
| | - Shaliawani Mohd Puzi
- 1 Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre , Kuala Lumpur, Malaysia
| | - Ramliza Ramli
- 1 Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre , Kuala Lumpur, Malaysia
| | - Mostafizur Rahman
- 1 Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre , Kuala Lumpur, Malaysia
| | - Bruno Silvester Lopes
- 2 Department of Medical Microbiology, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen , Aberdeen, United Kingdom
| |
Collapse
|
37
|
Misra R, Thakare R, Amrin N, Prasad KN, Chopra S, Dhole TN. Antimicrobial susceptibility pattern and sequence analysis of DNA gyrase and DNA topoisomerase IV in Salmonella enterica serovars Typhi and Paratyphi A isolates with decreased susceptibility to ciprofloxacin. Trans R Soc Trop Med Hyg 2016; 110:472-9. [PMID: 27618918 DOI: 10.1093/trstmh/trw051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/20/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We describe the antimicrobial susceptibility pattern of 100 typhoidal Salmonella isolates recovered from blood cultures and also investigate the association of decreased ciprofloxacin susceptibility with mutations in the genes coding for DNA gyrase and topoisomerase IV in 55 isolates. METHODS The study was conducted between January 2013 and December 2015 at a tertiary care centre in north India. Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion and E-test. Genotypic characterization included the screening of mutations in the quinolone resistance-determining region of gyrA, gyrB, parC, and parE by PCR. DNA sequence analysis was done for 55 isolates. RESULTS Out of 100 isolates recovered 80 were S. Typhi, 18 were Paratyphi A and two were Paratyphi B. Eighty two percent (66/80) of S. Typhi and 15/18 S. Paratyphi A showed decreased ciprofloxacin susceptibility. The most common mutation in gyrA led to a change at codon 83 of serine to phenylalanine (n=37) or tyrosine (n=12). Five S. Typhi isolates that were resistant to ciprofloxacin (MICs of 12, 16, 24 and 32 μg/ml) had a second mutation at codon 87 in the gyrA gene changing aspartate to asparagine. CONCLUSIONS There is a need to urgently review the use of fluoroquinolones for the management of enteric fever in endemic areas.
Collapse
Affiliation(s)
- Richa Misra
- Department of Microbiology, Division Bacteriology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow-226014, India
| | - Ritesh Thakare
- Division of Microbiology, Central Drug Research Institute, Lucknow-226031, India
| | - N Amrin
- Department of Microbiology, Division Bacteriology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow-226014, India
| | - Kashi Nath Prasad
- Department of Microbiology, Division Bacteriology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow-226014, India
| | - Sidharth Chopra
- Division of Microbiology, Central Drug Research Institute, Lucknow-226031, India
| | - Tapan Nirodhechand Dhole
- Department of Microbiology, Division Bacteriology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow-226014, India
| |
Collapse
|
38
|
Gopal M, Elumalai S, Arumugam S, Durairajpandian V, Kannan MA, Selvam E, Seetharaman S. GyrA ser83 and ParC trp106 Mutations in Salmonella enterica Serovar Typhi Isolated from Typhoid Fever Patients in Tertiary Care Hospital. J Clin Diagn Res 2016; 10:DC14-8. [PMID: 27630841 DOI: 10.7860/jcdr/2016/17677.8153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/01/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Typhoid fever is endemic in India and other developing countries, causing major public health problems with high morbidity and mortality. The resistance of Salmonella enterica serovar Typhi (S. Typhi) towards commonly prescribed antimicrobials is increasing in developing countries. However, there have been several reports of the therapeutic failure of fluoroquinolones in patients with Salmonella infection. Resistance to quinolones/ fluoroquinolones commonly arises due to target site mutation. AIM The present study was planned to analyze mutation in Quinolone Resistance Determining Region (QRDR) of quinolone resistant Salmonella isolates. MATERIALS AND METHODS A total of 133 S. Typhi isolates (blood (n = 131), stool (n=1) and bone marrow aspirate (n=1)) from tertiary care hospitals in Chennai and Puducherry, were included in this study. Minimum Inhibitory Concentrations (MIC) were carried out according to the Clinical Laboratory Standard Institute (CLSI)guidelines 2014. Mutations in gyrA and parC genes were analyzed by PCR-RFLP (Restriction Fragment Length Polymorphism) method followed by DNA sequencing. RESULTS Of the 133 S. Typhi, 99.2% were resistant to nalidixic acid and 21% were resistant to ciprofloxacin by MIC method. 94% of isolates showed Ser 83 mutation in gyrA and 21.8% of isolates showed Trp106-Gly mutation in parC. CONCLUSION Mutations in gyrA and parC genes are highly prevalent among Salmonella species. Irrational use of fluoroquinolones may increase the accumulation of mutations in the DNA gyrase and topoisomerase encoding genes, which lead to the emergence of high level fluoroquinolone-resistant Salmonella strains in future.
Collapse
Affiliation(s)
- Muthu Gopal
- Scientist-C, Model Rural Health Research Unit, National Institute of Epidemiology (ICMR), Primary Health Centre , Nadukallur, Tirunelveli, Tamil Nadu, India
| | - Sathishkumar Elumalai
- Research Scholar, Department of Microbiology, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras , Taramani, Chennai, India
| | - Suresh Arumugam
- Scientist-C, Centre for Drug Discovery and Development, Sathyabama University , Jeppiaar Nagar, Rajiv Gandhi Road, Chennai, India
| | - Vishnuprabu Durairajpandian
- Scientist, National Hub for Healthcare Instrumentation Development, Centre for Biotechnology, Anna University , Chennai, India
| | - Munirajan Arasambattu Kannan
- Professor, Department of Genetics, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras , Taramani, Chennai, India
| | - Esthermary Selvam
- Specialist Cum Head of Department of Microbiology, ESIC Hospital , K.K.Nagar, Chennai, Tamil Nadu, India
| | - Srivani Seetharaman
- Assistant Professor, Department of Microbiology, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras , Taramani, Chennai, India
| |
Collapse
|
39
|
Deekshit VK, Kumar BK, Rai P, Karunasagar I, Karunasagar I. Differential expression of virulence genes and role of gyrA mutations in quinolone resistant and susceptible strains of Salmonella Weltevreden and Newport isolated from seafood. J Appl Microbiol 2016; 119:970-80. [PMID: 26249136 DOI: 10.1111/jam.12924] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/13/2015] [Accepted: 06/27/2015] [Indexed: 11/30/2022]
Abstract
AIMS To investigate the differential expression of virulence genes and role of gyrA mutations in quinolone resistant and susceptible strains of Salmonella isolated from seafood. METHODS AND RESULTS Forty Salmonella isolates from seafood were tested for antibiotic sensitivity. Minimal inhibitory concentration (MIC) was determined and two nalidixic acid-resistant isolates, viz Salmonella Weltevreden (SW9) and Salmonella Newport (SN36) were selected for identifying the mechanism of resistance. SW9 showed mutation in the gyrA gene at codon 83 (Ser to Tyr) while SN36 presented at codon 87 (Asp to Asn). Experimental induction of resistance to a sensitive Salm. Newport (SN71) showed point mutation at codon 87 (Asp to Gly) in the gyrA gene, and was designated SN71R. All the isolates resistant to nalidixic acid had a single mutation at different positions in the gyrA gene. However, induction of resistance to a sensitive Salm. Weltevreden (SW30) was exceptional in that it did not show any mutation in the gyrA region. Use of Phe-Arg-β-naphthylamide (PAβN) also could not reduce MIC below the Clinical and Laboratory Standards Institute guidelines revealing the absence of efflux mediated resistance. Thus, the resistance mechanism in SW30R is unknown. The growth rate of quinolone resistant isolates was slower than the susceptible ones. The resistant isolates showed decreased epithelial cell invasion and intracellular replication. The mRNA expression levels of some of the genes were significantly (P < 0·005) reduced in SN71R compared to the sensitive strain (SN71). CONCLUSIONS Nalidixic acid-resistant Salmonella strains are associated with lower virulence and pathogenicity than the sensitive strains. SIGNIFICANCE AND IMPACT OF THE STUDY This study provided valuable information on the difference in the growth, cytotoxicity, infectivity and expression of virulence genes in resistant and susceptible strains. Furthermore, the gyrA mutation was shown to be the main mechanism of quinolone resistance in Salmonella other than the overexpression of efflux pumps or the presence of plasmid mediated quinolone resistance genes.
Collapse
Affiliation(s)
- V K Deekshit
- Department of Biomedical Sciences, Nitte University Center for Science Education and Research, UNESCO MIRCEN for Marine Biotechnology, University Enclave, Mangalore-575018, India
| | - B K Kumar
- Department of Biomedical Sciences, Nitte University Center for Science Education and Research, UNESCO MIRCEN for Marine Biotechnology, University Enclave, Mangalore-575018, India
| | - P Rai
- Department of Biomedical Sciences, Nitte University Center for Science Education and Research, UNESCO MIRCEN for Marine Biotechnology, University Enclave, Mangalore-575018, India
| | - I Karunasagar
- Department of Biomedical Sciences, Nitte University Center for Science Education and Research, UNESCO MIRCEN for Marine Biotechnology, University Enclave, Mangalore-575018, India
| | - I Karunasagar
- Department of Biomedical Sciences, Nitte University Center for Science Education and Research, UNESCO MIRCEN for Marine Biotechnology, University Enclave, Mangalore-575018, India
| |
Collapse
|
40
|
Al-Emran HM, Eibach D, Krumkamp R, Ali M, Baker S, Biggs HM, Bjerregaard-Andersen M, Breiman RF, Clemens JD, Crump JA, Cruz Espinoza LM, Deerin J, Dekker DM, Gassama Sow A, Hertz JT, Im J, Ibrango S, von Kalckreuth V, Kabore LP, Konings F, Løfberg SV, Meyer CG, Mintz ED, Montgomery JM, Olack B, Pak GD, Panzner U, Park SE, Razafindrabe JLT, Rabezanahary H, Rakotondrainiarivelo JP, Rakotozandrindrainy R, Raminosoa TM, Schütt-Gerowitt H, Sampo E, Soura AB, Tall A, Warren M, Wierzba TF, May J, Marks F. A Multicountry Molecular Analysis of Salmonella enterica Serovar Typhi With Reduced Susceptibility to Ciprofloxacin in Sub-Saharan Africa. Clin Infect Dis 2016; 62 Suppl 1:S42-6. [PMID: 26933020 PMCID: PMC4772832 DOI: 10.1093/cid/civ788] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Salmonella enterica serovar Typhi is a predominant cause of bloodstream infections in sub-Saharan Africa (SSA). Increasing numbers of S. Typhi with resistance to ciprofloxacin have been reported from different parts of the world. However, data from SSA are limited. In this study, we aimed to measure the ciprofloxacin susceptibility of S. Typhi isolated from patients with febrile illness in SSA. METHODS Febrile patients from 9 sites within 6 countries in SSA with a body temperature of ≥38.0°C were enrolled in this study. Blood samples were obtained for bacterial culture, and Salmonella isolates were identified biochemically and confirmed by multiplex polymerase chain reaction (PCR). Antimicrobial susceptibility of all Salmonella isolates was performed by disk diffusion test, and minimum inhibitory concentrations (MICs) against ciprofloxacin were measured by Etest. All Salmonella isolates with reduced susceptibility to ciprofloxacin (MIC > 0.06 µg/mL) were screened for mutations in quinolone resistance-determining regions in target genes, and the presence of plasmid-mediated quinolone resistance (PMQR) genes was assessed by PCR. RESULTS A total of 8161 blood cultures were performed, and 100 (1.2%) S. Typhi, 2 (<0.1%) Salmonella enterica serovar Paratyphi A, and 27 (0.3%) nontyphoid Salmonella (NTS) were isolated. Multidrug-resistant S. Typhi were isolated in Kenya (79% [n = 38]) and Tanzania (89% [n = 8]) only. Reduced ciprofloxacin-susceptible (22% [n = 11]) S. Typhi were isolated only in Kenya. Among those 11 isolates, all had a Glu133Gly mutation in the gyrA gene combined with either a gyrA (Ser83Phe) or gyrB mutation (Ser464Phe). One Salmonella Paratyphi A isolate with reduced susceptibility to ciprofloxacin was found in Senegal, with 1 mutation in gyrA (Ser83Phe) and a second mutation in parC (Ser57Phe). Mutations in the parE gene and PMQR genes were not detected in any isolate. CONCLUSIONS Salmonella Typhi with reduced susceptibility to ciprofloxacin was not distributed homogenously throughout SSA. Its prevalence was very high in Kenya, and was not observed in other study countries. Continuous monitoring of antimicrobial susceptibility is required to follow the potential spread of antimicrobial-resistant isolates throughout SSA.
Collapse
Affiliation(s)
- Hassan M Al-Emran
- Bernhard Nocht Institute for Tropical Medicine German Center for Infection Research, partner site Hamburg-Borstel-Lübeck, Hamburg, Germany
| | - Daniel Eibach
- Bernhard Nocht Institute for Tropical Medicine German Center for Infection Research, partner site Hamburg-Borstel-Lübeck, Hamburg, Germany
| | - Ralf Krumkamp
- Bernhard Nocht Institute for Tropical Medicine German Center for Infection Research, partner site Hamburg-Borstel-Lübeck, Hamburg, Germany
| | - Mohammad Ali
- International Vaccine Institute, Seoul, Republic of Korea Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stephen Baker
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Holly M Biggs
- Division of Infectious Diseases and International Health, Duke University Medical Center Duke Global Health Institute, Duke University, Durham, North Carolina
| | | | - Robert F Breiman
- Kenya Medical Research Institute-Centers for Disease Control and Prevention Kenya Collaboration, Nairobi Global Health Institute, Emory University, Atlanta, Georgia
| | - John D Clemens
- International Vaccine Institute, Seoul, Republic of Korea International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - John A Crump
- Division of Infectious Diseases and International Health, Duke University Medical Center Duke Global Health Institute, Duke University, Durham, North Carolina Kilimanjaro Christian Medical Centre, Moshi, Tanzania Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | - Jessica Deerin
- International Vaccine Institute, Seoul, Republic of Korea
| | - Denise Myriam Dekker
- Bernhard Nocht Institute for Tropical Medicine German Center for Infection Research, partner site Hamburg-Borstel-Lübeck, Hamburg, Germany
| | - Amy Gassama Sow
- Institut Pasteur de Dakar, Université Cheikh Anta Diop de Dakar, Senegal
| | - Julian T Hertz
- Division of Infectious Diseases and International Health, Duke University Medical Center Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | - Frank Konings
- International Vaccine Institute, Seoul, Republic of Korea
| | - Sandra Valborg Løfberg
- Bandim Health Project, Bissau, Guinea-Bissau Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Christian G Meyer
- Bernhard Nocht Institute for Tropical Medicine Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Germany
| | - Eric D Mintz
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joel M Montgomery
- Kenya Medical Research Institute-Centers for Disease Control and Prevention Kenya Collaboration, Nairobi
| | - Beatrice Olack
- Kenya Medical Research Institute-Centers for Disease Control and Prevention Kenya Collaboration, Nairobi
| | - Gi Deok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | - Ursula Panzner
- International Vaccine Institute, Seoul, Republic of Korea
| | - Se Eun Park
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | | | | | - Heidi Schütt-Gerowitt
- International Vaccine Institute, Seoul, Republic of Korea Institute of Medical Microbiology, University of Cologne, Germany
| | - Emmanuel Sampo
- Institute of Medical Microbiology, University of Cologne, Germany
| | | | - Adama Tall
- Institut Pasteur de Dakar, Université Cheikh Anta Diop de Dakar, Senegal
| | | | | | - Jürgen May
- Bernhard Nocht Institute for Tropical Medicine German Center for Infection Research, partner site Hamburg-Borstel-Lübeck, Hamburg, Germany
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
| |
Collapse
|
41
|
Eibach D, Al-Emran HM, Dekker DM, Krumkamp R, Adu-Sarkodie Y, Cruz Espinoza LM, Ehmen C, Boahen K, Heisig P, Im J, Jaeger A, von Kalckreuth V, Pak GD, Panzner U, Park SE, Reinhardt A, Sarpong N, Schütt-Gerowitt H, Wierzba TF, Marks F, May J. The Emergence of Reduced Ciprofloxacin Susceptibility inSalmonella entericaCausing Bloodstream Infections in Rural Ghana. Clin Infect Dis 2016; 62 Suppl 1:S32-6. [DOI: 10.1093/cid/civ757] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
42
|
Thong KL, Ngoi ST, Chai LC, Teh CSJ. Quinolone Resistance Mechanisms Among Salmonella enterica in Malaysia. Microb Drug Resist 2015; 22:259-72. [PMID: 26683630 DOI: 10.1089/mdr.2015.0158] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The prevalence of quinolone-resistant Salmonella enterica is on the rise worldwide. Salmonella enterica is one of the major foodborne pathogens in Malaysia. Therefore, we aim to investigate the occurrence and mechanisms of quinolone resistance among Salmonella strains isolated in Malaysia. A total of 283 Salmonella strains isolated from food, humans, and animals were studied. The disk diffusion method was used to examine the quinolone susceptibility of the strains, and the minimum inhibitory concentration (MIC) values of nalidixic acid and ciprofloxacin were also determined. DNA sequencing of the quinolone resistance-determining regions (QRDRs) of gyrase and topoisomerase IV genes and the plasmid-borne qnr genes was performed. The transfer of the qnr gene was examined through transconjugation experiment. A total of 101 nalidixic acid-resistant Salmonella strains were identified. In general, all strains were highly resistant to nalidixic acid (average MICNAL, 170 μg/ml). Resistance to ciprofloxacin was observed in 30.7% of the strains (1 ≤ MICCIP ≤ 2 μg/ml). Majority of the strains contained missense mutations in the QRDR of gyrA (69.3%). Silent mutations were frequently detected in gyrB (75.2%), parC (27.7%), and parE (51.5%) within and beyond the QRDRs. Novel mutations were detected in parC and parE. The plasmid-borne qnrS1 variant was found in 36.6% of the strains, and two strains were found to be able to transfer the qnrS1 gene. Overall, mutations in gyrA and the presence of qnrS1 genes might have contributed to the high level of quinolone resistance among the strains. Our study provided a better understanding on the status of quinolone resistance among Salmonella strains circulating in Malaysia.
Collapse
Affiliation(s)
- Kwai Lin Thong
- 1 Microbiology Division, Faculty of Science, Institute of Biological Sciences, University of Malaya , Kuala Lumpur, Malaysia
| | - Soo Tein Ngoi
- 1 Microbiology Division, Faculty of Science, Institute of Biological Sciences, University of Malaya , Kuala Lumpur, Malaysia
| | - Lay Ching Chai
- 1 Microbiology Division, Faculty of Science, Institute of Biological Sciences, University of Malaya , Kuala Lumpur, Malaysia
| | - Cindy Shuan Ju Teh
- 2 Department of Medical Microbiology, Faculty of Medicine, University of Malaya , Kuala Lumpur, Malaysia
| |
Collapse
|
43
|
Kongsoi S, Changkwanyeun R, Yokoyama K, Nakajima C, Changkaew K, Suthienkul O, Suzuki Y. Amino acid substitutions in GyrA affect quinolone susceptibility inSalmonellatyphimurium. Drug Test Anal 2015; 8:1065-1070. [DOI: 10.1002/dta.1910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 09/27/2015] [Accepted: 09/28/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Siriporn Kongsoi
- Division of Bioresources; Hokkaido University Research Center for Zoonosis Control; Sapporo Japan
| | - Ruchirada Changkwanyeun
- Division of Bioresources; Hokkaido University Research Center for Zoonosis Control; Sapporo Japan
| | - Kazumasa Yokoyama
- Central Research Laboratory; Kissei Pharmaceutical Co., Ltd; Nagano Japan
| | - Chie Nakajima
- Division of Bioresources; Hokkaido University Research Center for Zoonosis Control; Sapporo Japan
- Hokkaido University The Global Station for Zoonosis Control; Sapporo Japan
| | - Kanjana Changkaew
- Division of Bioresources; Hokkaido University Research Center for Zoonosis Control; Sapporo Japan
| | - Orasa Suthienkul
- Faculty of Public Health; Thammasat University; Rangsit Thailand
- Faculty of Public Health; Mahidol University; Bangkok Thailand
| | - Yasuhiko Suzuki
- Division of Bioresources; Hokkaido University Research Center for Zoonosis Control; Sapporo Japan
- Hokkaido University The Global Station for Zoonosis Control; Sapporo Japan
| |
Collapse
|
44
|
Clinical characteristics in adult patients with Salmonella bacteremia and analysis of ciprofloxacin-nonsusceptible isolates. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 48:692-8. [PMID: 26542649 DOI: 10.1016/j.jmii.2015.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/01/2015] [Accepted: 09/01/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this study is to describe clinical characteristics of Salmonella bacteremia in adult patients and analyze ciprofloxacin-nonsusceptible isolates. METHODS A total of 101 Salmonella blood isolates from adult patients were collected from January 2011 to December 2013 in MacKay Memorial Hospital. Eight ciprofloxacin-nonsusceptible Salmonella blood isolates were screened for carbapenemase and other β lactamase genes. Isolates were examined by PCR for the quinolone resistance-determining region (QRDR) of all subunits for DNA gyrase (gyrA and gyrB) genes and topoisomerase IV (parC and parE) genes. RESULTS There were 22 (21.78%) S. enterica serovar B, 5 (4.95%) S. enterica serovar C1, 7 (6.93%) S. enterica serovar C2, 65 (64.36%) S. enterica serovar D, and 2 (1.98%) S. enterica serovar Typhi (S. typhi) isolates. β-lactamase gene screening and sequencing yielded only one blaCMY-2-positive isolate. In multivariate risk factor analysis, renal insufficiency [odds ratio (OR) 3.774; p = 0.020] and heart disease (OR 2.922; p = 0.027) were more common among elderly patients (≥65 years). Independent risk factors for ciprofloxacin-nonsusceptible strains included S. enterica serovar C2 (OR 28.430; p = 0.032), renal insufficiency (OR 13.927; p = 0.032), and immunosuppression agent usage (OR 60.082; p = 0.006). 87.50% (7/8) of isolates had gyrA mutation, 62.50% (5/8) had parC mutation, and none had gyrB and parE mutations. Isolates with both Ser83Phe/Asp87Asn gyrA and Thr57Ser/Ser80Ile parC mutation genes were highly ciprofloxacin-resistant (minimum inhibitory concentration ≥4 mg/L). CONCLUSIONS Elderly patients with renal insufficiency and heart disease were at risk for Salmonella bacteremia. Those for ciprofloxacin-nonsusceptible strains included S. enterica serovar C2, renal insufficiency, and immunosuppression agent usage. The 8 ciprofloxacin-nonsusceptible isolates carried gyrA and parC mutations, which cause resistance that poses a major concern.
Collapse
|
45
|
Structure based in silico analysis of quinolone resistance in clinical isolates of Salmonella Typhi from India. PLoS One 2015; 10:e0126560. [PMID: 25962113 PMCID: PMC4427296 DOI: 10.1371/journal.pone.0126560] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 04/03/2015] [Indexed: 11/24/2022] Open
Abstract
Enteric fever is a major cause of morbidity in several parts of the Indian subcontinent. The treatment for typhoid fever majorly includes the fluoroquinolone group of antibiotics. Excessive and indiscriminate use of these antibiotics has led to development of acquired resistance in the causative organism Salmonella Typhi. The resistance towards fluoroquinolones is associated with mutations in the target gene of DNA Gyrase. We have estimated the Minimum Inhibitory Concentration (MIC) of commonly used fluoroquinolone representatives from three generations, ciprofloxacin, ofloxacin, levofloxacin and moxifloxacin, for 100 clinical isolates of Salmonella Typhi from patients in the Indian subcontinent. The MICs have been found to be in the range of 0.032 to 8 μg/ml. The gene encoding DNA Gyrase was subsequently sequenced and point mutations were observed in DNA Gyrase in the quinolone resistance determining region comprising Ser83Phe/Tyr and Asp87Tyr/Gly. The binding ability of these four fluoroquinolones in the quinolone binding pocket of wild type as well as mutant DNA Gyrase was computationally analyzed by molecular docking to assess their differential binding behaviour. This study has revealed that mutations in DNA Gyrase alter the characteristics of the binding pocket resulting in the loss of crucial molecular interactions and consequently decrease the binding affinity of fluoroquinolones with the target protein. The present study assists in understanding the underlying molecular and structural mechanism for decreased fluoroquinolone susceptibility in clinical isolates as a consequence of mutations in DNA Gyrase.
Collapse
|
46
|
Mohamed MAES, Eman SA. Antibacterial resistance pattern among Escherichia coli strains isolated from Mansoura hospitals in Egypt with a special reference to quinolones. ACTA ACUST UNITED AC 2015. [DOI: 10.5897/ajmr2014.7351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
47
|
Matayoshi M, Kitano T, Sasaki T, Nakamura M. Resistance phenotypes and genotypes among multiple-antimicrobial-resistant Salmonella enterica subspecies enterica serovar Choleraesuis strains isolated between 2008 and 2012 from slaughter pigs in Okinawa Prefecture, Japan. J Vet Med Sci 2015; 77:705-10. [PMID: 25715779 PMCID: PMC4488408 DOI: 10.1292/jvms.14-0683] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A total of 349 Salmonella enterica subspecies enterica
serovar Choleraesuis (S. Choleraesuis) strains, which were isolated
between 2008 and 2012 from 349 pigs at two slaughterhouses in Okinawa Prefecture, Japan,
were investigated for antimicrobial susceptibility and the presence of antimicrobial
resistance genes. All isolates were resistant to at least four antimicrobial agents. The
antimicrobial agents for which isolates showed a high incidence of resistance were as
follows: ampicillin (100%) and streptomycin (100%), followed by gentamicin (99.7%),
oxytetracycline (99.7%), sulfamethoxazole/trimethoprim (99.4%), nalidixic acid (40.1%) and
oxolinic acid (40.1%). All isolates were sensitive to cefuroxime, ceftiofur, colistin,
fosfomycin, enrofloxacin, orbifloxacin and danofloxacin. The predominant resistance
phenotypes and genotypes were: resistance to ampicillin, streptomycin, gentamicin,
oxytetracycline and sulfamethoxazole/trimethoprim (58.5%, 204/349) and
blaTEM-strA-strB-aadA1-aadA2-aacC2-tet
(B)-sul1-sul2-dhfrXII-dhfrXIII (36.1%, 126/349). The quinolone
resistance-determining regions (QRDRs) of gyrA, gyrB, parC and
parE of the quinolone-resistant isolates (n=12) showed amino acid
substitutions of Ser-83→Phe or Asp-87→Tyr in GyrA and Ser-107→Ala in ParC. To our
knowledge, this is the first report on the molecular characterization of antimicrobial
resistance among S. Choleraesuis strains in Japan.
Collapse
Affiliation(s)
- Masanao Matayoshi
- Okinawa Prefecture Central Livestock Hygiene Service Center, 2505 Ozato, Ozato, Nanjyo, Okinawa 901-1202, Japan
| | | | | | | |
Collapse
|
48
|
Piekarska K, Wołkowicz T, Zacharczuk K, Rzeczkowska M, Chróst A, Bareja E, Olak M, Gierczyński R. Co-existence of plasmid-mediated quinolone resistance determinants and mutations in gyrA and parC among fluoroquinolone-resistant clinical Enterobacteriaceae isolated in a tertiary hospital in Warsaw, Poland. Int J Antimicrob Agents 2014; 45:238-43. [PMID: 25468717 DOI: 10.1016/j.ijantimicag.2014.09.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/25/2014] [Accepted: 09/27/2014] [Indexed: 10/24/2022]
Abstract
Plasmid-mediated quinolone resistance (PMQR) determinants and the distribution of mutations in the quinolone resistance-determining regions (QRDRs) of gyrA and parC were investigated in 215 ciprofloxacin-resistant (MIC>1mg/L) clinical Enterobacteriaceae collected during a 6-month prospective study in a tertiary hospital in Warsaw, Poland. PMQR determinants were present in 49 isolates (22.8%), among which aac(6')-Ib-cr and qnrB1 predominated (85.7% and 26.5%, respectively). Mutations in gyrA and parC QRDRs were detected among 89.8% of isolates (MIC≥4mg/L). Changes in Ser-83, Ala-84 and Asp-87 in GyrA and Ser-80 and Glu-84 in ParC were detected. Five isolates with ciprofloxacin MICs in the range 1.5-16 mg/L were found to have unaltered QRDRs, with PMQR as the only fluoroquinolone (FQ) resistance trait detected. The remaining 44 PMQR-positive isolates were found to carry altered QRDRs. Three substitutions (two in GyrA and one in ParC) were detected in 23 isolates, whilst 8 isolates carried four mutations (two in GyrA and two in ParC). One isolate of Klebsiella pneumoniae with two amino acid substitutions in the ParC QRDR in the presence of aac(6')-Ib-cr and qnrB1 had a ciprofloxacin MIC of 16mg/L. The results presented here show that FQ resistance in these clinical Enterobacteriaceae is a complex interplay between PMQR determinants and mutations in gyrA and parC rather than a single stepwise accumulation of mutations in the gyrase and topoisomerase subunits. In addition, these results show the role of PMQR determinants in promoting QRDR mutations and the acquisition of high-level FQ resistance in clinical settings.
Collapse
Affiliation(s)
- Katarzyna Piekarska
- Department of Bacteriology, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland.
| | - Tomasz Wołkowicz
- Department of Bacteriology, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland
| | - Katarzyna Zacharczuk
- Department of Bacteriology, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland
| | - Magdalena Rzeczkowska
- Department of Bacteriology, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland
| | - Anna Chróst
- Department of Bacteriology, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland
| | - Elżbieta Bareja
- Department of Laboratory Diagnostics, Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland
| | - Monika Olak
- Department of Laboratory Diagnostics, Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland
| | - Rafał Gierczyński
- Department of Bacteriology, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland
| |
Collapse
|
49
|
Increase of multidrug efflux pump expression in fluoroquinolone-resistant Salmonella mutants induced by ciprofloxacin selective pressure. Res Vet Sci 2014; 97:182-6. [DOI: 10.1016/j.rvsc.2014.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 07/06/2014] [Accepted: 07/25/2014] [Indexed: 01/13/2023]
|
50
|
Pitondo-Silva A, Martins VV, Silva CFD, Stehling EG. Conjugation between quinolone-susceptible bacteria can generate mutations in the quinolone resistance-determining region, inducing quinolone resistance. Int J Antimicrob Agents 2014; 45:119-23. [PMID: 25262036 DOI: 10.1016/j.ijantimicag.2014.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 07/08/2014] [Accepted: 07/18/2014] [Indexed: 11/17/2022]
Abstract
Quinolones are an important group of antibacterial agents that can inhibit DNA gyrase and topoisomerase IV activity. DNA gyrase is responsible for maintaining bacteria in a negatively supercoiled state, being composed of subunits A and B. Topoisomerase IV is a homologue of DNA gyrase and consists of two subunits codified by the parC and parE genes. Mutations in gyrA and gyrB of DNA gyrase may confer resistance to quinolones, and the majority of resistant strains show mutations between positions 67 and 106 of gyrA, a region denoted the quinolone resistance-determining region (QRDR). The most frequent substitutions occur at positions 83 and 87, but little is known about the mechanisms promoting appearance of mutations in the QRDR. The present study proposes that some mutations in the QRDR could be generated as a result of the natural mechanism of conjugation between bacteria in their natural habitat. This event was observed following conjugation in vitro of two different isolates of quinolone-susceptible Pseudomonas aeruginosa, which transferred plasmids of different molecular weights to a recipient strain of Escherichia coli (HB101), also quinolone-susceptible, generating two different transconjugants that presented mutations in DNA gyrase and acquisition of resistance to all quinolones tested.
Collapse
Affiliation(s)
- André Pitondo-Silva
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo (USP), Av. do Café, s/n, Monte Alegre, Riberão Preto, SP CEP: 14040-903, Brazil
| | - Vinicius Vicente Martins
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo (USP), Av. do Café, s/n, Monte Alegre, Riberão Preto, SP CEP: 14040-903, Brazil
| | - Carolina Fávero da Silva
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo (USP), Av. do Café, s/n, Monte Alegre, Riberão Preto, SP CEP: 14040-903, Brazil
| | - Eliana Guedes Stehling
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo (USP), Av. do Café, s/n, Monte Alegre, Riberão Preto, SP CEP: 14040-903, Brazil.
| |
Collapse
|