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Pot M, Reynaud Y, Couvin D, Dereeper A, Ferdinand S, Bastian S, Foucan T, Pommier JD, Valette M, Talarmin A, Guyomard-Rabenirina S, Breurec S. Emergence of a Novel Lineage and Wide Spread of a blaCTX-M-15/IncHI2/ST1 Plasmid among Nosocomial Enterobacter in Guadeloupe. Antibiotics (Basel) 2022; 11:1443. [PMID: 36290101 PMCID: PMC9598596 DOI: 10.3390/antibiotics11101443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 04/04/2024] Open
Abstract
Between April 2018 and August 2019, a total of 135 strains of Enterobacter cloacae complex (ECC) were randomly collected at the University Hospital Center of Guadeloupe to investigate the structure and diversity of the local bacterial population. These nosocomial isolates were initially identified genetically by the hsp60 typing method, which revealed the clinical relevance of E. xiangfangensis (n = 69). Overall, 57/94 of the third cephalosporin-resistant strains were characterized as extended-spectrum-β-lactamase (ESBL) producers, and their whole-genome was sequenced using Illumina technology to determine the clonal relatedness and diffusion of resistance genes. We found limited genetic diversity among sequence types (STs). ST114 (n = 13), ST1503 (n = 9), ST53 (n = 5) and ST113 (n = 4), which belong to three different Enterobacter species, were the most prevalent among the 57 ESBL producers. The blaCTXM-15 gene was the most prevalent ESBL determinant (56/57) and was in most cases associated with IncHI2/ST1 plasmid replicon carriage (36/57). To fully characterize this predominant blaCTXM-15/IncHI2/ST1 plasmid, four isolates from different lineages were also sequenced using Oxford Nanopore sequencing technology to generate long-reads. Hybrid sequence analyses confirmed the circulation of a well-conserved plasmid among ECC members. In addition, the novel ST1503 and its associated species (ECC taxon 4) were analyzed, in view of its high prevalence in nosocomial infections. These genetic observations confirmed the overall incidence of nosocomial ESBL Enterobacteriaceae infections acquired in this hospital during the study period, which was clearly higher in Guadeloupe (1.59/1000 hospitalization days) than in mainland France (0.52/1,000 hospitalization days). This project revealed issues and future challenges for the management and surveillance of nosocomial and multidrug-resistant Enterobacter in the Caribbean.
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Affiliation(s)
- Matthieu Pot
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, 97139 Les Abymes, France
| | - Yann Reynaud
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, 97139 Les Abymes, France
| | - David Couvin
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, 97139 Les Abymes, France
| | - Alexis Dereeper
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, 97139 Les Abymes, France
| | - Séverine Ferdinand
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, 97139 Les Abymes, France
| | - Sylvaine Bastian
- Laboratory of Clinical Microbiology, University Hospital Center of Guadeloupe, 97159 Pointe-à-Pitre, France
| | - Tania Foucan
- Operational Hygiene Team, University Hospital Center of Guadeloupe, 97159 Pointe-à-Pitre, France
| | - Jean-David Pommier
- Division of Intensive Care, University Hospital Center of Guadeloupe, 97159 Pointe-à-Pitre, France
| | - Marc Valette
- Division of Intensive Care, University Hospital Center of Guadeloupe, 97159 Pointe-à-Pitre, France
| | - Antoine Talarmin
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, 97139 Les Abymes, France
| | | | - Sébastien Breurec
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, 97139 Les Abymes, France
- Faculty of Medicine Hyacinthe Bastaraud, University of the Antilles, 97157 Pointe-à-Pitre, France
- INSERM, Center for Clinical Investigation 1424, 97139 Les Abymes, France
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Gruel G, Couvin D, Guyomard-Rabenirina S, Arlet G, Bambou JC, Pot M, Roy X, Talarmin A, Tressieres B, Ferdinand S, Breurec S. High Prevalence of bla CTXM-1/IncI1-Iγ/ST3 Plasmids in Extended-Spectrum β-Lactamase-Producing Escherichia coli Isolates Collected From Domestic Animals in Guadeloupe (French West Indies). Front Microbiol 2022; 13:882422. [PMID: 35651489 PMCID: PMC9149308 DOI: 10.3389/fmicb.2022.882422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) have been classified in the group of resistant bacteria of highest priority. We determined the prevalence of ESBL-E collected in feces from household and shelter pets in Guadeloupe (French West Indies). A single rectal swab was taken from 125 dogs and 60 cats between June and September 2019. The prevalence of fecal carriage of ESBL-E was 7.6% (14/185, 95% CI: 4.2-12.4), within the range observed worldwide. The only risk factor associated with a higher prevalence of ESBL-E rectal carriage was a stay in a shelter, suggesting that refuges could be hotspots for their acquisition. All but one (Klebsiella pneumoniae from a cat) were Escherichia coli. We noted the presence of a bla CTX-M-1/IncI1-Iγ/sequence type (ST3) plasmid in 11 ESBL-producing E. coli isolates belonging to ST328 (n = 6), ST155 (n = 4) and ST953 (n = 1). A bla CTX-M-15 gene was identified in the three remaining ESBL-E isolates. The bla CTX-M-1 and most of the antimicrobial resistance genes were present in a well-conserved large conjugative IncI1-Iγ/ST3 plasmid characterized by two accessory regions containing antibiotic resistance genes. The plasmid has been detected worldwide in E. coli isolates from humans and several animal species, such as food-producing animals, wild birds and pets, and from the environment. This study shows the potential role of pets as a reservoir of antimicrobial-resistant bacteria or genes for humans and underlines the importance of basic hygiene measures by owners of companion animals.
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Affiliation(s)
- Gaëlle Gruel
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, Pointe-à-Pitre, France
| | - David Couvin
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, Pointe-à-Pitre, France
| | | | | | | | - Matthieu Pot
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, Pointe-à-Pitre, France
| | | | - Antoine Talarmin
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, Pointe-à-Pitre, France
| | - Benoit Tressieres
- INSERM 1424, Center for Clinical Investigation, University Hospital Center of Guadeloupe, Pointe-à-Pitre, France
| | - Séverine Ferdinand
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, Pointe-à-Pitre, France
| | - Sébastien Breurec
- Transmission, Reservoir and Diversity of Pathogens Unit, Pasteur Institute of Guadeloupe, Pointe-à-Pitre, France.,INSERM 1424, Center for Clinical Investigation, University Hospital Center of Guadeloupe, Pointe-à-Pitre, France.,Faculty of Medicine Hyacinthe Bastaraud, University of the Antilles, Pointe-à-Pitre, France
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Reolom RP, Klafke A. Resistência antimicrobiana em uroculturas de moradores das Zonas Norte e Nordeste de Porto Alegre. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2022. [DOI: 10.5712/rbmfc17(44)3067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: Infecção urinária é motivo comum de consulta na Atenção Primária, requerendo tratamento empírico. Para a seleção do antimicrobiano, é necessário conhecer o perfil de resistência dos uropatógenos na comunidade. Objetivo: Analisar o perfil de resistência antimicrobiana em uroculturas realizadas em pacientes da Atenção Primária à Saúde do Serviço de Saúde Comunitária do Grupo Hospitalar Conceição, de julho de 2017 a junho de 2019. Métodos: Estudo transversal, observacional e descritivo com uroculturas de pacientes ambulatoriais das Unidades de Saúde do Serviço de Saúde Comunitária do Grupo Hospitalar Conceição, nas Zonas Norte e Nordeste de Porto Alegre, de julho de 2017 a junho de 2019. Os dados das uroculturas foram fornecidos pelo laboratório do Grupo Hospitalar e analisados por meio das proporções, por sexo, micro-organismo e resistência antimicrobiana. Resultados: Encontraram-se 2.000 uroculturas positivas no período, principalmente por Escherichia coli (75,50%), Klebsiella pneumoniae (7,80%), Staphylococcus saprophyticus (4,95%), Enterococcus specie (3,35%) e Proteus mirabilis (2,85%). Entre os antibióticos orais testados, a maior resistência foi para ampicilina (48,95%), seguida por sulfametoxazol+trimetoprima (25,85%), norfloxacino (18,05%), ciprofloxacino (18,00%), amoxicilina+clavulanato (11,05%) e nitrofurantoína (8,60%). Considerando-se apenas E. coli, as resistências foram 47,75% para ampicilina, 29,74% para sulfametoxazol+trimetoprima, 19,74% para norfloxacino e ciprofloxacino, 8,08% para amoxicilina+clavulanato e 1,99% para nitrofurantoína. Conclusões: O perfil de resistência antimicrobiana nas Zonas Norte e Nordeste de Porto Alegre sugere que sejam utilizados para tratamento empírico de infecção do trato urinário nessa localidade nitrofurantoína ou amoxicilina+clavulanato.
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Benaissa E, Belouad E, Mechal Y, Benlahlou Y, Chadli M, Maleb A, Elouennass M. Multidrug-resistant community-acquired urinary tract infections in a northern region of Morocco: epidemiology and risk factors. Germs 2022; 11:562-569. [PMID: 35096673 DOI: 10.18683/germs.2021.1291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/16/2021] [Accepted: 11/26/2021] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Urinary tract infection is very common and is the second most frequent reason for consultation in office-based practice. The incidence varies from one country to another. The diffusion of MDR in the community complicates therapeutic management. The objective of this study was to describe the bacterial epidemiology and to determine the risk factors for the acquisition of MDR in community urinary tract infections in our region. METHODS This was a retrospective case-control study conducted in the bacteriology laboratory of the Mohammed V Military Teaching Hospital over an 8-month period from 01 October 2015 to 31 May 2016. Cases were defined as patients with community-acquired urinary tract infection with MDR and controls were defined as patients with a urinary tract infection without MDR. RESULTS Out of 373 isolates, enterobacteria represented 80%. E. coli represented 59.2%, followed by K. pneumoniae at 15%. The rate of MDR represented 13.4% of which ESBL enterobacteria represented 12.1%. Univariate analysis showed a statistically significant association between male sex (p=0.001), age >65 years (p=0.007), urban origin (p=0.003), previous hospitalization within 3 months (p=0.001) and antibiotic therapy within 6 months (p=0.001) with MDR community-acquired urinary tract infection. On the other hand, multivariate analysis by logistic regression showed that age >65 years (OR=8.4, CI: 2.1-42), previous hospitalization within 3 months (OR=13.4, CI: 3.3-140.2) and antibiotic therapy within 6 months (OR=9.2, CI: 4.1-60.1) were significantly associated to MDR community-acquired urinary tract infection. CONCLUSIONS The increase in resistance to enterobacteria in the community prompts a review of the list of antibiotics prescribed for probabilistic management of these infections in our region.
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Affiliation(s)
- Elmostafa Benaissa
- PhD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Elmehdi Belouad
- Msc, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Youness Mechal
- PhD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Yassine Benlahlou
- PhD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Mariama Chadli
- MD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Adil Maleb
- PhD, Department of Clinical Bacteriology, Mohammed VI Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
| | - Mostafa Elouennass
- MD, Department of Clinical Bacteriology, Mohammed V Military Teaching Hospital, Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Morocco
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Hussain T, Moqadasi M, Malik S, Salman Zahid A, Nazary K, Khosa SM, Arshad MM, Joyce J, Khan R, Puvvada S, Walizada K, Khan AR. Uropathogens Antimicrobial Sensitivity and Resistance Pattern From Outpatients in Balochistan, Pakistan. Cureus 2021; 13:e17527. [PMID: 34646592 PMCID: PMC8485873 DOI: 10.7759/cureus.17527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 01/09/2023] Open
Abstract
Objective To determine the pattern of microbes responsible for urinary tract infections and their susceptibility to different antibiotics. Method This is a cross-sectional study conducted at Quetta, Pakistan. The urine samples of 400 patients were collected and sent for culture and sensitivity analysis. The results were recorded on an excel datasheet. Descriptive statistics were used to describe the data. Results Out of 400 urine samples, 266 samples were culture positive for microorganisms. The most common organism on analysis was Escherichia coli 123/266 (46.24%) followed by Staphylococcus saprophyticus 59/266 (22.18%) and Klebsiella pneumonia 49/266 (18.42%). Gram-negative microorganisms were most susceptible to fosfomycin, cefoperazone/sulbactam, and meropenem. Gram-positive microorganisms were most susceptible to fosfomycin, cefoperazone/sulbactam, meropenem, and amoxicillin/clavulanate. High rates of resistance in E. coli were observed to most commonly prescribed broad-spectrum antibiotics; ceftriaxone (64.35%), cefotaxime (76.54%), ceftazidime (49.43%), cefepime (53.44%), levofloxacin (71.26%), and amoxicillin/clavulanate (70.31%). E. coli was the major multidrug-resistant organism. Conclusion High rates of antibiotic resistance and multi-drug resistance were revealed in this study due to the widespread and injudicious use of broad-spectrum antibiotics. Thus, it is highly recommended to regulate the pharmacies. Physicians should judiciously prescribe antibiotics and practice the culture and sensitivity of urine samples rather than blind prescription. Continued surveillance on uropathogens prevalence and resistance, new and next-generation antibiotics, and rapid diagnostic tests to differentiate viral from bacterial infections is the need of time.
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Affiliation(s)
- Taimoor Hussain
- Neurology/General Practitioner, Bolan Medical College, Quetta, PAK
| | - Mehdi Moqadasi
- Medical Laboratory Technology, Shafa Khana Sahib Zaman Hosptial, Quetta, PAK
| | - Sheza Malik
- Medicine, Army Medical College Rawalpindi, Rawalpindi, PAK
| | | | | | | | | | - John Joyce
- Intern, M.S. Ramaiah Medical College, Bangalore, IND
| | - Rajeswari Khan
- Medicine and Surgery, College of Medicine & Sagore Dutta Hospital, Kolkata, IND
| | - Sneha Puvvada
- Medicine and Surgery, M.S. Ramaiah Medical College, Bangalore, IND
| | | | - Abdul Rahim Khan
- Internal Medicine, Jinnah Medical and Dental College, Karachi, PAK
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Current antibiotic resistance patterns of rare uropathogens: survey from Central European Urology Department 2011-2019. BMC Urol 2021; 21:61. [PMID: 33849512 PMCID: PMC8042353 DOI: 10.1186/s12894-021-00821-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/24/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND While the resistance rates of commonly detected uropathogens are well described, those of less frequent Gram-negative uropathogenic bacteria have seldom been reported. The aim of this study was to examine the resistance rates of less frequent uropathogenic Gram-negatives in a population of patients treated in a Department of Urology of a tertiary referral centre in Central Europe over a period of 9 years. METHODS Data on all positive urine samples from urological in- and out-patients were extracted form the Department of Clinical Microbiology database from 2011 to 2019. Numbers of susceptible and resistant isolates per year were calculated for these uropathogens: Acinetobacter spp. (n = 74), Citrobacter spp. (n = 60), Enterobacter spp. (n = 250), Morganella morganii (n = 194), Providencia spp. (n = 53), Serratia spp. (n = 82) and Stenotrophomonas maltophilia (n = 27). Antimicrobial agents selected for the survey included: ampicillin, amoxicillin/clavulanic acid, piperacillin/tazobactam; cefuroxime, cefotaxime, ceftazidime and cefepime; ciprofloxacin and ofloxacin; gentamicin and amikacin; ertapenem, meropenem and imipenem; trimethoprim-sulfamethoxazole (co-trimoxazole), nitrofurantoin and colistin. RESULTS Penicillin derivatives have generally poor effect except piperacillin/tazobactam. Cefuroxime is not efficient unlike cefotaxime (except against Acinetobacter spp. and S. maltophilia). Susceptibility to fluoroquinolones is limited. Amikacin is somewhat more efficient than gentamicine but susceptibilities for both safely exceed 80%. Nitrofurantoin shows virtually no efficiency. Cotrimoxazole acts well against Citrobacter spp., Serratia spp. and it is the treatment of choice for S. maltophilia UTIs. Among carbapenems, ertapenem was less efficient than meropenem and imipenem except for S. maltophilia whose isolates were mostly not suceptible to any carbapenems. CONCLUSIONS Uropathogenic microorganisms covered in this report are noteworthy for their frequently multi-drug resistant phenotypes. Knowledge of resistance patterns helps clinicians choose the right empirical antibiotic treatment when the taxonomical assignment of the isolate is known but sensitivity results are pending.
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Gruel G, Sellin A, Riveiro H, Pot M, Breurec S, Guyomard-Rabenirina S, Talarmin A, Ferdinand S. Antimicrobial use and resistance in Escherichia coli from healthy food-producing animals in Guadeloupe. BMC Vet Res 2021; 17:116. [PMID: 33685450 PMCID: PMC7938459 DOI: 10.1186/s12917-021-02810-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 02/19/2021] [Indexed: 12/11/2022] Open
Abstract
Background Selection pressure exerted by use of antibiotics in both human and veterinary medicine is responsible for increasing antimicrobial resistance (AMR). The objectives of this study were to better understand antimicrobial use in pigs, beef cattle, and poultry on farms on Guadeloupe, French West Indies, and to acquire data on AMR in Escherichia coli in these food-producing animals. A cross-sectional survey was conducted at 45 farms on Guadeloupe, and practical use of antimicrobials was documented in declarative interviews between March and July 2018. A total of 216 fecal samples were collected between January 2018 and May 2019, comprising 124 from pigs, 75 from beef cattle, and 17 from poultry litter. E. coli isolates were obtained for further testing by isolation and identification from field samples. Antimicrobial susceptibility testing and screening for blaCTX-M, blaTEM, tetA, and tetB resistance genes by polymerase chain reaction on extracted genomic DNA were performed. Results The study showed rational use of antimicrobials, consisting of occasional use for curative treatment by veterinary prescription. Tetracycline was the most commonly used antimicrobial, but its use was not correlated to E. coli resistance. Extended-spectrum β-lactamase (ESBL) E. coli isolates were detected in 7.3% of pigs, 14.7% of beef cattle, and 35.3% of poultry. blaCTX-M-1 was the predominant gene found in ESBL-E. coli isolates (68.8%), followed by blaCTX-M-15 (31.3%). Conclusion Despite rational use of antimicrobials, the rate of ESBL-E. coli in food-producing animals in Guadeloupe, although moderate, is a concern. Further studies are in progress to better define the genetic background of the ESBL-E. coli isolates. Graphical abstract ![]()
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Affiliation(s)
- Gaëlle Gruel
- Laboratory of Microbial Ecosystems Interactions, Transmission Reservoir and Pathogens Diversity Unit, Institut Pasteur of Guadeloupe, Morne Joliviere - B.P. 484, 97183, Les Abymes Cedex, Guadeloupe, France
| | - Arantxa Sellin
- Laboratory of Microbial Ecosystems Interactions, Transmission Reservoir and Pathogens Diversity Unit, Institut Pasteur of Guadeloupe, Morne Joliviere - B.P. 484, 97183, Les Abymes Cedex, Guadeloupe, France
| | - Hélène Riveiro
- Laboratory of Microbial Ecosystems Interactions, Transmission Reservoir and Pathogens Diversity Unit, Institut Pasteur of Guadeloupe, Morne Joliviere - B.P. 484, 97183, Les Abymes Cedex, Guadeloupe, France
| | - Matthieu Pot
- Laboratory of Microbial Ecosystems Interactions, Transmission Reservoir and Pathogens Diversity Unit, Institut Pasteur of Guadeloupe, Morne Joliviere - B.P. 484, 97183, Les Abymes Cedex, Guadeloupe, France
| | - Sébastien Breurec
- Laboratory of Microbial Ecosystems Interactions, Transmission Reservoir and Pathogens Diversity Unit, Institut Pasteur of Guadeloupe, Morne Joliviere - B.P. 484, 97183, Les Abymes Cedex, Guadeloupe, France.,Faculté de Médecine Hyacinthe Bastaraud, Université des Antilles, Pointe-à-Pitre, Guadeloupe, France.,Centre d'Investigation Clinique, INSERM CIC 1424, Pointe-à-Pitre, Guadeloupe, France
| | - Stéphanie Guyomard-Rabenirina
- Laboratory of Microbial Ecosystems Interactions, Transmission Reservoir and Pathogens Diversity Unit, Institut Pasteur of Guadeloupe, Morne Joliviere - B.P. 484, 97183, Les Abymes Cedex, Guadeloupe, France
| | - Antoine Talarmin
- Laboratory of Microbial Ecosystems Interactions, Transmission Reservoir and Pathogens Diversity Unit, Institut Pasteur of Guadeloupe, Morne Joliviere - B.P. 484, 97183, Les Abymes Cedex, Guadeloupe, France
| | - Séverine Ferdinand
- Laboratory of Microbial Ecosystems Interactions, Transmission Reservoir and Pathogens Diversity Unit, Institut Pasteur of Guadeloupe, Morne Joliviere - B.P. 484, 97183, Les Abymes Cedex, Guadeloupe, France.
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Veeraraghavan B, Bakthavatchalam YD, Sahni RD. Orally Administered Amoxicillin/Clavulanate: Current Role in Outpatient Therapy. Infect Dis Ther 2020; 10:15-25. [PMID: 33306184 PMCID: PMC7954971 DOI: 10.1007/s40121-020-00374-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/19/2020] [Indexed: 02/04/2023] Open
Abstract
Oral amoxicillin/clavulanate is a community workhorse antibiotic, routinely prescribed for respiratory tract infections, skin infections as well as urinary tract infections (UTIs). Multiple adult and paediatric dose formulations of amoxicillin/clavulanate are available in different parts of the world. In adult formulations, clavulanic acid dose is restricted to 125 mg because of tolerability issues. Despite its popular use for 40 years, few pharmacokinetic/pharmacodynamic (PK/PD) studies were undertaken to justify the doses and breakpoints currently in use for various infections. Clavulanate has a minimal role in the combination’s use for respiratory infections. In the context of rising extended spectrum beta-lactamase (ESBL) prevalence globally, empirical and overuse of orally administered amoxicillin/clavulanate may select resistance in Gram-negative pathogens. The susceptibility test methods and interpretive criteria differ between the Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST). Third-generation oral cephalosporins such as ceftibuten or cefpodoxime can be combined with amoxicillin/clavulanate to tackle UTIs involving ESBL producing Escherichia coli and Klebsiella spp. Clinicians who routinely prescribe amoxicillin/clavulanate in outpatient settings should be aware of potential benefits and limitations of this combination.
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Affiliation(s)
| | | | - Rani Diana Sahni
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
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Current Antibiotic Resistance Trends of Uropathogens in Central Europe: Survey from a Tertiary Hospital Urology Department 2011-2019. Antibiotics (Basel) 2020; 9:antibiotics9090630. [PMID: 32971752 PMCID: PMC7559630 DOI: 10.3390/antibiotics9090630] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 12/18/2022] Open
Abstract
Monitoring of pathogen resistance profiles is necessary to guide empirical antibiotic therapy before culture and sensitivity results become available. The aim of this study was to describe current antibiotic resistance patterns of five most frequent causative uropathogens in a Department of Urology of a tertiary referral centre in Central Europe over a period of nine years. The Hospital Department of Clinical Microbiology database was used to extract data on all positive urine samples from inpatients in the Department of Urology between 2011 and 2019. Numbers of susceptible and resistant isolates per year were calculated for five most frequent uropathogens: Escherichia coli, Enterococcus spp., Klebsiella spp., Pseudomonas aeruginosa, and Proteus spp. Antimicrobial agents selected for the survey included: ampicillin, amoxicillin/clavulanic acid, piperacillin/tazobactam; cefuroxime, cefotaxime, ceftazidime and cefepime; ciprofloxacin and ofloxacin; gentamicin and amikacin; ertapenem, meropenem and imipenem; trimethoprim-sulfamethoxazole (co-trimoxazole), nitrofurantoin, colistin, and vancomycin. High resistance rates of Gram-negative uropathogens were demonstrated to most common antimicrobials, with statistically significant increasing or decreasing trends in some cases. No carbapenem-resistant Enterobacteriaceae were isolated. Vancomycin-resistant Enterococcus spp. strains were rare in our population.
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Guyomard-Rabenirina S, Reynaud Y, Pot M, Albina E, Couvin D, Ducat C, Gruel G, Ferdinand S, Legreneur P, Le Hello S, Malpote E, Sadikalay S, Talarmin A, Breurec S. Antimicrobial Resistance in Wildlife in Guadeloupe (French West Indies): Distribution of a Single bla CTX-M-1/IncI1/ST3 Plasmid Among Humans and Wild Animals. Front Microbiol 2020; 11:1524. [PMID: 32754130 PMCID: PMC7366356 DOI: 10.3389/fmicb.2020.01524] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/12/2020] [Indexed: 01/14/2023] Open
Abstract
Limited data are available on the contribution of wildlife to the spread of antibacterial resistance. We determined the prevalence of resistance to antibiotics in Escherichia coli isolates collected from wild animals in 2013 and 2014 and the genetic basis for resistance to third-generation cephalosporin in Guadeloupe. We recovered 52 antibiotic-resistant (AR) E. coli strains from 48 of the 884 (5.4%) wild animals tested (46 iguanas, 181 birds, 289 anoles, and 368 rodents at 163 sampling sites). Rodents had higher rates of carriage (n = 38, 10.3%) than reptiles and birds (2.4% and 1.1%, respectively, p < 0.001). A significant association (p < 0.001) was found between the degree of anthropization and the frequency of AR E. coli carriage for all species. The carriage rate of ciprofloxacin- and cefotaxime-resistant isolates was 0.7% (6/884) and 1.5% (13/884), respectively. Most (65.4%) AR E. coli were multi-drug resistant, and the prevalence of extended-spectrum beta-lactamase (ESBL)-producing E. coli was low (n = 7, 0.8%) in all species. Eight ESBL-producing E. coli were recovered, two genetically unrelated isolates being found in one bird. These isolates and 20 human invasive ESBL E. coli isolates collected in Guadeloupe during the same period were investigated by whole genome sequencing. blaCTX–M–1 was the only ESBL gene shared by three animal classes (humans, n = 2; birds, n = 2; rodents, n = 2). The blaCTX–M–1 gene and most of the antimicrobial resistance genes were present in a large conjugative IncI1 plasmid that was highly similar (>99% nucleotide identity) to ESBL-carrying plasmids found in several countries in Europe and in Australia. Although the prevalence of ESBL-producing E. coli isolates was very low in wild animals, it is of concern that the well-conserved IncI1 plasmid-carrying blaCTX–M–1 is widespread and occurs in various E. coli strains from animals and humans.
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Affiliation(s)
| | - Yann Reynaud
- Transmission, Reservoir and Diversity of Pathogens Unit, Institut Pasteur de la Guadeloupe, Pointe-a-Pitre, France
| | - Matthieu Pot
- Transmission, Reservoir and Diversity of Pathogens Unit, Institut Pasteur de la Guadeloupe, Pointe-a-Pitre, France
| | - Emmanuel Albina
- UMR ASTRE, CIRAD, Montpellier, France.,UMR ASTRE, F-34398, INRA, CIRAD, Université de Montpellier, Montpellier, France
| | - David Couvin
- Transmission, Reservoir and Diversity of Pathogens Unit, Institut Pasteur de la Guadeloupe, Pointe-a-Pitre, France
| | - Celia Ducat
- Transmission, Reservoir and Diversity of Pathogens Unit, Institut Pasteur de la Guadeloupe, Pointe-a-Pitre, France
| | - Gaëlle Gruel
- Transmission, Reservoir and Diversity of Pathogens Unit, Institut Pasteur de la Guadeloupe, Pointe-a-Pitre, France
| | - Severine Ferdinand
- Transmission, Reservoir and Diversity of Pathogens Unit, Institut Pasteur de la Guadeloupe, Pointe-a-Pitre, France
| | - Pierre Legreneur
- Inter-University Laboratory of Human Movement Biology-EA 7424, University of Lyon, University Claude Bernard Lyon 1, Villeurbanne, France
| | - Simon Le Hello
- Enteric Bacterial Pathogens Unit, Institut Pasteur, Paris, France.,UNICAEN, Groupe de Recherche sur l'Adaptation Microbienne, GRAM 2.0, EA2656, University of Caen Normandy, Caen, France
| | - Edith Malpote
- Laboratory of Clinical Microbiology, University Hospital of Guadeloupe, Pointe-a-Pitre/Les Abymes, France
| | - Syndia Sadikalay
- Transmission, Reservoir and Diversity of Pathogens Unit, Institut Pasteur de la Guadeloupe, Pointe-a-Pitre, France
| | - Antoine Talarmin
- Transmission, Reservoir and Diversity of Pathogens Unit, Institut Pasteur de la Guadeloupe, Pointe-a-Pitre, France
| | - Sebastien Breurec
- Transmission, Reservoir and Diversity of Pathogens Unit, Institut Pasteur de la Guadeloupe, Pointe-a-Pitre, France.,Faculty of Medicine Hyacinthe Bastaraud, University of the Antilles, Pointe-a-Pitre, France.,INSERM, Center for Clinical Investigation 1424, Pointe-a-Pitre/Les Abymes, France
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11
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Habouria H, Pokharel P, Maris S, Garénaux A, Bessaiah H, Houle S, Veyrier FJ, Guyomard-Rabenirina S, Talarmin A, Dozois CM. Three new serine-protease autotransporters of Enterobacteriaceae (SPATEs) from extra-intestinal pathogenic Escherichia coli and combined role of SPATEs for cytotoxicity and colonization of the mouse kidney. Virulence 2020; 10:568-587. [PMID: 31198092 PMCID: PMC6592367 DOI: 10.1080/21505594.2019.1624102] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Serine protease autotransporters of Enterobacteriaceae (SPATEs) are secreted proteins that contribute to virulence and function as proteases, toxins, adhesins, and/or immunomodulators. An extra-intestinal pathogenic E. coli (ExPEC) O1:K1 strain, QT598, isolated from a turkey, was shown to contain vat, tsh, and three uncharacterized SPATE-encoding genes. Uncharacterized SPATEs: Sha (Serine-protease hemagglutinin autotransporter), TagB and TagC (tandem autotransporter genes B and C) were tested for activities including hemagglutination, autoaggregation, and cytotoxicity when expressed in E. coli K-12. Sha and TagB conferred autoaggregation and hemagglutination activities. TagB, TagC, and Sha all exhibited cytopathic effects on a bladder epithelial cell line. In QT598, tagB and tagC are tandemly encoded on a genomic island, and were present in 10% of UTI isolates and 4.7% of avian E. coli. Sha is encoded on a virulence plasmid and was present in 1% of UTI isolates and 20% of avian E. coli. To specifically examine the role of SPATEs for infection, the 5 SPATE genes were deleted from strain QT598 and tested for cytotoxicity. Loss of all five SPATEs abrogated the cytopathic effect on bladder epithelial cells, although derivatives producing any of the 5 SPATEs retained cytopathic activity. In mouse infections, sha gene-expression was up-regulated a mean of sixfold in the bladder compared to growth in vitro. Loss of either tagBC or sha did not reduce urinary tract colonization. Deletion of all 5 SPATEs, however, significantly reduced competitive colonization of the kidney supporting a cumulative role of SPATEs for QT598 in the mouse UTI model.
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Affiliation(s)
- Hajer Habouria
- a Institut national de recherche scientifique (INRS)-Institut Armand Frappier , Laval , Quebec , Canada.,b Centre de recherche en infectiologie porcine et avicole (CRIPA)
| | - Pravil Pokharel
- a Institut national de recherche scientifique (INRS)-Institut Armand Frappier , Laval , Quebec , Canada.,b Centre de recherche en infectiologie porcine et avicole (CRIPA)
| | - Segolène Maris
- a Institut national de recherche scientifique (INRS)-Institut Armand Frappier , Laval , Quebec , Canada.,b Centre de recherche en infectiologie porcine et avicole (CRIPA)
| | - Amélie Garénaux
- a Institut national de recherche scientifique (INRS)-Institut Armand Frappier , Laval , Quebec , Canada.,b Centre de recherche en infectiologie porcine et avicole (CRIPA)
| | - Hicham Bessaiah
- a Institut national de recherche scientifique (INRS)-Institut Armand Frappier , Laval , Quebec , Canada.,b Centre de recherche en infectiologie porcine et avicole (CRIPA)
| | - Sébastien Houle
- a Institut national de recherche scientifique (INRS)-Institut Armand Frappier , Laval , Quebec , Canada.,b Centre de recherche en infectiologie porcine et avicole (CRIPA)
| | - Frédéric J Veyrier
- a Institut national de recherche scientifique (INRS)-Institut Armand Frappier , Laval , Quebec , Canada.,c Institut Pasteur International Network
| | - Stéphanie Guyomard-Rabenirina
- c Institut Pasteur International Network.,d Unité Environnement Santé , Institut Pasteur de Guadeloupe , Les Abymes , Guadeloupe , France
| | - Antoine Talarmin
- c Institut Pasteur International Network.,d Unité Environnement Santé , Institut Pasteur de Guadeloupe , Les Abymes , Guadeloupe , France
| | - Charles M Dozois
- a Institut national de recherche scientifique (INRS)-Institut Armand Frappier , Laval , Quebec , Canada.,b Centre de recherche en infectiologie porcine et avicole (CRIPA).,c Institut Pasteur International Network
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12
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Huttner A, Bielicki J, Clements MN, Frimodt-Møller N, Muller AE, Paccaud JP, Mouton JW. Oral amoxicillin and amoxicillin-clavulanic acid: properties, indications and usage. Clin Microbiol Infect 2019; 26:871-879. [PMID: 31811919 DOI: 10.1016/j.cmi.2019.11.028] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Amoxicillin has been in use since the 1970s; it is the most widely used penicillin both alone and in combination with the β-lactamase clavulanic acid. OBJECTIVES In this narrative review, we re-examine the properties of oral amoxicillin and clavulanic acid and provide guidance on their use, with emphasis on the preferred use of amoxicillin alone. SOURCES Published medical literature (MEDLINE database via Pubmed). CONTENT While amoxicillin and clavulanic acid have similar half-lives, clavulanic acid is more protein bound and even less heat stable than amoxicillin, with primarily hepatic metabolism. It is also more strongly associated with gastrointestinal side effects, including Clostridium difficile infection, and, thus, in oral combination formulations, limits the maximum daily dose of amoxicillin that can be given. The first ratio for an amoxicillin-clavulanic acid combination was set at 4:1 due to clavulanic acid's high affinity for β-lactamases; ratios of 2:1, 7:1, 14:1 and 16:1 are currently available in various regions. Comparative effectiveness data for the different ratios are scarce. Amoxicillin-clavulanic acid is often used as empiric therapy for many of the World Health Organization's Priority Infectious Syndromes in adults and children, leading to extensive consumption, when some of these syndromes could be handled with a delayed antibiotic prescription approach or amoxicillin alone. IMPLICATIONS Using available epidemiological and pharmacokinetic data, we provide guidance on indications for amoxicillin versus amoxicillin-clavulanic acid and on optimal oral administration, including choice of combination ratio. More data are needed, particularly on heat stability, pharmacodynamic effects and emergence of resistance in 'real-world' clinical settings.
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Affiliation(s)
- A Huttner
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.
| | - J Bielicki
- University of Basel Children's Hospital, Paediatric Infectious Diseases, Basel, Switzerland; Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
| | - M N Clements
- MRC Clinical Trials Unit at UCL, UCL, London, UK
| | - N Frimodt-Møller
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - A E Muller
- Department of Medical Microbiology, Haaglanden Medical Centre, The Hague, the Netherlands; Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - J-P Paccaud
- Global Antibiotic Research and Development Partnership, Geneva, Switzerland
| | - J W Mouton
- Department of Medical Microbiology, Haaglanden Medical Centre, The Hague, the Netherlands
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13
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Yang X, Wang D, Zhou Q, Nie F, Du H, Pang X, Fan Y, Bai T, Xu Y. Antimicrobial susceptibility testing of Enterobacteriaceae: determination of disk content and Kirby-Bauer breakpoint for ceftazidime/avibactam. BMC Microbiol 2019; 19:240. [PMID: 31675928 PMCID: PMC6824082 DOI: 10.1186/s12866-019-1613-5] [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: 01/08/2019] [Accepted: 10/15/2019] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Detection of ceftazidime/avibactam (CAZ/AVI) antibacterial activity is absolutely vital with the rapid growth of carbapenem resistant Enterobacteriaceae (CRE). But now, there is no available automated antimicrobial susceptibility testing card for CAZ/AVI, so Kirby-Bauer has become an economical and practical method for detecting CAZ/AVI antibacterial activity against Enterobacteriaceae. RESULT In this study, antimicrobial susceptibility testing of CAZ/AVI against 386 Enterobacteriaceae (188 Klebsiella pneumoniae, 122 Escherichia coli, 76 Enterobacter cloacae) isolated from clinical patients was performed by broth microdilution. Of the 386 strains, 54 extended spectrum β lactamases negative (ESBL(-)), 104 extended spectrum β lactamases positive (ESBL(+)), 228 CRE. 287 isolates were susceptible to CAZ/AVI and 99 isolates were resistant to CAZ/AVI. At the same time, to obtain optimal content avibactam (AVI) disk containing ceftazidime (30 μg), inhibition zone diameter of four kinds of ceftazidime (30 μg) disk containing different AVI content (0 μg, 10 μg, 25 μg, 50 μg) were tested by Kirby-Bauer method. The microdilution broth method interpretation was used as the standard to estimate susceptible or resistance and then coherence analysis was carried out between Kirby-Bauer and broth microdilution. The result shows the inhibition zone diameter of 30 μg/50 μg disk, susceptible isolates: 20.5 mm-31.5 mm, resistance isolates: 8.25 mm-21.5 mm. The inhibition zone diameter of 30 μg/25 μg disk, susceptible isolates: 19.7 mm-31.3 mm, resistance isolates: 6.5 mm-19.2 mm. The inhibition zone diameter of 30 μg/10 μg disk, susceptible isolates: 19.5 mm-31 mm, resistance isolates: 6.5 mm-11 mm. The inhibition zone diameter of ceftazidime (30 μg), susceptible isolates: 6.5 mm-27.5 mm, resistance isolates 6.5 mm. CONCLUSION Our results show that 30 μg/50 μg, 30 μg/25 μg, 30 μg/10 μg CAZ/AVI disk have significant statistical differences to determinate CAZ/AVI antibacterial activity, but for 30 μg/50 μg disk, there has a cross section between susceptible isolates (minimum 20.5 mm) and resistance isolates (maximum 21.5 mm). For 30 μg/25 μg disk, it is hard to distinguish the difference between susceptible isolates (minimum 19.7 mm) and resistance isolates (maximum 19.2 mm), so 30 μg/10 μg CAZ/AVI disk is more conducive to determinate antibacterial activity.
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Affiliation(s)
- Xianggui Yang
- Department of Laboratory Medicine, the First Affiliated Hospital of Chengdu Medical College, 278 Baoguang Road, Xindu, Chengdu, Sichuan, 610500, People's Republic of China
| | - Dan Wang
- Department of Laboratory Medicine, the First Affiliated Hospital of Chengdu Medical College, 278 Baoguang Road, Xindu, Chengdu, Sichuan, 610500, People's Republic of China
| | - Qin Zhou
- Department of Laboratory Medicine, the First Affiliated Hospital of Chengdu Medical College, 278 Baoguang Road, Xindu, Chengdu, Sichuan, 610500, People's Republic of China
| | - Fang Nie
- Department of Laboratory Medicine, the First Affiliated Hospital of Chengdu Medical College, 278 Baoguang Road, Xindu, Chengdu, Sichuan, 610500, People's Republic of China
| | - Hongfei Du
- Department of Laboratory Medicine, the First Affiliated Hospital of Chengdu Medical College, 278 Baoguang Road, Xindu, Chengdu, Sichuan, 610500, People's Republic of China
| | - Xueli Pang
- Department of Laboratory Medicine, the First Affiliated Hospital of Chengdu Medical College, 278 Baoguang Road, Xindu, Chengdu, Sichuan, 610500, People's Republic of China
| | - Yingzi Fan
- Department of Laboratory Medicine, the First Affiliated Hospital of Chengdu Medical College, 278 Baoguang Road, Xindu, Chengdu, Sichuan, 610500, People's Republic of China
| | - Tingting Bai
- Department of Laboratory Medicine, the First Affiliated Hospital of Chengdu Medical College, 278 Baoguang Road, Xindu, Chengdu, Sichuan, 610500, People's Republic of China
| | - Ying Xu
- Department of Laboratory Medicine, the First Affiliated Hospital of Chengdu Medical College, 278 Baoguang Road, Xindu, Chengdu, Sichuan, 610500, People's Republic of China.
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14
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Detection of O25b-ST131 clone, CTX-M-1 and CTX-M-15 genes via real-time PCR in Escherichia coli strains in patients with UTIs obtained from a university hospital in Istanbul. J Infect Public Health 2019; 12:640-644. [PMID: 30826300 DOI: 10.1016/j.jiph.2019.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/06/2018] [Accepted: 02/13/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Escherichia coli sequence type 131 is an important multidrug resistant clone responsible from more than half of ESBL-producing E.coli isolates. Aim of this study was to investigate the presence of O25b-ST131 clone, CTX-M-15 and CTX-M-1 genes in the E. coli strains isolated from both hospital and community acquired UTIs by real-time PCR and to reveal molecular epidemiological data. METHODS Non-duplicate E. coli (n = 101) strains isolated from UTI patients were included. Bacterial identifications were performed with VITEK Compact. Antimicrobial susceptibility tests, phenotypic ESBL and E-tests were performed conventionally. Real-time PCR was utilized to detect presence of O25b-ST131 clone, blaCTX-M-15 and blaCTX-M-1. RESULTS O25b-ST131 clone, CTX-M-1 and CTX-M-15 were detected in 22%, 73%, 37% in UTIs, respectively. Presence of O25b-ST131 clones and CTX-M-1 genes among E. coli strains isolated from inpatients were found statistically higher than outpatients. The most effective choice was found to be fosfomycin and nitrofurantoin in outpatients and inpatients, respectively. The MIC90 values of Amikacin, Cefotaxime, Cefepime and Ciprofloxacin were higher in inpatients than in oupatients, whereas Cefotaxime and Ciprofloxacin MIC50 values were found to be higher in inpatients than in outpatients. The highest increase of MIC90 values was observed in O25b-ST131, CTX-M-1 and CTX-M-15 coexistence. CONCLUSION The presence of O25b-ST131 clone, CTX-M-1 and CTX-M-15 genes in E. coli strains in patients with UTI has been revealed. In the presence of the O25b-ST131 clone, a significant increase was observed in the ciprofloxacin MIC values indicating the importance of monitorization of the clone using molecular epidemiology.
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15
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Sadikalay S, Reynaud Y, Guyomard-Rabenirina S, Falord M, Ducat C, Fabre L, Le Hello S, Talarmin A, Ferdinand S. High genetic diversity of extended-spectrum β-lactamases producing Escherichia coli in feces of horses. Vet Microbiol 2018; 219:117-122. [PMID: 29778183 DOI: 10.1016/j.vetmic.2018.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 04/07/2018] [Accepted: 04/11/2018] [Indexed: 11/17/2022]
Abstract
Extended-spectrum beta-lactamases (ESBLs), especially those of the CTX-M type, represent a major public health problem throughout the world. Although the carriage of ESBL-producing Enterobacteriaceae (EPE) in feces of horses is now well recognized, little is known about the diversity of EPE after treatment of horses with antibiotics. We undertook this study to assess and follow the diversity of EP Escherichia coli isolated from horses after antibiotic treatment for an infection. Fecal samples from two horses treated and two that were untreated were tested for the presence of EPE on different days. All isolated E. coli strains were evaluated for antimicrobial resistance (AMR) and by whole-genome sequencing. Multi locus sequence typing, phylogrouping, resistance genes and plasmid content were extracted from genomic data. A phylogenetic analysis based on single nucleotide polymorphism (SNP) divergence was also performed on the core genome. We isolated 35 strains belonging to the A, B1 and C phylo-groups. All but one expressed SHV-12 enzymes and one expressed CTX-M-1. Intra- and inter-horse genetic diversity of E. coli strains was identified in the genome analysis and 10 AMR profiles. Two distinct EP E. coli-resistant populations (phylo-group B1: ST4164-AMR3 and ST155-AMR2) were found in one horse, and five other resistant populations were found in the second horse (phylo-group A: ST1250-AMR1; phylo-group B1: ST1250-AMR1, ST6981-AMR1 and phylo-group C: ST10-AMR4). Some persistent EP E. coli strains were detected at least 1 month after treatment. These results indicate that EP E. coli strains isolated from horse feces show intra- and inter-host genetic diversity, even in a region with low ESBL prevalence and in horses that are rarely treated with third-generation cephalosporins. These results also suggest that horizontal gene transfer and/or selection of resistance genes probably occurs in vivo within the horse gut microbiome. Follow-up of EP E. coli resistance profiles for at least 1 month after treatment is warranted to prevent persistence of EP E. coli.
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Affiliation(s)
- Syndia Sadikalay
- Unité Environnement Santé, Institut Pasteur de Guadeloupe, Les Abymes, Guadeloupe, France
| | - Yann Reynaud
- Unité Environnement Santé, Institut Pasteur de Guadeloupe, Les Abymes, Guadeloupe, France
| | | | - Mélanie Falord
- Unité Environnement Santé, Institut Pasteur de Guadeloupe, Les Abymes, Guadeloupe, France
| | - Célia Ducat
- Unité Environnement Santé, Institut Pasteur de Guadeloupe, Les Abymes, Guadeloupe, France
| | - Laetitia Fabre
- Institut Pasteur, Unité des Bactéries Pathogènes Entériques, Centre National de Réfé.rence des Escherichia coli, Shigella et Salmonella, Paris, France
| | - Simon Le Hello
- Institut Pasteur, Unité des Bactéries Pathogènes Entériques, Centre National de Réfé.rence des Escherichia coli, Shigella et Salmonella, Paris, France
| | - Antoine Talarmin
- Unité Environnement Santé, Institut Pasteur de Guadeloupe, Les Abymes, Guadeloupe, France
| | - Séverine Ferdinand
- Unité Environnement Santé, Institut Pasteur de Guadeloupe, Les Abymes, Guadeloupe, France.
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16
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Tchesnokova V, Avagyan H, Rechkina E, Chan D, Muradova M, Haile HG, Radey M, Weissman S, Riddell K, Scholes D, Johnson JR, Sokurenko EV. Bacterial clonal diagnostics as a tool for evidence-based empiric antibiotic selection. PLoS One 2017; 12:e0174132. [PMID: 28350870 PMCID: PMC5369764 DOI: 10.1371/journal.pone.0174132] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/24/2017] [Indexed: 01/03/2023] Open
Abstract
Despite the known clonal distribution of antibiotic resistance in many bacteria, empiric (pre-culture) antibiotic selection still relies heavily on species-level cumulative antibiograms, resulting in overuse of broad-spectrum agents and excessive antibiotic/pathogen mismatch. Urinary tract infections (UTIs), which account for a large share of antibiotic use, are caused predominantly by Escherichia coli, a highly clonal pathogen. In an observational clinical cohort study of urgent care patients with suspected UTI, we assessed the potential for E. coli clonal-level antibiograms to improve empiric antibiotic selection. A novel PCR-based clonotyping assay was applied to fresh urine samples to rapidly detect E. coli and the urine strain's clonotype. Based on a database of clonotype-specific antibiograms, the acceptability of various antibiotics for empiric therapy was inferred using a 20%, 10%, and 30% allowed resistance threshold. The test's performance characteristics and possible effects on prescribing were assessed. The rapid test identified E. coli clonotypes directly in patients' urine within 25-35 minutes, with high specificity and sensitivity compared to culture. Antibiotic selection based on a clonotype-specific antibiogram could reduce the relative likelihood of antibiotic/pathogen mismatch by ≥ 60%. Compared to observed prescribing patterns, clonal diagnostics-guided antibiotic selection could safely double the use of trimethoprim/sulfamethoxazole and minimize fluoroquinolone use. In summary, a rapid clonotyping test showed promise for improving empiric antibiotic prescribing for E. coli UTI, including reversing preferential use of fluoroquinolones over trimethoprim/sulfamethoxazole. The clonal diagnostics approach merges epidemiologic surveillance, antimicrobial stewardship, and molecular diagnostics to bring evidence-based medicine directly to the point of care.
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Affiliation(s)
- Veronika Tchesnokova
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Hovhannes Avagyan
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA, United States of America
- Kaiser Permanente Washington, Seattle, WA, United States of America
| | - Elena Rechkina
- Kaiser Permanente Washington, Seattle, WA, United States of America
- ID Genomics, Inc., Seattle, WA, United States of America
| | - Diana Chan
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Mariya Muradova
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Helen Ghirmai Haile
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Matthew Radey
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Scott Weissman
- Children’s Hospital, Seattle, WA, United States of America
| | - Kim Riddell
- Kaiser Permanente Washington, Seattle, WA, United States of America
- * E-mail: (KR); (SD); (EVS)
| | - Delia Scholes
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
- * E-mail: (KR); (SD); (EVS)
| | - James R. Johnson
- VA Medical Center and University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Evgeni V. Sokurenko
- Department of Microbiology, University of Washington School of Medicine, Seattle, WA, United States of America
- Kaiser Permanente Washington, Seattle, WA, United States of America
- * E-mail: (KR); (SD); (EVS)
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17
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Guyomard-Rabenirina S, Dartron C, Falord M, Sadikalay S, Ducat C, Richard V, Breurec S, Gros O, Talarmin A. Resistance to antimicrobial drugs in different surface waters and wastewaters of Guadeloupe. PLoS One 2017; 12:e0173155. [PMID: 28253356 PMCID: PMC5333909 DOI: 10.1371/journal.pone.0173155] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/15/2017] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The first aim of this study was to evaluate the antimicrobial resistance of Enterobacteriaceae in different water environments of Guadeloupe and especially those impacted by waste water treatment plants (WWTP) effluents. The second objective was to characterize the genetic basis for antibiotic resistance of extended-spectrum beta-lactamase (ESBL) and AmpC beta-lactamase producing Enterobacteriaceae isolates (ESBLE and AmpCE). METHODS We have collected 70 surface waters (river and sea samples) impacted or not by WWTP and 18 waste waters from 2 WWTPs in 2012 and 2013. We i) determined the total and resistant bacterial counts and ii) tested isolated Enterobacteriaceae for their antimicrobial susceptibility. We also studied the genetic basis for antibiotic resistance of ESBLE and AmpCE, and the genetic background of Escherichia coli. RESULTS In rivers, contamination with Escherichia coli and antibiotic resistant coliforms (ARC) increased from the source to the mouth. Highest levels of river contamination with E. coli (9.26 x 105 MPN/100mL) and ARC (2.26 x 108 CFU/mL) were observed in surface water sampled near the discharge. A total of 246 Enterobacteriaceae strains resistant to antibiotics were isolated, mostly from waste waters and from river water collected near the discharge. Among these strains, 33 were Extended Spectrum Beta Lactamase (ESBLE) and 8 E. coli were AmpC beta-lactamase producers. All the ESBLE were isolated from waste waters or from river water collected near the discharge. The blaCTX-M gene was present in 29 of the 33 ESBLE strains, with 24 belonging to group 1. Numerous strains (68.7%) showed more than one acquired antibiotic resistance mechanism. E. coli strains belonged to different phylogenetic groups; among the B2 group, most strains belonged to the ST131 clone. CONCLUSION Our results demonstrated that many human activities can supply antibiotic-resistant bacteria in surface water. Nevertheless, WWTPs were the most important supplier of ESBLE in water environment of Guadeloupe.
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Affiliation(s)
| | - Celia Dartron
- Sorbonne Universités, UPMC Univ Paris 06, Univ Antilles, Univ Nice Sophia Antipolis, CNRS, Evolution Paris Seine—Institut de Biologie Paris Seine (EPS—IBPS), Paris, France
| | - Mélanie Falord
- Unité Environnement Santé, Institut Pasteur de la Guadeloupe, Les Abymes, Guadeloupe
| | - Syndia Sadikalay
- Unité Environnement Santé, Institut Pasteur de la Guadeloupe, Les Abymes, Guadeloupe
| | - Célia Ducat
- Unité Environnement Santé, Institut Pasteur de la Guadeloupe, Les Abymes, Guadeloupe
| | - Vincent Richard
- Institut Pasteur de Nouvelle Calédonie BP61—98845 Nouméa Cedex, Nouvelle-Calédonie
| | - Sébastien Breurec
- Unité Environnement Santé, Institut Pasteur de la Guadeloupe, Les Abymes, Guadeloupe
- Université des Antilles, Pointe à Pitre cedex, Guadeloupe
- Laboratoire de Microbiologie Clinique et Environnementale, Centre Hospitalier Universitaire de Pointe à Pitre, Guadeloupe
| | - Olivier Gros
- Sorbonne Universités, UPMC Univ Paris 06, Univ Antilles, Univ Nice Sophia Antipolis, CNRS, Evolution Paris Seine—Institut de Biologie Paris Seine (EPS—IBPS), Paris, France
| | - Antoine Talarmin
- Unité Environnement Santé, Institut Pasteur de la Guadeloupe, Les Abymes, Guadeloupe
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