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Hall RJ, Snaith AE, Thomas MJN, Brockhurst MA, McNally A. Multidrug resistance plasmids commonly reprogram the expression of metabolic genes in Escherichia coli. mSystems 2024; 9:e0119323. [PMID: 38376169 PMCID: PMC10949484 DOI: 10.1128/msystems.01193-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/23/2024] [Indexed: 02/21/2024] Open
Abstract
Multidrug-resistant Escherichia coli is a leading cause of global mortality. Transfer of plasmids carrying genes encoding beta-lactamases, carbapenamases, and colistin resistance between lineages is driving the rising rates of hard-to-treat nosocomial and community infections. Multidrug resistance (MDR) plasmid acquisition commonly causes transcriptional disruption, and while a number of studies have shown strain-specific fitness and transcriptional effects of an MDR plasmid across diverse bacterial lineages, fewer studies have compared the impacts of different MDR plasmids in a common bacterial host. As such, our ability to predict which MDR plasmids are the most likely to be maintained and spread in bacterial populations is limited. Here, we introduced eight diverse MDR plasmids encoding resistances against a range of clinically important antibiotics into E. coli K-12 MG1655 and measured their fitness costs and transcriptional impacts. The scale of the transcriptional responses varied substantially between plasmids, ranging from >650 to <20 chromosomal genes being differentially expressed. However, the scale of regulatory disruption did not correlate significantly with the magnitude of the plasmid fitness cost, which also varied between plasmids. The identities of differentially expressed genes differed between transconjugants, although the expression of certain metabolic genes and functions were convergently affected by multiple plasmids, including the downregulation of genes involved in L-methionine transport and metabolism. Our data show the complexity of the interaction between host genetic background and plasmid genetic background in determining the impact of MDR plasmid acquisition on E. coli. IMPORTANCE The increase in infections that are resistant to multiple classes of antibiotics, including those isolates that carry carbapenamases, beta-lactamases, and colistin resistance genes, is of global concern. Many of these resistances are spread by conjugative plasmids. Understanding more about how an isolate responds to an incoming plasmid that encodes antibiotic resistance will provide information that could be used to predict the emergence of MDR lineages. Here, the identification of metabolic networks as being particularly sensitive to incoming plasmids suggests the possible targets for reducing plasmid transfer.
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Affiliation(s)
- Rebecca J. Hall
- Institute of Microbiology and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ann E. Snaith
- Institute of Microbiology and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Matthew J. N. Thomas
- Division of Evolution and Genomic Sciences, University of Manchester, Manchester, United Kingdom
| | - Michael A. Brockhurst
- Division of Evolution and Genomic Sciences, University of Manchester, Manchester, United Kingdom
| | - Alan McNally
- Institute of Microbiology and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Ghanbarinasab F, Haeili M, Ghanati SN, Moghimi M. High prevalence of OXA-48-like and NDM carbapenemases among carbapenem resistant Klebsiella pneumoniae of clinical origin from Iran. IRANIAN JOURNAL OF MICROBIOLOGY 2023; 15:609-615. [PMID: 37941881 PMCID: PMC10628078 DOI: 10.18502/ijm.v15i5.13866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Background and Objectives Klebsiella pneumoniae is increasingly developing resistance to last-resort antibiotics such as carbapenems. This study aimed to investigate the dissemination of common carbapenemase encoding genes among 48 clinical isolates of carbapenem-resistant Klebsiella pneumoniae (CRKP). Materials and Methods Antimicrobial susceptibility testing was performed by broth dilution and disc diffusion methods. The phenotypic evaluation of carbapenemase production was performed by using Modified Carbapenem Inactivation Method. Presence of carbapenemase encoding genes blaKPC, blaNDM, blaOXA-48-like , blaIMP, and blaVIM was screened by PCR. Results Overall, carbapenemases were produced in all CRKP isolates. The blaOXA-48-like and blaNDM were the most prevalent genes detected among all and 66.6% (n=32) of CRKP isolates respectively. The blaVIM was detected in only one isolate co-harboring NDM and OXA-48-like carbapenemases. The blaKPC and blaIMP genes were not identified in any of the isolates. While tigecycline was the most active agent against CRKP isolates with low resistance rate (4.1%), high rate of resistance was observed to colistin (66.6%), amikacin (79%) and most of other tested antimicrobials. Conclusion Our results revealed predominant prevalence of OXA-48-like and NDM carbapenemases among CRKP clinical isolates. High rate of resistance to last-resort agents such as colistin among CRKP isolates is a source of great concern.
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Affiliation(s)
- Fatemeh Ghanbarinasab
- Department of Animal Biology, Faculty of Natural Sciences, University of Tabriz, Tabriz, Iran
| | - Mehri Haeili
- Department of Animal Biology, Faculty of Natural Sciences, University of Tabriz, Tabriz, Iran
| | - Somayeh Nasiri Ghanati
- Department of Animal Biology, Faculty of Natural Sciences, University of Tabriz, Tabriz, Iran
| | - Mohaddeseh Moghimi
- Department of Animal Biology, Faculty of Natural Sciences, University of Tabriz, Tabriz, Iran
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Bharadwaj A, Rastogi A, Pandey S, Gupta S, Sohal JS. Multidrug-Resistant Bacteria: Their Mechanism of Action and Prophylaxis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5419874. [PMID: 36105930 PMCID: PMC9467707 DOI: 10.1155/2022/5419874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/11/2022] [Accepted: 08/20/2022] [Indexed: 11/18/2022]
Abstract
In the present scenario, resistance to antibiotics is one of the crucial issues related to public health. Earlier, such resistance to antibiotics was limited to nosocomial infections, but it has now become a common phenomenon. Several factors, like extensive development, overexploitation of antibiotics, excessive application of broad-spectrum drugs, and a shortage of target-oriented antimicrobial drugs, could be attributed to this condition. Nowadays, there is a rise in the occurrence of these drug-resistant pathogens due to the availability of a small number of effective antimicrobial agents. It has been estimated that if new novel drugs are not discovered or formulated, there would be no effective antibiotic available to treat these deadly resistant pathogens by 2050. For this reason, we have to look for the formulation of some new novel drugs or other options or substitutes to treat such multidrug-resistant microorganisms (MDR). The current review focuses on the evolution of the most common multidrug-resistant bacteria and discusses how these bacteria escape the effects of targeted antibiotics and become multidrug resistant. In addition, we also discuss some alternative mechanisms to prevent their infection as well.
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Affiliation(s)
- Alok Bharadwaj
- Department of Biotechnology, GLA University, Mathura (U.P.)-281 406, India
| | - Amisha Rastogi
- Department of Biotechnology, GLA University, Mathura (U.P.)-281 406, India
| | - Swadha Pandey
- Department of Biotechnology, GLA University, Mathura (U.P.)-281 406, India
| | - Saurabh Gupta
- Department of Biotechnology, GLA University, Mathura (U.P.)-281 406, India
| | - Jagdip Singh Sohal
- Department of Biotechnology, GLA University, Mathura (U.P.)-281 406, India
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Chen C, Oelschlaeger P, Wang D, Xu H, Wang Q, Wang C, Zhao A, Yang KW. Structure and Mechanism-Guided Design of Dual Serine/Metallo-Carbapenemase Inhibitors. J Med Chem 2022; 65:5954-5974. [PMID: 35420040 DOI: 10.1021/acs.jmedchem.2c00213] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Serine/metallo-carbapenemase-coproducing pathogens, often referred to as "superbugs", are a significant clinical problem. They hydrolyze nearly all available β-lactam antibiotics, especially carbapenems considered as last-resort antibiotics, seriously endangering efficacious antibacterial treatment. Despite the continuous global spread of carbapenem resistance, no dual-action inhibitors are available in therapy. This Perspective is the first systematic investigation of all chemotypes, modes of inhibition, and crystal structures of dual serine/metallo-carbapenemase inhibitors. An overview of the key strategy for designing dual serine/metallo-carbapenemase inhibitors and their mechanism of action is provided, as guiding rules for the development of clinically available dual inhibitors, coadministrated with carbapenems, to overcome the carbapenem resistance issue.
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Affiliation(s)
- Cheng Chen
- College of Forestry, Northwest A&F University, Yangling 712100, Shaanxi, P. R. China
| | - Peter Oelschlaeger
- Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, 309 East Second Street, Pomona 91766, California, United States
| | - Dongmei Wang
- College of Forestry, Northwest A&F University, Yangling 712100, Shaanxi, P. R. China
| | - Hao Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310030, P. R. China
| | - Qian Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Henan University of Chinese Medicine, Jinshui District 450046, Zhengzhou, P. R. China
| | - Cheng Wang
- College of Forestry, Northwest A&F University, Yangling 712100, Shaanxi, P. R. China
| | - Aiguo Zhao
- College of Forestry, Northwest A&F University, Yangling 712100, Shaanxi, P. R. China
| | - Ke-Wu Yang
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xi'an 710127, P. R. China
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Dankittipong N, Fischer EAJ, Swanenburg M, Wagenaar JA, Stegeman AJ, de Vos CJ. Quantitative Risk Assessment for the Introduction of Carbapenem-Resistant Enterobacteriaceae (CPE) into Dutch Livestock Farms. Antibiotics (Basel) 2022; 11:antibiotics11020281. [PMID: 35203883 PMCID: PMC8868399 DOI: 10.3390/antibiotics11020281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 12/10/2022] Open
Abstract
Early detection of emerging carbapenem-resistant Enterobacteriaceae (CPE) in food-producing animals is essential to control the spread of CPE. We assessed the risk of CPE introduction from imported livestock, livestock feed, companion animals, hospital patients, and returning travelers into livestock farms in The Netherlands, including (1) broiler, (2) broiler breeder, (3) fattening pig, (4) breeding pig, (5) farrow-to-finish pig, and (6) veal calf farms. The expected annual number of introductions was calculated from the number of farms exposed to each CPE source and the probability that at least one animal in an exposed farm is colonized. The total number of farms with CPE colonization was estimated to be the highest for fattening pig farms, whereas the probability of introduction for an individual farm was the highest for broiler farms. Livestock feed and imported livestock are the most likely sources of CPE introduction into Dutch livestock farms. Sensitivity analysis indicated that the number of fattening pig farms determined the number of high introductions in fattening pigs from feed, and that uncertainty on CPE prevalence impacted the absolute risk estimate for all farm types. The results of this study can be used to inform risk-based surveillance for CPE in livestock farms.
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Affiliation(s)
- Natcha Dankittipong
- Department Population Health Sciences, Farm Animal Health, Utrecht University, Martinus G. de Bruingebouw, Yalelaan 7, 3584 CL Utrecht, The Netherlands; (E.A.J.F.); (A.J.S.)
- Correspondence:
| | - Egil A. J. Fischer
- Department Population Health Sciences, Farm Animal Health, Utrecht University, Martinus G. de Bruingebouw, Yalelaan 7, 3584 CL Utrecht, The Netherlands; (E.A.J.F.); (A.J.S.)
| | - Manon Swanenburg
- Wageningen Bioveterinary Research, Wageningen University & Research, Houtribweg 39, 8221 RA Lelystad, The Netherlands; (M.S.); (C.J.d.V.)
| | - Jaap A. Wagenaar
- Department Biomolecular Health Science, Infectious Diseases & Immunology, Utrecht University, Androclusgebouw, Yalelaan 1, 3584 CL Utrecht, The Netherlands;
| | - Arjan J. Stegeman
- Department Population Health Sciences, Farm Animal Health, Utrecht University, Martinus G. de Bruingebouw, Yalelaan 7, 3584 CL Utrecht, The Netherlands; (E.A.J.F.); (A.J.S.)
| | - Clazien J. de Vos
- Wageningen Bioveterinary Research, Wageningen University & Research, Houtribweg 39, 8221 RA Lelystad, The Netherlands; (M.S.); (C.J.d.V.)
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Chaudhary U, Agarwal S, Raghuraman K. Identification of extended spectrum beta lactamases, AmpC and carbapenemase production among isolates of Escherichia coli in North Indian tertiary care centre. Avicenna J Med 2021; 8:46-50. [PMID: 29682477 PMCID: PMC5898182 DOI: 10.4103/ajm.ajm_156_17] [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] [Indexed: 11/16/2022] Open
Abstract
Introduction: Identification of Extended spectrum beta lactamases (ESBL), AmpC production and carbapenemase production among isolates of Escherichia coli, helps clinician to rationalize the choice of antibiotics. However, there is a lack of simple and effective method for simultaneous identification of these beta lactamases. Aim: To determine the concurrent production of beta lactamases using twelve disc method on E. coli isolates. Materials and Methods: A total of 200 multidrug resistant E. coli were screened using twelve disc method. The isolates of ESBL were confirmed by ceftazidime/clavulanic acid and cefotaxime/clavulanic acid method. Metallo-beta-lactamases (MBL) were confirmed by imipenem EDTA combined disc method. Results: Among the 200 isolates, 42.5% were ESBL producers, 9% were MBL and 6.5% were Klebsiella pneumoniae carbapenemase (KPC) and AmpC each respectively. Coproduction was seen in 54 (27%). A significant difference in sensitivity was seen in cefuroxime, aztreonam, cefoxitin and ceftriaxone among inpatient and outpatients. Conclusion: The present study highlights burden of ESBL, AmpC, KPC and MBL along with their coproduction in a tertiary care hospital. In-house antibiotic policy, infection control and epidemiological surveys will help us in controlling these resistant bugs. We believe, the twelve disc method is a simple, inexpensive screening method for beta lactamase production.
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Affiliation(s)
- Uma Chaudhary
- Department of Microbiology, Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Shipra Agarwal
- Department of Microbiology, Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Kausalya Raghuraman
- Department of Microbiology, Pt BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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7
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Maillard JY, Bloomfield SF, Courvalin P, Essack SY, Gandra S, Gerba CP, Rubino JR, Scott EA. Reducing antibiotic prescribing and addressing the global problem of antibiotic resistance by targeted hygiene in the home and everyday life settings: A position paper. Am J Infect Control 2020; 48:1090-1099. [PMID: 32311380 PMCID: PMC7165117 DOI: 10.1016/j.ajic.2020.04.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/12/2022]
Abstract
Antimicrobial resistance (AMR) continues to threaten global health. Although global and national AMR action plans are in place, infection prevention and control is primarily discussed in the context of health care facilities with home and everyday life settings barely addressed. As seen with the recent global SARS-CoV-2 pandemic, everyday hygiene measures can play an important role in containing the threat from infectious microorganisms. This position paper has been developed following a meeting of global experts in London, 2019. It presents evidence that home and community settings are important for infection transmission and also the acquisition and spread of AMR. It also demonstrates that the targeted hygiene approach offers a framework for maximizing protection against colonization and infections, thereby reducing antibiotic prescribing and minimizing selection pressure for the development of antibiotic resistance. If combined with the provision of clean water and sanitation, targeted hygiene can reduce the circulation of resistant bacteria in homes and communities, regardless of a country's Human Development Index (overall social and economic development). Achieving a reduction of AMR strains in health care settings requires a mirrored reduction in the community. The authors call upon national and international policy makers, health agencies, and health care professionals to further recognize the importance of targeted hygiene in the home and everyday life settings for preventing and controlling infection, in a unified quest to tackle AMR.
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Affiliation(s)
- Jean-Yves Maillard
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK; International Scientific Forum on Home Hygiene, Somerset, UK.
| | | | | | - Sabiha Y Essack
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Sumanth Gandra
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Charles P Gerba
- Departments of Soil, Water and Environmental Science and Environmental Health, University of Arizona, Tucson, AZ, USA
| | - Joseph R Rubino
- Research & Development, Home Hygiene, Lysol/Harpic, Reckitt Benckiser LLC., One Philips Parkway, Montvale, NJ, USA
| | - Elizabeth A Scott
- College of Natural, Behavioral and Health Sciences, Simmons University, Boston, MA, USA
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Rising Threat of OXA-48 and other Carbapenemase Encoding Genes among Carbapenem Resistant Enterobacteriaceae in India. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.3.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Members of Enterobacteriaceae family are responsible for both community and hospital acquired infections. Because of development of antimicrobial resistance carbapenem has remained as last resort of drug for treatment of infections caused by these bacteria.Mechanism for development of this resistance in carbapenem resistant Enterobacteriaceae (CRE) may due to production of carbapenemases, efflux mechanism or loss of outer membrane porins.The most common carbapenemase enzymes are Class A – KPC, Class B – NDM, VIM and IMP and Class D oxacillinase(OXA-48 like enzymes).In India, most prevalent carbapenemase encoding gene is NDM-1but there is rising threat of OXA-48 prevalence. Unlike the phenotypic methods, the genotypic methods are useful to discriminate the type of carbapenemase enzyme, specifically for OXA-48 like enzymes. Total 170 CRE isolates were subjected for multiplex PCR study for their molecular characterization. Of the 170 CRE isolates,68.2 % (n=116) were positive for NDM-1 gene while 44.1 % (n= 75) of the isolates showed presence of OXA-48 gene. VIM (2.3%), KPC (1.7 %) were responsible for carbapenemase production while none of the isolates showed presence of IMP gene. NDM-1 and OXA-48 coexisted in 21.2 % (n=36) of the total isolates. OXA-48 causes weak hydrolysis of carbapenem because of which it is under reported with routine diagnostic methods. Early detection of OXA-48 and other carbapenemase encoding genes, helps for contact precautions and effective therapy which prevents further escalation and horizontal spread of CRE.
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Thapa Shrestha U, Shrestha S, Adhikari N, Rijal KR, Shrestha B, Adhikari B, Banjara MR, Ghimire P. Plasmid Profiling and Occurrence of β-Lactamase Enzymes in Multidrug-Resistant Uropathogenic Escherichia coli in Kathmandu, Nepal. Infect Drug Resist 2020; 13:1905-1917. [PMID: 32606839 PMCID: PMC7320882 DOI: 10.2147/idr.s250591] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Extended-spectrum β-lactamases (ESBL) among Gram-negative bacteria, predominantly Escherichia coli (E. coli), in Nepal, have been rising. The main objectives of this study were to determine the prevalence of uropathogenic E. coli, antibiotic resistance, ESBLs, ABLs (AmpC type β-lactamases), MBLs (metallo-β-lactamases) and KPCs (Klebsiella pneumoniae carbapenemases) and their correlation with plasmid profiling patterns among patients with urinary tract infections in a tertiary hospital in Kathmandu, Nepal. METHODS The mid-stream urine samples collected from patients were inoculated in cystine-lactose-electrolyte-deficient (CLED) agar plates. E. coli producing ESBLs, ABLs, MBLs/KPC were identified phenotypically using standard microbiological methods. Plasmids were extracted by alkaline lysis method from E. coli isolates and profiled using agarose gel electrophoresis. RESULTS Out of the total 2661 urine samples, E. coli were isolated in 64.34% (507/788), among which 170 (33.53%) were multidrug-resistant (MDR) isolates. All MDR isolates were resistant to amoxicillin and third-generation cephalosporins but were highly sensitive to imipenem (94.12%, 160/170), amikacin (92.94%, 158/170) and nitrofurantoin (86.47%, 147/170). Among 170 MDR isolates, 78.2% (133/170) were ESBLs, 46.3% (50/170) were AmpC, 11.2% (19/170) were MBL and 0.6% (1/170) were KPC producers. Coproduction of β-lactamases was detected in 24.12% (41/170) of isolates. E. coli isolates showed one plasmid (>33.5 kb), which was present in all the isolates. Overall, 44 different plasmid profile groups were identified based on molecular weight and number of plasmids. β-Lactamase producers were relatively resistant to the higher number of antibiotics tested (≤10) than non-producers (≤8), and the number of plasmids were higher in β-lactamase producers (≤7) than those in non-producers (≤5). CONCLUSION The higher prevalence of the ESBLs, AmpCs, KPCs and MBLs along with their coproduction in E. coli isolates highlights the importance of routine surveillance of ESBLs, AmpCs, KPCs and MBLs in microbiology laboratories using various phenotypic methods.
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Affiliation(s)
- Upendra Thapa Shrestha
- Kantipur College of Medical Science, Tribhuvan University, Sitapaila, Kathmandu, Nepal
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Sabnum Shrestha
- Kantipur College of Medical Science, Tribhuvan University, Sitapaila, Kathmandu, Nepal
| | - Nabaraj Adhikari
- Kantipur College of Medical Science, Tribhuvan University, Sitapaila, Kathmandu, Nepal
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Basudha Shrestha
- Department of Microbiology, Kathmandu Model Hospital, Kathmandu, Nepal
| | - Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
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OXA-48 Carbapenemase in Klebsiella pneumoniae Sequence Type 307 in Ecuador. Microorganisms 2020; 8:microorganisms8030435. [PMID: 32204571 PMCID: PMC7143988 DOI: 10.3390/microorganisms8030435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 01/04/2023] Open
Abstract
Antibiotic resistance is on the rise, leading to an increase in morbidity and mortality due to infectious diseases. Klebsiella pneumoniae is a Gram-negative bacterium that causes bronchopneumonia, abscesses, urinary tract infection, osteomyelitis, and a wide variety of infections. The ubiquity of this microorganism confounds with the great increase in antibiotic resistance and have bred great concern worldwide. K. pneumoniae sequence type (ST) 307 is a widespread emerging clone associated with hospital-acquired infections, although sporadic community infections have also been reported. The aim of our study is to describe the first case of Klebsiella pneumoniae (ST) 307 harboring the blaOXA-48-like gene in Ecuador. We characterized a new plasmid that carry OXA-48 and could be the source of future outbreaks. The strain was recovered from a patient with cancer previously admitted in a Ukrainian hospital, suggesting that this mechanism of resistance could be imported. These findings highlight the importance of programs based on active molecular surveillance for the intercontinental spread of multidrug-resistant microorganisms with emergent carbapenemases.
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Abstract
β-Lactam antibiotics have been widely used as therapeutic agents for the past 70 years, resulting in emergence of an abundance of β-lactam-inactivating β-lactamases. Although penicillinases in Staphylococcus aureus challenged the initial uses of penicillin, β-lactamases are most important in Gram-negative bacteria, particularly in enteric and nonfermentative pathogens, where collectively they confer resistance to all β-lactam-containing antibiotics. Critical β-lactamases are those enzymes whose genes are encoded on mobile elements that are transferable among species. Major β-lactamase families include plasmid-mediated extended-spectrum β-lactamases (ESBLs), AmpC cephalosporinases, and carbapenemases now appearing globally, with geographic preferences for specific variants. CTX-M enzymes include the most common ESBLs that are prevalent in all areas of the world. In contrast, KPC serine carbapenemases are present more frequently in the Americas, the Mediterranean countries, and China, whereas NDM metallo-β-lactamases are more prevalent in the Indian subcontinent and Eastern Europe. As selective pressure from β-lactam use continues, multiple β-lactamases per organism are increasingly common, including pathogens carrying three different carbapenemase genes. These organisms may be spread throughout health care facilities as well as in the community, warranting close attention to increased infection control measures and stewardship of the β-lactam-containing drugs in an effort to control selection of even more deleterious pathogens.
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Pal A, Dhara L, Tripathi A. Contribution of acrB upregulation & OmpC/Ompk36 loss over the presence of blaNDM towards carbapenem resistance development among pathogenic Escherichia coli & Klebsiella spp. Indian J Med Res 2020; 149:528-538. [PMID: 31411177 PMCID: PMC6676854 DOI: 10.4103/ijmr.ijmr_716_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background & objectives: The global spread of carbapenem-resistant Enterobacteriaceae (CRE) is an emerging clinical problem. Hence, in this study, the plausible role of extended-spectrum beta-lactamases (ESBLs)/carbapenemases, OmpC/Ompk36, acrB and their combinations was explored among CRE. Methods: The minimum inhibitory concentration (MIC) of meropenem, enzyme-phenotypes (ESBLs/IR and metallo-beta-lactamase (MBL)/non-MBL carbapenemase), genotypes (blaTEM,blaSHV and blaCTX-M; blaNDM and blaVIM;blaKPC and blaOXA-48-like variants), acrB and outer membrane protein (OMP) expressions were analyzed with a total of 101 non-duplicate clinical isolates, obtained from various samples of patients visiting two tertiary care units of Eastern India during May 2013 - October 2016. This included Escherichia coli (n=36) and Klebsiella pneumoniae (n=65), categorized into two groups, namely Group I (resistant to all carbapenems; n=93; E. coli=34 and Klebsiella spp.=59) and Group II (non-resistant to all the carbapenems; n=8; E. coli=2 and Klebsiella spp.=6). Results: Though 88.17 per cent of Group I isolates exhibited ESBL property, the presence of carbapenemase activity (70.96%) and that of blaNDM gene (42/66: 63.63%) indicated their contributions towards the emergence of CRE. Further, porin loss and/or efflux pump activation among ESBL/carbapenemase-producing isolates heightened the MIC of meropenem from 64 to 256 mg/l (range exhibited by only ESBL/carbapenemase-producing isolates) to >256 mg/l. Interpretation & conclusions: These findings implied the major contribution of porin loss and/or efflux pump activation over the presence of ESBLs/carbapenemases in imparting carbapenem resistance in pathogenic bacteria.
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Affiliation(s)
- Arijit Pal
- Department of Biochemistry & Medical Biotechnology, Calcutta School of Tropical Medicine, Kolkata, India
| | - Lena Dhara
- Department of Biochemistry & Medical Biotechnology, Calcutta School of Tropical Medicine, Kolkata, India
| | - Anusri Tripathi
- Department of Biochemistry & Medical Biotechnology, Calcutta School of Tropical Medicine, Kolkata, India
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13
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Amladi AU, Abirami B, Devi SM, Sudarsanam TD, Kandasamy S, Kekre N, Veeraraghavan B, Sahni RD. Susceptibility profile, resistance mechanisms & efficacy ratios of fosfomycin, nitrofurantoin & colistin for carbapenem-resistant Enterobacteriaceae causing urinary tract infections. Indian J Med Res 2019; 149:185-191. [PMID: 31219082 PMCID: PMC6563748 DOI: 10.4103/ijmr.ijmr_2086_17] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives The escalation in carbapenem resistance among Enterobacteriaceae has resulted in a lack of effective therapeutic alternatives. Older antimicrobials, fosfomycin, nitrofurantoin and colistin for urinary tract infections (UTIs) caused by carbapenem-resistant Enterobacteriaceae (CRE) may be effective treatment options. The objectives of this study were to evaluate the utility of fosfomycin, nitrofurantoin and colistin in treating UTI caused by CRE and molecular characterization of the plasmid-mediated carbapenem resistance mechanisms. Methods Consecutive, non-duplicate isolates of CR Escherichia coli and Klebsiella spp. from urine cultures were included (n=150). Minimum inhibitory concentrations (MIC) were determined by E-test (fosfomycin and nitrofurantoin) and broth microdilution (colistin). Efficacy ratios were derived by dividing susceptibility breakpoints by observed MIC values of the drugs for the isolates. Isolates were screened for genes coding for carbapenemases using multiplex PCR. Fosfomycin, nitrofurantoin and colistin-resistant isolates were screened for plasmid-borne resistance genes fos A3, oqx AB and mcr-1, respectively using PCR. Results Among E. coli, 98.9, 56 and 95 per cent isolates were susceptible to fosfomycin, nitrofurantoin and colistin, respectively, while 94 and 85 per cent of Klebsiella spp. were susceptible to fosfomycin and colistin, respectively. The efficacy ratios indicated fosfomycin as the drug of choice for UTI caused by CR E. coli and Klebsiella spp., followed by colistin. The blaNDM gene was most common, followed by blaOXA48-like. Plasmid-borne genes encoding resistance to fosfomycin, nitrofurantoin and colistin were absent. Interpretation & conclusions With increasing resistance against the current treatment options, older drugs may emerge as effective options. Molecular screening of resistant isolates is essential to prevent the spread of plasmid-borne resistance against these drugs.
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Affiliation(s)
| | - Baby Abirami
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - S Manjula Devi
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | | | | | - Nitin Kekre
- Department of Urology, Christian Medical College, Vellore, India
| | | | - Rani Diana Sahni
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
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14
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Ahn K, Hwang GY, Kim YK, Kim HY, Jeong HR, Hong JS, Uh Y. Nosocomial Outbreak Caused by NDM-5 and OXA-181 Carbapenemase Co-producing Escherichia coli. Infect Chemother 2019; 51:177-182. [PMID: 31270997 PMCID: PMC6609740 DOI: 10.3947/ic.2019.51.2.177] [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: 09/20/2018] [Accepted: 02/13/2019] [Indexed: 11/24/2022] Open
Abstract
Carbapenemase-producing Enterobacteriaceae (CPE) is an important and increasing threat to global health. From July to September 2017, 20 inpatients at a tertiary care hospital in Korea were either colonized or infected with carbapenem-resistant Escherichia coli strains. All of E. coli isolates co-produced blaNDM-5 and blaOXA-181 carbapenemase genes and shared ≥88% clonal relatedness on the basis of a cladistic calculation of the distribution of pulsed-field gel electrophoresis patterns. Rapid detection of CPE is one of the most important factors to prevent CPE dissemination because it takes long time for CPE to become negative.
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Affiliation(s)
- Kwangjin Ahn
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Gyu Yel Hwang
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Young Keun Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.,Infection Control Department, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Hyo Youl Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.,Infection Control Department, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
| | - Hye Ran Jeong
- Infection Control Department, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Jun Sung Hong
- Department of Laboratory Medicine and Research Institute of Antimicrobial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Young Uh
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.,Infection Control Department, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
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15
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Jhang J, Wang HY, Yoo G, Hwang GY, Uh Y, Yoon KJ. NDM-5 and OXA-48 Co-producing Uropathogenic Escherichia coli Isolate: First Case in Korea. Ann Lab Med 2019; 38:277-279. [PMID: 29401566 PMCID: PMC5820076 DOI: 10.3343/alm.2018.38.3.277] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 08/30/2017] [Accepted: 12/11/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jinho Jhang
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hye Young Wang
- Optipharm, Inc., Wonju Eco Environmental Technology Center, Wonju, Korea
| | - Gilsung Yoo
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Gyu Yel Hwang
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Uh
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
| | - Kap Jun Yoon
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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16
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Bedenić B, Slade M, Starčević LŽ, Sardelić S, Vranić-Ladavac M, Benčić A, Zujić Atalić V, Bogdan M, Bubonja-Šonje M, Tomić-Paradžik M, Tot T, Lukić-Grlić A, Drenjančević D, Varda-Brkić D, Bandić-Pavlović D, Mihaljević S, Zarfel G, Gužvinec M, Conzemius R, Barišić I, Tambić-Andraševic A. Epidemic spread of OXA-48 beta-lactamase in Croatia. J Med Microbiol 2018; 67:1031-1041. [PMID: 29927373 DOI: 10.1099/jmm.0.000777] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE A dramatic increase in OXA-48 β-lactamase was observed recently not only in large hospital centres, but also in smaller suburban hospital centres in geographic areas bordering Croatia. The aim of the study was to analyse the epidemiology, the mechanisms of antibiotic resistance and the routes of spread of OXA-48 carbapenemase in Croatia. METHODS Carbapenemase and other β-lactamase and fluoroquinolone resistance genes were detected by PCR and sequencing. Whole-genome sequencing (WGS) was performed on five representative isolates. The isolates were genotyped by PFGE. RESULTS Forty-eight isolates positive for OXA-48, collected from seven hospital centres in Croatia from May 2016 to May 2017, were analysed (40 Klebsiella pneumoniae, 5 Enterobacter cloacae, 2 Escherichia coli and one Citrobacter freundii). Thirty-three isolates were ESBL positive and harboured group 1 CTX-M 1 β-lactamases. In addition to the β-lactam resistance genes detected by PCR (blaSHV-1, blaOXA-48 and blaOXA-1), WGS of five representative isolates revealed the presence of genes encoding aminoglycoside resistance, aadA2 and aph3-Ia, fluoroquinolone resistance determinants aac(6)Ib-c, oqxA and oqxB, the sulfonamide resistance gene sul1, and fosA (fosfomycin resistance). IncL plasmid was found in all isolates. Two K. pneumoniae isolates belonged to ST16, two E. cloacae to ST66 and E. coli to ST354. K. pneumoniae isolates were allocated to five clusters by PFGE which occured in different hospitals, indicating epidemic spread. CONCLUSIONS The OXA-48-positive organisms found in this study showed wide variability in antibiotic susceptibility, β-lactamase content and PFGE banding patterns. This study revealed a switch from the predominance of VIM-1 in 2012-2013 to that of OXA-48 in the 2015 to 2017.
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Affiliation(s)
- Branka Bedenić
- 1School of Medicine, University of Zagreb, Croatia.,2University Hospital Center Zagreb, Croatia
| | - Mia Slade
- 3Croatian Institute of Transfusion Medicine (CITM), Croatia
| | | | | | | | - Ana Benčić
- 1School of Medicine, University of Zagreb, Croatia
| | - Vlasta Zujić Atalić
- 6Public Health Institute of Osijek-Baranja County, Osijek, Croatia.,7School of Medicine, University of Osijek, University Hospital Center Osijek, Croatia
| | - Maja Bogdan
- 6Public Health Institute of Osijek-Baranja County, Osijek, Croatia.,7School of Medicine, University of Osijek, University Hospital Center Osijek, Croatia
| | | | | | - Tatjana Tot
- 10Department for Microbiology, General Hospital Karlovac, Croatia
| | - Amarela Lukić-Grlić
- 1School of Medicine, University of Zagreb, Croatia.,11Children's Hospital Zagreb, Croatia
| | - Domagoj Drenjančević
- 7School of Medicine, University of Osijek, University Hospital Center Osijek, Croatia
| | | | - Daniela Bandić-Pavlović
- 1School of Medicine, University of Zagreb, Croatia.,2University Hospital Center Zagreb, Croatia
| | - Slobodan Mihaljević
- 1School of Medicine, University of Zagreb, Croatia.,2University Hospital Center Zagreb, Croatia
| | - Gernot Zarfel
- 12Institute for Microbiology, Hygiene and Environmental Medicine, Medical University of Graz, Austria
| | - Marija Gužvinec
- 13University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Rick Conzemius
- 14AIT, Austrian Institute for Technology, Vienna, Austria
| | - Ivan Barišić
- 14AIT, Austrian Institute for Technology, Vienna, Austria
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17
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Agarwal A, Srivastava J, Maheshwari U, Iftikhar M. Molecular characterization and antimicrobial susceptibility profile of New Delhi metallo-beta-lactamase-1-producing Escherichia coli among hospitalized patients. J Lab Physicians 2018; 10:149-154. [PMID: 29692579 PMCID: PMC5896180 DOI: 10.4103/jlp.jlp_76_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Carbapenemase-producing microorganisms are becoming a major concern among hospital-acquired infections. There is also increased multidrug resistance seen among these isolates. AIMS We have conducted this study to determine the prevalence of New Delhi metallo-beta-lactamase-1 (NDM-1) gene-producing Escherichia coli among hospitalized patients in a tertiary care hospital in Northern India. SETTINGS AND DESIGN The study was conducted in the Department of Microbiology with the tertiary care hospital settings. It was a prospective cross-sectional observational study conducted during January 2014-August 2014. MATERIALS AND METHODS A total of 500 nonduplicate E. coli samples were processed. The isolates with reduced susceptibility to ertapenem, i.e., zone diameter between 19 and 21 mm, were considered carbapenemase producers. These isolates were subjected to modified Hodge test for phenotypic confirmation. Polymerase chain reaction was performed on all the screened isolates for molecular detection of NDM-1 gene. STATISTICAL ANALYSIS USED Chi-square test was used to analyze the data and P < 0.05 was considered statistically significant. RESULTS Out of 500 E. coli isolates, 61 (12.2%) were screened for carbapenemase production. 47 (9.4%) isolates were positive by modified Hodge test and 36 (7.2%) isolates showed the presence of blaNDM-1 gene (P < 0.05). CONCLUSION There is an increased prevalence of NDM-1 gene-producing E. coli isolates. These carbapenemase-producing isolates are more resistant to other group of antibiotics (aminoglycosides, fluoroquinolones along with β-lactam group). Early detection of blaNDM-1 gene can help in choosing the effective treatment options for hospitalized patients in time, thereby reducing the risk of mortality.
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Affiliation(s)
- Anjali Agarwal
- Department of Microbiology, Hind Institute of Medical Sciences, Barabanki, India
| | - Jyoti Srivastava
- Department of Microbiology, Hind Institute of Medical Sciences, Barabanki, India
| | - Ujjwal Maheshwari
- Department of Cardiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Mohd Iftikhar
- Department of Microbiology, State Reference Laboratory, GSVM, Kanpur, Uttar Pradesh, India
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18
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Chandola P, Gupta RM, Lall M, Sen S, Shergill SPS, Dutta V. Molecular detection of blaNDM-1 (New Delhi metallobetalactamase-1) in nosocomial Enterobacteriaceae isolates by nested, multiplex polymerase chain reaction. Med J Armed Forces India 2018; 74:108-115. [PMID: 29692474 DOI: 10.1016/j.mjafi.2017.02.009] [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: 02/09/2016] [Accepted: 02/17/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Carbapenems are considered "drugs of last resort" in many life-threatening infections. Advent of carbapenemases like KPC, OXA-48, VIM, IMP, and NDM have greatly affected the efficacy of these drugs, posing serious threat to global health and infection control. NDM bears special significance to the India subcontinent, labeled as place of origin and reservoir. NDM tends to escape detection by routine phenotypic methods, requiring molecular confirmation. This study utilizes nested, multiplex polymerase chain reaction (PCR) for reliable detection of blaNDM-1 in nosocomial Enterobacteriaceae isolates. METHODS This study was conducted to detect prevalence of blaNDM-1, blaIMP, blaVIMand blaKPC genes by multiplex PCR among multidrug/carbapenem-resistant nosocomial Enterobacteriaceae isolates. From March 2013 to April 2014, 100 consecutive non-repeat isolates of Enterobacteriaceae from various inpatient clinical samples were analyzed. Imipenem-resistant isolates identified by Kirby Bauer disk diffusion method with Clinical and Laboratory Standards Institute guidelines were further subjected to nested, multiplex PCR to simultaneously detect blaNDM-1, blaIMP, blaVIMand blaKPC genes. RESULTS Out of 100 isolates, 17 (17%) were found to be imipenem-resistant. blaNDM-1 was detected in all 17 isolates by nested, multiplex PCR. blaVIM was co-carried in 4 isolates while one isolate co-harbored blaIMP with blaNDM-1. Imipenem resistance and NDM-1 carriage was predominant amongst Klebsiella isolates. Maximum NDM-1 producers were isolated from the intensive care unit (70.6%). CONCLUSION NDM-1 prevalence in nosocomial Enterobacteriaceae isolates in our hospital was found to be 17%. A nested, multiplex PCR was used for rapid detection of various carbapenemase genes with high sensitivity and specificity which is essential not only for favorable patient outcome but also for timely implementation of appropriate infection control practices to prevent further spread of such organisms.
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Affiliation(s)
- Parnika Chandola
- Assistant Professor (Microbiology and Molecular Medicine), Army Hospital (R&R), New Delhi 10, India
| | - R M Gupta
- Professor & Consultant (Pathology, Microbiology and Virology), Army Hospital (R&R), New Delhi 10, India
| | - Mahima Lall
- Study Leave (Microbiology), All India Institute of Medical Sciences, New Delhi, India
| | - Sourav Sen
- Professor & Head, Dept of Microbiology, Armed Forces Medical College, Pune 40, India
| | - S P S Shergill
- Assistant Professor (Microbiology and Molecular Medicine), Army Hospital (R&R), New Delhi 10, India
| | - Vibha Dutta
- Commandant, Command Hospital (Central Command), Lucknow, India
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19
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Mairi A, Pantel A, Sotto A, Lavigne JP, Touati A. OXA-48-like carbapenemases producing Enterobacteriaceae in different niches. Eur J Clin Microbiol Infect Dis 2017; 37:587-604. [PMID: 28990132 DOI: 10.1007/s10096-017-3112-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/15/2017] [Indexed: 12/26/2022]
Abstract
The emergence of carbapenem-resistant enterobacterial species poses a serious threat to public health worldwide. OXA-48-type carbapenem-hydrolyzing class D β-lactamases are widely distributed among Enterobacteriaceae, with significant geographical differences. To date, 11 OXA-48-like variants have been identified, with classical OXA-48 being the most widespread. These enzymes show high-level hydrolytic activity against penicillins and low-level hydrolysis towards carbapenems. Since the first description of the OXA-48 carbapenemase in Turkey, bacterial strains producing the enzyme have been extensively reported in nosocomial and community outbreaks in many parts of the word, particularly in the Mediterranean area and European countries. The rapid spread of Enterobacteriaceae producing OXA-48-like enzymes in different ecosystems has become a serious issue recently. The number of reservoirs for such organisms is increasing, not only in hospitals, but also in the community, among animals (e.g., livestock, companion animals, and wildlife) and in the environment. This review aims to summarize the main characteristics of the OXA-48-type carbapenemases, covering genetic and enzymatic traits, their epidemiology, clonality and associated genes, correlation with extended-spectrum β-lactamases (ESBLs) or plasmidic AmpC (pAmpC) in different bacterial species worldwide.
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Affiliation(s)
- Assia Mairi
- Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, 06000, Bejaia, Algeria.,Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, 186 Chemin du Carreau de Lanes, CS83021, 30908, Nîmes, France
| | - Alix Pantel
- Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, 186 Chemin du Carreau de Lanes, CS83021, 30908, Nîmes, France.,Department of Microbiology, University Hospital of Nîmes, Nîmes, France
| | - Albert Sotto
- Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, 186 Chemin du Carreau de Lanes, CS83021, 30908, Nîmes, France
| | - Jean-Philippe Lavigne
- Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, 186 Chemin du Carreau de Lanes, CS83021, 30908, Nîmes, France. .,Department of Microbiology, University Hospital of Nîmes, Nîmes, France.
| | - Aziz Touati
- Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, 06000, Bejaia, Algeria
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20
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van Duin D, Paterson DL. Multidrug-Resistant Bacteria in the Community: Trends and Lessons Learned. Infect Dis Clin North Am 2017; 30:377-390. [PMID: 27208764 DOI: 10.1016/j.idc.2016.02.004] [Citation(s) in RCA: 305] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Multidrug resistant (MDR) bacteria are one of the most important threats to public health. Typically, MDR bacteria are associated with nosocomial infections. However, some MDR bacteria have become prevalent causes of community-acquired infections. The spread of MDR bacteria into the community is a crucial development, and is associated with increased morbidity, mortality, health care costs, and antibiotic use. Factors associated with community dissemination of MDR bacteria overlap but are distinct from those associated with nosocomial spread. Prevention of further community spread of MDR bacteria is of the utmost importance, and requires a multidisciplinary approach involving all stakeholders.
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Affiliation(s)
- David van Duin
- Division of Infectious Diseases, University of North Carolina, CB 7030, 130 Mason Farm Road, Chapel Hill, NC 27599, USA.
| | - David L Paterson
- The University of Queensland, Building 71/918 RBWH, Herston, QLD 4029, Australia
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21
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Hsu LY, Apisarnthanarak A, Khan E, Suwantarat N, Ghafur A, Tambyah PA. Carbapenem-Resistant Acinetobacter baumannii and Enterobacteriaceae in South and Southeast Asia. Clin Microbiol Rev 2017; 30:1-22. [PMID: 27795305 PMCID: PMC5217790 DOI: 10.1128/cmr.masthead.30-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Carbapenem-resistant Gram-negative bacteria, in particular the Acinetobacter baumannii-calcoaceticus complex and Enterobacteriaceae, are escalating global public health threats. We review the epidemiology and prevalence of these carbapenem-resistant Gram-negative bacteria among countries in South and Southeast Asia, where the rates of resistance are some of the highest in the world. These countries house more than a third of the world's population, and several are also major medical tourism destinations. There are significant data gaps, and the almost universal lack of comprehensive surveillance programs that include molecular epidemiologic testing has made it difficult to understand the origins and extent of the problem in depth. A complex combination of factors such as inappropriate prescription of antibiotics, overstretched health systems, and international travel (including the phenomenon of medical tourism) probably led to the rapid rise and spread of these bacteria in hospitals in South and Southeast Asia. In India, Pakistan, and Vietnam, carbapenem-resistant Enterobacteriaceae have also been found in the environment and community, likely as a consequence of poor environmental hygiene and sanitation. Considerable political will and effort, including from countries outside these regions, are vital in order to reduce the prevalence of such bacteria in South and Southeast Asia and prevent their global spread.
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Affiliation(s)
- Li-Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
| | | | - Erum Khan
- Aga Khan University, Karachi, Pakistan
| | - Nuntra Suwantarat
- Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
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22
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Carbapenem-Resistant Acinetobacter baumannii and Enterobacteriaceae in South and Southeast Asia. Clin Microbiol Rev 2016. [PMID: 27795305 DOI: 10.1128/cmr.00042-16] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Carbapenem-resistant Gram-negative bacteria, in particular the Acinetobacter baumannii-calcoaceticus complex and Enterobacteriaceae, are escalating global public health threats. We review the epidemiology and prevalence of these carbapenem-resistant Gram-negative bacteria among countries in South and Southeast Asia, where the rates of resistance are some of the highest in the world. These countries house more than a third of the world's population, and several are also major medical tourism destinations. There are significant data gaps, and the almost universal lack of comprehensive surveillance programs that include molecular epidemiologic testing has made it difficult to understand the origins and extent of the problem in depth. A complex combination of factors such as inappropriate prescription of antibiotics, overstretched health systems, and international travel (including the phenomenon of medical tourism) probably led to the rapid rise and spread of these bacteria in hospitals in South and Southeast Asia. In India, Pakistan, and Vietnam, carbapenem-resistant Enterobacteriaceae have also been found in the environment and community, likely as a consequence of poor environmental hygiene and sanitation. Considerable political will and effort, including from countries outside these regions, are vital in order to reduce the prevalence of such bacteria in South and Southeast Asia and prevent their global spread.
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23
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Emergence of carbapenemase-producing urinary isolates at a tertiary care hospital in Dhaka, Bangladesh. Tzu Chi Med J 2016; 28:94-98. [PMID: 28757733 PMCID: PMC5442910 DOI: 10.1016/j.tcmj.2016.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/14/2016] [Accepted: 04/06/2016] [Indexed: 11/22/2022] Open
Abstract
Objectives: A growing incidence of pathogens producing carbapenemases has been observed in many countries including Bangladesh. The present study was carried out to determine the presence of carbapenemase producers among uropathogens. Materials and Methods: A total of 138 Gram-negative uropathogens were isolated and identified by conventional methods and were screened for carbapenemase production using imipenem discs. Phenotypic identification of carbapenemase production was done by the double disc synergy test, combined disc assay, and modified Hodge test. The minimum inhibitory concentration of imipenem was determined by the agar dilution method. Genes encoding blaNDM-1, blaIMP, blaVIM, blaKPC and blaOXA-48/blaOXA-181 were identified by polymerase chain reaction. Results: Twenty (14.49%) imipenem resistant strains were detected among 138 Gram-negative uro-pathogens. The most common isolates were Escherichia coli and Klebsiella spp. Among 20 imipenem resistant strains, 16 (80%) carbapenemase producers were detected by polymerase chain reaction, 13 (65%) by double disc synergy, 15 (75%) by combined disc assay, and seven (35%) by modified Hodge test. The blaNDM-1 gene was most prevalent (55%), followed by blaOXA-48/OXA-181, blaKPC (20%), blaVIM (15%), and blaIMP (10%). More than one carbapenemase gene was present in nine (45%) of the isolates. The minimum inhibitory concentration of imipenem of the carbapenemase producers ranged from ≥128 μg/mL to 4 μg/mL. Overall, carbapenemase encoding genes were detected in 11.6% (16/138) of the studied Gram-negative uropathogens. All (100%) of the carbapenemase-producing organisms were resistant to all tested antibiotics apart from colistin. Conclusion: The study shows a significant rate of urinary isolates were carbapenemase producers, including a high prevalence of blaNDM-1, in Bangladesh.
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Bakthavatchalam YD, Anandan S, Veeraraghavan B. Laboratory Detection and Clinical Implication of Oxacillinase-48 like Carbapenemase: The Hidden Threat. J Glob Infect Dis 2016; 8:41-50. [PMID: 27013843 PMCID: PMC4785756 DOI: 10.4103/0974-777x.176149] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Carbapenemase producing Gram-negative pathogen is of great concern for physician. The challenging aspects are treatment option and infection control. Monitoring of respective carbapenemase resistance mechanism is necessary to prevent the outbreaks. Currently, the rapid emergence of oxacillinase (OXA-48) like is alarming. Increasing frequency of OXA-48 is seen than the classical carbapenemase (KPC, NDM, IMP, and VIM) across the world. The bla OXA-48 gene is commonly identified in Escherichia coli and Klebsiella pneumoniae. The transferrable plasmid of OXA-48 is associated with rapid spread and inter-species dissemination. In general, OXA-48-like enzymes weakly hydrolyzes both carbapenem and broad spectrum cephalosporins. Except OXA-163, which effectively hydrolyze cephalosporin. This poor hydrolytic profile obscures the detection of OXA-48-like. It may go undetected in routine diagnosis and complicates the treatment option. Co-production of OXA-48-like with CTX-M-15 and other carbapenemase (NDM, VIM) leads to the emergence of multidrug resistant strains.
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Affiliation(s)
| | - Shalini Anandan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
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Anandan S, Damodaran S, Gopi R, Bakthavatchalam YD, Veeraraghavan B. Rapid Screening for Carbapenem Resistant Organisms: Current Results and Future Approaches. J Clin Diagn Res 2015; 9:DM01-3. [PMID: 26500909 DOI: 10.7860/jcdr/2015/14246.6530] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/03/2015] [Indexed: 11/24/2022]
Abstract
Carbapenem producing Enterobacteriaceae (CPE) is a major public health threat. A total of 120 carbapenem resistant E.coli (n=32) and K.pneumoniae (n=88) from blood stream infections were screened for the presence of carbapenem resistant genes KPC, NDM, IMP, VIM, and OXA-48 like using both conventional multiplex PCR and Xpert(®) Carba-R test. Additionally 26 faeces samples were directly screened with Xpert(®) Carba-R test. Of the tested isolates, 40% (n=48) of NDM and 39.2% (n=47/) of OXA-48-like were identified. Co-production of OXA-48 and NDM was seen in 15 (12.5%) isolates. In Xpert(®) Carba-R test, only NDM was identified in 55% (n=66) of tested isolates. Of the tested faeces samples, 12 were identified as carbapenemase producers: nine with NDM, two with the co-production of NDM and VIM and in Klebsiella spp (n=1), NDM and KPC co-production was seen. However, Xpert(®) Carba-R test fails to detect OXA-48 like as compared with multiplex PCR. The sensitivity, specificity, PPV, NPV of Xpert(®) Carba-R test was 100%, 77%, 96% and 100% respectively. Incorporation of OXA-48 like specific sequence in the panel of Xpert(®) Carba-R test may improve its sensitivity and maximize the coverage of assay.
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Affiliation(s)
- Shalini Anandan
- Associate Professor, Department of Clinical Microbiology, Christian Medical College , Vellore, Tamil Nadu, India
| | - Sunganya Damodaran
- Associate Research Officer, Department of Clinical Microbiology, Christian Medical College , Vellore, Tamil Nadu, India
| | - Radha Gopi
- Associate Research Officer, Department of Clinical Microbiology, Christian Medical College , Vellore, Tamil Nadu, India
| | - Yamuna Devi Bakthavatchalam
- Associate Research Officer, Department of Clinical Microbiology, Christian Medical College , Vellore, Tamil Nadu, India
| | - Balaji Veeraraghavan
- Professor and Head, Department of Clinical Microbiology, Christian Medical College , Vellore, Tamil Nadu, India
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Meletis G, Chatzidimitriou D, Malisiovas N. Double- and multi-carbapenemase-producers: the excessively armored bacilli of the current decade. Eur J Clin Microbiol Infect Dis 2015; 34:1487-93. [PMID: 25894987 DOI: 10.1007/s10096-015-2379-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/30/2015] [Indexed: 11/29/2022]
Abstract
Multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative nosocomial pathogens commonly carry one carbapenemase gene conferring resistance to carbapenems and other beta-lactam antibiotics. However, increasing reports show that double-carbapenemase-producing (DCP) and even multi-carbapenemase-producing (MCP) bacteria are emerging in some parts of the world, diminishing further, in some cases, the already limited treatment options. In the present review, the up-to-date reports of DCP and MCP isolates are summarized and concerns regarding their emergence are discussed.
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Affiliation(s)
- G Meletis
- Labnet Laboratories, Agiou Dimitriou str. 161, 53337, Thessaloniki, Greece,
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