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Pakbin B, Brück WM, Rossen JWA. Virulence Factors of Enteric Pathogenic Escherichia coli: A Review. Int J Mol Sci 2021; 22:9922. [PMID: 34576083 PMCID: PMC8468683 DOI: 10.3390/ijms22189922] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 12/18/2022] Open
Abstract
Escherichia coli are remarkably versatile microorganisms and important members of the normal intestinal microbiota of humans and animals. This harmless commensal organism can acquire a mixture of comprehensive mobile genetic elements that contain genes encoding virulence factors, becoming an emerging human pathogen capable of causing a broad spectrum of intestinal and extraintestinal diseases. Nine definite enteric E. coli pathotypes have been well characterized, causing diseases ranging from various gastrointestinal disorders to urinary tract infections. These pathotypes employ many virulence factors and effectors subverting the functions of host cells to mediate their virulence and pathogenesis. This review summarizes new developments in our understanding of diverse virulence factors associated with encoding genes used by different pathotypes of enteric pathogenic E. coli to cause intestinal and extraintestinal diseases in humans.
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Affiliation(s)
- Babak Pakbin
- Institute for Life Technologies, University of Applied Sciences Western Switzerland Valais-Wallis, 1950 Sion 2, Switzerland;
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
- Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin 15315-3419, Iran
| | - Wolfram M. Brück
- Institute for Life Technologies, University of Applied Sciences Western Switzerland Valais-Wallis, 1950 Sion 2, Switzerland;
| | - John W. A. Rossen
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
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2
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Cheng Y, Chen Y, Liu Y, Guo Y, Zhou Y, Xiao T, Zhang S, Xu H, Chen Y, Shan T, Xiao Y, Zhou K. Identification of novel tetracycline resistance gene tet(X14) and its co-occurrence with tet(X2) in a tigecycline-resistant and colistin-resistant Empedobacter stercoris. Emerg Microbes Infect 2021; 9:1843-1852. [PMID: 32731802 PMCID: PMC7473080 DOI: 10.1080/22221751.2020.1803769] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Tigecycline is one of the last-resort antibiotics to treat severe infections. Recently, tigecycline resistance has sporadically emerged with an increasing trend, and Tet(X) family represents a new resistance mechanism of tigecycline. In this study, a novel chromosome-encoded tigecycline resistance gene, tet(X14), was identified in a tigecycline-resistant and colistin-resistant Empedobacter stercoris strain ES183 recovered from a pig fecal sample in China. Tet(X14) shows 67.14-96.39% sequence identity to the other variants [Tet(X) to Tet(X13)]. Overexpression of Tet(X14) in Escherichia coli confers 16-fold increase in tigecycline MIC (from 0.125 to 2 mg/L), which is lower than that of Tet(X3), Tet(X4) and Tet(X6). Structural modelling predicted that Tet(X14) shared a high homology with the other 12 variants with RMSD value from 0.003 to 0.055, and Tet(X14) can interact with tetracyclines by a similar pattern as the other Tet(X)s. tet(X14) and two copies of tet(X2) were identified on a genome island with abnormal GC content carried by the chromosome of ES183, and no mobile genetic elements were found surrounding, suggesting that tet(X14) might be heterologously obtained by ES183 via recombination. Blasting in Genbank revealed that Tet(X14) was exclusively detected on the chromosome of Riemerella anatipestifer, mainly encoded on antimicrobial resistance islands. E. stercoris and R. anatipestifer belong to the family Flavobacteriaceae, suggesting that the members of Flavobacteriaceae maybe the major reservoir of tet(X14). Our study reports a novel chromosome-encoded tigecycline resistance gene tet(X14). The expanded members of Tet(X) family warrants the potential large-scale dissemination and the necessity of continuous surveillance for tet(X)-mediated tigecycline resistance.
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Affiliation(s)
- Yingying Cheng
- Shenzhen Institute of Respiratory Diseases, Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Shenzhen, People's Republic of China.,The First Affiliated Hospital (Shenzhen People's Hospital), Southern University of Science and Technology, Shenzhen, People's Republic of China
| | - Yong Chen
- Shenzhen Institute of Respiratory Diseases, Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Shenzhen, People's Republic of China.,The First Affiliated Hospital (Shenzhen People's Hospital), Southern University of Science and Technology, Shenzhen, People's Republic of China
| | - Yang Liu
- Shenzhen Institute of Respiratory Diseases, Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Shenzhen, People's Republic of China.,The First Affiliated Hospital (Shenzhen People's Hospital), Southern University of Science and Technology, Shenzhen, People's Republic of China
| | - Yuqi Guo
- Shenzhen Institute of Respiratory Diseases, Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Shenzhen, People's Republic of China.,The First Affiliated Hospital (Shenzhen People's Hospital), Southern University of Science and Technology, Shenzhen, People's Republic of China
| | - Yanzi Zhou
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Tingting Xiao
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Shuntian Zhang
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Hao Xu
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Yunbo Chen
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Tongling Shan
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Shanghai, People's Republic of China
| | - Yonghong Xiao
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Kai Zhou
- Shenzhen Institute of Respiratory Diseases, Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Shenzhen, People's Republic of China.,The First Affiliated Hospital (Shenzhen People's Hospital), Southern University of Science and Technology, Shenzhen, People's Republic of China
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3
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Abstract
Microorganisms vehiculated by food might benefit health, cause minimal change within the equilibrium of the host microbial community or be associated with foodborne diseases. In this chapter we will focus on human pathogenic bacteria for which food is conclusively demonstrated as their transmission mode to human. We will describe the impact of foodborne diseases in public health, the reservoirs of foodborne pathogens (the environment, human and animals), the main bacterial pathogens and food vehicles causing human diseases, and the drivers for the transmission of foodborne diseases related to the food-chain, host or bacteria features. The implication of food-chain (foodborne pathogens and commensals) in the transmission of resistance to antibiotics relevant to the treatment of human infections is also evidenced. The multiplicity and interplay of drivers related to intensification, diversification and globalization of food production, consumer health status, preferences, lifestyles or behaviors, and bacteria adaptation to different challenges (stress tolerance and antimicrobial resistance) from farm to human, make the prevention of bacteria-food-human transmission a modern and continuous challenge. A global One Health approach is mandatory to better understand and minimize the transmission pathways of human pathogens, including multidrug-resistant pathogens and commensals, through food-chain.
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Affiliation(s)
- Patrícia Antunes
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
| | - Carla Novais
- Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Luísa Peixe
- Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
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Zhou K, Tang X, Wang L, Guo Z, Xiao S, Wang Q, Zhuo C. An Emerging Clone (ST457) of Acinetobacter baumannii Clonal Complex 92 With Enhanced Virulence and Increasing Endemicity in South China. Clin Infect Dis 2019; 67:S179-S188. [PMID: 30423046 DOI: 10.1093/cid/ciy691] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background The global dissemination of carbapenem-resistant Acinetobacter baumannii clonal complex (CC) 92 has become an urgent public health concern. Methods A. baumannii isolates were collected in 5 tertiary hospitals in south China during 2012-2015, and their clinical data were obtained. The clinical characterization was studied by statistical analysis. Whole-genome sequencing and a Galleria mellonella infection model were used to investigate the genetic characterization and pathogenicity of isolates, respectively. Results Sequence type (ST)457, following ST195, become the second-most prevalent clone in our collection. Patients infected by ST457 had significantly higher 7-day mortality rates (44.4% vs 14.3%; P = .01) and proportions of 7-day deaths (70.6% vs 26.7%; P = .01) than those infected by the other STs of CC92, except for ST195 and ST208. Consistently, the day of death after culture was significantly sooner in patients infected with ST457 than those with the non-ST195/208 members of CC92 (8.71 ± 15.27 vs 25.20 ± 6.51; P = .02). This is accordant with results that ST457 had enhanced virulence with a high mortality rate through use of the G. mellonella larvae infection model. Genomic analysis suggests that ST457 evolved distinctly from the other CC92 members mainly via recombinations. This clone exclusively shared a few virulence factors with the hypervirulence strain LAC-4, including a capsule biosynthesis locus (KL49) that is supposed to be important for the hypervirulence in LAC-4. Conclusions The rising trends in prevalence and enhanced virulence of ST457 highlight the urgent need for tailored surveillance to control the further dissemination of this clone.
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Affiliation(s)
- Kai Zhou
- Shenzhen Institute of Respiratory Diseases, the First Affiliated Hospital (Shenzhen People's Hospital), Southern University of Science and Technology.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, the First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou
| | - Xiang Tang
- State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University
| | - Luxia Wang
- Guangzhou General Hospital of Guangzhou Military, China
| | - Zhenghui Guo
- Guangzhou General Hospital of Guangzhou Military, China
| | - Shunian Xiao
- State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University
| | - Qin Wang
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, the First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou
| | - Chao Zhuo
- State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University
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5
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Li X, Lau SKP, Woo PCY. Molecular characterisation of emerging pathogens of unexplained infectious disease syndromes. Expert Rev Mol Diagn 2019; 19:839-848. [PMID: 31385539 DOI: 10.1080/14737159.2019.1651200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: The discoveries of HIV and Helicobacter pylori in the 1980s were landmarks in identification of novel pathogens causing unexplained infectious syndromes using conventional microbiological technologies. In the last few decades, advancement of molecular technologies has provided us with more robust tools to expand our armamentarium in this microbial hunting process. Areas covered: In this article, we give a brief overview of the most important molecular technologies we use for identification of emerging microbes associated with unexplained infectious syndromes, including 16S rRNA and other conserved targets sequencing for bacteria, internal transcribed spacer (ITS) and other target gene sequencing for fungi, polymerase and other gene sequencing for viruses, as well as deep sequencing. Then, we use several representative examples to illustrate how these techniques have been used for the discoveries of a few notable bacterial, fungal and viral pathogens associated with unexplained infectious syndromes in the last 20-30 years. Expert opinion: In the past and present, characterization of emerging pathogens of unexplained infectious disease syndromes has relied on a combination of conventional culture- and phenotype-based technologies and nucleic acid amplification and sequencing. In the next era, we envisage more widespread adoption of next generation technologies that can detect both known and previously undescribed pathogens.
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Affiliation(s)
- Xin Li
- Department of Microbiology, The University of Hong Kong , Hong Kong , China
| | - Susanna K P Lau
- Department of Microbiology, The University of Hong Kong , Hong Kong , China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong , Hong Kong , China.,Carol Yu Centre for Infection, The University of Hong Kong , Hong Kong , China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University , Hangzhou , China
| | - Patrick C Y Woo
- Department of Microbiology, The University of Hong Kong , Hong Kong , China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong , Hong Kong , China.,Carol Yu Centre for Infection, The University of Hong Kong , Hong Kong , China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University , Hangzhou , China
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Nepal S, Bonn F, Grasso S, Stobernack T, de Jong A, Zhou K, Wedema R, Rosema S, Becher D, Otto A, Rossen JW, van Dijl JM, Bathoorn E. An ancient family of mobile genomic islands introducing cephalosporinase and carbapenemase genes in Enterobacteriaceae. Virulence 2019; 9:1377-1389. [PMID: 30101693 PMCID: PMC6177240 DOI: 10.1080/21505594.2018.1509666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The exchange of mobile genomic islands (MGIs) between microorganisms is often mediated by phages, which may provide benefits to the phage’s host. The present study started with the identification of Enterobacter cloacae, Klebsiella pneumoniae and Escherichia coli isolates with exceptional cephalosporin and carbapenem resistance phenotypes from patients in a neonatal ward. To identify possible molecular connections between these isolates and their β-lactam resistance phenotypes, the respective bacterial genome sequences were compared. This unveiled the existence of a family of ancient MGIs that were probably exchanged before the species E. cloacae, K. pneumoniae and E. coli emerged from their common ancestry. A representative MGI from E. cloacae was named MIR17-GI, because it harbors the novel β-lactamase gene variant blaMIR17. Importantly, our observations show that the MIR17-GI-like MGIs harbor genes associated with high-level resistance to cephalosporins. Among them, MIR17-GI stands out because MIR17 also displays carbapenemase activity. As shown by mass spectrometry, the MIR17 carbapenemase is among the most abundantly expressed proteins of the respective E. cloacae isolate. Further, we show that MIR17-GI-like islands are associated with integrated P4-like prophages. This implicates phages in the spread of cephalosporin and carbapenem resistance amongst Enterobacteriaceae. The discovery of an ancient family of MGIs, mediating the spread of cephalosporinase and carbapenemase genes, is of high clinical relevance, because high-level cephalosporin and carbapenem resistance have serious implications for the treatment of patients with enterobacteriaceal infections.
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Affiliation(s)
- Suruchi Nepal
- a Department of Medical Microbiology , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Florian Bonn
- b Institute for Microbiology , Ernst-Moritz-Arndt-University Greifswald , Greifswald , Germany
| | - Stefano Grasso
- a Department of Medical Microbiology , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Tim Stobernack
- a Department of Medical Microbiology , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Anne de Jong
- c Department of Molecular Genetics , University of Groningen, Groningen Biomolecular Sciences and Biotechnology Institute , Groningen , The Netherlands
| | - Kai Zhou
- a Department of Medical Microbiology , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands.,d State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital , Zhejiang University , Hangzhou , China
| | - Ronald Wedema
- a Department of Medical Microbiology , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Sigrid Rosema
- a Department of Medical Microbiology , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Dörte Becher
- b Institute for Microbiology , Ernst-Moritz-Arndt-University Greifswald , Greifswald , Germany
| | - Andreas Otto
- b Institute for Microbiology , Ernst-Moritz-Arndt-University Greifswald , Greifswald , Germany
| | - John W Rossen
- a Department of Medical Microbiology , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Jan Maarten van Dijl
- a Department of Medical Microbiology , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Erik Bathoorn
- a Department of Medical Microbiology , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
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7
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Souverein D, Euser SM, Herpers BL, Kluytmans J, Rossen JWA, Den Boer JW. Association between rectal colonization with Highly Resistant Gram-negative Rods (HR-GNRs) and subsequent infection with HR-GNRs in clinical patients: A one year historical cohort study. PLoS One 2019; 14:e0211016. [PMID: 30682095 PMCID: PMC6347189 DOI: 10.1371/journal.pone.0211016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/07/2019] [Indexed: 01/01/2023] Open
Abstract
Objective Rectal colonization with Highly Resistant Gram-negative Rods (HR-GNRs) probably precedes infection. We aimed to assess the association between rectal HR-GNR colonization and subsequent HR-GNR infection in clinical patients during a follow-up period of one year in a historical cohort study design. Methods Rectal HR-GNR colonization was assessed by culturing. Subsequent development of infection was determined by assessing all clinical microbiological culture results extracted from the laboratory information system including clinical data regarding HR-GNR infections. A multivariable logistic regression model was constructed with HR-GNR rectal colonization as independent variable and HR-GNR infection as dependent variable. Gender, age, antibiotic use, historic clinical admission and previous (HR-GNR) infections were included as possible confounders. Results 1133 patients were included of whom 68 patients (6.1%) were colonized with a HR-GNR. In total 22 patients with HR-GNR infections were detected. Urinary tract infections were most common (n = 14, 63.6%), followed by bloodstream infections (n = 5, 22.7%) and other infections (n = 8, 36.4%). Eight out of 68 HR-GNR colonized patients (11.8%) developed a subsequent HR-GNR infection compared to 14 out of 1065 HR-GNR negative patients (1.3%), resulting in an odds ratio (95% CI) of 7.1 (2.8–18.1) in the multivariable logistic regression analyses. Conclusions Rectal colonization with a HR-GNR was a significant risk factor for a subsequent HR-GNR infection. This implies that historical colonization culture results should be considered in the choice of empirical antibiotic therapy to include coverage of the cultured HR-GNR, at least in critically ill patients.
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Affiliation(s)
- Dennis Souverein
- Department of Epidemiology and Infection Prevention, Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands
- * E-mail:
| | - Sjoerd M. Euser
- Department of Epidemiology and Infection Prevention, Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands
| | - Bjorn L. Herpers
- Department of Epidemiology and Infection Prevention, Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands
| | - Jan Kluytmans
- Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands
- University Medical Center, Utrecht, the Netherlands
| | - John W. A. Rossen
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jeroen W. Den Boer
- Department of Epidemiology and Infection Prevention, Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands
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Guschin VA, Manuilov VA, Makarov VV, Tkachuk AP. The proper structure of a biosafety system as a way of reducing the vulnerability of a society, economy or state in the face of a biogenic threat. Bulletin of RSMU 2018. [DOI: 10.24075/brsmu.2018.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To understand how vulnerable are a society, an economy and a state in the face of a biohazard, one should attempt to identify any potential holes in the national biosafety system, such as the lack of important components or technologies for biological monitoring and the inadequacy of existing analytical methods used to prevent or counteract biogenic threats. In Russia, biological monitoring is quite advanced. However, the agencies that ensure proper functioning of its components lack collaboration and do not form a well-coordinated network. Each of such agencies alone cannot provide comprehensive information on the subject. In the Russian Federation, there are at least 4 state-funded programs that collect epidemiological data and are quite efficient in performing the narrow task of monitoring infections. But because there is no central database where epidemiological data can be channeled and subsequently shared, these agencies do not complete each other. This leaves the Russian society, economy and state vulnerable to biogenic threats. We need an adequately organized, modern, fully functional and effective system for monitoring biohazards that will serve as a basis for the national biosafety system and also a tool for the identification and elimination of its weaknesses.
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Affiliation(s)
- V. A. Guschin
- Laboratory of Population Variability Mechanisms in Pathogenic Microorganisms, Gamaleya Research Institute of Epidemiology and Microbiology, Moscow; Department of Virology, Faculty of Biology, Lomonosov Moscow State University, Moscow
| | - V. A. Manuilov
- Laboratory of Translational Medicine, Gamaleya Research Institute of Epidemiology and Microbiology, Moscow
| | - V. V. Makarov
- Center for Strategic Planning of the Ministry of Health of the Russian Federation, Moscow
| | - A. P. Tkachuk
- Laboratory of Translational Medicine, Gamaleya Research Institute of Epidemiology and Microbiology, Moscow
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Karnisova L, Marejkova M, Hrbackova H, Mellmann A, Karch H, Fruth A, Drevinek P, Blahova K, Bielaszewska M, Nunvar J. Attack of the clones: whole genome-based characterization of two closely related enterohemorrhagic Escherichia coli O26 epidemic lineages. BMC Genomics 2018; 19:647. [PMID: 30170539 PMCID: PMC6119250 DOI: 10.1186/s12864-018-5045-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/27/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Enterohemorrhagic Escherichia coli (EHEC) O26:H11/H-, the most common non-O157 serotype causing hemolytic uremic syndrome worldwide, are evolutionarily highly dynamic with new pathogenic clones emerging rapidly. Here, we investigated the population structure of EHEC O26 isolated from patients in several European countries using whole genome sequencing, with emphasis on a detailed analysis of strains of the highly virulent new European clone (nEC) which has spread since 1990s. RESULTS Genome-wide single nucleotide polymorphism (SNP)-based analysis of 32 EHEC O26 isolated in the Czech Republic, Germany, Austria and Italy demonstrated a split of the nEC (ST29C2 clonal group) into two distinct lineages, which we termed, based on their temporal emergence, as "early" nEC and "late" nEC. The evolutionary divergence of the early nEC and late nEC is marked by the presence of 59 and 70 lineage-specific SNPs (synapomorphic mutations) in the genomes of the respective lineages. In silico analyses of publicly available E. coli O26 genomic sequences identified the late nEC lineage worldwide. Using a PCR designed to target the late nEC synapomorphic mutation in the sen/ent gene, we identified the early nEC decline accompanied by the late nEC rise in Germany and the Czech Republic since 2004 and 2013, respectively. Most of the late nEC strains harbor one of two major types of Shiga toxin 2a (Stx2a)-encoding prophages. The type I stx2a-phage is virtually identical to stx2a-phage of EHEC O104:H4 outbreak strain, whereas the type II stx2a-phage is a hybrid of EHEC O104:H4 and EHEC O157:H7 stx2a-phages and carries a novel mutation in Stx2a. Strains harboring these two phage types do not differ by the amounts and biological activities of Stx2a produced. CONCLUSIONS Using SNP-level analyses, we provide the evidence of the evolutionary split of EHEC O26:H11/H- nEC into two distinct lineages, and a recent replacement of the early nEC by the late nEC in Germany and the Czech Republic. PCR targeting the late nEC synapomorphic mutation in ent/sen enables the discrimination of early nEC strains and late nEC strains in clinical and environmental samples, thereby facilitating further investigations of their geographic distribution, prevalence, clinical significance and epidemiology.
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Affiliation(s)
- Lucia Karnisova
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Monika Marejkova
- National Reference Laboratory for E. coli and Shigella, National Institute of Public Health, Prague, Czech Republic
| | - Hana Hrbackova
- Laboratory for Tissue Cultures, National Institute of Public Health, Prague, Czech Republic
| | - Alexander Mellmann
- Institute for Hygiene and the National Consulting Laboratory on Hemolytic Uremic Syndrome, University of Münster, Münster, Germany
| | - Helge Karch
- Institute for Hygiene and the National Consulting Laboratory on Hemolytic Uremic Syndrome, University of Münster, Münster, Germany
| | - Angelika Fruth
- National Reference Center for Salmonella and Other Enteric Pathogens, Robert Koch Institute, Wernigerode, Germany
| | - Pavel Drevinek
- Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Kveta Blahova
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Martina Bielaszewska
- National Reference Laboratory for E. coli and Shigella, National Institute of Public Health, Prague, Czech Republic
| | - Jaroslav Nunvar
- Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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10
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Gomes A, van Oosten M, Bijker KLB, Boiten KE, Salomon EN, Rosema S, Rossen JWA, Natour E, Douglas YL, Kampinga GA, van Assen S, Sinha B. Sonication of heart valves detects more bacteria in infective endocarditis. Sci Rep 2018; 8:12967. [PMID: 30154489 PMCID: PMC6113321 DOI: 10.1038/s41598-018-31029-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/10/2018] [Indexed: 11/09/2022] Open
Abstract
Optimal antimicrobial treatment of infective endocarditis requires identification and susceptibility patterns of pathogens. Sonication of explanted heart valves could increase the identification and culture of pathogens, as shown in prosthetic joint and pacemaker/ICD infections. We tested 26 explanted heart valves from 20 patients with active definite endocarditis for added diagnostic value of sonication to the standard microbiological workup in a prospective diagnostic proof of concept study. Two sonication protocols (broth enrichment vs. centrifugation) were compared in an additional 35 negative control valves for contamination rates. We selected sonication/centrifugation based on acceptable false positive rates (11.4%; 4/35). Sonication/enrichment yielded many false positive results in negative controls (28.6%; 10/35), mainly Propionibacterium acnes (next-generation sequencing excluded technical problems). Compared to direct culture only, adding sonication/centrifugation (including molecular testing) significantly increased the diagnostic yield from 6/26 to 17/26 valves (p = 0.003). Most importantly, culture positives almost doubled (from 6 to 10), providing unique quantitative information about antimicrobial susceptibility. Even if direct molecular testing was added to the standard workup, sonication/centrifugation provided additional diagnostic information in a significant number of valves (8/26; 31%; p = 0.013). We concluded that sonication/centrifugation added relevant diagnostic information in the workup of heart valves with infective endocarditis, with acceptable contamination rates.
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Affiliation(s)
- Anna Gomes
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Marleen van Oosten
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kasper L B Bijker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kathleen E Boiten
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisa N Salomon
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sigrid Rosema
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - John W A Rossen
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ehsan Natour
- Department of Thoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yvonne L Douglas
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Greetje A Kampinga
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sander van Assen
- Department of Internal Medicine (Infectious Diseases), Treant Zorggroep, Hoogeveen, The Netherlands
| | - Bhanu Sinha
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Zhou K, Yu W, Cao X, Shen P, Lu H, Luo Q, Rossen JWA, Xiao Y. Characterization of the population structure, drug resistance mechanisms and plasmids of the community-associated Enterobacter cloacae complex in China. J Antimicrob Chemother 2018; 73:66-76. [PMID: 29088362 DOI: 10.1093/jac/dkx361] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/31/2017] [Indexed: 01/06/2023] Open
Abstract
Objectives To investigate the population structure, drug resistance mechanisms and plasmids of community-associated Enterobacter cloacae complex (CA-ECC) isolates in China. Methods Sixty-two CA-ECC isolates collected from 31 hospitals across China were typed by hsp60 typing and MLST. ESBL and AmpC-overexpression phenotype was determined by double-disc synergy test. Replicon typing and conjugation were performed for plasmid analysis. All ESBL-positive isolates and representative conjugants were subjected to detailed characterization by WGS. Results Enterobacter hormaechei and Enterobacter kobei were predominant in our collections. MLST distinguished 46 STs with a polyclonal structure. ST591 was the most prevalent clone detected in northern China. Twenty-two isolates (35.5%) were ESBL positive and half of them were E. kobei. ESBL positivity was related to ESBL production (15/22) and to AmpC overexpression (18/22). Core-genome phylogenetic analysis identified intra- and inter-regional dissemination of ESBL-producing E. kobei clones. ESBL producers were exclusively classified as E. hormaechei and E. kobei, and blaCTX-M-3 was the most prevalent ESBL genotype (10/15) detected in four different environments. In the ESBL-positive population, the ESBL producers encoded more drug resistance genes (8-24 genes) by carrying more plasmids (1-3 plasmids) than the non-ESBL-producing isolates, resulting in an inter-group difference in drug susceptibilities. IncHI-type plasmids were prevalent in the ESBL producers (12/15). All IncHI2-type plasmids (n = 11) carried ESBL genes and shared a similar backbone to p09-036813-1A_261 recovered from Salmonella enterica in Canada. Conclusions The species-specific distribution, species-dependent ESBL mechanism and endemic plasmids identified in our study highlight the necessity for tailored surveillance of CA-ECC in the future.
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Affiliation(s)
- Kai Zhou
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medicine School, Zhejiang University, Hangzhou, China
| | - Wei Yu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medicine School, Zhejiang University, Hangzhou, China
| | - Xiaoli Cao
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Ping Shen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medicine School, Zhejiang University, Hangzhou, China
| | - Haifeng Lu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medicine School, Zhejiang University, Hangzhou, China
| | - Qixia Luo
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medicine School, Zhejiang University, Hangzhou, China
| | - John W A Rossen
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medicine School, Zhejiang University, Hangzhou, China
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12
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Köckerling E, Karrasch L, Schweitzer A, Razum O, Krause G. Public Health Research Resulting from One of the World's Largest Outbreaks Caused by Entero-Hemorrhagic Escherichia coli in Germany 2011: A Review. Front Public Health 2017; 5:332. [PMID: 29312915 PMCID: PMC5732330 DOI: 10.3389/fpubh.2017.00332] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 11/23/2017] [Indexed: 02/04/2023] Open
Abstract
In 2011, Germany experienced one of the largest outbreaks of entero-hemorrhagic Escherichia coli (EHEC) ever reported. Four years thereafter, we systematically searched for scientific publications in PubMed and MEDPILOT relating to this outbreak in order to assess the pattern of respective research activities and to assess the main findings and recommendations in the field of public health. Following PRISMA guidelines, we selected 133 publications, half of which were published within 17 months after outbreak onset. Clinical medicine was covered by 71, microbiology by 60, epidemiology by 46, outbreak reporting by 11, and food safety by 9 papers. Those on the last three topics drew conclusions on methods in surveillance, diagnosis, and outbreak investigation, on resources in public health, as well as on inter-agency collaboration, and public communication. Although the outbreak primarily affected Germany, most publications were conducted by multinational cooperations. Our findings document how soon and in which fields research was conducted with respect to this outbreak.
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Affiliation(s)
- Elena Köckerling
- Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany.,Department Münster, Institute for Rehabilitation Research IfR, Münster, Germany
| | - Laura Karrasch
- Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| | - Aparna Schweitzer
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Hannover Medical School, Hannover, Germany
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13
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Souverein D, Euser SM, van der Reijden WA, Herpers BL, Kluytmans J, Rossen JWA, Den Boer JW. Clinical sensitivity and specificity of the Check-Points Check-Direct ESBL Screen for BD MAX, a real-time PCR for direct ESBL detection from rectal swabs. J Antimicrob Chemother 2017. [DOI: 10.1093/jac/dkx189] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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14
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Wang A, Zhou K, Liu Y, Yang L, Zhang Q, Guan J, Zhong N, Zhuo C. A potential role of transposon IS431 in the loss of mecA gene. Sci Rep 2017; 7:41237. [PMID: 28120911 PMCID: PMC5264636 DOI: 10.1038/srep41237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 12/19/2016] [Indexed: 11/18/2022] Open
Abstract
Acquisition of a vancomycin-resistance-determinant may trigger deletion of the mecA gene. However, the molecular mechanisms involved remain largely unknown. In this study, we successfully produced vancomycin-intermediate-resistant Staphylococcus aureus (VISA) from Methicillin-resistant-S. aureus (MRSA) through serial passages with vancomycin. Five MRSA isolates achieved a vancomycin MIC of >8 mg/ml after 45-day serial exposure to vancomycin. After 20-day passages in media without antibiotics, three of the isolates were restored to pre-induction levels, whilst the remaining 2 (3503-1 and 4126-1) retained a vancomycin MIC >6 mg/ml. The oxacillin MICs for strain 3503-1 and its induced equivalents 3503VR6 and 3503VR10, were 512 μg/ml, <2 μg/ml, and <2 μg/ml, respectively. Oxacillin MICs for 4126-1 and its induced strain 4126VR10 were 512 μg/ml and 128 μg/ml, respectively. Strains 3503-1 and 3503VR6 were sensitive to gentamicin while 4126-1 and 4126VR10 were resistant. PFGE analysis demonstrated that comparing to the parental strain 3503VR6 and 3503VR10 lacked a DNA fragment of 40-kb and 80-kb, respectively. Both deleted regions localized around the transposon IS431. The deletion region of 3503VR10 was further investigated by whole-genome sequencing. We conclude that transition from MRSA to VISA may cause deletion of the mobile genetic element staphylococcal cassette chromosome mec (SCCmec), and possibly be mediated by IS431, resulting in increased susceptibility to oxacillin.
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Affiliation(s)
- Aihua Wang
- State Key Laboratory of Respiratory Diseases, the first affiliated hospital of Guangzhou Medical College, Guangzhou, China
| | - Kai Zhou
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Medicine School, Zhejiang University, Hangzhou, China
| | - Yang Liu
- National University of Singapore, Singapore
| | - Liang Yang
- National University of Singapore, Singapore
| | - Qin Zhang
- Daxian people's hospital, Dazhou, China
| | - Jing Guan
- State Key Laboratory of Respiratory Diseases, the first affiliated hospital of Guangzhou Medical College, Guangzhou, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Diseases, the first affiliated hospital of Guangzhou Medical College, Guangzhou, China
| | - Chao Zhuo
- State Key Laboratory of Respiratory Diseases, the first affiliated hospital of Guangzhou Medical College, Guangzhou, China
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15
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Zhou K, Yu W, Bonnet R, Cattoir V, Shen P, Wang B, Rossen J, Xiao Y. Emergence of a novel Enterobacter kobei clone carrying chromosomal-encoded CTX-M-12 with diversified pathogenicity in northeast China. New Microbes New Infect 2017; 17:7-10. [PMID: 28243445 PMCID: PMC5320061 DOI: 10.1016/j.nmni.2017.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/05/2017] [Accepted: 01/11/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
- K. Zhou
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medicine School, Zhejiang University, Hangzhou, China
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - W. Yu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medicine School, Zhejiang University, Hangzhou, China
| | - R. Bonnet
- Clermont Université, Université d'Auvergne, Inserm U1071, INRA USC2018, Clermont-Ferrand, France Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - V. Cattoir
- CHU de Caen, Service de Microbiologie, Caen, France
- Université de Caen Basse-Normandie, EA4655 (équipe “Antibiorésistance”), Caen, France
- CNR de la Résistance aux Antibiotiques, Laboratoire Associé “Entérocoques et résistances particulières des bactéries à Gram positif”, Caen, France
| | - P. Shen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medicine School, Zhejiang University, Hangzhou, China
| | - B. Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medicine School, Zhejiang University, Hangzhou, China
| | - J.W. Rossen
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Y. Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medicine School, Zhejiang University, Hangzhou, China
- Corresponding author: Y. Xiao
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16
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Zhang J, Zhou K, Zheng B, Zhao L, Shen P, Ji J, Wei Z, Li L, Zhou J, Xiao Y. High Prevalence of ESBL-Producing Klebsiella pneumoniae Causing Community-Onset Infections in China. Front Microbiol 2016; 7:1830. [PMID: 27895637 PMCID: PMC5109008 DOI: 10.3389/fmicb.2016.01830] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/01/2016] [Indexed: 11/13/2022] Open
Abstract
The aim of this work was to investigate the epidemiological and genetic characteristics of ESBL-producing Klebsiella pneumoniae (ESBL-Kp) causing community-onset infections. K. pneumoniae isolates were collected from 31 Chinese secondary hospitals between August 2010 and 2011. Genes encoding ESBL and AmpC beta-lactamases were detected by PCR. The isolates were assigned to sequence types (STs) using multi-locus sequence typing (MLST). Eleven ESBL-Kp strains were selected for whole-genome sequencing (WGS) for investigating the genetic environment and plasmids encoding ESBL genes. A total of 578 K. pneumoniae isolates were collected, and 184 (31.8%) carried ESBL genes. The prevalence of ESBL-Kp varied from different geographical areas of China (10.2–50.3%). The three most prevalent ESBL genes were blaCTX-M-14 (n = 74), blaCTX-M-15 (n = 60), and blaCTX-M-3 (n = 40). MLST assigned 127 CTX-M-14 and CTX-M-15 producers to 54 STs, and CC17 was the most prevalent population (12.6%). STs (23, 37, and 86) that were known frequently associated with hypervirulent K. pneumoniae (hvKP) account for 14.1% (18/127). Phylogenetic analysis by concatenating the seven loci of MLST revealed the existence of ESBL-producing K. quasipneumoniae (two strains) and K. varricola (one strain), which was further confirmed by WGS. This study highlights the challenge of community-onset infections caused by ESBL-Kp in China. The prevalence of STs frequently associating with hvKP should be of concern. Surveillance of ESBL-KP causing community-onset infections now appears imperative.
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Affiliation(s)
- Jing Zhang
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China; Department of Respiratory Disease, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China
| | - Kai Zhou
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, China
| | - Beiwen Zheng
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, China
| | - Lina Zhao
- Department of Clinical Laboratory, The First Affiliated Hospital of Soochow University Soochow, China
| | - Ping Shen
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, China
| | - Jinru Ji
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, China
| | - Zeqing Wei
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, China
| | - Lanjuan Li
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, China
| | - Jianying Zhou
- Department of Respiratory Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, China
| | - Yonghong Xiao
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, China
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17
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Ferdous M, Kooistra-Smid AMD, Zhou K, Rossen JWA, Friedrich AW. Virulence, Antimicrobial Resistance Properties and Phylogenetic Background of Non-H7 Enteropathogenic Escherichia coli O157. Front Microbiol 2016; 7:1540. [PMID: 27733849 PMCID: PMC5039186 DOI: 10.3389/fmicb.2016.01540] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/14/2016] [Indexed: 02/02/2023] Open
Abstract
Escherichia coli (E.coli) O157 that do not produce Shiga toxin and do not possess flagellar antigen H7 are of diverse H serotypes. In this study, the antibiotic resistance properties, genotype of a set of virulence associated genes and the phylogenetic background of E. coli O157:non-H7 groups were compared. Whole genome sequencing was performed on fourteen O157:non-H7 isolates collected in the STEC-ID-net study. The genomes were compared with E. coli O157 genomes and a typical Enteropathogenic E. coli (tEPEC) genome downloaded from NCBI. Twenty-six (86%) of the analyzed genomes had the intimin encoding gene eae but of different types mostly correlating with their H types, e.g., H16, H26, H39, and H45 carried intimin type ε, β, κ, and α, respectively. They belonged to several E. coli phylogenetic groups, i.e., to phylogenetic group A, B1, B2, and D. Seven (50%) of our collected O157:non-H7 isolates were resistant to two or more antibiotics. Several mobile genetic elements, such as plasmids, insertion elements, and pathogenicity islands, carrying a set of virulence and resistance genes were found in the E. coli O157:non-H7 isolates. Core genome phylogenetic analysis showed that O157:non-H7 isolates probably evolved from different phylogenetic lineages and were distantly related to the E. coli O157:H7 lineage. We hypothesize that independent acquisition of mobile genetic elements by isolates of different lineages have contributed to the different molecular features of the O157:non-H7 strains. Although distantly related to the STEC O157, E. coli O157:non-H7 isolates from multiple genetic background could be considered as pathogen of concern for their diverse virulence and antibiotic resistance properties.
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Affiliation(s)
- Mithila Ferdous
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen Groningen, Netherlands
| | - Anna M D Kooistra-Smid
- Department of Medical Microbiology, University Medical Center Groningen, University of GroningenGroningen, Netherlands; Department of Medical Microbiology, Certe Laboratory for Infectious DiseasesGroningen, Netherlands
| | - Kai Zhou
- Department of Medical Microbiology, University Medical Center Groningen, University of GroningenGroningen, Netherlands; State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China
| | - John W A Rossen
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen Groningen, Netherlands
| | - Alexander W Friedrich
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen Groningen, Netherlands
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18
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Souverein D, Euser SM, Herpers BL, Diederen B, Houtman P, van Seventer M, van Ess I, Kluytmans J, Rossen JWA, Den Boer JW. Prevalence, risk factors and molecular epidemiology of highly resistant gram negative rods in hospitalized patients in the Dutch region Kennemerland. Antimicrob Resist Infect Control 2016; 5:8. [PMID: 26962447 PMCID: PMC4784298 DOI: 10.1186/s13756-016-0107-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/03/2016] [Indexed: 11/29/2022] Open
Abstract
Background This paper describes (1) the Highly Resistant Gram Negative Rod (HR-GNR) prevalence rate, (2) their genotypes, acquired resistance genes and (3) associated risk factors of HR-GNR colonization among the hospitalized population in the Dutch region Kennemerland. Methods Between 1 October 2013 and 31 March 2014, cross-sectional prevalence measurements were performed in three regional hospitals as part of each hospitals infection control program. Rectal swabs were analyzed at the Regional Public Health Laboratory Kennemerland by direct culturing. Genotypes and acquired resistance genes of positive isolates were determined using Whole Genome Sequencing with the MiSeq instrument (Illumina). Association between several independent variables and HR-GNR positivity was examined using logistic regression models. Results Out of 427 patients, 24 HR-GNR positive isolates were recovered from 22 patients, resulting in a regional HR-GNR colonization prevalence (95 % CI) of 5.2 % (3.6–7.9). Of these 22 positive patients, 15 were Extended Spectrum Beta-Lactamase (ESBL) positive (3.5 % (2.1–5.7)), 7 patients were positive for a Fluoroquinolones and Aminoglycosides (Q&A) resistant Enterobacteriaceae (1.6 % (0.8–3.3)) and from one patient (0.2 % (0–1.3)) a Stenotrophomonas maltophilia resistant towards co-trimoxazole was isolated. No carbapenemase producing Enterobacteriaceae (CPE), multi-resistant Acinetobacter species or multi-resistant Pseudomonas aeruginosa were isolated. The ESBL genes found were blaCTX-M-1 (n = 4, 25.0 %), blaCTX-M-15 (n = 3, 18.8 %), blaCTX-M-27 (n = 2, 12.5 %), blaCTX-M-14b (n = 2, 12.5 %), blaCTX-M-9 (n = 2, 12.5 %), blaCTX-M-14 (n = 1, 6.3 %), blaCTX-M-3 (n = 1, 6.3 %), blaSHV-11 (n = 1, 6.3 %) and blaSHV-12 (n = 1, 6.3 %). Being known HR-GNR positive in the past was the only significant associated risk factor for HR-GNR positivity, odds ratio (95 % CI): 7.32 (1.82–29.35), p-value = 0.005. Conclusions Similar ESBL prevalence rates and genotypes (3.5 %) were found in comparison to other Dutch studies. When previously HR-GNR positive patients are readmitted, they should be screened for HR-GNR colonization since colonization with GR-GNRs could be prolonged. We recommend for future studies to include all defined HR-GNRs in addition to ESBLs in prevalence studies, in order to obtain a more comprehensive overview of colonization with HR-GNRs.
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Affiliation(s)
- Dennis Souverein
- Department of Epidemiology and Infection Prevention, Regional Public Health Laboratory Kennemerland, Boerhaavelaan 26, 2035 RC Haarlem, The Netherlands
| | - Sjoerd M Euser
- Department of Epidemiology and Infection Prevention, Regional Public Health Laboratory Kennemerland, Boerhaavelaan 26, 2035 RC Haarlem, The Netherlands
| | - Bjorn L Herpers
- Department of Epidemiology and Infection Prevention, Regional Public Health Laboratory Kennemerland, Boerhaavelaan 26, 2035 RC Haarlem, The Netherlands
| | - Bram Diederen
- Department of Epidemiology and Infection Prevention, Regional Public Health Laboratory Kennemerland, Boerhaavelaan 26, 2035 RC Haarlem, The Netherlands
| | - Patricia Houtman
- Department of Infection Prevention, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Marina van Seventer
- Department of Infection Prevention, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Ingeborg van Ess
- Department of Infection Prevention, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands
| | - Jan Kluytmans
- Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, and University Medical Center, Utrecht, The Netherlands
| | - John W A Rossen
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jeroen W Den Boer
- Department of Epidemiology and Infection Prevention, Regional Public Health Laboratory Kennemerland, Boerhaavelaan 26, 2035 RC Haarlem, The Netherlands
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19
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Zhou K, Lokate M, Deurenberg RH, Tepper M, Arends JP, Raangs EGC, Lo-Ten-Foe J, Grundmann H, Rossen JWA, Friedrich AW. Use of whole-genome sequencing to trace, control and characterize the regional expansion of extended-spectrum β-lactamase producing ST15 Klebsiella pneumoniae. Sci Rep 2016; 6:20840. [PMID: 26864946 PMCID: PMC4749987 DOI: 10.1038/srep20840] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/13/2016] [Indexed: 12/23/2022] Open
Abstract
The study describes the transmission of a CTX-M-15-producing ST15 Klebsiella pneumoniae between patients treated in a single center and the subsequent inter-institutional spread by patient referral occurring between May 2012 and September 2013. A suspected epidemiological link between clinical K. pneumoniae isolates was supported by patient contact tracing and genomic phylogenetic analysis from May to November 2012. By May 2013, a patient treated in three institutions in two cities was involved in an expanding cluster caused by this high-risk clone (HiRiC) (local expansion, CTX-M-15 producing, and containing hypervirulence factors). A clone-specific multiplex PCR was developed for patient screening by which another patient was identified in September 2013. Genomic phylogenetic analysis including published ST15 genomes revealed a close homology with isolates previously found in the USA. Environmental contamination and lack of consistent patient screening were identified as being responsible for the clone dissemination. The investigation addresses the advantages of whole-genome sequencing in the early detection of HiRiC with a high propensity of nosocomial transmission and prolonged circulation in the regional patient population. Our study suggests the necessity for inter-institutional/regional collaboration for infection/outbreak management of K. pneumoniae HiRiCs.
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Affiliation(s)
- Kai Zhou
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Medicine School, Zhejiang University, China
| | - Mariette Lokate
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Ruud H Deurenberg
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Marga Tepper
- Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Netherlands
| | - Jan P Arends
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Erwin G C Raangs
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Jerome Lo-Ten-Foe
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Hajo Grundmann
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - John W A Rossen
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Alexander W Friedrich
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Zhou K, Lokate M, Deurenberg RH, Arends J, Lo-Ten Foe J, Grundmann H, Rossen JWA, Friedrich AW. Characterization of a CTX-M-15 Producing Klebsiella Pneumoniae Outbreak Strain Assigned to a Novel Sequence Type (1427). Front Microbiol 2015; 6:1250. [PMID: 26617589 PMCID: PMC4639626 DOI: 10.3389/fmicb.2015.01250] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 10/27/2015] [Indexed: 12/01/2022] Open
Abstract
Extended-spectrum -lactamase producing Klebsiella pneumoniae have emerged as one of the major nosocomial pathogens. Between July and September 2012, a CTX-M-15 producing K. pneumoniae caused an outbreak in a university hospital in the Netherlands. The outbreak isolates were characterized and assigned to a novel sequence type (ST1427). An epidemiological link between affected patients was supported by patient contact tracing and whole-genome phylogenetic analysis. Intra-strain polymorphism was detected among multiple isolates obtained from different body sites of the index patient, which may relate to antibiotic treatment and/or host adaptation. Environmental contamination caused by the outbreak clone was found in the patient rooms even on medical equipment. The novel clone was not closely related to any known endemic/epidemic clone, but carried a set of a plasmid-borne resistance genes [blaCTX−M−15, blaTEM−1, blaOXA−1, aac(6′)-Ib-cr, qnrB1, tetA(A), aac(3)-II]. Analysis of its virulence factors revealed a previously uncharacterized capsular biosynthesis region and two uncharacterized fimbriae gene clusters, and suggested that the new clone was not hypervirulent. To our knowledge, this is the first outbreak report of K. pneumoniae ST1427, and our study could be of help to understand the features of this newly emerging clone.
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Affiliation(s)
- Kai Zhou
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen Groningen, Netherlands ; State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University Hangzhou, China ; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases Hangzhou, China
| | - Mariëtte Lokate
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen Groningen, Netherlands
| | - Ruud H Deurenberg
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen Groningen, Netherlands
| | - Jan Arends
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen Groningen, Netherlands
| | - Jerome Lo-Ten Foe
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen Groningen, Netherlands
| | - Hajo Grundmann
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen Groningen, Netherlands
| | - John W A Rossen
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen Groningen, Netherlands
| | - Alexander W Friedrich
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen Groningen, Netherlands
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21
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Gabarrini G, de Smit M, Westra J, Brouwer E, Vissink A, Zhou K, Rossen JWA, Stobernack T, van Dijl JM, van Winkelhoff AJ. The peptidylarginine deiminase gene is a conserved feature of Porphyromonas gingivalis. Sci Rep 2015; 5:13936. [PMID: 26403779 PMCID: PMC4585897 DOI: 10.1038/srep13936] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/11/2015] [Indexed: 01/27/2023] Open
Abstract
Periodontitis is an infective process that ultimately leads to destruction of the soft and hard tissues that support the teeth (the periodontium). Periodontitis has been proposed as a candidate risk factor for development of the autoimmune disease rheumatoid arthritis (RA). Porphyromonas gingivalis, a major periodontal pathogen, is the only known prokaryote expressing a peptidyl arginine deiminase (PAD) enzyme necessary for protein citrullination. Antibodies to citrullinated proteins (anti-citrullinated protein antibodies, ACPA) are highly specific for RA and precede disease onset. Objective of this study was to assess P. gingivalis PAD (PPAD) gene expression and citrullination patterns in representative samples of P. gingivalis clinical isolates derived from periodontitis patients with and without RA and in related microbes of the Porphyromonas genus. Our findings indicate that PPAD is omnipresent in P. gingivalis, but absent in related species. No significant differences were found in the composition and expression of the PPAD gene of P. gingivalis regardless of the presence of RA or periodontal disease phenotypes. From this study it can be concluded that if P. gingivalis plays a role in RA, it is unlikely to originate from a variation in PPAD gene expression.
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Affiliation(s)
- Giorgio Gabarrini
- Center for Dentistry and Oral Hygiene, University of Groningen and University Medical Center Groningen, the Netherlands
| | - Menke de Smit
- Center for Dentistry and Oral Hygiene, University of Groningen and University Medical Center Groningen, the Netherlands
| | - Johanna Westra
- Department of Rheumatology and Clinical Immunology, University of Groningen and University Medical Center Groningen, the Netherlands
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University of Groningen and University Medical Center Groningen, the Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, the Netherlands
| | - Kai Zhou
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - John W A Rossen
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Tim Stobernack
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Jan Maarten van Dijl
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Arie Jan van Winkelhoff
- Center for Dentistry and Oral Hygiene, University of Groningen and University Medical Center Groningen, the Netherlands.,Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, the Netherlands
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22
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Dik JWH, Poelman R, Friedrich AW, Panday PN, Lo-Ten-Foe JR, van Assen S, van Gemert-Pijnen JEWC, Niesters HGM, Hendrix R, Sinha B. An integrated stewardship model: antimicrobial, infection prevention and diagnostic (AID). Future Microbiol 2015; 11:93-102. [PMID: 26323589 DOI: 10.2217/fmb.15.99] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Considering the threat of antimicrobial resistance and the difficulties it entails in treating infections, it is necessary to cross borders and approach infection management in an integrated, multidisciplinary manner. We propose the antimicrobial, infection prevention and diagnostic stewardship model comprising three intertwined programs: antimicrobial, infection prevention and diagnostic stewardship, involving all stakeholders. The focus is a so-called 'theragnostics' approach. This leads to a personalized infection management plan, improving patient care and minimizing resistance development. Furthermore, it is important that healthcare regions nationally and internationally work together, ensuring that the patient (and microorganism) transfers will not cause problems in a neighboring institution. This antimicrobial, infection prevention and diagnostic stewardship model can serve as a blue print to implement innovative, integrative infection management.
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Affiliation(s)
- Jan-Willem H Dik
- Clinical Bacteriology Unit, Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Randy Poelman
- Clinical Virology Unit, Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alexander W Friedrich
- Infection Prevention Unit, Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Prashant Nannan Panday
- Department of Clinical Pharmacy, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jerome R Lo-Ten-Foe
- Clinical Bacteriology Unit, Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sander van Assen
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Julia E W C van Gemert-Pijnen
- Department of Psychology Health & Technology, Faculty Behavioral, Management & Social Sciences, University of Twente, Enschede, The Netherlands
| | - Hubert G M Niesters
- Clinical Virology Unit, Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ron Hendrix
- Clinical Bacteriology Unit, Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Certe Laboratory for Infectious Diseases, Groningen, The Netherlands
| | - Bhanu Sinha
- Clinical Bacteriology Unit, Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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23
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Willemsen I, van Esser J, Kluytmans-van den Bergh M, Zhou K, Rossen JW, Verhulst C, Verduin K, Kluytmans J. Retrospective identification of a previously undetected clinical case of OXA-48-producing K. pneumoniae and E. coli: the importance of adequate detection guidelines. Infection 2015; 44:107-10. [PMID: 26062812 DOI: 10.1007/s15010-015-0805-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 05/29/2015] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The laboratory detection of OXA-48-carbapenemase-producing Enterobacteriaceae is difficult, as minimum inhibition concentrations for carbapenems are often below the clinical breakpoint. In 2011, the Dutch national guideline for the detection of highly resistant micro-organisms was issued, which includes recommendations on the use of carbapenem screening breakpoints for the detection of carbapenemase-producing Enterobacteriaceae. MATERIALS AND METHODS During a validation study of the Check-MDR CT103 microarray (Check-Points, Wageningen, The Netherlands) in 2013, an OXA-48-like carbapenemase gen was identified in two isolates that were previously obtained from a patient with non-Hodgkin lymphoma in 2007. Whole-genome sequencing (WGS) and subsequent BLAST Ringe Image Generator (BRIG) analysis were performed to establish the presence of OXA-48 carbapenemase encoding plasmids and their similarity. RESULTS This case report describes the first documented OXA-48-producing Klebsiella pneumonia (ST648) and Escherichia coli (ST866) in the Netherlands. A similar IncL/M plasmid was identified in both strains, suggesting within-patient horizontal transfer. CONCLUSION This case illustrates that OXA-48-carbapenemase-producing Enterobacteriaceae can be unnoticed without adequate laboratory detection procedures. Our observation stresses the importance of uniform and adequate laboratory methods for the timely and accurate detection of important antimicrobial resistance.
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Affiliation(s)
- Ina Willemsen
- Laboratory for Microbiology and Infection Control, Amphia Hospital, PO Box 90158, 4800 RK, Breda, The Netherlands.
| | - Joost van Esser
- Department for internal medicine, Amphia Hospital, Breda, The Netherlands
| | - Marjolein Kluytmans-van den Bergh
- Amphia Academy Infectious Disease Foundation, Amphia Hospital, Breda, The Netherlands.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Kai Zhou
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - John W Rossen
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carlo Verhulst
- Laboratory for Microbiology and Infection Control, Amphia Hospital, PO Box 90158, 4800 RK, Breda, The Netherlands
| | - Kees Verduin
- Laboratory for Microbiology and Infection Control, Amphia Hospital, PO Box 90158, 4800 RK, Breda, The Netherlands
| | - Jan Kluytmans
- Laboratory for Microbiology and Infection Control, Amphia Hospital, PO Box 90158, 4800 RK, Breda, The Netherlands.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
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