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Hala S, Malaikah M, Huang J, Bahitham W, Fallatah O, Zakri S, Antony CP, Alshehri M, Ghazzali RN, Ben-Rached F, Alsahafi A, Alsaedi A, AlAhmadi G, Kaaki M, Alazmi M, AlhajHussein B, Yaseen M, Zowawi HM, Alghoribi MF, Althaqafi AO, Al-Amri A, Moradigaravand D, Pain A. The emergence of highly resistant and hypervirulent Klebsiella pneumoniae CC14 clone in a tertiary hospital over 8 years. Genome Med 2024; 16:58. [PMID: 38637822 PMCID: PMC11025284 DOI: 10.1186/s13073-024-01332-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Klebsiella pneumoniae is a major bacterial and opportunistic human pathogen, increasingly recognized as a healthcare burden globally. The convergence of resistance and virulence in K. pneumoniae strains has led to the formation of hypervirulent and multidrug-resistant strains with dual risk, limiting treatment options. K. pneumoniae clones are known to emerge locally and spread globally. Therefore, an understanding of the dynamics and evolution of the emerging strains in hospitals is warranted to prevent future outbreaks. METHODS In this study, we conducted an in-depth genomic analysis on a large-scale collection of 328 multidrug-resistant (MDR) K. pneumoniae strains recovered from 239 patients from a single major hospital in the western coastal city of Jeddah in Saudi Arabia from 2014 through 2022. We employed a broad range of phylogenetic and phylodynamic methods to understand the evolution of the predominant clones on epidemiological time scales, virulence and resistance determinants, and their dynamics. We also integrated the genomic data with detailed electronic health record (EHR) data for the patients to understand the clinical implications of the resistance and virulence of different strains. RESULTS We discovered a diverse population underlying the infections, with most strains belonging to Clonal Complex 14 (CC14) exhibiting dominance. Specifically, we observed the emergence and continuous expansion of strains belonging to the dominant ST2096 in the CC14 clade across hospital wards in recent years. These strains acquired resistance mutations against colistin and extended spectrum β-lactamase (ESBL) and carbapenemase genes, namely blaOXA-48 and blaOXA-232, located on three distinct plasmids, on epidemiological time scales. Strains of ST2096 exhibited a high virulence level with the presence of the siderophore aerobactin (iuc) locus situated on the same mosaic plasmid as the ESBL gene. Integration of ST2096 with EHR data confirmed the significant link between colonization by ST2096 and the diagnosis of sepsis and elevated in-hospital mortality (p-value < 0.05). CONCLUSIONS Overall, these results demonstrate the clinical significance of ST2096 clones and illustrate the rapid evolution of an emerging hypervirulent and MDR K. pneumoniae in a clinical setting.
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Affiliation(s)
- Sharif Hala
- Pathogen Genomics Laboratory, Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, 23955-6900, Jeddah, Makkah, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Mohammed Malaikah
- Pathogen Genomics Laboratory, Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, 23955-6900, Jeddah, Makkah, Saudi Arabia
- Laboratory of Infectious Disease Epidemiology, Biological and Environmental Science and Engineering (BESE) Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
| | - Jiayi Huang
- Laboratory of Infectious Disease Epidemiology, Biological and Environmental Science and Engineering (BESE) Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
- KAUST Computational Bioscience Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
| | - Wesam Bahitham
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Omniya Fallatah
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Samer Zakri
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Chakkiath Paul Antony
- Pathogen Genomics Laboratory, Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, 23955-6900, Jeddah, Makkah, Saudi Arabia
- International Institute for Zoonosis Control, Hokkaido University, Sapporo, 001-0020, Japan
| | - Mohammed Alshehri
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Raeece Naeem Ghazzali
- Pathogen Genomics Laboratory, Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, 23955-6900, Jeddah, Makkah, Saudi Arabia
| | - Fathia Ben-Rached
- Pathogen Genomics Laboratory, Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, 23955-6900, Jeddah, Makkah, Saudi Arabia
| | - Abdullah Alsahafi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Asim Alsaedi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Ghadeer AlAhmadi
- King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Mai Kaaki
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Meshari Alazmi
- KAUST Computational Bioscience Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
- College of Computer Science and Engineering, University of Hail, Hail, Saudi Arabia
| | - Baraa AlhajHussein
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Muhammad Yaseen
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Hosam M Zowawi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
- The University of Queensland, UQ Centre for Clinical Research, Herston, QLD, Australia
| | - Majed F Alghoribi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Abdulhakeem O Althaqafi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Abdulfattah Al-Amri
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Infectious Disease Research Department, King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Western Region, Saudi Arabia
| | - Danesh Moradigaravand
- Laboratory of Infectious Disease Epidemiology, Biological and Environmental Science and Engineering (BESE) Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia.
- KAUST Computational Bioscience Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia.
| | - Arnab Pain
- Pathogen Genomics Laboratory, Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, 23955-6900, Jeddah, Makkah, Saudi Arabia.
- The University of Queensland, UQ Centre for Clinical Research, Herston, QLD, Australia.
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2
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Bin Saleh K, Badreldin HA, Alqahtani T, Alsuhebany N, Alowais SA, Sulaiman KA, Alrashed M, Alsaeed Y, Alyousef A, Aldugiem R, Aljuhani O, Alharbi N, Alghnam S, Almotiri A, Zowawi HM, Alshehri N, Johani SA, Bosaeed M. Assessing the influence of COVID-19 on influenza prevalence: A multicenter time series study. J Infect Public Health 2023; 16:1989-1993. [PMID: 37879151 DOI: 10.1016/j.jiph.2023.09.018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, countries around the world implemented various interventions to manage the spread of respiratory illnesses, including influenza. However, there is a lack of studies that have assessed the influence of COVID-19 on influenza prevalence in Saudi Arabia. In this study, we aimed to evaluate the prevalence of positive influenza cases before and during the COVID-19 pandemic in relation to the mitigation measures and policy initiatives in Saudi Arabia. METHODS A multicenter, time-series cross-sectional study was conducted to evaluate influenza prevalence before and during the COVID-19 pandemic between 01/01/2017 and 31/12/2021. This study included all patients who were screened for influenza infection at healthcare facilities across Saudi Arabia using polymerase chain reaction (PCR). The primary outcome was to determine the prevalence of influenza infections before and during the COVID-19 pandemic, while the secondary outcome was to describe the demographic data and comorbidities of the included patients in both periods. RESULTS During the study period, 5238 cases were identified based on a positive PCR result for influenza virus. The yearly number of influenza cases in the pre-COVID-19 period was 1123 (2.03 %), 1075 (1.63 %), and 1883 (2.20 %) cases in 2017, 2018, and 2019, respectively. On the other hand, the number of cases during the COVID-19 pandemic was 417 (0.63 %) and 740 (1.27 %) in 2020 and 2021, respectively, with a comparable number of performed tests. Patients infected with the influenza virus between 2020 and 2021 were older than patients who were infected before the COVID-19 pandemic. CONCLUSION The study found a lower number of influenza cases during the COVID-19 pandemic, with no clear peak during November and December 2020 and 2021.
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Affiliation(s)
- Khalid Bin Saleh
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Abdulaziz Medical City, Riyadh, Saudi Arabia.
| | - Hisham A Badreldin
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Tariq Alqahtani
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nada Alsuhebany
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Shuroug A Alowais
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Khalid Al Sulaiman
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Abdulaziz Medical City, Riyadh, Saudi Arabia; Saudi Critical Care Pharmacy Research (SCAPE) Platform, Riyadh, Saudi Arabia
| | - Mohammed Alrashed
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Yara Alsaeed
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Rema Aldugiem
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ohoud Aljuhani
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Naif Alharbi
- Gulf Center for Disease Prevention and Control, Saudi Arabia
| | - Suliman Alghnam
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ahmed Almotiri
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hosam M Zowawi
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | | | - Sameera Al Johani
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohammad Bosaeed
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Ertl NG, Irwin AD, Macdonald J, Bauer MJ, Wang CYT, Harris PNA, Heney C, Zowawi HM, Whiley DM. Rapid molecular detection of CMY-2, and CTX-M group 1 and 9 variants via recombinase polymerase amplification. JAC Antimicrob Resist 2023; 5:dlad023. [PMID: 36936189 PMCID: PMC10020033 DOI: 10.1093/jacamr/dlad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 02/19/2023] [Indexed: 03/18/2023] Open
Abstract
Background Due to their prevalence worldwide, the β-lactamases CTX-M and plasmid-mediated CMY-2 are important antimicrobial resistance enzymes in a clinical setting. While culture- and PCR-based detection methods exist for these targets, they are time consuming and require specialist equipment and trained personnel to carry out. Methods In this study, three rapid diagnostic single-plex and a prototype triplex assay were developed, using recombinase polymerase amplification with lateral flow detection (RPA-LF), and tested for their sensitivity and specificity using two isolate DNA panels (n = 90 and n = 120 isolates). In addition, the RPA-LF assays were also tested with a small number of faecal extract samples (n = 18). Results The RPA-LF assays were able to detect bla CXT-M-group-1, bla CTX-M-group-9 and bla CMY-2-type variants with high sensitivity (82.1%-100%) and specificity (100%) within a short turnaround time (15-20 min for amplification and detection). Conclusions RPA-LF assays developed in this study have the potential to be used at or close to the point of care, as well as in low-resource settings, producing rapid results to support healthcare professionals in their treatment decisions.
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Affiliation(s)
- Nicole G Ertl
- Corresponding author. E-mail: ; @padstamundo, @MolecularEngeer
| | - Adam D Irwin
- The University of Queensland, UQ Centre for Clinical Research, Faculty of Medicine, Brisbane, QLD, Australia
- Infection Management and Prevention Service, Children’s Health Queensland, Brisbane, QLD, Australia
| | - Joanne Macdonald
- Centre for Bioinnovation and School of Science, Technology and Engineering, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Michelle J Bauer
- The University of Queensland, UQ Centre for Clinical Research, Faculty of Medicine, Brisbane, QLD, Australia
| | - Claire Y T Wang
- Infection Management and Prevention Service, Children’s Health Queensland, Brisbane, QLD, Australia
| | - Patrick N A Harris
- The University of Queensland, UQ Centre for Clinical Research, Faculty of Medicine, Brisbane, QLD, Australia
- Microbiology Department, Central Laboratory, Pathology Queensland, Brisbane, QLD, Australia
| | - Claire Heney
- Microbiology Department, Central Laboratory, Pathology Queensland, Brisbane, QLD, Australia
| | - Hosam M Zowawi
- The University of Queensland, UQ Centre for Clinical Research, Faculty of Medicine, Brisbane, QLD, Australia
- College of Medicine, King Saud bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - David M Whiley
- The University of Queensland, UQ Centre for Clinical Research, Faculty of Medicine, Brisbane, QLD, Australia
- Infection Management and Prevention Service, Children’s Health Queensland, Brisbane, QLD, Australia
- Microbiology Department, Central Laboratory, Pathology Queensland, Brisbane, QLD, Australia
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4
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Ayfan AKS, Macdonald J, Irwin AD, Zowawi HM, Forde BM, Paterson DL, Lahra MM, Whiley DM. Proof-of-concept, rapid, instrument-free molecular detection of Neisseria gonorrhoeae and ciprofloxacin susceptibility. J Antimicrob Chemother 2022; 77:2933-2936. [PMID: 35880750 DOI: 10.1093/jac/dkac242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To develop instrument-free point-of-care methods using recombinase polymerase amplification (RPA) technology coupled with a simple lateral flow detection system to detect Neisseria gonorrhoeae and susceptibility to ciprofloxacin. METHODS For identification of gonococcal infection, an RPA-based method was developed targeting the gonococcal porA pseudogene (NG-porA-RPA). For ciprofloxacin susceptibility, predictive WT sequences at codons 91 and 95 of the gonococcal gyrA DNase gene were targeted. Given the known complexities of SNP detection using RPA (e.g. the ability to accommodate mismatches) we trialled several different assays incorporating various additional non-template mismatches in the oligonucleotide sequences to reduce affinity for the mutant (resistant) gyrA sequences. Assays were evaluated using a bank of N. gonorrhoeae (n = 10) and non-gonococcal (n = 5) isolates and a panel of N. gonorrhoeae nucleic acid amplification test (NAAT)-positive clinical sample extracts (n = 40). RESULTS The NG-porA-RPA assay was specific to N. gonorrhoeae and provided a positive percentage agreement (PPA) of 87.5% (35/40) compared with a commercial N. gonorrhoeae NAAT when applied to the 40 clinical sample extracts. For gyrA, the non-template bases successfully reduced banding intensity for double-mutant strains (mutations at both 91 and 95), but not for rarer single-mutant (91 only) strains. The most promising gyrA assay, NG-gyrA-RPA08, correctly detected 83% (25/30) of infections from NAAT-positive clinical samples confirmed to have WT gyrA sequences based on Sanger sequencing. CONCLUSIONS These proof-of-concept data show that RPA technology has considerable promise for detecting N. gonorrhoeae and associated antibiotic susceptibility and would offer a diagnostic-based stewardship strategy identified as urgently needed by the WHO.
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Affiliation(s)
- Abdulrahman K S Ayfan
- Faculty of Medicine, The University of Queensland Centre for Clinical Research (UQCCR), Brisbane, Australia.,Faculty of Science, Biochemistry Department, King Abdul-Aziz University (KAU), Jeddah, Saudi Arabia
| | - Joanne Macdonald
- School of Science and Engineering, Genecology Research Centre, University of Sunshine Coast (USC), Sunshine Coast, Australia
| | - Adam D Irwin
- Faculty of Medicine, The University of Queensland Centre for Clinical Research (UQCCR), Brisbane, Australia.,Infection Management and Prevention Services, Queensland Children's Hospital, Brisbane, Australia
| | - Hosam M Zowawi
- Faculty of Medicine, The University of Queensland Centre for Clinical Research (UQCCR), Brisbane, Australia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Brian M Forde
- Faculty of Medicine, The University of Queensland Centre for Clinical Research (UQCCR), Brisbane, Australia
| | - David L Paterson
- Faculty of Medicine, The University of Queensland Centre for Clinical Research (UQCCR), Brisbane, Australia
| | - Monica M Lahra
- World Health Organization Collaborating Centre for STDs, Prince of Wales Hospital, Sydney, Australia
| | - David M Whiley
- Faculty of Medicine, The University of Queensland Centre for Clinical Research (UQCCR), Brisbane, Australia.,Infection Management and Prevention Services, Queensland Children's Hospital, Brisbane, Australia.,Pathology Queensland, Department of Microbiology, Brisbane, Australia
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Alenazi MW, Algaisi A, Zowawi HM, Aldibasi O, Hashem AM, Khalaf Alharbi N. Seroprevalence of COVID-19 in Riyadh City during the early increase of COVID-19 infections in Saudi Arabia, June 2020. Saudi J Biol Sci 2022; 29:103282. [PMID: 35475117 PMCID: PMC9027288 DOI: 10.1016/j.sjbs.2022.103282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 03/14/2022] [Accepted: 04/17/2022] [Indexed: 12/15/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus (SARS-CoV-2) emerged in December 2019 and caused a global pandemic of the Coronavirus Disease 2019 (COVID-19). More than 170 million cases have been reported worldwide with mortality rate of 1–3%. The detection of SARS-CoV-2 by molecular testing is limited to acute infections, therefore serological studies provide a better estimation of the virus spread in a population. This study aims to evaluate the seroprevalence of SARS-CoV-2 in the major city of Riyadh, Saudi Arabia during the sharp increase of the pandemic, in June 2020. Serum samples from non-COVID patients (n = 432), patients visiting hospitals for other complications and confirmed negative for COVID-19, and healthy blood donors (n = 350) were collected and evaluated using an in-house enzyme-linked immunosorbent assay (ELISA). The overall percentage of positive samples was 7.80% in the combined two populations (n = 782). The seroprevalence was lower in the blood donors (6%) than non-COVID-19 patients (9.25%), p = 0.0004. This seroprevalence rate is higher than the documented cases, indicating asymptomatic or mild unreported COVID-19 infections in these two populations. This warrants further national sero-surveys and highlights the importance of real-time serological surveillance during pandemics.
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Hindawi SI, El-Kafrawy SA, Hassan AM, Badawi MA, Bayoumi MM, Almalki AA, Zowawi HM, Tolah AM, Alandijany TA, Abunada Q, Picard-Maureau M, Damanhouri GA, Azhar EI. Efficient inactivation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in human apheresis platelet concentrates with amotosalen and ultraviolet A light. Transfus Clin Biol 2021; 29:31-36. [PMID: 34411748 PMCID: PMC8366050 DOI: 10.1016/j.tracli.2021.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/06/2021] [Accepted: 08/12/2021] [Indexed: 12/11/2022]
Abstract
Objectives The detection of SARS-CoV-2 RNA in blood and platelet concentrates from asymptomatic donors, and the detection of viral particles on the surface and inside platelets during in vitro experiments, raised concerns over the potential risk for transfusion-transmitted-infection (TTI). The objective of this study was to assess the efficacy of the amotosalen/UVA pathogen reduction technology for SARS-CoV-2 in human platelet concentrates to mitigate such potential risk. Material and methods Five apheresis platelet units in 100% plasma were spiked with a clinical SARS-CoV-2 isolate followed by treatment with amotosalen/UVA (INTERCEPT Blood System), pre- and posttreatment samples were collected as well as untreated positive and negative controls. The infectious viral titer was assessed by plaque assay and the genomic titer by quantitative RT-PCR. To exclude the presence of infectious particles post-pathogen reduction treatment below the limit of detection, three consecutive rounds of passaging on permissive cell lines were conducted. Results SARS-CoV-2 in platelet concentrates was inactivated with amotosalen/UVA below the limit of detection with a mean log reduction of > 3.31 ± 0.23. During three consecutive rounds of passaging, no viral replication was detected. Pathogen reduction treatment also inhibited nucleic acid detection with a log reduction of > 4.46 ± 0.51 PFU equivalents. Conclusion SARS-CoV-2 was efficiently inactivated in platelet concentrates by amotosalen/UVA treatment. These results are in line with previous inactivation data for SARS-CoV-2 in plasma as well as MERS-CoV and SARS-CoV-1 in platelets and plasma, demonstrating efficient inactivation of human coronaviruses.
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Affiliation(s)
- S I Hindawi
- Department of Hematology, Blood Transfusion Services, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
| | - S A El-Kafrawy
- Special Infectious Agents Unit, BSL3, King Fahd Medical Research Center and Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - A M Hassan
- Special Infectious Agents Unit, BSL3, King Fahd Medical Research Center and Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - M A Badawi
- Department of Hematology, Blood Transfusion Services, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - M M Bayoumi
- Blood Transfusion Services, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia
| | - A A Almalki
- Blood Transfusion Services, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia
| | - H M Zowawi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 3660, Riyadh 11481, Saudi Arabia
| | - A M Tolah
- Special Infectious Agents Unit, BSL3, King Fahd Medical Research Center and Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - T A Alandijany
- Special Infectious Agents Unit, BSL3, King Fahd Medical Research Center and Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Q Abunada
- Cerus Europe B.V., Stationsstraat 79-D, 3811 Amersfoort, The Netherlands
| | - M Picard-Maureau
- Cerus Europe B.V., Stationsstraat 79-D, 3811 Amersfoort, The Netherlands
| | - G A Damanhouri
- Department of Hematology, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - E I Azhar
- Special Infectious Agents Unit, BSL3, King Fahd Medical Research Center and Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
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7
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Ayfan AKS, Macdonald J, Harris PNA, Heney C, Paterson DL, Trembizki E, Wang CYT, Whiley DM, Zowawi HM, Irwin AD. Rapid detection of NDM and VIM carbapenemase encoding genes by recombinase polymerase amplification and lateral flow-based detection. Eur J Clin Microbiol Infect Dis 2021; 40:2447-2453. [PMID: 33974185 DOI: 10.1007/s10096-021-04267-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/29/2021] [Indexed: 12/26/2022]
Abstract
Carbapenemase-producing organisms (CPOs) pose a serious clinical threat and rapid detection tools are essential to aid in patient management. We developed rapid and simple molecular tests to detect blaNDM-type and blaVIM-type carbapenemase genes using recombinase polymerase amplification (RPA) combined with a lateral flow detection. The tests could provide results in approximately 15 min when using DNA extracts, with limits of detection of 9.2 copies/μl for the blaNDM-type assay and 7.5 copies/μl for blaVIM-type assay, and successfully detected all isolates harbouring the carbapenemase encoding genes in a panel of 57 isolates. These RPA tests may be suitable for use in low-resource settings to tailor rapid implementation of infection control precautions and antibiotic stewardship.
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Affiliation(s)
- Abdulrahman K S Ayfan
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
- Faculty of Science, Biochemistry Department, King Abdul-Aziz University (KAU), Jeddah, Saudi Arabia
| | - Joanne Macdonald
- School of Science and Engineering, Genecology Research Centre, University of Sunshine Coast (USC), Sunshine Coast, Australia
| | - Patrick N A Harris
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
- Department of Microbiology, Pathology Queensland, Brisbane, Australia
| | - Claire Heney
- Department of Microbiology, Pathology Queensland, Brisbane, Australia
| | - David L Paterson
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
| | - Ella Trembizki
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
| | - Claire Y T Wang
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Australia
| | - David M Whiley
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
- Department of Microbiology, Pathology Queensland, Brisbane, Australia
| | - Hosam M Zowawi
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
- College of Medicine, King Saud bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Adam D Irwin
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia.
- Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Australia.
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8
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Alharbi NK, Alghnam S, Algaissi A, Albalawi H, Alenazi MW, Albargawi AM, Alharbi AG, Alhazmi A, Al Qarni A, Alfarhan A, Zowawi HM, Alhatmi H, Alghamdi J, Alroqi F, Batarfi K, Arabi YM, Hashem AM, Bosaeed M, Aldibasi O. Nationwide Seroprevalence of SARS-CoV-2 in Saudi Arabia. J Infect Public Health 2021; 14:832-838. [PMID: 34118732 PMCID: PMC8188888 DOI: 10.1016/j.jiph.2021.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 01/29/2021] [Revised: 03/18/2021] [Accepted: 04/11/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Estimated seroprevalence of Coronavirus Infectious Disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) is a critical evidence for a better evaluation of the virus spread and monitoring the progress of COVID-19 pandemic in a population. In the Kingdom of Saudi Arabia (KSA), SARS-CoV-2 seroprevalence has been reported in specific regions, but an extensive nationwide study has not been reported. Here, we report a nationwide study to determine the prevalence of SARS-CoV-2 in the population of KSA during the pandemic, using serum samples from healthy blood donors, non-COVID patients and healthcare workers (HCWs) in six different regions of the kingdom, with addition samples from COVID-19 patients. METHODS A total of 11,703 serum samples were collected from different regions of the KSA including; 5395 samples from residual healthy blood donors (D); 5877 samples from non-COVID patients collected through residual sera at clinical biochemistry labs from non-COVID patients (P); and 400 samples from consented HCWs. To determine the seroprevalence of SARS-CoV-2, all serum samples, in addition to positive control sera from RT-PCR confirmed COVID-19 patients, were subjected to in-house ELISA with a sample pooling strategy, which was further validated by testing individual samples that make up some of the pools, with a statistical estimation method to report seroprevalence estimates. RESULTS Overall (combining D and P groups) seroprevalence estimate was around 11% in Saudi Arabia; and was 5.1% (Riyadh), 1.5% (Jazan), 18.4% (Qassim), 20.8% (Hail), 14.7% (ER; Alahsa), and 18.8% in Makkah. Makkah samples were only D group and had a rate of 24.4% and 12.8% in the cities of Makkah and Jeddah, respectively. The seroprevalence in Saudi Arabia across the sampled areas would be 12 times the reported COVID-19 infection rate. Among HCWs, 7.5% (4.95-10.16 CI 95%) had reactive antibodies to SARS-CoV-2 without reporting any previously confirmed infection. This was higher in HCWs with hypertension. The study also presents the demographics and prevalence of co-morbidities in HCWs and subset of non-COVID-19 population. INTERPRETATION Our study estimates the overall national serological prevalence of COVID-19 in Saudi Arabia to be 11%, with an apparent disparity between regions. This indicates the prevalence of asymptomatic or mild unreported COVID-19 cases.
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Affiliation(s)
- Naif Khalaf Alharbi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Suliman Alghnam
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah Algaissi
- Department of Medical Laboratories Technology, College of Applied Medical Sciences, Medical Research Center, Jazan University, Jazan 45142, Saudi Arabia
| | - Hind Albalawi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed W Alenazi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Areeb M Albargawi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - Abdulaziz Alhazmi
- Department of Microbiology and Parasitology, Faculty of Medicine, Medical Research Center, Jazan University Hospital, Jazan University, Saudi Arabia
| | - Ali Al Qarni
- King Abdulaziz Hospital, Ministry of National Guard - Health Affairs, Alahsa, Saudi Arabia
| | - Ali Alfarhan
- King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Hosam M Zowawi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hind Alhatmi
- King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Jahad Alghamdi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fayhan Alroqi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Khalid Batarfi
- King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Yaseen M Arabi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Anwar M Hashem
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Bosaeed
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Omar Aldibasi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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9
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Mohd Sazlly Lim S, Heffernan AJ, Zowawi HM, Roberts JA, Sime FB. Semi-mechanistic PK/PD modelling of meropenem and sulbactam combination against carbapenem-resistant strains of Acinetobacter baumannii. Eur J Clin Microbiol Infect Dis 2021; 40:1943-1952. [PMID: 33884516 DOI: 10.1007/s10096-021-04252-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/30/2020] [Indexed: 11/25/2022]
Abstract
Due to limited treatment options for carbapenem-resistant Acinetobacter baumannii (CR-AB) infections, antibiotic combinations are commonly used. In this study, we explored the potential efficacy of meropenem-sulbactam combination (MEM/SUL) against CR-AB. The checkerboard method was used to screen for synergistic activity of MEM/SUL against 50 clinical CR-AB isolates. Subsequently, time-kill studies against two CR-AB isolates were performed. Time-kill data were described using a semi-mechanistic pharmacokinetic/pharmacodynamic (PK/PD) model. Subsequently, Monte Carlo simulations were performed to estimate the probability of 2-log kill, 1-log kill or stasis at 24-h following combination therapy. The MEM/SUL demonstrated synergy against 28/50 isolates. No antagonism was observed. The MIC50 and MIC90 of MEM/SUL were decreased fourfold, compared to the monotherapy MIC. In the time-kill studies, the combination displayed synergistic killing against both isolates at the highest clinically achievable concentrations. At concentrations equal to the fractional inhibitory concentration, synergism was observed against one isolate. The PK/PD model adequately delineated the data and the interaction between meropenem and sulbactam. The effect of the combination was driven by sulbactam, with meropenem acting as a potentiator. The simulations of various dosing regimens revealed no activity for the monotherapies. At best, the MEM/SUL regimen of 2 g/4 g every 8 h demonstrated a probability of target attainment of 2-log10 kill at 24 h of 34%. The reduction in the MIC values and the achievement of a moderate PTA of a 2-log10 reduction in bacterial burden demonstrated that MEM/SUL may potentially be effective against some CR-AB infections.
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Affiliation(s)
- Sazlyna Mohd Sazlly Lim
- Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, Pharmacy Australia Centre of Excellence, University of Queensland, Level 4, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Aaron J Heffernan
- Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, Pharmacy Australia Centre of Excellence, University of Queensland, Level 4, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
- School of Medicine, Griffith University, Southport, Australia
| | - Hosam M Zowawi
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Jason A Roberts
- Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, Pharmacy Australia Centre of Excellence, University of Queensland, Level 4, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Fekade B Sime
- Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, Pharmacy Australia Centre of Excellence, University of Queensland, Level 4, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia.
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia.
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10
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Hala S, Paul Antony C, Alshehri M, Alsaedi A, O.Al Thaqafi A, Momin AA, Kaaki M, Alhaj-Hussein BT, Zowawi HM, Al-Amri A, Pain A. Emergence of mobile colistin resistance genes mcr-1 and mcr-8 in Saudi Arabia. J Infect Public Health 2020. [DOI: 10.1016/j.jiph.2020.01.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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11
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Hala S, Antony CP, Alshehri M, Althaqafi AO, Alsaedi A, Mufti A, Kaaki M, Alhaj-Hussein BT, Zowawi HM, Al-Amri A, Pain A. First report of Klebsiella quasipneumoniae harboring bla KPC-2 in Saudi Arabia. Antimicrob Resist Infect Control 2019; 8:203. [PMID: 31890159 PMCID: PMC6923860 DOI: 10.1186/s13756-019-0653-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 05/03/2019] [Accepted: 11/14/2019] [Indexed: 12/20/2022] Open
Abstract
Background Nosocomial infections caused by multi-drug resistant Enterobacteriaceae are a global public health threat that ought to be promptly identified, reported, and addressed accurately. Many carbapenem-resistant Enterobacteriaceae-associated genes have been identified in Saudi Arabia but not the endemic Klebsiella pneumoniae carbapenemases (KPCs), which are encoded by blaKPC-type genes. KPCs are known for their exceptional spreading potential. Methods We collected n = 286 multi-drug resistant (MDR) Klebsiella spp. isolates as part of screening for resistant patterns from a tertiary hospital in Saudi Arabia between 2014 and 2018. Antimicrobial susceptibility testing was carried out using both VITEK II and the broth microdilution of all collected isolates. Detection of resistance-conferring genes was carried out using Illumina whole-genome shotgun sequencing and PacBio SMRT sequencing protocols. Results A Carbapenem-resistant Enterobacteriaceae (CRE) Klebsiella quasipneumoniae subsp. similipneumoniae strain was identified as a novel ST-3510 carrying a blaKPC-2 carbapenemase encoding gene. The isolate, designated as NGKPC-421, was obtained from shotgun Whole Genome Sequencing (WGS) surveillance of 286 MDR Klebsiella spp. clinical isolates. The NGKPC-421 isolate was collected from a septic patient in late 2017 and was initially misidentified as K. pneumoniae. The sequencing and assembly of the NGKPC-421 genome resulted in the identification of a putative ~ 39.4 kb IncX6 plasmid harboring a blaKPC-2 gene, flanked by transposable elements (ISKpn6-blaKPC-2–ISKpn27). Conclusion This is the first identification of a KPC-2-producing CRE in the Gulf region. The impact on this finding is of major concern to the public health in Saudi Arabia, considering that it is the religious epicenter with a continuous mass influx of pilgrims from across the world. Our study strongly highlights the importance of implementing rapid sequencing-based technologies in clinical microbiology for precise taxonomic classification and monitoring of antimicrobial resistance patterns.
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Affiliation(s)
- Sharif Hala
- 1Pathogen Genomics Laboratory, Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia.,Clinical Microbiology Department, King Abdullah International Medical Research Centre - Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,3King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Chakkiath Paul Antony
- 1Pathogen Genomics Laboratory, Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia.,7Red Sea Research Center, Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Mohammed Alshehri
- Clinical Microbiology Department, King Abdullah International Medical Research Centre - Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,3King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Abdulhakeem O Althaqafi
- 3King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,WHO Collaborating Centre for Infection Prevention and Control, and GCC Center for Infection Control, Riyadh, Saudi Arabia
| | - Asim Alsaedi
- 3King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,WHO Collaborating Centre for Infection Prevention and Control, and GCC Center for Infection Control, Riyadh, Saudi Arabia
| | - Areej Mufti
- 3King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mai Kaaki
- 3King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | | | - Hosam M Zowawi
- Clinical Microbiology Department, King Abdullah International Medical Research Centre - Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.,3King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,WHO Collaborating Centre for Infection Prevention and Control, and GCC Center for Infection Control, Riyadh, Saudi Arabia.,5UQ Centre for Clinical Research, Herston, Queensland, The University of Queensland, Queensland, Australia
| | - Abdulfattah Al-Amri
- 3King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Arnab Pain
- 1Pathogen Genomics Laboratory, Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia.,6Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Thuwal, Japan
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12
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Choudhury MA, Sidjabat HE, Zowawi HM, Marsh PhD N, Larsen E, Runnegar PhD N, Paterson DL, McMillan DJ, Rickard CM. Skin colonization at peripheral intravenous catheter insertion sites increases the risk of catheter colonization and infection. Am J Infect Control 2019; 47:1484-1488. [PMID: 31331714 DOI: 10.1016/j.ajic.2019.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peripheral intravenous catheters (PIVCs) break the skin barrier, and preinsertion antiseptic disinfection and sterile dressings are used to reduce risk of catheter-related bloodstream infection (CRBSI). In this study, the impact of PIVC skin site colonization on tip colonization and the development of CRBSI was investigated. METHODS A total of 137 patients' PIVC skin site swabs and paired PIVC tips were collected at catheter removal, cultured, and bacterial species and clonality were identified. RESULTS Of 137 patients, 45 (33%) had colonized skin sites and/or PIVC tips. Of 16 patients with paired colonization of both the skin site and PIVC tips, 11 (69%) were colonized with the same bacterial species. Of these, 77% were clonally related, including 1 identical clone of Pseudomonas aeruginosa in a patient with systemic infection and the same organism identified in blood culture. CONCLUSIONS The results demonstrate that opportunistic pathogen colonization at the skin site poses a significant risk for PIVC colonization and CRBSI. Further research is needed to improve current preinsertion antiseptic disinfection of PIVC skin site and the sterile insertion procedure to potentially reduce PIVC colonization and infection risk.
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Affiliation(s)
- Md Abu Choudhury
- University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Brisbane, Australia; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Inflammation and Healing Research Cluster, School of Health and Sports Sciences, University of the Sunshine Coast, Sippy Downs, Brisbane, Australia.
| | - Hanna E Sidjabat
- University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Brisbane, Australia
| | - Hosam M Zowawi
- University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Brisbane, Australia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia and World Health Organization Collaborating Centre for Infection Prevention and Control, Riyadh, Saudi Arabia
| | - Nicole Marsh PhD
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Naomi Runnegar PhD
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Princess Alexandra Hospital, Brisbane, Australia
| | - David L Paterson
- University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Brisbane, Australia
| | - David J McMillan
- Inflammation and Healing Research Cluster, School of Health and Sports Sciences, University of the Sunshine Coast, Sippy Downs, Brisbane, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia
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13
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Huber CA, Pflüger V, Reed S, Cottrell K, Sidjabat HE, Ranasinghe A, Zowawi HM, Harris P, Paterson DL. Bacterial identification using a SCIEX 5800 TOF/TOF MALDI research instrument and an external database. J Microbiol Methods 2019; 164:105685. [PMID: 31400360 DOI: 10.1016/j.mimet.2019.105685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/03/2019] [Accepted: 08/03/2019] [Indexed: 10/26/2022]
Abstract
In our current study we were identifying 26 bacterial isolates using a SCIEX 5800 TOF/TOF MALDI instrument and an external database. The results were compared with the results of a Vitek® MS system and in case of discrepancies at the species level 16s rRNA sequencing was performed for further verification.
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Affiliation(s)
- Charlotte A Huber
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia.
| | | | - Sarah Reed
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - Kyra Cottrell
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - Hanna E Sidjabat
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - Ama Ranasinghe
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - Hosam M Zowawi
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia; World Health Organization Collaborating Centre for Infection Prevention and Control, Riyadh, Saudi Arabia
| | - Patrick Harris
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - David L Paterson
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia
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14
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Harris PNA, Ben Zakour NL, Roberts LW, Wailan AM, Zowawi HM, Tambyah PA, Lye DC, Jureen R, Lee TH, Yin M, Izharuddin E, Looke D, Runnegar N, Rogers B, Bhally H, Crowe A, Schembri MA, Beatson SA, Paterson DL. Whole genome analysis of cephalosporin-resistant Escherichia coli from bloodstream infections in Australia, New Zealand and Singapore: high prevalence of CMY-2 producers and ST131 carrying blaCTX-M-15 and blaCTX-M-27. J Antimicrob Chemother 2019; 73:634-642. [PMID: 29253152 DOI: 10.1093/jac/dkx466] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 11/09/2017] [Indexed: 12/11/2022] Open
Abstract
Objectives To characterize MDR Escherichia coli from bloodstream infections (BSIs) in Australia, New Zealand and Singapore. Methods We collected third-generation cephalosporin-resistant (3GC-R) E. coli from blood cultures in patients enrolled in a randomized controlled trial from February 2014 to August 2015. WGS was used to characterize antibiotic resistance genes, MLST, plasmids and phylogenetic relationships. Antibiotic susceptibility was determined using disc diffusion and Etest. Results A total of 70 3GC-R E. coli were included, of which the majority were ST131 (61.4%). BSI was most frequently from a urinary source (69.6%), community associated (62.9%) and in older patients (median age 71 years). The median Pitt score was 1 and ICU admission was infrequent (3.1%). ST131 possessed more acquired resistance genes than non-ST131 (P = 0.003). Clade C1/C2 ST131 predominated (30.2% and 53.5% of ST131, respectively) and these were all ciprofloxacin resistant. All clade A ST131 (n = 6) were community associated. The predominant ESBL types were blaCTX-M (80.0%) and were strongly associated with ST131 (95% carried blaCTX-M), with the majority blaCTX-M-15. Clade C1 was associated with blaCTX-M-14 and blaCTX-M-27, whereas blaCTX-M-15 predominated in clade C2. Plasmid-mediated AmpC genes (mainly blaCMY-2) were frequent (17.1%) but were more common in non-ST131 (P < 0.001) isolates from Singapore and Brisbane. Two strains carried both blaCMY-2 and blaCTX-M. The majority of plasmid replicon types were IncF. Conclusions In a prospective collection of 3GC-R E. coli causing BSI, community-associated Clade C1/C2 ST131 predominate in association with blaCTX-M ESBLs, although a significant proportion of non-ST131 strains carried blaCMY-2.
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Affiliation(s)
- Patrick N A Harris
- University of Queensland, UQ Centre for Clinical Research, Royal Brisbane & Women's Hospital, Queensland, Australia.,Microbiology Department, Central Laboratory, Pathology Queensland, Royal Brisbane & Women's Hospital, Queensland, Australia
| | - Nouri L Ben Zakour
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Leah W Roberts
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Alexander M Wailan
- University of Queensland, UQ Centre for Clinical Research, Royal Brisbane & Women's Hospital, Queensland, Australia.,Infection Genomics, Wellcome Trust Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Hosam M Zowawi
- University of Queensland, UQ Centre for Clinical Research, Royal Brisbane & Women's Hospital, Queensland, Australia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,WHO Collaborating Centre for Infection Prevention and Control, and GCC Centre for Infection Control, Riyadh, Saudi Arabia
| | - Paul A Tambyah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - David C Lye
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, Division of Microbiology, National University Hospital, Singapore
| | - Tau H Lee
- Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Mo Yin
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - Ezlyn Izharuddin
- Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - David Looke
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,The University of Queensland, School of Medicine, Brisbane, Queensland, Australia
| | - Naomi Runnegar
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,The University of Queensland, School of Medicine, Brisbane, Queensland, Australia
| | - Benjamin Rogers
- Centre for Inflammatory Disease, Monash University, Clayton, Victoria, Australia.,Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
| | - Hasan Bhally
- Department of Medicine, North Shore Hospital, Milford, Auckland, New Zealand
| | - Amy Crowe
- Department of Infectious Diseases, St Vincent's Hospital, Melbourne, Australia
| | - Mark A Schembri
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Scott A Beatson
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - David L Paterson
- University of Queensland, UQ Centre for Clinical Research, Royal Brisbane & Women's Hospital, Queensland, Australia.,Wesley Medical Research, Wesley Hospital, Toowong, Queensland, Australia
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Zowawi HM, Syrmis MW, Kidd TJ, Balkhy HH, Walsh TR, Al Johani SM, Al Jindan RY, Alfaresi M, Ibrahim E, Al-Jardani A, Al Salman J, Dashti AA, Sidjabat HE, Baz O, Trembizki E, Whiley DM, Paterson DL. Identification of carbapenem-resistant Pseudomonas aeruginosa in selected hospitals of the Gulf Cooperation Council States: dominance of high-risk clones in the region. J Med Microbiol 2018; 67:846-853. [PMID: 29664716 DOI: 10.1099/jmm.0.000730] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 01/09/2023] Open
Abstract
PURPOSE The molecular epidemiology and resistance mechanisms of carbapenem-resistant Pseudomonas aeruginosa (CRPA) were determined in hospitals in the countries of the Gulf Cooperation Council (GCC), namely, Saudi Arabia, the United Arab Emirates, Oman, Qatar, Bahrain and Kuwait. METHODOLOGY Isolates were screened for common carbapenem-resistance genes by PCR. Relatedness between isolates was assessed using previously described genotyping methods: an informative-single nucleotide polymorphism MassARRAY iPLEX assay (iPLEX20SNP) and the enterobacterial repetitive intergenic consensus (ERIC)-PCR assay, with selected isolates being subjected to multilocus sequence typing (MLST). Ninety-five non-repetitive isolates that were found to be resistant to carbapenems were subjected to further investigation.Results/Key findings. The most prevalent carbapenemase-encoding gene, blaVIM-type, was found in 37/95 (39 %) isolates, while only 1 isolate (from UAE) was found to have blaIMP-type. None of the CRPA were found to have blaNDM-type or blaKPC-type. We found a total of 14 sequence type (ST) clusters, with 4 of these clusters being observed in more than 1 country. Several clusters belonged to the previously recognized internationally disseminated high-risk clones ST357, ST235, ST111, ST233 and ST654. We also found the less predominant ST316, ST308 and ST823 clones, and novel MLST types (ST2010, ST2011, ST2012 and ST2013), in our collection. CONCLUSION Overall our data show that 'high-risk' CRPA clones are now detected in the region and highlight the need for strategies to limit further spread of such organisms, including enhanced surveillance, infection control precautions and further promotion of antibiotic stewardship programmes.
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Affiliation(s)
- Hosam M Zowawi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia.,King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.,WHO Collaborating Centre for Infection Prevention and Control, and GCC Center for Infection Control, Riyadh, Saudi Arabia
| | | | - Timothy J Kidd
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland 4072, Australia.,Centre for Experimental Medicine, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Hanan H Balkhy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.,WHO Collaborating Centre for Infection Prevention and Control, and GCC Center for Infection Control, Riyadh, Saudi Arabia
| | - Timothy R Walsh
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia.,Department of Medical Microbiology and Infectious Diseases, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - Sameera M Al Johani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Microbiology, Department of Pathology and Lab Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Reem Y Al Jindan
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mubarak Alfaresi
- Pathology and Laboratory Medicine Department at Sheikh Khalifa General Hospital, Umm Al Quwain, UAE.,College of Medicine, University of Sharjah, UAE
| | - Emad Ibrahim
- Clinical Microbiology Department, Hamad Medical Corporation, Doha, Qatar
| | - Amina Al-Jardani
- Medical Microbiology Department, The Royal Hospital, Muscat, Oman
| | - Jameela Al Salman
- Samlaniya Medical Complex, Infectious Diseases Unit, Manama, Bahrain
| | - Ali A Dashti
- Medical Laboratory Department, Faculty of Allied Health Sciences, Health Science Center, Kuwait University, Kuwait City, Kuwait
| | - Hanna E Sidjabat
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - Omar Baz
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Ella Trembizki
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia
| | - David M Whiley
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia.,Pathology Queensland, Brisbane, Queensland 4029, Australia
| | - David L Paterson
- The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, Australia
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Abstract
Antimicrobial resistance (AMR) is increasingly being highlighted as an urgent public and animal health issue worldwide. This issue is well demonstrated in bacteria that are resistant to last-line antibiotics, suggesting a future with untreatable infections. International agencies have suggested combating strategies against AMR. Saudi Arabia has several challenges that can stimulate the emergence and spread of multidrug-resistant bacteria. Tackling these challenges need efforts from multiple sectors to successfully control the spread and emergence of AMR in the country. Actions should include active surveillance to monitor the emergence and spread of AMR. Infection prevention and control precautions should also be optimized to limit further spread. Raising awareness is essential to limit inappropriate antibiotics use, and the antibiotic stewardship programs in hospital settings, outpatients, and community pharmacies, should regulate the ongoing use of antimicrobials.
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Affiliation(s)
- Hosam M Zowawi
- From the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Zowawi HM, Forde BM, Alfaresi M, Alzarouni A, Farahat Y, Chong TM, Yin WF, Chan KG, Li J, Schembri MA, Beatson SA, Paterson DL. Stepwise evolution of pandrug-resistance in Klebsiella pneumoniae. Sci Rep 2015; 5:15082. [PMID: 26478520 PMCID: PMC4609946 DOI: 10.1038/srep15082] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [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: 04/07/2015] [Accepted: 09/01/2015] [Indexed: 01/21/2023] Open
Abstract
Carbapenem resistant Enterobacteriaceae (CRE) pose an urgent risk to global human health. CRE that are non-susceptible to all commercially available antibiotics threaten to return us to the pre-antibiotic era. Using Single Molecule Real Time (SMRT) sequencing we determined the complete genome of a pandrug-resistant Klebsiella pneumoniae isolate, representing the first complete genome sequence of CRE resistant to all commercially available antibiotics. The precise location of acquired antibiotic resistance elements, including mobile elements carrying genes for the OXA-181 carbapenemase, were defined. Intriguingly, we identified three chromosomal copies of an ISEcp1-bla(OXA-181) mobile element, one of which has disrupted the mgrB regulatory gene, accounting for resistance to colistin. Our findings provide the first description of pandrug-resistant CRE at the genomic level, and reveal the critical role of mobile resistance elements in accelerating the emergence of resistance to other last resort antibiotics.
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Affiliation(s)
- Hosam M Zowawi
- The University of Queensland, Centre for Clinical Research (UQCCR), Herston QLD 4029, Australia.,Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Australia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,World Health Organization Collaborating Centre for Infection Prevention and Control, and the Gulf Cooperation Council Center for Infection Control, Riyadh, Saudi Arabia
| | - Brian M Forde
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Australia.,School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Mubarak Alfaresi
- Pathology and Laboratory Medicine Department at Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | - Abdulqadir Alzarouni
- Urology Department, Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | - Yasser Farahat
- Urology Department, Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
| | - Teik-Min Chong
- Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Wai-Fong Yin
- Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Kok-Gan Chan
- Division of Genetics and Molecular Biology, Institute of Biological Sciences, Faculty of Science, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Jian Li
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia
| | - Mark A Schembri
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Australia.,School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Scott A Beatson
- Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Australia.,School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - David L Paterson
- The University of Queensland, Centre for Clinical Research (UQCCR), Herston QLD 4029, Australia.,Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Australia
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Zowawi HM, Harris PNA, Roberts MJ, Tambyah PA, Schembri MA, Pezzani MD, Williamson DA, Paterson DL. The emerging threat of multidrug-resistant Gram-negative bacteria in urology. Nat Rev Urol 2015; 12:570-84. [PMID: 26334085 DOI: 10.1038/nrurol.2015.199] [Citation(s) in RCA: 228] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Antibiotic resistance in Gram-negative uropathogens is a major global concern. Worldwide, the prevalence of Enterobacteriaceae that produce extended-spectrum β-lactamase or carbapenemase enzymes continues to increase at alarming rates. Likewise, resistance to other antimicrobial agents including aminoglycosides, sulphonamides and fluoroquinolones is also escalating rapidly. Bacterial resistance has major implications for urological practice, particularly in relation to catheter-associated urinary tract infections (UTIs) and infectious complications following transrectal-ultrasonography-guided biopsy of the prostate or urological surgery. Although some new drugs with activity against Gram-negative bacteria with highly resistant phenotypes will become available in the near future, the existence of a single agent with activity against the great diversity of resistance is unlikely. Responding to the challenges of Gram-negative resistance will require a multifaceted approach including considered use of current antimicrobial agents, improved diagnostics (including the rapid detection of resistance) and surveillance, better adherence to basic measures of infection prevention, development of new antibiotics and research into non-antibiotic treatment and preventive strategies.
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Affiliation(s)
- Hosam M Zowawi
- The University of Queensland, UQ Centre for Clinical Research, Building 71/918 Royal Brisbane Hospital, Herston, QLD 4006, Australia
| | - Patrick N A Harris
- The University of Queensland, UQ Centre for Clinical Research, Building 71/918 Royal Brisbane Hospital, Herston, QLD 4006, Australia
| | - Matthew J Roberts
- The University of Queensland, UQ Centre for Clinical Research, Building 71/918 Royal Brisbane Hospital, Herston, QLD 4006, Australia
| | - Paul A Tambyah
- Division of Infectious Diseases, National University Health System, 1E Kent Ridge Road, 119228, Singapore
| | - Mark A Schembri
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - M Diletta Pezzani
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, G. B. Grassi 74, 20157 Milan, Italy
| | - Deborah A Williamson
- Department of Pathology, University of Otago, 23A Mein Street, Newtown, Wellington 6242, New Zealand
| | - David L Paterson
- The University of Queensland, UQ Centre for Clinical Research, Building 71/918 Royal Brisbane Hospital, Herston, QLD 4006, Australia
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Zowawi HM, Malak A, Mar FA, Rihab HH, Turki A, Abdullah HK, Tiffany HB, Stephan H, Balkhy HH, Paterson DL. Social media platforms for raising awareness of appropriate antibiotics use in the Gulf Cooperation Council states. HAMDAN MEDICAL JOURNAL 2015. [DOI: 10.7707/hmj.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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