1
|
Mavroidi A, Katsiaflaka A, Petinaki E, Froukala E, Papadopoulos D, Vrioni G, Tsakris A. M1 UKStreptococcus pyogenes causing community-acquired pneumonia, pleural empyema and streptococcal toxic shock syndrome. J Glob Antimicrob Resist 2024; 37:185-189. [PMID: 38552876 DOI: 10.1016/j.jgar.2024.03.016] [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] [Received: 01/24/2024] [Revised: 03/07/2024] [Accepted: 03/23/2024] [Indexed: 05/14/2024] Open
Abstract
OBJECTIVES Streptococcus pyogenes causes superficial infections but can also cause deep-seated infections and toxin-mediated diseases. In the present study, phylogenetic and in silico prediction analyses were performed on an antimicrobial resistant M1UKS. pyogenes strain causing severe clinical manifestations during the current surge of invasive group A Streptococcus (iGAS) disease. METHODS A 40-year-old patient was admitted to the hospital with fever, chest pain and fatigue. Based on the clinical and laboratory findings, a diagnosis of sepsis with disseminated intravascular coagulation, community-acquired pneumonia, pleural empyema and streptococcal toxic shock syndrome was made. Microbial identification was performed by multiplex PCR and conventional culturing. Furthermore, antimicrobial susceptibility testing, whole genome sequencing, phylogenomic analysis and in silico prediction analysis of antimicrobial resistance genes and virulence factors were performed. RESULTS S. pyogenes isolates were detected in pleural fluid and sputum of the patient. Both isolates belonged to the M1UK lineage of the emm1/ST28 clone, being closely related with an M1UK GAS strain from Australia. They exhibited resistance to erythromycin and clindamycin and susceptibility-increased exposure to levofloxacin and carried genes encoding for protein homologues of antibiotic efflux pumps. Moreover, several virulence factors, and a previously described single-nucleotide polymorphism in the 5' transcriptional leader sequence of the ssrA gene, which enhances expression of SpeA, were detected. CONCLUSIONS The present antimicrobial-resistant M1UKS. pyogenes strain represents the first report of this emerging lineage associated with such manifestations of iGAS disease.
Collapse
Affiliation(s)
- Angeliki Mavroidi
- Department of Microbiology, University Hospital of Patras, Patras, Greece
| | - Anna Katsiaflaka
- Department of Microbiology, General Hospital of Larissa, Larissa, Greece
| | - Efthymia Petinaki
- Department of Microbiology, Medical School University of Thessaly, Larissa, Greece
| | - Elisavet Froukala
- Department of Microbiology, Medical School University of Athens, Athens, Greece
| | | | - Georgia Vrioni
- Department of Microbiology, Medical School University of Athens, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School University of Athens, Athens, Greece.
| |
Collapse
|
2
|
Mavroidi A, Gartzonika K, Spanakis N, Froukala E, Kittas C, Vrioni G, Tsakris A. Comprehensive Analysis of Virulence Determinants and Genomic Islands of blaNDM-1-Producing Enterobacter hormaechei Clinical Isolates from Greece. Antibiotics (Basel) 2023; 12:1549. [PMID: 37887250 PMCID: PMC10604629 DOI: 10.3390/antibiotics12101549] [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] [Received: 09/23/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Nosocomial outbreaks of multidrug-resistant (MDR) Enterobacter cloacae complex (ECC) are often reported worldwide, mostly associated with a small number of multilocus-sequence types of E. hormaechei and E. cloacae strains. In Europe, the largest clonal outbreak of blaNDM-1-producing ECC has been recently reported, involving an ST182 E. hormaechei strain in a Greek teaching hospital. In the current study, we aimed to further investigate the genetic make-up of two representative outbreak isolates. Comparative genomics of whole genome sequences (WGS) was performed, including whole genome-based taxonomic analysis and in silico prediction of virulence determinants of the bacterial cell surface, plasmids, antibiotic resistance genes and virulence factors present on genomic islands. The enterobacterial common antigen and the colanic antigen of the cell surface were identified in both isolates, being similar to the gene clusters of the E. hormaechei ATCC 49162 and E. cloacae ATCC 13047 type strains, whereas the two strains possessed different gene clusters encoding lipopolysaccharide O-antigens. Other virulence factors of the bacterial cell surface, such as flagella, fimbriae and pili, were also predicted to be encoded by gene clusters similar to those found in Enterobacter spp. and other Enterobacterales. Secretion systems and toxin-antitoxin systems, which also contribute to pathogenicity, were identified. Both isolates harboured resistance genes to multiple antimicrobial classes, including β-lactams, aminoglycosides, quinolones, chloramphenicol, trimethoprim, sulfonamides and fosfomycin; they carried blaTEM-1, blaOXA-1, blaNDM-1, and one of them also carried blaCTXM-14, blaCTXM-15 and blaLAP-2 plasmidic alleles. Our comprehensive analysis of the WGS assemblies revealed that blaNDM-1-producing outbreak isolates possess components of the bacterial cell surface as well as genomic islands, harbouring resistance genes to several antimicrobial classes and various virulence factors. Differences in the plasmids carrying β-lactamase genes between the two strains have also shown diverse modes of acquisition and an ongoing evolution of these mobile elements.
Collapse
Affiliation(s)
- Angeliki Mavroidi
- Department of Microbiology, General University Hospital of Patras, 26504 Patras, Greece;
| | - Konstantina Gartzonika
- Department of Microbiology, Medical School, Ioannina University Hospital, 45110 Ioannina, Greece; (K.G.); (C.K.)
| | - Nick Spanakis
- Department of Microbiology, Medical School, University of Athens, 11527 Athens, Greece; (N.S.); (E.F.); (G.V.)
| | - Elisavet Froukala
- Department of Microbiology, Medical School, University of Athens, 11527 Athens, Greece; (N.S.); (E.F.); (G.V.)
| | - Christos Kittas
- Department of Microbiology, Medical School, Ioannina University Hospital, 45110 Ioannina, Greece; (K.G.); (C.K.)
| | - Georgia Vrioni
- Department of Microbiology, Medical School, University of Athens, 11527 Athens, Greece; (N.S.); (E.F.); (G.V.)
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, University of Athens, 11527 Athens, Greece; (N.S.); (E.F.); (G.V.)
| |
Collapse
|
3
|
Gartzonika K, Politi L, Mavroidi A, Tsantes AG, Spanakis N, Priavali E, Vrioni G, Tsakris A. High prevalence of clonally-related ST182 NDM-1-producing Enterobacter cloacae complex clinical isolates in Greece. Int J Antimicrob Agents 2023:106837. [PMID: 37156401 DOI: 10.1016/j.ijantimicag.2023.106837] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
NDM-type metallo-β-lactamase (MBL)-producing Enterobacterales remain uncommon in the European region, especially among species other than Klebsiella pneumoniae and Escherichia coli. The aim of this study was to describe epidemiological and molecular characteristics of a widespread NDM-1-producing Enterobacter cloacae complex outbreak in Greece. Over a 6-year period (March 2016-March 2022), a retrospective study was conducted in a tertiary care Greek hospital. Ninety single-patient carbapenem-non-susceptible E. cloacae complex clinical isolates were consecutively recovered. The isolates were subjected to further investigation, including antimicrobial susceptibility testing and combined-disk tests for carbapenemase production, PCR and sequencing for resistance genes, molecular fingerprinting by PFGE, plasmid profiling, replicon typing, conjugation experiments, genotyping by multilocus sequence typing, whole genome sequencing and phylogenetic analysis. Phenotypic and molecular testing confirmed the presence of blaNDM-1 in 47 (52.2%) of the E. cloacae complex isolates. MLST analysis clustered all but four of the NDM-1 producers into a single MLST ST (ST182), whereas single isolates belonged to different STs (ST190, ST269, ST443, ST743). PFGE analysis has revealed that ST182 isolates were clustered into a single clonal type, with three subtypes, which differed from the clonal types detected among the remaining carbapenem non-susceptible E. cloacae complex isolates of the study period. All ST182 blaNDM-1-carrying isolates also harbored the blaACT-16 AmpC gene, while blaESBL, blaOXA-1 and blaTEM-1 genes were detected in most of the cases. In all clonal isolates the blaNDM-1 gene was located on an IncA/C-type plasmid and flanked upstream by an ISAba125 element and downstream by bleMBL. Conjugation experiments failed to produce carbapenem resistant transconjugants, indicating a low dynamic for horizontal gene transfer. Application of enforced infection control measures led to the absence of new NDM-positive cases for periods of time during the survey. Our study represents the largest clonal outbreak of NDM-producing E. cloacae complex in Europe.
Collapse
Affiliation(s)
- Konstantina Gartzonika
- Department of Microbiology, Medical School, Ioannina University Hospital, Ioannina, Greece
| | - Lida Politi
- Department of Microbiology, Medical School, University of Athens, Athens, Greece; National Public Health Organization, Athens, Greece
| | - Angeliki Mavroidi
- Department of Microbiology, General University Hospital of Patras, Rio, Greece
| | - Andreas G Tsantes
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Nicholas Spanakis
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Efthalia Priavali
- Department of Microbiology, Medical School, Ioannina University Hospital, Ioannina, Greece
| | - Georgia Vrioni
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, University of Athens, Athens, Greece.
| |
Collapse
|
4
|
Katsiari M, Mavroidi A, Kesesidis N, Palla E, Zourla K, Ntorlis K, Konstantinidis K, Laskou M, Strigklis K, Sakkalis A, Nikolaou C, Platsouka ED, Karakasiliotis I, Vrioni G, Tsakris A. Emergence of Clonally-Related South Asian Clade I Clinical Isolates of Candida auris in a Greek COVID-19 Intensive Care Unit. J Fungi (Basel) 2023; 9:jof9020243. [PMID: 36836357 PMCID: PMC9964037 DOI: 10.3390/jof9020243] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
Candida auris has recently emerged as a multidrug-resistant yeast implicated in various healthcare-associated invasive infections and hospital outbreaks. In the current study, we report the first five intensive care unit (ICU) cases affected by C. auris isolates in Greece, during October 2020-January 2022. The ICU of the hospital was converted to a COVID-19 unit on 25 February 2021, during the third wave of COVID-19 in Greece. Identification of the isolates was confirmed by Matrix Assisted Laser Desorption Ionization Time of Flight mass spectroscopy (MALDI-TOF]. Antifungal susceptibility testing was performed by the EUCAST broth microdilution method. Based on the tentative CDC MIC breakpoints, all five C. auris isolates were resistant to fluconazole (≥32 μg/mL), while three of them exhibited resistance to amphotericin B (≥2 μg/mL). The environmental screening also revealed the dissemination of C. auris in the ICU. Molecular characterization of C. auris clinical and environmental isolates was performed by MultiLocus Sequence Typing (MLST) of a set of four genetic loci, namely ITS, D1/D2, RPB1 and RPB2, encoding for the internal transcribed spacer region (ITS) of the ribosomal subunit, the large ribosomal subunit region and the RNA polymerase II largest subunit, respectively. MLST analysis showed that all isolates possessed identical sequences in the four genetic loci and clustered with the South Asian clade I strains. Additionally, PCR amplification and sequencing of the CJJ09_001802 genetic locus, encoding for the "nucleolar protein 58" that contains clade-specific repeats was performed. Sanger sequence analysis of the TCCTTCTTC repeats within CJJ09_001802 locus also assigned the C. auris isolates to the South Asian clade I. Our study confirms that C. auris is an emerging yeast pathogen in our region, especially in the setting of the ongoing COVID-19 worldwide pandemic. Adherence to strict infection control is needed to restrain further spread of the pathogen.
Collapse
Affiliation(s)
- Maria Katsiari
- Intensive Care Unit, Konstantopouleio-Patission General Hospital, 14233 Athens, Greece
| | - Angeliki Mavroidi
- Department of Microbiology, Konstantopouleio-Patission General Hospital, 14233 Athens, Greece
| | - Nikolaos Kesesidis
- Laboratory of Biology, Department of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Eleftheria Palla
- Department of Microbiology, Konstantopouleio-Patission General Hospital, 14233 Athens, Greece
| | - Konstantina Zourla
- Department of Microbiology, Konstantopouleio-Patission General Hospital, 14233 Athens, Greece
| | - Kyriakos Ntorlis
- Intensive Care Unit, Konstantopouleio-Patission General Hospital, 14233 Athens, Greece
| | - Konstantinos Konstantinidis
- Laboratory of Biology, Department of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Maria Laskou
- Intensive Care Unit, Konstantopouleio-Patission General Hospital, 14233 Athens, Greece
| | | | - Anastasios Sakkalis
- Intensive Care Unit, Konstantopouleio-Patission General Hospital, 14233 Athens, Greece
| | - Charikleia Nikolaou
- Intensive Care Unit, Konstantopouleio-Patission General Hospital, 14233 Athens, Greece
| | - Evangelia D. Platsouka
- Department of Microbiology, Konstantopouleio-Patission General Hospital, 14233 Athens, Greece
| | - Ioannis Karakasiliotis
- Laboratory of Biology, Department of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Georgia Vrioni
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 MikrasAsias Street, 11527 Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 MikrasAsias Street, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-210-7462011
| |
Collapse
|
5
|
Katsiari M, Mavroidi A, Palla E, Zourla K, Alonistiotis T, Ntorlis K, Nikolaou C, Vrioni G, Tsakris A. Possible COVID-19-Associated Pulmonary Aspergillosis Due to Aspergillus niger in Greece. Antibiotics (Basel) 2022; 11:300. [PMID: 35326764 PMCID: PMC8944507 DOI: 10.3390/antibiotics11030300] [Citation(s) in RCA: 2] [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] [Received: 01/26/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 02/07/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes direct damage to the pulmonary epithelium, enabling Aspergillus invasion. Rapid progression and high mortality of invasive aspergillosis have been reported. In the present study, we report a rare case of possible COVID-19-associated pulmonary aspergillosis (CAPA) caused by A. niger in a Greek patient. Diagnosis was based on ECMM/ISHAM specific criteria and the new algorithm “BM-AspICU” for the invasive pulmonary aspergillosis diagnostic strategy. The fungal isolate was recovered in a non-bronchoalveolar lavage (non-BAL) sample and its identification was performed by standard macroscopic and microscopic morphological studies. MALDI-TOF analysis confirmed the identification of A. niger. In addition, galactomannan antigen and Aspergillus real-time PCR testing were positive in the non-BAL sample, while in serum they proved negative. The A. niger isolate showed an MIC for fluconazole ≥128 μg/mL, for itraconazole and posaconazole 0.25 μg/mL, for voriconazole 0.5 μg/mL, for flucytosine 4 μg/mL, for amphotericin B 1 μg/mL, and for all echinocandins (caspofungin, anidulafungin, micafungin) >8 μg/mL. The patient was initially treated with voriconazole; amphotericin B was subsequently added, when a significant progression of cavitation was demonstrated on chest computed tomography. A. niger was not isolated in subsequent samples and the patient’s unfavorable outcome was attributed to septic shock caused by a pandrug-resistant Acinetobacter baumannii strain.
Collapse
Affiliation(s)
- Maria Katsiari
- Intensive Care Medicine, General Hospital of N. Ionia Konstantopouleio-Patission, 14233 Athens, Greece; (M.K.); (T.A.); (K.N.); (C.N.)
| | - Angeliki Mavroidi
- Department of Microbiology, General Hospital of N. Ionia Konstantopouleio-Patission, 14233 Athens, Greece; (A.M.); (E.P.); (K.Z.)
| | - Eleftheria Palla
- Department of Microbiology, General Hospital of N. Ionia Konstantopouleio-Patission, 14233 Athens, Greece; (A.M.); (E.P.); (K.Z.)
| | - Konstantina Zourla
- Department of Microbiology, General Hospital of N. Ionia Konstantopouleio-Patission, 14233 Athens, Greece; (A.M.); (E.P.); (K.Z.)
| | - Theodoros Alonistiotis
- Intensive Care Medicine, General Hospital of N. Ionia Konstantopouleio-Patission, 14233 Athens, Greece; (M.K.); (T.A.); (K.N.); (C.N.)
| | - Kyriakos Ntorlis
- Intensive Care Medicine, General Hospital of N. Ionia Konstantopouleio-Patission, 14233 Athens, Greece; (M.K.); (T.A.); (K.N.); (C.N.)
| | - Charikleia Nikolaou
- Intensive Care Medicine, General Hospital of N. Ionia Konstantopouleio-Patission, 14233 Athens, Greece; (M.K.); (T.A.); (K.N.); (C.N.)
| | - Georgia Vrioni
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| |
Collapse
|
6
|
Mavroidi A, Katsiari M, Likousi S, Palla E, Roussou Z, Nikolaou C, Mathas C, Merkouri E, Platsouka ED. Changing Characteristics and In Vitro Susceptibility to Ceftazidime/Avibactam of Bloodstream Extensively Drug-Resistant Klebsiella pneumoniae from a Greek Intensive Care Unit. Microb Drug Resist 2020; 26:28-37. [DOI: 10.1089/mdr.2019.0090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Angeliki Mavroidi
- Department of Microbiology, Konstantopouleio-Patission, General Hospital of N. Ionias, Athens, Greece
| | - Maria Katsiari
- Intensive Care Unit, Konstantopouleio-Patission, General Hospital of N. Ionias, Athens, Greece
| | - Sofia Likousi
- Department of Microbiology, Konstantopouleio-Patission, General Hospital of N. Ionias, Athens, Greece
| | - Eleftheria Palla
- Department of Microbiology, Konstantopouleio-Patission, General Hospital of N. Ionias, Athens, Greece
| | - Zoi Roussou
- Department of Microbiology, Konstantopouleio-Patission, General Hospital of N. Ionias, Athens, Greece
| | - Charikleia Nikolaou
- Intensive Care Unit, Konstantopouleio-Patission, General Hospital of N. Ionias, Athens, Greece
| | - Christos Mathas
- Intensive Care Unit, Konstantopouleio-Patission, General Hospital of N. Ionias, Athens, Greece
| | - Eleni Merkouri
- Department of Microbiology, Konstantopouleio-Patission, General Hospital of N. Ionias, Athens, Greece
| | - Evangelia D. Platsouka
- Department of Microbiology, Konstantopouleio-Patission, General Hospital of N. Ionias, Athens, Greece
| |
Collapse
|
7
|
Mavroidi A, Katsiari M, Palla E, Likousi S, Roussou Z, Nikolaou C, Platsouka ED. Investigation of Extensively Drug-Resistant blaOXA-23-Producing Acinetobacter baumannii Spread in a Greek Hospital. Microb Drug Resist 2017; 23:488-493. [DOI: 10.1089/mdr.2016.0101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Angeliki Mavroidi
- Department of Microbiology, General Hospital of Nea Ionia, “Konstantopouleio-Patission,” Athens, Greece
| | - Maria Katsiari
- Intensive Care Unit, General Hospital of Nea Ionia, “Konstantopouleio-Patission,” Athens Greece
| | - Eleftheria Palla
- Department of Microbiology, General Hospital of Nea Ionia, “Konstantopouleio-Patission,” Athens, Greece
| | - Sofia Likousi
- Department of Microbiology, General Hospital of Nea Ionia, “Konstantopouleio-Patission,” Athens, Greece
| | - Zoi Roussou
- Department of Microbiology, General Hospital of Nea Ionia, “Konstantopouleio-Patission,” Athens, Greece
| | - Charikleia Nikolaou
- Intensive Care Unit, General Hospital of Nea Ionia, “Konstantopouleio-Patission,” Athens Greece
| | - Evangelia D. Platsouka
- Department of Microbiology, General Hospital of Nea Ionia, “Konstantopouleio-Patission,” Athens, Greece
| |
Collapse
|
8
|
Mavroidi A, Katsiari M, Likousi S, Palla E, Roussou Z, Nikolaou C, Maguina A, Platsouka ED. Characterization of ST258 Colistin-Resistant, blaKPC-Producing Klebsiella pneumoniae in a Greek Hospital. Microb Drug Resist 2016; 22:392-8. [DOI: 10.1089/mdr.2015.0282] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Angeliki Mavroidi
- Department of Microbiology, General Hospital of Nea Ionia “Konstantopouleio-Patission,” Athens, Greece
| | - Maria Katsiari
- Intensive Care Unit, General Hospital of Nea Ionia “Konstantopouleio-Patission,” Athens, Greece
| | - Sofia Likousi
- Department of Microbiology, General Hospital of Nea Ionia “Konstantopouleio-Patission,” Athens, Greece
| | - Eleftheria Palla
- Department of Microbiology, General Hospital of Nea Ionia “Konstantopouleio-Patission,” Athens, Greece
| | - Zoi Roussou
- Department of Microbiology, General Hospital of Nea Ionia “Konstantopouleio-Patission,” Athens, Greece
| | - Charikleia Nikolaou
- Intensive Care Unit, General Hospital of Nea Ionia “Konstantopouleio-Patission,” Athens, Greece
| | - Asimina Maguina
- Intensive Care Unit, General Hospital of Nea Ionia “Konstantopouleio-Patission,” Athens, Greece
| | - Evangelia D. Platsouka
- Department of Microbiology, General Hospital of Nea Ionia “Konstantopouleio-Patission,” Athens, Greece
| |
Collapse
|
9
|
Mavroidi A, Likousi S, Palla E, Katsiari M, Roussou Z, Maguina A, Platsouka ED. Molecular identification of tigecycline- and colistin-resistant carbapenemase-producing Acinetobacter baumannii from a Greek hospital from 2011 to 2013. J Med Microbiol 2015; 64:993-997. [PMID: 26297501 DOI: 10.1099/jmm.0.000127] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
An alarming increase in the resistance rates of tigecycline and colistin among carbapenemase-producing Acinetobacter baumannii recovered from a Greek hospital over a 3-year period (2011-2013) was investigated. The antimicrobial resistance profiles and carbapenemase gene content were determined for a collection of colistin- and/or tigecycline-resistant carbapenemase-producing A. baumannii isolates (n = 42), which were recovered consecutively during the study period. A gradual increase in the incidence of blaOXA-23 producers was observed from 2011 to 2013. A cluster of 21 isolates comprised tigecycline-resistant blaOXA-23 producers displayed a single antimicrobial resistance pattern. The emergence of two blaOXA-23 producers resistant to both tigecycline and colistin was documented. Furthermore, determination of the mechanisms of colistin and tigecycline resistance and molecular typing by the tri-locus sequence typing (3LST) scheme for nine isolates recovered from bloodstream infections were performed. Out of nine isolates, five tigecycline- and two colistin-resistant isolates were blaOXA-23 producers of 3LST ST101 corresponding to the international clone II recovered during 2012-2013. All nine isolates were positive for the presence of the adeB gene of the AdeABC efflux pump. Three colistin-resistant isolates possessed novel substitutions in PmrB, which may be implicated in colistin resistance. To the best of our knowledge, this is the first report of the acquisition of tigecycline and colistin resistance among blaOXA-23-producing A. baumannii of 3LST ST101 in Greece; thus, continuous surveillance and molecular characterization, prudent use of antibiotics and implementation of infection control measures for A. baumannii are urgent.
Collapse
Affiliation(s)
- Angeliki Mavroidi
- Department of Microbiology, General Hospital of Nea Ionia, 'Konstantopouleio-Patission', Athens, Greece
| | - Sofia Likousi
- Department of Microbiology, General Hospital of Nea Ionia, 'Konstantopouleio-Patission', Athens, Greece
| | - Eleftheria Palla
- Department of Microbiology, General Hospital of Nea Ionia, 'Konstantopouleio-Patission', Athens, Greece
| | - Maria Katsiari
- Intensive Care Unit, General Hospital of Nea Ionia, 'Konstantopouleio-Patission', Athens, Greece
| | - Zoi Roussou
- Department of Microbiology, General Hospital of Nea Ionia, 'Konstantopouleio-Patission', Athens, Greece
| | - Asimina Maguina
- Intensive Care Unit, General Hospital of Nea Ionia, 'Konstantopouleio-Patission', Athens, Greece
| | - Evangelia D Platsouka
- Department of Microbiology, General Hospital of Nea Ionia, 'Konstantopouleio-Patission', Athens, Greece
| |
Collapse
|
10
|
Mavroidi A, Liakopoulos A, Gounaris A, Goudesidou M, Gaitana K, Miriagou V, Petinaki E. Successful control of a neonatal outbreak caused mainly by ST20 multidrug-resistant SHV-5-producing Klebsiella pneumoniae, Greece. BMC Pediatr 2014; 14:105. [PMID: 24742105 PMCID: PMC4011775 DOI: 10.1186/1471-2431-14-105] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 04/08/2014] [Indexed: 11/21/2022] Open
Abstract
Background Extended spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-Kp) infection can cause significant morbidity and mortality in neonates. We investigated a nosocomial ESBL-Kp outbreak in a neonatal intensive care unit (NICU) of the University Hospital of Larissa (UHL), Central Greece. Methods A total of sixty-four ESBL-Kp were studied; twenty six isolates were recovered from the NICU and were compared with thirty-eight randomly selected isolates from different wards of the hospital during the period March- December 2012. All isolates were characterized by antimicrobial susceptibility testing, ESBL-production by double-disk synergy test, molecular typing using BOX-PCR, whereas selected isolates were further characterized by beta lactamase and virulence gene content, multilocus sequence typing and phylogenetic analysis. All neonates affected by ESBL-Kp were put under strict contact isolation, along with appropriate infection control measures. Results The outbreak strain of ST20 multidrug-resistant SHV-5-producing K. pneumoniae was identified in all infected (n = 13) and three colonized neonates. A novel ST (ST1114) was also identified among SHV-5 producers (n = 10) recovered from nine colonized infants, but it was not related with ST20. Both STs were identified only in the NICU and not in other wards of the hospital. No ESBL-Kp were isolated from the hands of the nursing staff and the environment. Although we were not able to identify the source of the outbreak, no ESBL-Kp were isolated in the NICU after this period and we assumed that the outbreak was successfully controlled. All neonates received parenteral nutrition and most of them were delivered by caesarean section and showed low gestational age (<32 weeks) and low birth weights (<1500 g). Conclusion According to our knowledge, this is the first description of an outbreak of multidrug-resistant SHV-5 producing K. pneumoniae assigned to ST20.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Efthymia Petinaki
- Department of Microbiology, University Hospital of Larissa, Larissa, Greece.
| |
Collapse
|
11
|
Liakopoulos A, Mavroidi A, Vourli S, Panopoulou M, Zachariadou L, Chatzipanagiotou S, Spiliopoulou I, Zerva L, Petinaki E. Molecular characterization of Streptococcus agalactiae from vaginal colonization and neonatal infections: a 4-year multicenter study in Greece. Diagn Microbiol Infect Dis 2014; 78:487-90. [PMID: 24503505 DOI: 10.1016/j.diagmicrobio.2013.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 10/16/2013] [Revised: 12/11/2013] [Accepted: 12/15/2013] [Indexed: 12/01/2022]
Abstract
A multicenter collection comprising of 171 Streptococcus agalactiae isolates from pregnant women recovered between 2007 and 2010 and 46 from unmatched neonates with invasive infections was subjected to antimicrobial susceptibility testing and genetic characterization. High rates of erythromycin resistance (20.47%) were observed only in isolates from pregnant women. ST1 was dominant in the vaginal colonization, whereas the hypervirulent ST-17 clone was detected in 67.39% of neonatal infections.
Collapse
Affiliation(s)
| | - Angeliki Mavroidi
- Department of Microbiology, University Hospital of Larissa, Larissa, Greece
| | - Sofia Vourli
- Department of Clinical Microbiology, "ATTIKON" Hospital, University of Athens, Greece
| | - Maria Panopoulou
- Department of Microbiology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | - Stylianos Chatzipanagiotou
- Department of Biopathology and Clinical Microbiology, Athens Medical School, Aeginition Hospital, Athens, Greece
| | - Iris Spiliopoulou
- Department of Microbiology, School of Medicine, University of Patras, Greece
| | - Loukia Zerva
- Department of Clinical Microbiology, "ATTIKON" Hospital, University of Athens, Greece
| | - Efthymia Petinaki
- Department of Microbiology, University Hospital of Larissa, Larissa, Greece; Department of Microbiology, Medical School, University of Thessaly, Biopolis, Larissa, Greece.
| |
Collapse
|
12
|
Liakopoulos A, Mavroidi A, Katsifas EA, Theodosiou A, Karagouni AD, Miriagou V, Petinaki E. Carbapenemase-producing Pseudomonas aeruginosa from central Greece: molecular epidemiology and genetic analysis of class I integrons. BMC Infect Dis 2013; 13:505. [PMID: 24168643 PMCID: PMC3870975 DOI: 10.1186/1471-2334-13-505] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [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: 06/18/2013] [Accepted: 10/20/2013] [Indexed: 12/17/2022] Open
Abstract
Background Multidrug-resistant Pseudomonas aeruginosa is a serious challenge for antimicrobial therapy of nosocomial infections, as it possesses several mechanisms of antimicrobial resistance. In Central Greece, a sudden increase of infections caused by carbapenem-resistant P. aeruginosa was observed during 2011, indicating the need for further analysis. Methods Five-hundred and sixty-eight P. aeruginosa isolates were collected consecutively during an 8-month period in 2011 from inpatients treated in three hospitals in the Thessaly region (1,000,000 habitants) of Greece. Carbapenem-resistant P. aeruginosa (n = 284) were characterized by antimicrobial susceptibility testing and β-lactamase content, and the genetic relatedness of carbapenemase-producing isolates was assessed by BOX-PCR, multilocus sequence typing, and eBURST analysis. Mapping of the class I integrons of Verona integron-encoded metallo-β-lactamase (VIM)-carrying isolates was also performed, and clinical data of the VIM producers were reviewed. Results Eighty (14.1%) out of the 568 P. aeruginosa isolates recovered from clinical specimens were VIM producers. Multilocus sequence typing revealed high prevalence of the international clones ST111 and ST235 among blaVIM-2- and blaVIM-4-positive isolates, respectively. blaVIM-17 was identified in an isolate of a novel sequence type (ST1457). blaVIM gene cassettes were carried by five distinct class I integrons, including two novel ones. Conclusions Since the first report of VIM-producing P. aeruginosa in 2000, this microorganism still remains among the most prevalent multidrug resistant pathogens in Greece. The spread of VIM-producers belonging to the most common international clones (ST111 and ST235), the spread of integrons of divergent structures, and the emergence of novel integrons underscore their ongoing evolution.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Efthymia Petinaki
- Department of Microbiology, University Hospital of Larissa, Larissa, Greece.
| |
Collapse
|
13
|
Mavroidi A, Miriagou V, Liakopoulos A, Tzelepi Ε, Stefos A, Dalekos GN, Petinaki E. Ciprofloxacin-resistant Escherichia coli in Central Greece: mechanisms of resistance and molecular identification. BMC Infect Dis 2012; 12:371. [PMID: 23259844 PMCID: PMC3548683 DOI: 10.1186/1471-2334-12-371] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [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: 09/03/2012] [Accepted: 12/18/2012] [Indexed: 12/02/2022] Open
Abstract
Background Fluoroquinolone resistant E. coli isolates, that are also resistant to other classes of antibiotics, is a significant challenge to antibiotic treatment and infection control policies. In Central Greece a significant increase of ciprofloxacin-resistant Escherichia coli has occurred during 2011, indicating the need for further analysis. Methods A total of 106 ciprofloxacin-resistant out of 505 E. coli isolates consecutively collected during an eight months period in a tertiary Greek hospital of Central Greece were studied. Antimicrobial susceptibility patterns and mechanisms of resistance to quinolones were assessed, whereas selected isolates were further characterized by multilocus sequence typing and β-lactamase content. Results Sequence analysis of the quinolone-resistance determining region of the gyrA and parC genes has revealed that 63% of the ciprofloxacin-resistant E. coli harbored a distinct amino acid substitution pattern (GyrA:S83L + D87N; ParC:S80I + E84V), while 34% and 3% carried the patterns GyrA:S83L + D87N; ParC:S80I and GyrA:S83L + D87N; ParC:S80I + E84G respectively. The aac (6’)-1b-cr plasmid-mediated quinolone resistance determinant was also detected; none of the isolates was found to carry the qnrA, qnrB and qnrS. Genotyping of a subset of 35 selected ciprofloxacin-resistant E. coli by multilocus sequence typing has revealed the presence of nine sequence types; ST131 and ST410 were the most prevalent and were exclusively correlated with hospital and health care associated infections, while strains belonging to STs 393, 361 and 162 were associated with community acquired infections. The GyrA:S83L + D87N; ParC:S80I + E84V substitution pattern was found exclusively among ST131 ciprofloxacin-resistant E. coli. Extended-spectrum β-lactamase-positive ST131 ciprofloxacin-resistant isolates produced CTX-M-type enzymes; eight the CTX-M-15 and one the CTX-M-3 variant. CTX-M-1 like and KPC-2 enzymes were detected in five and four ST410 ciprofloxacin-resistant E. coli isolates, respectively. Conclusions Our findings suggest that, ST131 and ST410 predominate in the ciprofloxacin resistant E. coli population.
Collapse
Affiliation(s)
- Angeliki Mavroidi
- Department of Microbiology, University Hospital of Larissa, Larissa, Greece
| | | | | | | | | | | | | |
Collapse
|
14
|
Mavroidi A, Neonakis I, Liakopoulos A, Papaioannou A, Ntala M, Tryposkiadis F, Miriagou V, Petinaki E. Detection of Citrobacter koseri carrying beta-lactamase KPC-2 in a hospitalised patient, Greece, July 2011. Euro Surveill 2011; 16:19990. [PMID: 22008199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
This report describes the detection of Citrobacter koseri carrying K. pneumoniae carbapenemase (KPC-2) isolated in July 2011 from a Greek patient, who was also colonised by a Klebsiella pneumoniae strain coproducing KPC-2 and Verona integron-encoded metallo-beta-lactamase (VIM)-1.
Collapse
Affiliation(s)
- A Mavroidi
- Department of Microbiology, University Hospital of Larissa, Greece
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Mavroidi A, Neonakis I, Liakopoulos A, Papaioannou A, Ntala M, Tryposkiadis F, Miriagou V, Petinaki E. Detection of Citrobacter koseri carrying beta-lactamase KPC-2 in a hospitalised patient, Greece, July 2011. Euro Surveill 2011. [DOI: 10.2807/ese.16.41.19990-en] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This report describes the detection of Citrobacter koseri carrying K. pneumoniae carbapenemase (KPC-2) isolated in July 2011 from a Greek patient, who was also colonised by a Klebsiella pneumoniae strain co-producing KPC-2 and Verona integron-encoded metallo-beta-lactamase (VIM)-1.
Collapse
Affiliation(s)
- A Mavroidi
- Department of Microbiology, University Hospital of Larissa, Greece
| | - I Neonakis
- Department of Microbiology, University Hospital of Heraklion, Crete, Greece
- Department of Microbiology, University Hospital of Larissa, Greece
| | - A Liakopoulos
- Department of Microbiology, University Hospital of Larissa, Greece
| | - A Papaioannou
- Department of Microbiology, University Hospital of Larissa, Greece
| | - M Ntala
- Department of Cardiology, University Hospital of Larissa, Greece
| | - F Tryposkiadis
- Department of Cardiology, University Hospital of Larissa, Greece
| | - V Miriagou
- Laboratory of Bacteriology, Hellenic Pasteur Institute, Athens, Greece
| | - E Petinaki
- Department of Microbiology, University Hospital of Larissa, Greece
| |
Collapse
|
16
|
Mavroidi A, Paraskakis I, Pangalis A, Kirikou E, Charisiadou A, Athanasiou T, Tassios P, Tzouvelekis L. Spread of the Streptococcus pneumoniae Taiwan19F-14 clone among children in Greece. Clin Microbiol Infect 2007; 13:1213-6. [DOI: 10.1111/j.1469-0691.2007.01837.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
17
|
Aanensen DM, Mavroidi A, Bentley SD, Reeves PR, Spratt BG. Predicted functions and linkage specificities of the products of the Streptococcus pneumoniae capsular biosynthetic loci. J Bacteriol 2007; 189:7856-76. [PMID: 17766420 PMCID: PMC2168755 DOI: 10.1128/jb.00837-07] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The sequences of the capsular biosynthetic (cps) loci of 90 serotypes of Streptococcus pneumoniae have recently been determined. Bioinformatic procedures were used to predict the general functions of 1,973 of the 1,999 gene products and to identify proteins within the same homology group, Pfam family, and CAZy glycosyltransferase family. Correlating cps gene content with the 54 known capsular polysaccharide (CPS) structures provided tentative assignments of the specific functions of the different homology groups of each functional class (regulatory proteins, enzymes for synthesis of CPS constituents, polymerases, flippases, initial sugar transferases, glycosyltransferases [GTs], phosphotransferases, acetyltransferases, and pyruvyltransferases). Assignment of the glycosidic linkages catalyzed by the 342 GTs (92 homology groups) is problematic, but tentative assignments could be made by using this large set of cps loci and CPS structures to correlate the presence of particular GTs with specific glycosidic linkages, by correlating inverting or retaining linkages in CPS repeat units with the inverting or retaining mechanisms of the GTs predicted from their CAZy family membership, and by comparing the CPS structures of serotypes that have very similar cps gene contents. These large-scale comparisons between structure and gene content assigned the linkages catalyzed by 72% of the GTs, and all linkages were assigned in 32 of the serotypes with known repeat unit structures. Clear examples where very similar initial sugar transferases or glycosyltransferases catalyze different linkages in different serotypes were also identified. These assignments should provide a stimulus for biochemical studies to evaluate the reactions that are proposed.
Collapse
Affiliation(s)
- David M Aanensen
- Department of Infectious Disease Epidemiology, Imperial College London, Room G22, Old Medical School Building, St. Mary's Hospital, Norfolk Place, London W2 1PG, United Kingdom
| | | | | | | | | |
Collapse
|
18
|
Mavroidi A, Aanensen DM, Godoy D, Skovsted IC, Kaltoft MS, Reeves PR, Bentley SD, Spratt BG. Genetic relatedness of the Streptococcus pneumoniae capsular biosynthetic loci. J Bacteriol 2007; 189:7841-55. [PMID: 17766424 PMCID: PMC2168730 DOI: 10.1128/jb.00836-07] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Streptococcus pneumoniae (the pneumococcus) produces 1 of 91 capsular polysaccharides (CPS) that define the serotype. The cps loci of 88 pneumococcal serotypes whose CPS is synthesized by the Wzy-dependent pathway were compared with each other and with additional streptococcal polysaccharide biosynthetic loci and were clustered according to the proportion of shared homology groups (HGs), weighted for the sequence similarities between the genes encoding the shared HGs. The cps loci of the 88 pneumococcal serotypes were distributed into eight major clusters and 21 subclusters. All serotypes within the same serogroup fell into the same major cluster, but in six cases, serotypes within the same serogroup were in different subclusters and, conversely, nine subclusters included completely different serotypes. The closely related cps loci within a subcluster were compared to the known CPS structures to relate gene content to structure. The Streptococcus oralis and Streptococcus mitis polysaccharide biosynthetic loci clustered within the pneumococcal cps loci and were in a subcluster that also included the cps locus of pneumococcal serotype 21, whereas the Streptococcus agalactiae cps loci formed a single cluster that was not closely related to any of the pneumococcal cps clusters.
Collapse
Affiliation(s)
- Angeliki Mavroidi
- Department of Infectious Disease Epidemiology, Imperial College London, Room G22, Old Medical School Building, St. Mary's Hospital, Norfolk Place, London W2 1PG, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Mavroidi A, Paraskakis I, Pangalis A, Kirikou E, Charisiadou A, Athanasiou T, Tassios P, Tzouvelekis L. P993 High prevalence and persistence of the Streptococcus pneumoniae Taiwan19F-14 clone among children in Greece. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70834-8] [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: 11/30/2022]
|
20
|
Bentley SD, Aanensen DM, Mavroidi A, Saunders D, Rabbinowitsch E, Collins M, Donohoe K, Harris D, Murphy L, Quail MA, Samuel G, Skovsted IC, Kaltoft MS, Barrell B, Reeves PR, Parkhill J, Spratt BG. Genetic analysis of the capsular biosynthetic locus from all 90 pneumococcal serotypes. PLoS Genet 2006; 2:e31. [PMID: 16532061 PMCID: PMC1391919 DOI: 10.1371/journal.pgen.0020031] [Citation(s) in RCA: 525] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 01/25/2006] [Indexed: 11/18/2022] Open
Abstract
Several major invasive bacterial pathogens are encapsulated. Expression of a polysaccharide capsule is essential for survival in the blood, and thus for virulence, but also is a target for host antibodies and the basis for effective vaccines. Encapsulated species typically exhibit antigenic variation and express one of a number of immunochemically distinct capsular polysaccharides that define serotypes. We provide the sequences of the capsular biosynthetic genes of all 90 serotypes of Streptococcus pneumoniae and relate these to the known polysaccharide structures and patterns of immunological reactivity of typing sera, thereby providing the most complete understanding of the genetics and origins of bacterial polysaccharide diversity, laying the foundations for molecular serotyping. This is the first time, to our knowledge, that a complete repertoire of capsular biosynthetic genes has been available, enabling a holistic analysis of a bacterial polysaccharide biosynthesis system. Remarkably, the total size of alternative coding DNA at this one locus exceeds 1.8 Mbp, almost equivalent to the entire S. pneumoniae chromosomal complement.
Collapse
Affiliation(s)
- Stephen D Bentley
- Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
The evolution of the capsular biosynthetic (cps) locus of serogroup 6 Streptococcus pneumoniae was investigated by analyzing sequence variation within three serotype-specific cps genes from 102 serotype 6A and 6B isolates. Sequence variation within these cps genes was related to the genetic relatedness of the isolates, determined by multilocus sequence typing, and to the inferred patterns of recent evolutionary descent, explored using the eBURST algorithm. The serotype-specific cps genes had a low percent G+C, and there was a low level of sequence diversity in this region among serotype 6A and 6B isolates. There was also little sequence divergence between these serotypes, suggesting a single introduction of an ancestral cps sequence, followed by slight divergence to create serotypes 6A and 6B. A minority of serotype 6B isolates had cps sequences (class 2 sequences) that were approximately 5% divergent from those of other serotype 6B isolates (class 1 sequences) and which may have arisen by a second, more recent introduction from a related but distinct source. Expression of a serotype 6A or 6B capsule correlated perfectly with a single nonsynonymous polymorphism within wciP, the rhamnosyl transferase gene. In addition to ample evidence of the horizontal transfer of the serotype 6A and 6B cps locus into unrelated lineages, there was evidence for relatively frequent changes from serotype 6A to 6B, and vice versa, among very closely related isolates and examples of recent recombinational events between class 1 and 2 cps serogroup 6 sequences.
Collapse
Affiliation(s)
- Angeliki Mavroidi
- Department of Infectious Disease Epidemiology, Imperial College London, Room G22, Old Medical School Building, St. Mary's Hospital, Norfolk Place, London W2 1PG, United Kingdom
| | | | | | | | | | | |
Collapse
|
22
|
Abstract
An Escherichia coli clinical strain resistant to all beta-lactams except carbapenems was isolated in a Greek hospital. Analysis of beta-lactamase content by isoelectric focusing, PCR assays specific for various bla genes, and DNA sequencing showed that the strain produced TEM-1, a Citrobacter freundii AmpC-related cephalosporinase, and CTX-M-3. The blaCTX.M-3 gene was carried by a 120-kb plasmid that was readily transferable to a susceptible E. coli host.
Collapse
Affiliation(s)
- A Mavroidi
- Laboratory of Bacteriology, Hellenic Pasteur Institute, Athens, Greece
| | | | | | | | | | | |
Collapse
|
23
|
Mavroidi A, Tzelepi E, Tsakris A, Miriagou V, Sofianou D, Tzouvelekis LS. An integron-associated beta-lactamase (IBC-2) from Pseudomonas aeruginosa is a variant of the extended-spectrum beta-lactamase IBC-1. J Antimicrob Chemother 2001; 48:627-30. [PMID: 11679551 DOI: 10.1093/jac/48.5.627] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An extended-spectrum beta-lactamase, IBC-2, produced by a clinical strain of Pseudomonas aeruginosa, was characterized. bla(IBC-2) was found, as a gene cassette, to be the sole gene within the variable region of a class 1 integron probably located in the chromosome. IBC-2 is a variant of IBC-1 and GES-1, differing by one amino acid from each of these beta-lactamases. When expressed in Escherichia coli, IBC-2 was observed to confer resistance to ceftazidime and decreased susceptibility to other oxyimino-beta-lactams.
Collapse
Affiliation(s)
- A Mavroidi
- Laboratory of Bacteriology, Hellenic Pasteur Institute, Athens, Greece
| | | | | | | | | | | |
Collapse
|
24
|
Mavroidi A, Tzouvelekis LS, Kyriakis KP, Avgerinou H, Daniilidou M, Tzelepi E. Multidrug-resistant strains of Neisseria gonorrhoeae in Greece. Antimicrob Agents Chemother 2001; 45:2651-4. [PMID: 11502546 PMCID: PMC90709 DOI: 10.1128/aac.45.9.2651-2654.2001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Eighty-seven out of 575 gonococci isolated in Greece from 1991 to 1998 belonged to serovar Bropyst and exhibited resistance to penicillin, tetracycline, erythromycin, and chloramphenicol. Conventional and molecular typing showed three clusters, A, B, and C, that were associated with networks of high- frequency transmitters (cluster A with homosexuals and clusters B and C with refugees from Eastern Europe). Study of one isolate revealed mutations in the penA, mtrR, and porB genes that may explain the multidrug-resistant phenotype.
Collapse
Affiliation(s)
- A Mavroidi
- National Reference Center for Neisseria gonorrhoeae, Department of Bacteriology, Hellenic Pasteur Institute, Athens, Greece
| | | | | | | | | | | |
Collapse
|
25
|
Mavroidi A, Tsakris A, Tzelepi E, Pournaras S, Loukova V, Tzouvelekis LS. Carbapenem-hydrolysing VIM-2 metallo- beta-lactamase in Pseudomonas aeruginosa from Greece. J Antimicrob Chemother 2000; 46:1041-2. [PMID: 11102432 DOI: 10.1093/jac/46.6.1041] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
26
|
Mavroidi A, Tzouvelekis LS, Tassios PT, Flemetakis A, Daniilidou M, Tzelepi E. Characterization of Neisseria gonorrhoeae strains with decreased susceptibility to fluoroquinolones isolated in Greece from 1996 to 1999. J Clin Microbiol 2000; 38:3489-91. [PMID: 10970412 PMCID: PMC87415 DOI: 10.1128/jcm.38.9.3489-3491.2000] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Of the 331 Neisseria gonorrhoeae strains isolated in Greece from 1996 to 1999, 39 (11.8%) exhibited decreased susceptibility to quinolones due to gyrA and parC mutations. Conventional typing and pulsed-field gel electrophoresis showed that 34 of these isolates were clonally related. Epidemiological data indicated that the epidemic clone was sustained in a group of high-frequency transmitters.
Collapse
Affiliation(s)
- A Mavroidi
- National Reference Center for Neisseria gonorrhoeae, Department of Bacteriology, Hellenic Pasteur Institute, Greece
| | | | | | | | | | | |
Collapse
|
27
|
Tzelepi E, Arvanitidou M, Tzouvelekis LS, Mavroidi A, Tsakris A. The isoelectric focusing patterns of beta-lactamases of Yersinia intermedia isolates from aquatic environments. J Antimicrob Chemother 2000; 46:513-5. [PMID: 10980185 DOI: 10.1093/jac/46.3.513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
28
|
Tzelepi E, Kouppari G, Mavroidi A, Zaphiropoulou A, Tzouvelekis LS. Erythromycin resistance amongst group A beta-haemolytic streptococci isolated in a paediatric hospital in Athens, Greece. J Antimicrob Chemother 1999; 43:745-6. [PMID: 10382903 DOI: 10.1093/jac/43.5.745] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
29
|
Tzelepi E, Arvanitidou M, Mavroidi A, Tsakris A. Antibiotic susceptibilities of Yersinia enterocolitica and Y. intermedia isolates from aquatic environments. J Med Microbiol 1999; 48:157-160. [PMID: 9989643 DOI: 10.1099/00222615-48-2-157] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Of 37 Yersinia isolates from various aquatic environments, seven were Y. enterocolitica and 30 Y. intermedia. These isolates were biotyped, serotyped and tested for their susceptibility to 20 antibiotics. All Y. enterocolitica isolates were of biovar 1; those of Y. intermedia were distributed amongst four biovars (1, 2, 4 and 6). On the basis of combined biotyping and serotyping results, Y. enterocolitica isolates were distributed in five and Y. intermedia in 17 groups. With the exception of one Y. enterocolitica isolate which was resistant to tetracycline and streptomycin, the isolates were sensitive to the non-beta-lactam antibiotics. In contrast, various patterns of beta-lactam insensitivity were detected, including ampicillin and ticarcillin (35 isolates), cephalothin (33 isolates), carbenicillin (32 isolates), amoxycillin/clavulanate (23 isolates) and cefoxitin (22 isolates). No correlation between biotype or serotype and the susceptibility pattern of the isolates was apparent. Both inducible cephalosporinase activity against third-generation cephalosporins and inhibition of resistance to penicillins were detected in all Y. enterocolitica and Y. intermedia isolates by double-disk tests.
Collapse
Affiliation(s)
| | - M Arvanitidou
- Departments of Hygiene, Medical School, Aristotelian University of Thessaloniki, Greece
| | | | - A Tsakris
- Microbiology, Medical School, Aristotelian University of Thessaloniki, Greece
| |
Collapse
|