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Stein C, Makarewicz O, Pfeifer Y, Brandt C, Ramos JC, Klinger M, Pletz MW. Direct RNA-based detection and differentiation of CTX-M-type extended-spectrum β-lactamases (ESBL). PLoS One 2013; 8:e80079. [PMID: 24224038 PMCID: PMC3818264 DOI: 10.1371/journal.pone.0080079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 10/08/2013] [Indexed: 11/19/2022] Open
Abstract
The current global spread of multi-resistant Gram-negatives, particularly extended spectrum β-lactamases expressing bacteria, increases the likelihood of inappropriate empiric treatment of critically ill patients with subsequently increased mortality. From a clinical perspective, fast detection of resistant pathogens would allow a pre-emptive correction of an initially inappropriate treatment. Here we present diagnostic amplification-sequencing approach as proof of principal based on the fast molecular detection and correct discrimination of CTX-M-β-lactamases, the most frequent ESBL family. The workflow consists of the isolation of total mRNA and CTX-M-specific reverse transcription (RT), amplification and pyrosequencing. Due to the high variability of the CTX-M-β-lactamase-genes, degenerated primers for RT, qRT as well as for pyrosequencing, were used and the suitability and discriminatory performance of two conserved positions within the CTX-M genes were analyzed, using one protocol for all isolates and positions, respectively. Using this approach, no information regarding the expected CTX-M variant is needed since all sequences are covered by these degenerated primers. The presented workflow can be conducted within eight hours and has the potential to be expanded to other β-lactamase families.
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Affiliation(s)
- Claudia Stein
- Center for Infectious Diseases and Infection’s Control, Jena University Hospital, Jena, Germany
| | - Oliwia Makarewicz
- Center for Infectious Diseases and Infection’s Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Yvonne Pfeifer
- Nosocomial pathogens and antibiotic resistance, Robert Koch Institute, Wernigerode, Germany
| | - Christian Brandt
- Center for Infectious Diseases and Infection’s Control, Jena University Hospital, Jena, Germany
| | - João Costa Ramos
- Center for Infectious Diseases and Infection’s Control, Jena University Hospital, Jena, Germany
| | - Mareike Klinger
- Center for Infectious Diseases and Infection’s Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Mathias W. Pletz
- Center for Infectious Diseases and Infection’s Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
- * E-mail:
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2
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Goldstein FW. Cephalosporinase induction and cephalosporin resistance: a longstanding misinterpretation. Clin Microbiol Infect 2002; 8:823-5. [PMID: 12519358 DOI: 10.1046/j.1469-0691.2002.00492.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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3
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Ravaoarinoro M, Therrien C. Beta-lactamases and outer membrane investigations in beta-lactam-resistant Comamonas acidovorans strains. Int J Antimicrob Agents 1999; 12:27-31. [PMID: 10389644 DOI: 10.1016/s0924-8579(98)00095-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Imipenem-induced beta-lactamase (level of expression, specific activity and kinetic parameters (Vmax and Km) in response to nitrocefin) and outer membrane proteins (OMPs) (hydrophobicity, permeability and electrophoretic pattern) were characterized in, one beta-lactam sensitive (PAC-9), one resistant (PAC-1) and two resistant laboratory mutants (PAC-9M, PAC-9M2) of Comamonas acidovorans strains. Beta-lactamases from both mutant strains showed different Vmax values compared to the parental strains. Beta-lactam resistance was found to be associated in PAC-1 with inducible beta-lactamase production and OMP alteration by the appearance of a 102-KDa protein. Moreover, PAC-1 was less permeable to nitrocefin than PAC-9. These data indicate that C. acidovorans resistance to beta-lactam resulted from synergy between beta-lactamase and OMP alterations.
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Affiliation(s)
- M Ravaoarinoro
- Department of Microbiology and Infectious Diseases, Hôtel-Dieu Pavilion, University of Montreal Hospital Center, Québec, Canada.
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4
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Sutherland R. Beta-lactam/beta-lactamase inhibitor combinations: development, antibacterial activity and clinical applications. Infection 1995; 23:191-200. [PMID: 8522374 DOI: 10.1007/bf01781195] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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5
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Stark C, Edlund C, Hedberg M, Nord CE. Induction of beta-lactamase by cefoxitin in anaerobic intestinal microflora. Eur J Clin Microbiol Infect Dis 1995; 14:18-24. [PMID: 7729448 DOI: 10.1007/bf02112613] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Beta-lactamases produced by two anaerobic bacterial strains, Bacteroides ovatus Ax34:1 and Clostridium butyricum NBL3, were shown to be significantly inducible under anaerobic conditions in subinhibitory concentrations of cefoxitin. The induction ratio of beta-lactamase production for Bacteroides ovatus was 2.6 and for Clostridium butyricum 1.6. Incubation of faecal samples with different concentrations of cefoxitin did not result in any induction of beta-lactamase production. When adding a highly inducible aerobic strain (Citrobacter freundii F72:6, induction ratio of 26.5 in broth culture) to faecal samples, an induction ratio of 4.5 was reached. Faeces seem to inhibit beta-lactamase induction in aerobic and anaerobic bacteria. The inducible enzymes produced by the anaerobic strains did not have the same properties as beta-lactamases from aerobic inducible strains, according to substrate profiles and inhibition studies. The results of the present study indicate that increased levels of beta-lactamases in the normal intestinal microflora, which often are observed after administration of beta-lactam agents, are probably due to selection of stably derepressed mutants rather than to induction of beta-lactamase production.
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Affiliation(s)
- C Stark
- Department of Immunology, Microbiology, Pathology and Infectious Diseases, Huddinge University Hospital, Karolinska Institute, Sweden
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6
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Vázquez F, Mendoza MC, Villar MH, Pérez F, Méndez FJ. Survey of bacteraemia in a Spanish hospital over a decade (1981-1990). J Hosp Infect 1994; 26:111-21. [PMID: 7911144 DOI: 10.1016/0195-6701(94)90053-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The aetiology, epidemiology and in-vitro antibiotic susceptibility of bacteraemic isolates in a Spanish hospital, over a decade (1981-1990), were reviewed. A total of 4363 possible episodes were microbiologically confirmed (incidence: 15.7 cases per 1000 admissions). A slight increase in the number of Gram-positive cocci and anaerobes over the last 4 years was found. The most frequent species (annual range) were: Escherichia coli (13.5%-18.9%), Staphylococcus aureus (10.5%-17.8%), Klebsiella spp. (3.0%-9.4%), Enterococcus faecalis (3.0%-8.2%), Pseudomonas aeruginosa (2.5%-5.8%) and Streptococcus pneumoniae (1.8%-5.6%). Males were more affected than females (ratio 1.7:1). The portal of entry was known in 2126 episodes, of which the most frequent were urinary and gasto-intestinal tracts (24.4% and 19.4% respectively). Bacteraemia was associated with rapidly and ultimately fatal underlying diseases in 7.2% and 15.1% of the cases respectively. The hospital location of patients was: medical ward 46.0%, surgical ward 22.7%, paediatric ward 16.9%, and intensive care unit 14.4%.
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Affiliation(s)
- F Vázquez
- Departamento de Biología Funcional (Area de Microbiología), Facultad de Medicina, Universidad de Oviedo, Spain
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7
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Ravaoarinoro M, Toma E, Fallara A. Inducible beta-lactamases in clinical isolates of non-aeruginosa Pseudomonas. APMIS 1992; 100:523-30. [PMID: 1610551 DOI: 10.1111/j.1699-0463.1992.tb00906.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The incidence of antimicrobial resistance and expression of imipenem-inducible beta-lactamase were examined in 22 strains of non-aeruginosa Pseudomonas isolated from clinical specimens. The percentage of strains resistant to form one to eight antibiotics was 45. The most active antibiotics against all strains were norfloxacin, ciprofloxacin and imipenem. Eighteen out of the 22 strains were positive for beta-lactamase in a spectrophotometric assay using nitrocefin as substrate. A low inducible beta-lactamase specific activity (0.001-0.999 nmoles nitrocefin hydrolyzed/min/mg protein) was found in twelve strains whereas six strains had a relatively high specific activity (3.5-159.8 nmoles nitrocefin hydrolyzed/min/mg protein). Five strains representing different Pseudomonas spp. and showing high beta-lactamase activity were studied further. Crude enzymes from two species (Pseudomonas mendocina, Pseudomonas acidovorans) hydrolyzed cefazolin at a higher rate than penicillin and ampicillin. All enzymes from the five species were inhibited by cloxacillin and p-chloromercuribenzoate (1 mM), but were insensitive to inhibition by clavulanic acid, ethylenediamine acetic acid (EDTA) at the same concentration. The isoelectric point and molecular weight of the main beta-lactamase band from the 5 species were 6.5-6.8 and 47,000 respectively.
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Affiliation(s)
- M Ravaoarinoro
- Department of Microbiology and Infectious Diseases, Hôtel-Dieu de Montréal Hospital, Canada
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8
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Mittermayer H, Rotter M, Breitfellner G, Riezinger F, Thiel W, Binder L, Watschinger R. Resistance of gram-negative bacilli and staphylococci from blood cultures to aminoglycoside antibiotics. Comparison of 3 in vitro investigations from Austria 1982-1988. ZENTRALBLATT FUR BAKTERIOLOGIE : INTERNATIONAL JOURNAL OF MEDICAL MICROBIOLOGY 1990; 272:448-57. [PMID: 2113808 DOI: 10.1016/s0934-8840(11)80046-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A total of 790 blood culture isolates was collected during 3 study periods in 1982/83, 1984/85 and 1987/88. Staphylococci were the most frequent bacteria in the first two periods (56.5% and 63%, respectively). During the last period, E. coli was the most frequent of all species (27%). Differences in the distribution of bacteria between the laboratories were considerable. In one laboratory in Vienna, coagulase-negative staphylococci dominated in all 3 study periods (32%, 33% and 47%). Susceptibility against gentamicin, tobramycin and netilmicin (MIC less than or equal to 4 mg/l), as well as against amikacin (MIC less than or equal to 8 mg/l) were determined by a microdilution method. The resistance rates against gentamicin (G) were 25%, 21% and 25%, against tobramycin (T) 27%, 19% and 25%, against netilmicin (N) 6%, 4% and 19%, and against amikacin (A), 5%, 2% and 19%. Most resistant strains were staphylococci (G 26%-41%, T 26%-46%, N 3%-31%, A 3%-36%), whereas gram-negative bacilli were more susceptible (G 12%-14%, T 7%-11%, N 7%-9%, A 1%-7.5%). The increase of resistance against netilmicin and amikacin in staphylococci was most striking. Nearly all those strain could be attributed to one laboratory in Vienna. Most of them were coagulase-negative staphylococci. In the first study period, the most frequent pattern was resistance against gentamicin and tobramycin, whereas in the last period resistance to all 4 aminoglycosides dominated. The study demonstrates considerable local differences in antibiotic resistance. Monitoring of antibiotic resistance in collaborative studies using standardized methods should be a valuable tool in planning strategies for controlling an epidemic spread of resistance.
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Affiliation(s)
- H Mittermayer
- Institut für Medizinische Mikrobiologie und Hygiene, Krakenhauses der Elisabethinen, Linz
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Lindh ELISABET, Dornbusch KATHRINE, Jalakas KIRSTI, Forsgren ARNE. Antibiotic susceptibility and β-lactamase production in clinical isolates ofEnterobacter spp. APMIS 1990. [DOI: 10.1111/j.1699-0463.1990.tb01058.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Stanley GL, Pfaller MA, Mori M, Wenzel RP. Nosocomial gram-negative bloodstream isolates: a comparison of in vitro antibiotic potency. J Hosp Infect 1989; 14:217-25. [PMID: 2575103 DOI: 10.1016/0195-6701(89)90038-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Nosocomial bloodstream infections add to the morbidity, mortality and length of hospitalization that is attributed to the underlying diseases alone. We have compared the in vitro potency of fifteen antibiotics against 136 isolates from clinically significant nosocomial gram-negative bacteraemias. Ciprofloxacin was the most potent antibiotic and had the broadest spectrum of activity (98% of isolates susceptible, MIC90 range: 0.06-0.5 micrograms ml-1). We subjected all isolates to beta-lactamase induction but antibiotic susceptibility was unaffected by this procedure.
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Affiliation(s)
- G L Stanley
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City
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Affiliation(s)
- I Phillips
- Department of Microbiology, United Medical and Dental Schools, St Thomas' Hospital, London, England
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THORE MAGNUS, JALAKAS KIRSTI, ERIKSSON INGE, DORNBUSCH KATHRINE. Evaluation of a disk approximation test of inducible beta-lactamases inEnterobacteriacaeandPseudomonas aeruginosa. APMIS 1989. [DOI: 10.1111/j.1699-0463.1989.tb00794.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Jones RN, Barry AL. Susceptibility of stably derepressed beta-lactamase producing strains to imipenem and four quinolones. Eur J Clin Microbiol Infect Dis 1988; 7:82-3. [PMID: 3132387 DOI: 10.1007/bf01962184] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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14
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Dornbusch K, Bengtsson S, Brorson JE, Fritz H, Henning C, Kronvall G, Larsson P, Malmborg AS, Thore M, Tärnvik A. Susceptibility to beta-lactam antibiotics and gentamicin of gram-negative bacilli isolated from hospitalized patients: a Swedish multicenter study. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1988; 20:641-7. [PMID: 3065931 DOI: 10.3109/00365548809035665] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A total of 952 blood and 1543 urine isolates of gram-negative bacilli from hospitalized patients in 1986-1987 were consecutively collected by 10 Swedish laboratories and tested for susceptibility to 8 beta-lactam antibiotics and to gentamicin. The isolates were mostly Escherichia coli (58% and 44%, respectively) and Klebsiella sp. (17% and 18%). Resistance to ampicillin in blood and urine isolates was found in 35% and 45%, respectively, to piperacillin in 5% and 6%, to cephalothin in 26% and 34%, to cefuroxime in 12% and 22%, to cefotaxime in 3% and 5%, to ceftazidime in 1% and 1%, to imipenem in 0.5% and 0.1%, to aztreonam in 3% and 2%, and to gentamicin in 0.8% and 0%. Resistance of clinically important gram-negative bacilli to new beta-lactam antibiotics and to gentamicin is infrequent in Sweden.
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Affiliation(s)
- K Dornbusch
- Department of Clinical Microbiology, Karolinska Hospital, Stockholm, Sweden
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15
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Sanders CC, Sanders WE. Clinical importance of inducible beta-lactamases in gram-negative bacteria. EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY 1987; 6:435-8. [PMID: 3311737 DOI: 10.1007/bf02013106] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The clinical problems caused by inducible beta-lactamases in certain gram-negative bacteria are being recognized with increasing frequency. These problems include the rapid emergence of multiple beta-lactam resistance during therapy with many of the newer beta-lactam antibiotics. Such multiply resistant organisms are now spreading within the hospital and have become important nosocomial pathogens. This has been a particularly difficult problem for intensive care units, cystic fibrosis centers and burn units where there are clusters of patients who are highly susceptible to infections with organisms like Enterobacter spp., Serratia spp. and Pseudomonas aeruginosa, which possess inducible beta-lactamases. Only through an awareness of these problems, their cause, and restriction of the use of certain newer beta-lactam antibiotics can these problems be controlled.
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Affiliation(s)
- C C Sanders
- Department of Medical Microbiology, Creighton University School of Medicine, Omaha, Nebraska 68178
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Incidence of inducible beta-lactamases in gram-negative septicemia isolates from twenty-nine European laboratories. European Study Group on Antibiotic Resistance. EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY 1987; 6:460-6. [PMID: 3117535 DOI: 10.1007/bf02013111] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In 1984 the European Study Group on Antibiotic Resistance (ESGAR), which is made up of 29 laboratories in 12 European countries, consecutively collected gram-negative bacilli and staphylococci isolates from blood and using the microdilution method performed susceptibility testing with 11 beta-lactam antibiotics. A total of 2,578 isolates were collected; 68% were gram-negatives and 32% staphylococci. Pseudomonas spp. accounted for 12% of the strains, Enterobacter spp. 7%, Serratia spp. 3%, indole-positive Proteus spp. 1%, Citrobacter spp. and Morganella spp. 0.9% each. Strains with inducible beta-lactamases were detected by the cefoxitin disc diffusion method in 11% of all gram-negatives and in 67% of the relevant species. The production of inducible beta-lactamase was confirmed by elevated MICs to and decreased killing by piperacillin, cefotaxime and ceftazidime after induction of enzyme production with low concentrations of cefoxitin. This phenomenon was not observed with mecillinam or the new penem Sch 34343.
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