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Gonçalves DLDR, Chang MR, Nobrega GD, Venancio FA, Higa Júnior MG, Fava WS. Hospital sewage in Brazil: a reservoir of multidrug-resistant carbapenemase-producing Enterobacteriaceae. BRAZ J BIOL 2024; 84:e277750. [PMID: 38985067 DOI: 10.1590/1519-6984.277750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 03/20/2024] [Indexed: 07/11/2024] Open
Abstract
The One Health concept recognizes that human health is clearly linked to the health of animals and the environment. Infections caused by bacteria resistant to carbapenem antibiotics have become a major challenge in hospitals due to limited therapeutic options and consequent increase in mortality. In this study, we investigated the presence of carbapenem-resistant Enterobacteriaceae in 84 effluent samples (42 from hospital and 42 from non-hospital) from Campo Grande, midwest Brazil. First, sewage samples were inoculated in a selective culture medium. Bacteria with reduced susceptibility to meropenem and ertapenem were then identified and their antimicrobial susceptibility was determined using the Vitek-2 system. The blaKPC genes were detected using PCR and further confirmed by sequencing. Carbapenem-resistant Enterobacteriaceae (CRE) were identified in both hospital (n=32) and non-hospital effluent (n=16), with the most common being Klebsiella pneumoniae and of the Enterobacter cloacae complex species. This is the first study to indicate the presence of the blaKPC-2 gene in carbapenem-resistant Enterobacteriaceae, classified as a critical priority by the WHO, in hospital sewage in this region. The dissemination of carbapenem antibiotic-resistant genes may be associated with clinical pathogens. Under favorable conditions and microbial loads, resistant bacteria and antimicrobial-resistance genes found in hospital sewage can disseminate into the environment, causing health problems. Therefore, sewage treatment regulations should be implemented to minimize the transfer of antimicrobial resistance from hospitals.
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Affiliation(s)
- D L D R Gonçalves
- Universidade Federal do Mato Grosso do Sul - UFMS, Programa em Saúde e Desenvolvimento na Região Centro Oeste, Campo Grande, MS, Brasil
| | - M R Chang
- Universidade Federal do Mato Grosso do Sul - UFMS, Faculdade de Medicina, Programa de Pós-graduação em Doenças Infecciosas e Parasitárias, Campo Grande, MS, Brasil
- Universidade Federal do Mato Grosso do Sul - UFMS, Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição, Laboratório de Pesquisas Microbiológicas, Campo Grande, MS, Brasil
| | - G D Nobrega
- Universidade Federal do Mato Grosso do Sul - UFMS, Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição, Laboratório de Pesquisas Microbiológicas, Campo Grande, MS, Brasil
| | - F A Venancio
- Universidade Estadual do Mato Grosso do Sul - UEMS, Campo Grande, MS, Brasil
| | - M G Higa Júnior
- Universidade Federal do Mato Grosso do Sul - UFMS, Hospital Universitário Maria Aparecida Pedrossian - EBSERH, Comissão de Controle e Infecção Hospitalar, Campo Grande, MS, Brasil
| | - W S Fava
- Universidade Federal de Mato Grosso do Sul - UFMS, Faculdade de Medicina, Laboratório de Doenças Infecciosas e Parasitárias, Campo Grande, MS, Brasil
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2
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Siqueira JAM, Teixeira DM, da Piedade GJL, Souza CDO, Moura TCF, Bahia MDNM, Brasiliense DM, Santos DSADS, Morais LLCDS, da Silva DDFL, Carneiro BS, Pinheiro KDC, Junior ECS, Catete CP, Souza E Guimarães RJDP, Ferreira JL, Chagas Junior WDD, Machado RS, Tavares FN, Resque HR, Dos Santos Lobo P, Guerra SDFDS, Soares LS, da Silva LD, Gabbay YB. Environmental health of water bodies from a Brazilian Amazon Metropolis based on a conventional and metagenomic approach. J Appl Microbiol 2024; 135:lxae101. [PMID: 38627246 DOI: 10.1093/jambio/lxae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 04/03/2024] [Accepted: 04/15/2024] [Indexed: 05/03/2024]
Abstract
AIMS The present study aimed to use a conventional and metagenomic approach to investigate the microbiological diversity of water bodies in a network of drainage channels and rivers located in the central area of the city of Belém, northern Brazil, which is considered one of the largest cities in the Brazilian Amazon. METHODS AND RESULTS In eight of the analyzed points, both bacterial and viral microbiological indicators of environmental contamination-physical-chemical and metals-were assessed. The bacterial resistance genes, drug resistance mechanisms, and viral viability in the environment were also assessed. A total of 473 families of bacteria and 83 families of viruses were identified. Based on the analysis of metals, the levels of three metals (Cd, Fe, and Mn) were found to be above the recommended acceptable level by local legislation. The levels of the following three physicochemical parameters were also higher than recommended: biochemical oxygen demand, dissolved oxygen, and turbidity. Sixty-three bacterial resistance genes that conferred resistance to 13 different classes of antimicrobials were identified. Further, five mechanisms of antimicrobial resistance were identified and viral viability in the environment was confirmed. CONCLUSIONS Intense human actions combined with a lack of public policies and poor environmental education of the population cause environmental degradation, especially in water bodies. Thus, urgent interventions are warranted to restore the quality of this precious and scarce asset worldwide.
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Affiliation(s)
| | - Dielle Monteiro Teixeira
- Laboratório de Vírus Gastroentéricos, Seção de Virologia, Instituto Evandro Chagas (SVSA/MS), CEP 67030-000, Brazil
| | | | - Cintya de Oliveira Souza
- Laboratório de Enteroinfecções Bacterianas II, Seção de Bacteriologia e Micologia, Instituto Evandro Chagas (SVSA/MS), CEP 67030-000, Brazil
| | - Tuane Carolina Ferreira Moura
- Laboratório de Enteroinfecções Bacterianas II, Seção de Bacteriologia e Micologia, Instituto Evandro Chagas (SVSA/MS), CEP 67030-000, Brazil
| | - Marcia de Nazaré Miranda Bahia
- Laboratório de Enteroinfecções Bacterianas II, Seção de Bacteriologia e Micologia, Instituto Evandro Chagas (SVSA/MS), CEP 67030-000, Brazil
| | - Danielle Murici Brasiliense
- Laboratório de Patógenos Especiais, Seção de Bacteriologia e Micologia, Instituto Evandro Chagas (SVSA/MS), CEP 67030-000, Brazil
| | | | | | | | - Bruno Santana Carneiro
- Laboratório de Indicadores Físico-Químicos de Qualidade da Água, Seção de Meio Ambiente, Instituto Evandro Chagas (SVSA/MS), CEP 67030-000, Brazil
| | - Kenny da Costa Pinheiro
- Laboratório de Bioinformática, Seção de Virologia, Instituto Evandro Chagas (SVSA/MS), CEP 67030-000, Brazil
| | - Edivaldo Costa Sousa Junior
- Laboratório de Epidemiologia em Leishmanioses, Seção de Parasitologia, Instituto Evandro Chagas (SVSA/MS), CEP 67030-000, Brazil
| | - Clístenes Pamplona Catete
- Laboratório de Geoprocessamento, Seção de Epidemiologia, Instituto Evandro Chagas (SVSA/MS), CEP 67030-000, Brazil
| | | | - James Lima Ferreira
- Laboratório de Enterovírus, Seção de Virologia, Instituto Evandro Chagas (SVSA/MS), CEP 67030-000, Brazil
| | | | - Raiana Scerni Machado
- Laboratório de Enterovírus, Seção de Virologia, Instituto Evandro Chagas (SVSA/MS), CEP 67030-000, Brazil
| | - Fernando Neto Tavares
- Laboratório de Enterovírus, Seção de Virologia, Instituto Evandro Chagas (SVSA/MS), CEP 67030-000, Brazil
| | - Hugo Reis Resque
- Laboratório de Vírus Gastroentéricos, Seção de Virologia, Instituto Evandro Chagas (SVSA/MS), CEP 67030-000, Brazil
| | - Patrícia Dos Santos Lobo
- Laboratório de Vírus Gastroentéricos, Seção de Virologia, Instituto Evandro Chagas (SVSA/MS), CEP 67030-000, Brazil
| | | | - Luana Silva Soares
- Laboratório de Vírus Gastroentéricos, Seção de Virologia, Instituto Evandro Chagas (SVSA/MS), CEP 67030-000, Brazil
| | - Luciana Damascena da Silva
- Laboratório de Vírus Gastroentéricos, Seção de Virologia, Instituto Evandro Chagas (SVSA/MS), CEP 67030-000, Brazil
| | - Yvone Benchimol Gabbay
- Laboratório de Vírus Gastroentéricos, Seção de Virologia, Instituto Evandro Chagas (SVSA/MS), CEP 67030-000, Brazil
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Da Silva Pimenta J, Magalhães GLG, Soncini JGM, Licopan N, Vespero EC. Epidemiological and molecular study of Providencia rettgeri outbreak at a university hospital during the COVID-19 reference center. Int Microbiol 2024:10.1007/s10123-024-00523-9. [PMID: 38691195 DOI: 10.1007/s10123-024-00523-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 04/13/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024]
Abstract
In 2014, Brazil detected New Delhi metallo-β-lactamase (NDM)-producing Enterobacterales from a Providencia rettgeri isolate obtained through surveillance swabs in the Southern region. Subsequently, various species have reported several NDM enzymes. However, comprehensive data on the current epidemiology of NDM-producing P. rettgeri in Brazil remains limited. This study, aimed to provide a detailed characterization of the phenotypic, genotypic, and epidemiological profile of clinical isolates of P. rettgeri NDM. From April 2020 to December 2022, 18 carbapenem-resistant P. rettgeri strains, previously identified using Vitek2®, were isolated at the University Hospital of Londrina. Resistance and virulence genes were assessed through genetic analysis using ERIC PCR and NextSeq (Illumina) sequencing. Statistical analysis was conducted using SPSS version 2.0. Genomic analysis confirmed the presence of β-lactamase blaNDM-1 and blaOXA-1. All isolates showed the presence of the NDM encoding gene and genetic similarity above 90% between isolates. Clinical parameters of patients infected with P. rettgeri exhibited significant association with mechanical ventilation, prior use of carbapenems, and polymyxins. We also report a significant association between P. rettgeri infection and death outcome. This study characterizes NDM-1 metallo-β-lactmases isolates, among P. rettgeri isolates from patients at the University Hospital (HU), during the COVID-19 pandemic. The emergence of this novel resistance mechanism among P. rettgeri poses a significant challenge, limiting the therapeutic options for infections in our hospital.
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Affiliation(s)
- Julia Da Silva Pimenta
- Clinical and Laboratory Pathophysiology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil.
| | | | - Joao Gabriel Material Soncini
- Clinical and Laboratory Pathophysiology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Nilton Licopan
- Department of Microbiology, Institute of Biomedical Sciences (IBS), University of São Paulo, São Paulo, São Paulo, Brazil
| | - Eliana Carolina Vespero
- Department of Pathology, Clinical and Toxicological Analyzes, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
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Camargo CH, Yamada AY, de Souza AR, Sacchi CT, Reis AD, Santos MBN, de Assis DB, de Carvalho E, Takagi EH, Cunha MPV, Tiba-Casas MR. Genomic characterization of New Delhi metallo-beta-lactamase-producing species of Morganellaceae, Yersiniaceae, and Enterobacteriaceae (other than Klebsiella) from Brazil over 2013-2022. Microbiol Immunol 2024; 68:1-5. [PMID: 37859304 DOI: 10.1111/1348-0421.13100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/21/2023]
Abstract
Over the last decade, New Delhi metallo-beta-lactamase (NDM) carbapenemase has silently spread in Brazil. In this study, we analyzed a large collection of Enterobacterales other than Klebsiella spp. received in our reference laboratory between 2013 and 2022. A total of 32 clinical isolates displaying different pulsed-field gel electrophoresis profiles, and represented by 11 species in the families Enterobacteriaceae (Citrobacter freundii, Citrobacter portucalensis, Enterobacter hormaechei, and Escherichia coli), Morganellaceae (Morganella morganii, Proteus mirabilis, Proteus vulgaris, Providencia rettgeri, Providencia stuartii, and Raoultella ornithinolytica), and Yersiniaceae (Serratia marcescens) had their whole genomes sequenced and further analyzed. Antimicrobial susceptibility was determined by disk diffusion, except for polymyxin B, assessed by broth microdilution. The blaNDM-1 allele was predominant (n = 29), but blaNDM-5 was identified in an E. coli specimen with a novel ST, and the blaNDM-7 allele was found in E. hormaechei ST45 and E. coli ST1049. Polymyxin was active against all but one Enterobacteriaceae isolate: an mcr-1-producing E. coli presenting minimal inhibitory concentration (4 mg/L). Isolates producing extended-spectrum β-lactamases were common: cefotaximase from Munich (CTX-M)-15 (n = 10), CTX-M-2 (n = 4), and CTX-M-8 (n = 3) were detected, and the mcr-1-producing E. coli was found to co-produce both CTX-M-8 and CTX-M-55 β-lactamases. The mcr-9 gene was found in 5/8 E. hormaechei isolates, distributed in four different sequence types, all of them presenting susceptibility to polymyxin. This study showed that NDM-producing Enterobacterales other than Klebsiella are already spread in Brazil, in diversified species, and cocarrying important resistance genes. Prompt detection and effective implementation of measures to prevent further spread are mandatory for mitigating the dissemination of NDM carbapenemase in hospital settings and preserving the already limited antimicrobial therapy options.
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Affiliation(s)
- Carlos Henrique Camargo
- Centro de Bacteriologia, Instituto Adolfo Lutz, São Paulo, Brazil
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Amanda Yaeko Yamada
- Centro de Bacteriologia, Instituto Adolfo Lutz, São Paulo, Brazil
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Camargo CH, Yamada AY, de Souza AR, Cunha MPV, Ferraro PSP, Sacchi CT, Dos Santos MB, Campos KR, Tiba-Casas MR, Freire MP, Barretti P. Genomic analysis and antimicrobial activity of β-lactam/β-lactamase inhibitors and other agents against KPC-producing Klebsiella pneumoniae clinical isolates from Brazilian hospitals. Sci Rep 2023; 13:14603. [PMID: 37670032 PMCID: PMC10480165 DOI: 10.1038/s41598-023-41903-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/01/2023] [Indexed: 09/07/2023] Open
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CRKP) are highly disseminated worldwide, and isolates co-resistant to other antimicrobial agents pose a threat to effective antimicrobial therapy. Therefore, evaluation of novel antimicrobial drugs is needed to identify potential treatments with better outcomes. We evaluated the in vitro activity of novel antimicrobial drugs/combinations against 97 KPC-producing Klebsiella pneumoniae isolates recovered from different hospitals in Brazil during 2021-2022. Clonality, resistance and virulence genes were detected by whole-genome sequencing. The majority of the isolates (54.6%) were classified as extensively drug resistant or multidrug resistant (44.3%); one isolate showed a pandrug resistance phenotype. The most active antimicrobial agents were meropenem-vaborbactam, cefiderocol, and ceftazidime-avibactam, with sensitivities higher than 90%; resistance to ceftazidime-avibactam was associated with KPC-33 or KPC-44 variants. Colistin and polymyxin B were active against 58.6% of the isolates. The 97 isolates were distributed into 17 different sequence types, with a predominance of ST11 (37.4%). Although high in vitro susceptibility rates were detected for meropenem-vaborbactam and cefiderocol, only ceftazidime-avibactam is currently available in Brazil. Our findings showed limited susceptibility to antimicrobial drugs employed for infection treatment of carbapenem-resistant K. pneumoniae, underscoring the urgent need for stringent policies for antimicrobial stewardship to preserve the activity of such drugs.
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Affiliation(s)
- Carlos Henrique Camargo
- Centro de Bacteriologia, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 9º Andar, São Paulo, SP, 01246-902, Brazil.
- Faculdade de Medicina, Universidade de São Paulo, Avenida Dr. Arnaldo 455, São Paulo, 01246-902, Brazil.
| | - Amanda Yaeko Yamada
- Centro de Bacteriologia, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 9º Andar, São Paulo, SP, 01246-902, Brazil
- Faculdade de Medicina, Universidade de São Paulo, Avenida Dr. Arnaldo 455, São Paulo, 01246-902, Brazil
| | - Andreia Rodrigues de Souza
- Centro de Bacteriologia, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 9º Andar, São Paulo, SP, 01246-902, Brazil
| | - Marcos Paulo Vieira Cunha
- Centro de Bacteriologia, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 9º Andar, São Paulo, SP, 01246-902, Brazil
| | - Pedro Smith Pereira Ferraro
- Centro de Bacteriologia, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 9º Andar, São Paulo, SP, 01246-902, Brazil
| | - Claudio Tavares Sacchi
- Laboratório Estratégico, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 10º Andar, São Paulo, 01246-902, Brazil
| | - Marlon Benedito Dos Santos
- Laboratório Estratégico, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 10º Andar, São Paulo, 01246-902, Brazil
| | - Karoline Rodrigues Campos
- Laboratório Estratégico, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 10º Andar, São Paulo, 01246-902, Brazil
| | - Monique Ribeiro Tiba-Casas
- Centro de Bacteriologia, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 9º Andar, São Paulo, SP, 01246-902, Brazil
| | - Maristela Pinheiro Freire
- Faculdade de Medicina, Universidade de São Paulo, Avenida Dr. Arnaldo 455, São Paulo, 01246-902, Brazil
| | - Pasqual Barretti
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Av. Prof. Montenegro, S/N, Botucatu, 18618-687, Brazil
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Massarine NCM, de Souza GHDA, Nunes IB, Salomé TM, Barbosa MDS, Faccin I, Rossato L, Simionatto S. How Did COVID-19 Impact the Antimicrobial Consumption and Bacterial Resistance Profiles in Brazil? Antibiotics (Basel) 2023; 12:1374. [PMID: 37760671 PMCID: PMC10526034 DOI: 10.3390/antibiotics12091374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
The indiscriminate use of antibiotics has favored the selective pressure of multidrug resistance among microorganisms. This research evaluated the pattern of antibiotic prescriptions among the Brazilian population between January 2018 and December 2021. Additionally, the study sought to analyze the incidence rates of central line-associated bloodstream infection (CLABSI) and examine the profiles of antibiotic resistance. We assessed the hospital and community antimicrobial consumption from the National Health Surveillance Agency Database and correlated it to microorganisms. The consumption of antimicrobials in the hospital environment increased by 26% in 2021, highlighting polymyxin B, which increased by 204%. In 2021, 244,266 cases of CLABSI were reported, indicating a nosocomial infection rate of 7.9%. The rate of resistance to polymyxin B was higher in Pseudomonas aeruginosa (1400%) and Klebsiella pneumoniae (514%). Azithromycin emerged as the predominant antibiotic utilized within the community setting, accounting for 24% of the overall consumption. Pearson's correlation analysis revealed a significant and positive correlation (r = 0.71) between the elevated usage of azithromycin and the incidence of COVID-19. Our results indicate an increase in antimicrobial consumption during the COVID-19 pandemic and reinforce the fact that the misuse of antimicrobials may lead to an expansion in antimicrobial resistance.
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Collar GDS, Moreira NK, Wink PL, Barth AL, Raro OHF, Dias C, de Lima Machado A, Mott MP, Caierão J. Detection of polymyxins resistance among Enterobacterales: evaluation of available methods and proposal of a new rapid and feasible methodology. Ann Clin Microbiol Antimicrob 2023; 22:71. [PMID: 37563615 PMCID: PMC10416366 DOI: 10.1186/s12941-023-00618-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/23/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Fast and accurate detection of polymyxins resistance is necessary as they remain the last resources to treat infections caused by Carbapenem-resistant Enterobacterales in many regions. We evaluated the rapid colorimetric polymyxin B elution (RCPE) and developed its miniaturized version, RCPE microelution (RCPEm), aiming to detect polymyxins resistance among Enterobacterales. METHODS The methodologies consist of exposing the bacterial population in a solution (NP solution) where polymyxin B disks were previously eluted to obtain a concentration of 2 µg/mL for RCPE and 3 µg/mL for RCPEm. RESULTS Two hundred sixty-seven Enterobacterales were evaluated, 90 (33.7%) resistant to polymyxin B by broth microdilution. It was observed 0.6% of major error (ME) by RCPE, with a specificity of 99.4%. The miniaturized version (RCPEm) presented the same ME and specificity values, but slightly higher sensitivity (97.8% vs. 95.6%) with 2.2% of very major error (VME). CONCLUSIONS RCPE and RCPEm proved to be useful alternatives to determine polymyxin B susceptibility in clinical microbiology laboratories, presenting low cost, being easy to perform, and demanding short incubation time.
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Affiliation(s)
- Gabriela da Silva Collar
- Laboratório de Pesquisa em Bacteriologia Clínica (LaBaC), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil.
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil.
| | - Natália Kehl Moreira
- Laboratório de Pesquisa em Bacteriologia Clínica (LaBaC), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Priscila Lamb Wink
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
- Laboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil
| | - Afonso Luís Barth
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
- Laboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil
| | - Otávio Hallal Ferreira Raro
- Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil
| | - Cícero Dias
- Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil
| | | | | | - Juliana Caierão
- Laboratório de Pesquisa em Bacteriologia Clínica (LaBaC), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil.
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil.
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Kiffer CRV, Rezende TFT, Costa-Nobre DT, Marinonio ASS, Shiguenaga LH, Kulek DNO, Arend LNVS, Santos ICDO, Sued-Karam BR, Rocha-de-Souza CM, Kraft L, Abreu A, Peral RTDS, Carvalho-Assef APD, Pillonetto M. A 7-Year Brazilian National Perspective on Plasmid-Mediated Carbapenem Resistance in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii Complex and the Impact of the Coronavirus Disease 2019 Pandemic on Their Occurrence. Clin Infect Dis 2023; 77:S29-S37. [PMID: 37406041 DOI: 10.1093/cid/ciad260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Carbapenemase production is a global public health threat. Antimicrobial resistance (AMR) data analysis is critical to public health policy. Here we analyzed carbapenemase detection trends using the AMR Brazilian Surveillance Network. METHODS Carbapenemase detection data from Brazilian hospitals included in the public laboratory information system dataset were evaluated. The detection rate (DR) was defined as carbapenemase detected by gene tested per isolate per year. The temporal trends were estimated using the Prais-Winsten regression model. The impact of COVID-19 on carbapenemase genes in Brazil was determined for the period 2015-2022. Detection pre- (October 2017 to March 2020) and post-pandemic onset (April 2020 to September 2022) was compared using the χ2 test. Analyses were performed with Stata 17.0 (StataCorp, College Station, TX). RESULTS 83 282 blaKPC and 86 038 blaNDM were tested for all microorganisms. Enterobacterales DR for blaKPC and blaNDM was 68.6% (41 301/60 205) and 14.4% (8377/58 172), respectively. P. aeruginosa DR for blaNDM was 2.5% (313/12 528). An annual percent increase for blaNDM of 41.1% was observed, and a decrease for blaKPC of -4.0% in Enterobacterales, and an annual increase for blaNDM of 71.6% and for blaKPC of 22.2% in P. aeruginosa. From 2020 to 2022, overall increases of 65.2% for Enterobacterales, 77.7% for ABC, and 61.3% for P. aeruginosa were observed in the total isolates. CONCLUSIONS This study shows the strengths of the AMR Brazilian Surveillance Network with robust data related to carbapenemases in Brazil and the impact of COVID-19 with a change in carbapenemase profiles with blaNDM rising over the years.
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Affiliation(s)
- Carlos R V Kiffer
- Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
- Infectious Diseases Discipline, Laboratório Especial de Microbiologia Clínica-LEMC/ALERTA, EPM, UNIFESP, São Paulo, Brazil
| | - Thais F T Rezende
- Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
- Infectious Diseases Discipline, Laboratório Especial de Microbiologia Clínica-LEMC/ALERTA, EPM, UNIFESP, São Paulo, Brazil
| | | | | | | | - Debora Nicole Oliveira Kulek
- Laboratorio Central do Paraná - LACENPR, Secretaria de Estado da Saúde, Curitiba, Parana, Brazil
- Escola de Medicina e Ciencias da Vida - EMCV, Pontifícia Universidade Católica do Paraná-PUCPR, Curitiba, Parana, Brazil
| | - Lavinia Nery Villa Stangler Arend
- Laboratorio Central do Paraná - LACENPR, Secretaria de Estado da Saúde, Curitiba, Parana, Brazil
- Escola de Medicina e Ciencias da Vida - EMCV, Pontifícia Universidade Católica do Paraná-PUCPR, Curitiba, Parana, Brazil
| | - Ivson Cassiano de Oliveira Santos
- Instituto Oswaldo Cruz (IOC)-Fundação Instituto Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Laboratório de Pesquisa em Infecção Hospitalar-LAPIH, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Bruna Ribeiro Sued-Karam
- Instituto Oswaldo Cruz (IOC)-Fundação Instituto Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Laboratório de Pesquisa em Infecção Hospitalar-LAPIH, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Claudio Marcos Rocha-de-Souza
- Instituto Oswaldo Cruz (IOC)-Fundação Instituto Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Laboratório de Pesquisa em Infecção Hospitalar-LAPIH, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Leticia Kraft
- Coordenação Geral de Laboratórios de Saúde Publica, Departamento de Articulação Estratégica de Vigilância em Saúde e Ambiente, Secretaria de Vigilância em Saúde e Ambiente, Ministério da Saúde, Brasilia, Distrito Federal, Brazil
| | - Andre Abreu
- Núcleo de Epidemiologia e Vigilância em Saúde, Instituto Oswaldo Cruz-FIOCRUZ, Brasilia, Distrito Federal, Brazil
| | - Renata Tigulini de Souza Peral
- Coordenação Geral de Laboratórios de Saúde Publica, Departamento de Articulação Estratégica de Vigilância em Saúde e Ambiente, Secretaria de Vigilância em Saúde e Ambiente, Ministério da Saúde, Brasilia, Distrito Federal, Brazil
| | - Ana Paula D'Alincourt Carvalho-Assef
- Instituto Oswaldo Cruz (IOC)-Fundação Instituto Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Laboratório de Pesquisa em Infecção Hospitalar-LAPIH, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marcelo Pillonetto
- Laboratorio Central do Paraná - LACENPR, Secretaria de Estado da Saúde, Curitiba, Parana, Brazil
- Escola de Medicina e Ciencias da Vida - EMCV, Pontifícia Universidade Católica do Paraná-PUCPR, Curitiba, Parana, Brazil
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9
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Boralli CMDS, Paganini JA, Meneses RS, Mata CPSMD, Leite EMM, Schürch AC, Paganelli FL, Willems RJL, Camargo ILBC. Characterization of blaKPC-2 and blaNDM-1 Plasmids of a K. pneumoniae ST11 Outbreak Clone. Antibiotics (Basel) 2023; 12:antibiotics12050926. [PMID: 37237829 DOI: 10.3390/antibiotics12050926] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
The most common resistance mechanism to carbapenems is the production of carbapenemases. In 2021, the Pan American Health Organization warned of the emergence and increase in new carbapenemase combinations in Enterobacterales in Latin America. In this study, we characterized four Klebsiella pneumoniae isolates harboring blaKPC and blaNDM from an outbreak during the COVID-19 pandemic in a Brazilian hospital. We assessed their plasmids' transference ability, fitness effects, and relative copy number in different hosts. The K. pneumoniae BHKPC93 and BHKPC104 strains were selected for whole genome sequencing (WGS) based on their pulsed-field gel electrophoresis profile. The WGS revealed that both isolates belong to ST11, and 20 resistance genes were identified in each isolate, including blaKPC-2 and blaNDM-1. The blaKPC gene was present on a ~56 Kbp IncN plasmid and the blaNDM-1 gene on a ~102 Kbp IncC plasmid, along with five other resistance genes. Although the blaNDM plasmid contained genes for conjugational transfer, only the blaKPC plasmid conjugated to E. coli J53, without apparent fitness effects. The minimum inhibitory concentrations (MICs) of meropenem/imipenem against BHKPC93 and BHKPC104 were 128/64 and 256/128 mg/L, respectively. Although the meropenem and imipenem MICs against E. coli J53 transconjugants carrying the blaKPC gene were 2 mg/L, this was a substantial increment in the MIC relative to the original J53 strain. The blaKPC plasmid copy number was higher in K. pneumoniae BHKPC93 and BHKPC104 than in E. coli and higher than that of the blaNDM plasmids. In conclusion, two ST11 K. pneumoniae isolates that were part of a hospital outbreak co-harbored blaKPC-2 and blaNDM-1. The blaKPC-harboring IncN plasmid has been circulating in this hospital since at least 2015, and its high copy number might have contributed to the conjugative transfer of this particular plasmid to an E. coli host. The observation that the blaKPC-containing plasmid had a lower copy number in this E. coli strain may explain why this plasmid did not confer phenotypic resistance against meropenem and imipenem.
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Affiliation(s)
- Camila Maria Dos Santos Boralli
- Laboratory of Molecular Epidemiology and Microbiology, Department of Physics and Interdisciplinary Science, São Carlos Institute of Physics, University of São Paulo, São Carlos 13563-120, Brazil
| | | | - Rodrigo Silva Meneses
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | | | | | - Anita C Schürch
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Fernanda L Paganelli
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Rob J L Willems
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Ilana Lopes Baratella Cunha Camargo
- Laboratory of Molecular Epidemiology and Microbiology, Department of Physics and Interdisciplinary Science, São Carlos Institute of Physics, University of São Paulo, São Carlos 13563-120, Brazil
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10
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Carneiro MDS, Volpato FCZ, Wilhelm CM, Wink PL, Barth AL. Evaluation of Early Reading of Broth Microdilution Technique for Polymyxin B. Microb Drug Resist 2023; 29:59-64. [PMID: 36802271 DOI: 10.1089/mdr.2022.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Delay in the results of standard phenotypic susceptibility tests is the main obstacle to adequate antibiotic treatment. For this reason, the European Committee for Antimicrobial Susceptibility Testing has proposed the Rapid Antimicrobial Susceptibility Testing for the disk diffusion method directly from blood culture. However, to date, there are no studies evaluating early readings of polymyxin B broth microdilution (BMD), the only standardized methodology for assessing susceptibility to polymyxins. This study aimed to evaluate modifications in the BMD technique for polymyxin B using fewer antibiotic dilutions and reading after an incubation time of 8-9 hr (early reading) in comparison to 16-20 hr of incubation (standard reading) for isolates of Enterobacterales, Acinetobacter baumannii complex, and Pseudomonas aeruginosa. A total of 192 isolates of gram-negative bacteria were evaluated and the minimum inhibitory concentrations were read after early and standard incubations. The early reading presented 93.2% of essential agreement and 97.9% of categorical agreement with the standard reading of BMD. Only three isolates (2.2%) presented major errors and only one (1.7%) presented a very major error. These results indicate a high agreement between the early and the standard reading times of BMD of polymyxin B.
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Affiliation(s)
- Maiara Dos Santos Carneiro
- LABRESIS-Laboratório de Pesquisa em Resistência Bacteriana, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,PPGCF-Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fabiana Caroline Zempulski Volpato
- LABRESIS-Laboratório de Pesquisa em Resistência Bacteriana, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,PPGCM-Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Camila Mörschbächer Wilhelm
- LABRESIS-Laboratório de Pesquisa em Resistência Bacteriana, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,PPGCF-Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Priscila Lamb Wink
- LABRESIS-Laboratório de Pesquisa em Resistência Bacteriana, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,PPGCF-Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Afonso Luís Barth
- LABRESIS-Laboratório de Pesquisa em Resistência Bacteriana, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,PPGCF-Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,PPGCM-Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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11
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de Carvalho FM, Valiatti TB, Santos FF, Silveira ACDO, Guimarães APC, Gerber AL, Souza CDO, Cassu Corsi D, Brasiliense DM, Castelo-Branco DDSCM, Anzai EK, Bessa-Neto FO, Guedes GMDM, de Souza GHDA, Lemos LN, Ferraz LFC, Bahia MDNM, Vaz MSM, da Silva RGB, Veiga R, Simionatto S, Monteiro WAP, Lima WADO, Kiffer CRV, Campos Pignatari AC, Cayô R, de Vasconcelos ATR, Gales AC. Exploring the Bacteriome and Resistome of Humans and Food-Producing Animals in Brazil. Microbiol Spectr 2022; 10:e0056522. [PMID: 35993730 PMCID: PMC9602611 DOI: 10.1128/spectrum.00565-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/03/2022] [Indexed: 12/30/2022] Open
Abstract
The epidemiology of antimicrobial resistance (AMR) is complex, with multiple interfaces (human-animal-environment). In this context, One Health surveillance is essential for understanding the distribution of microorganisms and antimicrobial resistance genes (ARGs). This report describes a multicentric study undertaken to evaluate the bacterial communities and resistomes of food-producing animals (cattle, poultry, and swine) and healthy humans sampled simultaneously from five Brazilian regions. Metagenomic analysis showed that a total of 21,029 unique species were identified in 107 rectal swabs collected from distinct hosts, the highest numbers of which belonged to the domain Bacteria, mainly Ruminiclostridium spp. and Bacteroides spp., and the order Enterobacterales. We detected 405 ARGs for 12 distinct antimicrobial classes. Genes encoding antibiotic-modifying enzymes were the most frequent, followed by genes related to target alteration and efflux systems. Interestingly, carbapenemase-encoding genes such as blaAIM-1, blaCAM-1, blaGIM-2, and blaHMB-1 were identified in distinct hosts. Our results revealed that, in general, the bacterial communities from humans were present in isolated clusters, except for the Northeastern region, where an overlap of the bacterial species from humans and food-producing animals was observed. Additionally, a large resistome was observed among all analyzed hosts, with emphasis on the presence of carbapenemase-encoding genes not previously reported in Latin America. IMPORTANCE Humans and food production animals have been reported to be important reservoirs of antimicrobial resistance (AMR) genes (ARGs). The frequency of these multidrug-resistant (MDR) bacteria tends to be higher in low- and middle-income countries (LMICs), due mainly to a lack of public health policies. Although studies on AMR in humans or animals have been carried out in Brazil, this is the first multicenter study that simultaneously collected rectal swabs from humans and food-producing animals for metagenomics. Our results indicate high microbial diversity among all analyzed hosts, and several ARGs for different antimicrobial classes were also found. As far as we know, we have detected for the first time ARGs encoding carbapenemases, such as blaAIM-1, blaCAM-1, blaGIM-2, and blaHMB-1, in Latin America. Thus, our results support the importance of metagenomics as a tool to track the colonization of food-producing animals and humans by antimicrobial-resistant bacteria. In addition, a network surveillance system called GUARANI, created for this study, is ready to be expanded and to collect additional data.
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Affiliation(s)
- Fabíola Marques de Carvalho
- Bioinformatics Laboratory, National Laboratory of Scientific Computing (LNCC), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tiago Barcelos Valiatti
- Universidade Federal de São Paulo (UNIFESP), Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, São Paulo, Brazil
| | - Fernanda Fernandes Santos
- Universidade Federal de São Paulo (UNIFESP), Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, São Paulo, Brazil
| | | | - Ana Paula C. Guimarães
- Bioinformatics Laboratory, National Laboratory of Scientific Computing (LNCC), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alexandra Lehmkuhl Gerber
- Bioinformatics Laboratory, National Laboratory of Scientific Computing (LNCC), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cintya de Oliveira Souza
- Seção de Bacteriologia e Micologia, Instituto Evandro Chagas (IEC), Secretaria de Vigilância em Saúde (SVS), Ministério da Saúde, Ananindeua, Pará, Brazil
| | - Dandara Cassu Corsi
- Universidade Federal de São Paulo (UNIFESP), Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, São Paulo, Brazil
| | - Danielle Murici Brasiliense
- Seção de Bacteriologia e Micologia, Instituto Evandro Chagas (IEC), Secretaria de Vigilância em Saúde (SVS), Ministério da Saúde, Ananindeua, Pará, Brazil
| | | | | | - Francisco Ozório Bessa-Neto
- Universidade Federal de São Paulo (UNIFESP), Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, São Paulo, Brazil
- Universidade Federal de São Paulo (UNIFESP), Laboratório de Imunologia e Bacteriologia (LIB), Setor de Biologia Molecular, Microbiologia e Imunologia, Departamento de Ciências Biológicas (DCB), Instituto de Ciências Ambientais, Químicas e Farmacêuticas (ICAQF), Diadema, São Paulo, Brazil
| | - Glaucia Morgana de Melo Guedes
- Postgraduate Program in Medical Microbiology, Group of Applied Medical Microbiology, Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil
| | | | - Leandro Nascimento Lemos
- Bioinformatics Laboratory, National Laboratory of Scientific Computing (LNCC), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lúcio Fábio Caldas Ferraz
- Laboratory of Molecular Biology of Microorganisms, University São Francisco (USF), Bragança Paulista, São Paulo, Brazil
| | - Márcia de Nazaré Miranda Bahia
- Seção de Bacteriologia e Micologia, Instituto Evandro Chagas (IEC), Secretaria de Vigilância em Saúde (SVS), Ministério da Saúde, Ananindeua, Pará, Brazil
| | - Márcia Soares Mattos Vaz
- Universidade Federal da Grande Dourados (UFGD), Laboratório de Pesquisa em Ciências da Saúde, Dourados, Mato Grosso do Sul, Brazil
| | - Ramon Giovani Brandão da Silva
- Universidade Federal de São Paulo (UNIFESP), Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, São Paulo, Brazil
- Universidade Federal de São Paulo (UNIFESP), Laboratório de Imunologia e Bacteriologia (LIB), Setor de Biologia Molecular, Microbiologia e Imunologia, Departamento de Ciências Biológicas (DCB), Instituto de Ciências Ambientais, Químicas e Farmacêuticas (ICAQF), Diadema, São Paulo, Brazil
| | - Ruanita Veiga
- Universidade Federal de São Paulo (UNIFESP), Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, São Paulo, Brazil
| | - Simone Simionatto
- Universidade Federal da Grande Dourados (UFGD), Laboratório de Pesquisa em Ciências da Saúde, Dourados, Mato Grosso do Sul, Brazil
| | | | - William Alencar de Oliveira Lima
- Seção de Bacteriologia e Micologia, Instituto Evandro Chagas (IEC), Secretaria de Vigilância em Saúde (SVS), Ministério da Saúde, Ananindeua, Pará, Brazil
| | - Carlos Roberto Veiga Kiffer
- Universidade Federal de São Paulo (UNIFESP), Laboratório Especial de Microbiologia Clínica (LEMC), Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, São Paulo, Brazil
| | - Antonio Carlos Campos Pignatari
- Universidade Federal de São Paulo (UNIFESP), Laboratório Especial de Microbiologia Clínica (LEMC), Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, São Paulo, Brazil
| | - Rodrigo Cayô
- Universidade Federal de São Paulo (UNIFESP), Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, São Paulo, Brazil
- Universidade Federal de São Paulo (UNIFESP), Laboratório de Imunologia e Bacteriologia (LIB), Setor de Biologia Molecular, Microbiologia e Imunologia, Departamento de Ciências Biológicas (DCB), Instituto de Ciências Ambientais, Químicas e Farmacêuticas (ICAQF), Diadema, São Paulo, Brazil
| | | | - Ana Cristina Gales
- Universidade Federal de São Paulo (UNIFESP), Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, São Paulo, Brazil
- Universidade Federal de São Paulo (UNIFESP), Laboratório Especial de Microbiologia Clínica (LEMC), Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, São Paulo, Brazil
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12
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Genomic Diversity of NDM-Producing Klebsiella Species from Brazil, 2013–2022. Antibiotics (Basel) 2022; 11:antibiotics11101395. [PMID: 36290053 PMCID: PMC9598336 DOI: 10.3390/antibiotics11101395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Since its first report in the country in 2013, NDM-producing Enterobacterales have been identified in all the Brazilian administrative regions. In this study, we characterized by antimicrobial susceptibility testing and by molecular typing a large collection of NDM-producing Klebsiella isolates from different hospitals in Brazil, mainly from the state of Sao Paulo, over the last decade. Methods: Bacterial isolates positive for blaNDM-genes were identified by MALDI-TOF MS and submitted to antimicrobial susceptibility testing by disk diffusion or broth microdilution (for polymyxin B). All isolates were submitted to pulsed-field gel electrophoresis, and isolates belonging to different clusters were submitted to whole genome sequencing by Illumina technology and downstream analysis. Mating out assays were performed by conjugation, plasmid sizes were determined by S1-PFGE, and plasmid content was investigated by hybrid assembly after MinIon long reads sequencing. Results: A total of 135 NDM-producing Klebsiella were identified, distributed into 107 different pulsotypes; polymyxin B was the only antimicrobial with high activity against 88.9% of the isolates. Fifty-four isolates presenting diversified pulsotypes were distributed in the species K. pneumoniae (70%), K. quasipneumoniae (20%), K. variicola (6%), K. michiganensis (a K. oxytoca Complex species, 2%), and K. aerogenes (2%); blaNDM-1 was the most frequent allele (43/54, 80%). There was a predominance of Clonal Group 258 (ST11 and ST340) encompassing 35% of K. pneumoniae isolates, but another thirty-one different sequence types (ST) were identified, including three described in this study (ST6244 and ST6245 for K. pneumoniae, and ST418 for K. michiganensis). The blaNDM-1 and blaNDM-7 were found to be located into IncF and IncX3 type transferable plasmids, respectively. Conclusions: Both clonal (mainly driven by CG258) and non-clonal expansion of NDM-producing Klebsiella have been occurring in Brazil in different species and clones, associated with different plasmids, since 2013.
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13
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Silva BR, Queiroz PA, Amaral PHRD, Freitas BCD, Stocco AF, Sampiron EG, Vandresen F, Tognim MCB, Caleffi-Ferracioli KR, Scodro RBDL, Cardoso RF, La Porta FDA, Siqueira VLD. Polymyxin B Activity Rescue by (−)-Camphene-Based Thiosemicarbazide Against Carbapenem-Resistant Enterobacterales. Microb Drug Resist 2022; 28:962-971. [PMID: 36256860 DOI: 10.1089/mdr.2021.0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Due to the significant shortage of therapeutic options for carbapenem-resistant Enterobacterales (CRE) infections, new drugs or therapeutic combinations are urgently required. We show in this study that (-)-camphene-based thiosemicarbazide (TSC) may act synergistically with polymyxin B (PMB) against CRE, rescuing the activity of this antimicrobial. With the specific aim of a better molecular understanding of this effect caused by the presence of TSC, theoretical calculations were also performed in this study. Based on these findings, it is concluded that the presence of TSC moieties contributes to significant changes in the hydrogen atom charge of PMB structure, which trend more positives for the PMB/TSC system studied. This could lead to the formation of stronger hydrogen bonds in the Enterobacterales active site and, thus contribute to a molecular understanding of the PMB rescue of activity promoted by the presence of TSC moiety. As such, the clinical potential of these drug combinations requires further evaluation.
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Affiliation(s)
- Bruna Renata Silva
- Postgraduate Program in Bioscience and Physiopathology, State University of Maringa, Maringa, Parana, Brazil
| | - Paula Assis Queiroz
- Postgraduate Program in Bioscience and Physiopathology, State University of Maringa, Maringa, Parana, Brazil
| | - Pedro Henrique Rodrigues do Amaral
- Laboratory of Medical Bacteriology, Department of Clinical Analysis and Biomedicine, State University of Maringa, Maringa, Parana, Brazil
| | - Beatriz Cardoso de Freitas
- Postgraduate Program in Bioscience and Physiopathology, State University of Maringa, Maringa, Parana, Brazil
| | - Alison Fernando Stocco
- Department of Chemistry, Federal Technological University of Parana, Londrina, Parana, Brazil
| | - Eloisa Gibin Sampiron
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil
| | - Fábio Vandresen
- Department of Chemistry, Federal Technological University of Parana, Londrina, Parana, Brazil
| | | | - Katiany Rizzieri Caleffi-Ferracioli
- Postgraduate Program in Bioscience and Physiopathology, State University of Maringa, Maringa, Parana, Brazil
- Laboratory of Medical Bacteriology, Department of Clinical Analysis and Biomedicine, State University of Maringa, Maringa, Parana, Brazil
| | - Regiane Bertin de Lima Scodro
- Laboratory of Medical Bacteriology, Department of Clinical Analysis and Biomedicine, State University of Maringa, Maringa, Parana, Brazil
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil
| | - Rosilene Fressatti Cardoso
- Postgraduate Program in Bioscience and Physiopathology, State University of Maringa, Maringa, Parana, Brazil
- Laboratory of Medical Bacteriology, Department of Clinical Analysis and Biomedicine, State University of Maringa, Maringa, Parana, Brazil
| | | | - Vera Lucia Dias Siqueira
- Postgraduate Program in Bioscience and Physiopathology, State University of Maringa, Maringa, Parana, Brazil
- Laboratory of Medical Bacteriology, Department of Clinical Analysis and Biomedicine, State University of Maringa, Maringa, Parana, Brazil
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14
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Genetic Diversity of Virulent Polymyxin-Resistant Klebsiella aerogenes Isolated from Intensive Care Units. Antibiotics (Basel) 2022; 11:antibiotics11081127. [PMID: 36009996 PMCID: PMC9405322 DOI: 10.3390/antibiotics11081127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022] Open
Abstract
This study evaluated the scope and genetic basis of polymyxin-resistant Klebsiella aerogenes in Brazil. Eight polymyxin-resistant and carbapenemase-producing K. aerogenes strains were isolated from patients admitted to the ICU of a tertiary hospital. Bacterial species were identified by automated systems and antimicrobial susceptibility profile was confirmed using broth microdilution. The strains displayed a multidrug resistant profile and were subjected to whole-genome sequencing. Bioinformatic analysis revealed a variety of antimicrobial resistance genes, including the blaKPC-2. No plasmid-mediated colistin resistance gene was identified. Nonetheless, nonsynonymous mutations in mgrB, pmrA, pmrB, and eptA were detected, justifying the colistin resistance phenotype. Virulence genes encoding yersiniabactin, colibactin, and aerobactin were also found, associated with ICEKp4 and ICEKp10, and might be related to the high mortality observed among the patients. In fact, this is the first time ICEKp is identified in K. aerogenes in Brazil. Phylogenetic analysis grouped the strains into two clonal groups, belonging to ST93 and ST16. In summary, the co-existence of antimicrobial resistance and virulence factors is deeply worrying, as it could lead to the emergence of untreatable invasive infections. All these factors reinforce the need for surveillance programs to monitor the evolution and dissemination of multidrug resistant and virulent strains among critically ill patients.
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15
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Conceição-Neto OC, da Costa BS, Pontes LDS, Silveira MC, Justo-da-Silva LH, de Oliveira Santos IC, Teixeira CBT, Tavares e Oliveira TR, Hermes FS, Galvão TC, Antunes LCM, Rocha-de-Souza CM, Carvalho-Assef APD. Polymyxin Resistance in Clinical Isolates of K. pneumoniae in Brazil: Update on Molecular Mechanisms, Clonal Dissemination and Relationship With KPC-Producing Strains. Front Cell Infect Microbiol 2022; 12:898125. [PMID: 35909953 PMCID: PMC9334684 DOI: 10.3389/fcimb.2022.898125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/24/2022] [Indexed: 11/14/2022] Open
Abstract
In Brazil, the production of KPC-type carbapenemases in Enterobacteriales is endemic, leading to widespread use of polymyxins. In the present study, 502 Klebsiella pneumoniae isolates were evaluated for resistance to polymyxins, their genetic determinants and clonality, in addition to the presence of carbapenem resistance genes and evaluation of antimicrobial resistance. Resistance to colistin (polymyxin E) was evaluated through initial selection on EMB agar containing 4% colistin sulfate, followed by Minimal Inhibitory Concentration (MIC) determination by broth microdilution. The susceptibility to 17 antimicrobials was assessed by disk diffusion. The presence of blaKPC, blaNDM and blaOXA-48-like carbapenemases was investigated by phenotypic methods and conventional PCR. Molecular typing was performed by PFGE and MLST. Allelic variants of the mcr gene were screened by PCR and chromosomal mutations in the pmrA, pmrB, phoP, phoQ and mgrB genes were investigated by sequencing. Our work showed a colistin resistance frequency of 29.5% (n = 148/502) in K. pneumoniae isolates. Colistin MICs from 4 to >128 µg/mL were identified (MIC50 = 64 µg/mL; MIC90 >128 µg/mL). All isolates were considered MDR, with the lowest resistance rates observed for amikacin (34.4%), and 19.6% of the isolates were resistant to all tested antimicrobials. The blaKPC gene was identified in 77% of the isolates, in consonance with the high rate of resistance to polymyxins related to its use as a therapeutic alternative. Through XbaI-PFGE, 51 pulsotypes were identified. MLST showed 21 STs, with ST437, ST258 and ST11 (CC11) being the most prevalent, and two new STs were determined: ST4868 and ST4869. The mcr-1 gene was identified in 3 K. pneumoniae isolates. Missense mutations in chromosomal genes were identified, as well as insertion sequences in mgrB. Furthermore, the identification of chromosomal mutations in K. pneumoniae isolates belonging from CC11 ensures its success as a high-risk epidemic clone in Brazil and worldwide.
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Affiliation(s)
- Orlando C. Conceição-Neto
- Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz - Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Faculdade de Medicina, Universidade Estácio de Sá (UNESA), Rio de Janeiro, Brazil
| | - Bianca Santos da Costa
- Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz - Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Leilane da Silva Pontes
- Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz - Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Melise Chaves Silveira
- Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz - Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | | | - Ivson Cassiano de Oliveira Santos
- Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz - Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Camila Bastos Tavares Teixeira
- Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz - Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Thamirys Rachel Tavares e Oliveira
- Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz - Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Fernanda Stephens Hermes
- Laboratório de Genômica Funcional e Bioinformática (LAGFB), Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro, Brazil
| | - Teca Calcagno Galvão
- Laboratório de Genômica Funcional e Bioinformática (LAGFB), Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro, Brazil
| | - L. Caetano M. Antunes
- Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz - Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Cláudio Marcos Rocha-de-Souza
- Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz - Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Ana P. D. Carvalho-Assef
- Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz - Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- *Correspondence: Ana P. D. Carvalho-Assef,
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Migliorini LB, Leaden L, de Sales RO, Correa NP, Marins MM, Koga PCM, Toniolo ADR, de Menezes FG, Martino MDV, Mingorance J, Severino P. The Gastrointestinal Load of Carbapenem-Resistant Enterobacteriacea Is Associated With the Transition From Colonization to Infection by Klebsiella pneumoniae Isolates Harboring the blaKPC Gene. Front Cell Infect Microbiol 2022; 12:928578. [PMID: 35865821 PMCID: PMC9294314 DOI: 10.3389/fcimb.2022.928578] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/26/2022] [Indexed: 01/15/2023] Open
Abstract
Background Healthcare-associated infections by carbapenem-resistant Klebsiella pneumoniae are difficult to control. Virulence and antibiotic resistance genes contribute to infection, but the mechanisms associated with the transition from colonization to infection remain unclear. Objective We investigated the transition from carriage to infection by K. pneumoniae isolates carrying the K. pneumoniae carbapenemase–encoding gene blaKPC (KpKPC). Methods KpKPC isolates detected within a 10-year period in a single tertiary-care hospital were characterized by pulsed-field gel electrophoresis (PFGE), multilocus sequencing typing, capsular lipopolysaccharide and polysaccharide typing, antimicrobial susceptibility profiles, and the presence of virulence genes. The gastrointestinal load of carbapenem-resistant Enterobacteriaceae and of blaKPC-carrying bacteria was estimated by relative quantification in rectal swabs. Results were evaluated as contributors to the progression from carriage to infection. Results No PGFE type; ST-, K-, or O-serotypes; antimicrobial susceptibility profiles; or the presence of virulence markers, such yersiniabactin and colibactin, were associated with carriage or infection, with ST437 and ST11 being the most prevalent clones. Admission to intensive and semi-intensive care units was a risk factor for the development of infections (OR 2.79, 95% CI 1.375 to 5.687, P=0.005), but higher intestinal loads of carbapenem-resistant Enterobacteriaceae or of blaKPC-carrying bacteria were the only factors associated with the transition from colonization to infection in this cohort (OR 8.601, 95% CI 2.44 to 30.352, P<0.001). Conclusion The presence of resistance and virulence mechanisms were not associated with progression from colonization to infection, while intestinal colonization by carbapenem-resistant Enterobacteriacea and, more specifically, the load of gastrointestinal carriage emerged as an important determinant of infection.
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Affiliation(s)
- Letícia Busato Migliorini
- Albert Einstein Research and Education Institute, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Laura Leaden
- Albert Einstein Research and Education Institute, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Romário Oliveira de Sales
- Albert Einstein Research and Education Institute, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Maryana Mara Marins
- Albert Einstein Research and Education Institute, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | | | | | | | - Jesús Mingorance
- Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Patricia Severino
- Albert Einstein Research and Education Institute, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- *Correspondence: Patricia Severino,
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Camargo CH. Current status of NDM-producing Enterobacterales in Brazil: a narrative review. Braz J Microbiol 2022; 53:1339-1344. [PMID: 35690653 DOI: 10.1007/s42770-022-00779-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/03/2022] [Indexed: 01/05/2023] Open
Abstract
New Delhi metallo-β-lactamase (NDM)-producing Enterobacterales was first detected in Brazil in 2014, in a Providencia rettgeri isolate recovered from surveillance swabs in the Southern region. Since then, an increasing number of NDM enzymes have been reported in different species. Nevertheless, comprehensive data on the current epidemiology of NDM-producing Enterobacterales in Brazil are lacking. Therefore, this study reviewed the available information on the status of NDM-producing bacteria in Brazil. The main finding was the diversity of bacteria producing NDM, including Klebsiella, Enterobacter, Morganella, Proteus, Escherichia, and Providencia. Limited data on clonality are available, but a few studies report different clonal backgrounds in NDM-producing K. pneumoniae, likely indicating local outbreaks. Over the years, a rise in the number of reported strains in different locations has been verified; however, different biases may have contributed to this finding. Therefore, a national surveillance study is warranted to identify the actual prevalence and incidence of NDM-producing Enterobacterales in Brazil and their role in patient management and outcome.
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Affiliation(s)
- Carlos Henrique Camargo
- Instituto Adolfo Lutz, Avenida Dr. Arnaldo, 9º Andar, 351, São Paulo, CEP 01246-902, Brazil.
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Rodrigues Pires de Campos L, Farrel Côrtes M, Deo B, Rizek C, Santos S, Perdigão L, Costa SF. Risk factors for bloodstream infection by multidrug-resistant organisms in critically ill patients in a reference trauma hospital. Am J Infect Control 2022; 50:673-679. [PMID: 34756966 DOI: 10.1016/j.ajic.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Bloodstream infections (BSI) by multidrug-resistant (MDR) organisms are responsible for significant mortality in critically ill trauma patients. Our objective is to identify the risk factors for BSI by MDR agents and their resistance mechanisms in a trauma reference hospital. METHODS During 18 months, all patients admitted in our Intensive Care Unit (ICU) were enrolled in this prospective cohort. We included the first episode of BSI by carbapenem-resistant Gram-negative bacteria, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococcus. Demographic and clinical data were compared among patients with and without BSI and variables with P < .05 were tested in a multivariate analysis. We performed PCR for identification of carbapenemase and SCC mec genes and Pulsed-field gel electrophoresis for clonality. RESULTS Out of 1,528 patients, 302 (19.8%) were trauma and 66 (4.3%) had a MDR-BSI (19.5% were trauma). The multivariate analysis showed that mechanical ventilation (OR3.16; 95% CI 1-8; P = .02), hemodialysis (OR3.16; 95% CI 1-5; P = .0003) and surgery (OR1.76; 95% CI 1-3; P = .04) were independent risk factors for MDR-BSI. The most frequent MDR were Klebsiella pneumoniae (n = 26) and MRSA (n = 27). Regarding K pneumoniae strains (n = 24), 20 (83.8%) harbored bla KPC gene and 1 bla NDM. The majority of KPC isolates belonged to a predominant clone; while the MRSA were polyclonal and SCC mec type II. CONCLUSIONS Mechanical ventilation, surgery and hemodialysis were independent risk factors for MDR-BSI in our cohort, but trauma was not. KPC was the main mechanism of resistance among carbapenem-resistant K pneumoniae that belonged to a predominant clone which could indicate cross-transmission.
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Soares de Moraes L, Gomes Magalhaes GL, Material Soncini JG, Pelisson M, Eches Perugini MR, Vespero EC. High mortality from carbapenem-resistant Klebsiella pneumoniae bloodstream infection. Microb Pathog 2022; 167:105519. [PMID: 35483557 DOI: 10.1016/j.micpath.2022.105519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/18/2022]
Abstract
In this study, it was evaluated clinical data of 107 patients with bloodstream infection (BSI) by Klebsiella pneumoniae and performed phenotypic and molecular analyzes in 50.5% (54/107) of the samples, those that showed a resistance profile to carbapenemics. The blaKPC gene was present in 90.4% (49/54) of the samples, blaNDM gene in one sample and, in 7.4% (4/54) of the samples, no carbapenemase gene was found. In the similarity analysis, it was found 4 main clones and 11 samples were not genetically related. The median age of the patients was 58 (40-70) years old and 60.7% (65/107) were male. When comparing two groups of patients with BSI due to K. pneumoniae with and without resistance to carbapenems, the variables ICU permanence, renal failure (IR), previous use of antimicrobials, Charlson's comorbidity index (ICCi), some invasive procedures and death showed a statistically significant difference (p < 0.05). And when relating death as a dependent variable, IR, liver failure and patients with BSI XDR or PDR, were predictors of increased mortality. Our study showed a higher mortality rate in patients with BSI due to carbapenem-resistant pneumonia with additional resistance or not to polymyxins.
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Affiliation(s)
- Luana Soares de Moraes
- Clinical and Laboratory Microbiology, Department of Pathology, Clinical and Toxicological Analysis, State University of Londrina, Paraná, Brazil
| | - Gerusa Luciana Gomes Magalhaes
- Clinical and Laboratory Microbiology, Department of Pathology, Clinical and Toxicological Analysis, State University of Londrina, Paraná, Brazil
| | - João Gabriel Material Soncini
- Clinical and Laboratory Microbiology, Department of Pathology, Clinical and Toxicological Analysis, State University of Londrina, Paraná, Brazil
| | - Marsileni Pelisson
- Clinical and Laboratory Microbiology, Department of Pathology, Clinical and Toxicological Analysis, State University of Londrina, Paraná, Brazil
| | - Marcia Regina Eches Perugini
- Clinical and Laboratory Microbiology, Department of Pathology, Clinical and Toxicological Analysis, State University of Londrina, Paraná, Brazil
| | - Eliana Carolina Vespero
- Clinical and Laboratory Microbiology, Department of Pathology, Clinical and Toxicological Analysis, State University of Londrina, Paraná, Brazil.
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Antimicrobial resistance and genetic background of non-typhoidal Salmonella enterica strains isolated from human infections in São Paulo, Brazil (2000-2019). Braz J Microbiol 2022; 53:1249-1262. [PMID: 35446010 PMCID: PMC9433476 DOI: 10.1007/s42770-022-00748-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/30/2022] [Indexed: 11/02/2022] Open
Abstract
Salmonella enterica causes Salmonellosis, an important infection in humans and other animals. The number of multidrug-resistant (MDR) phenotypes associated with Salmonella spp. isolates is increasing worldwide, causing public health concern. Here, we aim to characterize the antimicrobial-resistant phenotype of 789 non-typhoidal S. enterica strains isolated from human infections in the state of São Paulo, Brazil, along 20 years (2000-2019). Among the non-susceptible isolates, 31.55, 14.06, and 13.18% were resistant to aminoglycosides, tetracycline, and β-lactams, respectively. Moreover, 68 and 11 isolates were considered MDR and Extended Spectrum β-Lactamase (ESBL) producers, respectively, whereas one isolate was colistin-resistant. We selected four strains to obtain a draft of the Genome Sequence; one S. Infantis (ST32), one S. Enteritidis (ST11), one S. I 4,[5],12:i:- (ST19), and one S. Typhimurium (ST313). Among them, three presented at least one of the following antimicrobial resistance genes (AMR) linked to mobile DNA: blaTEM-1B, dfrA1, tetA, sul1, floR, aac(6')-laa, and qnrE1. This is the first description of the plasmid-mediated quinolone resistance (PMQR) gene qnrE1 in a clinical isolate of S. I 4,[5],12:i:-. The S. Typhimurium is a colistin-resistant isolate, but did not harbor mcr genes, but it presented mutations within the mgrB, pmrB, and pmrC regions that might be linked to the colistin-resistant phenotype. The virulence pattern of the four isolates resembled the virulence pattern of the highly pathogenic S. Typhimurium UK-1 reference strain in assays involving the in vivo Galleria mellonella model. In conclusion, most isolates studied here are susceptible, but a small percentage present an MDR or ESBL-producer and pathogenic phenotype. Sequence analyses revealed plasmid-encoded AMR genes, such as β-lactam and fluoroquinolone resistance genes, indicating that these characteristics can be potentially disseminated among other bacterial strains.
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Zhang J, Liu W, Shi W, Cui X, Liu Y, Lu Z, Xiao W, Hua T, Yang M. A Nomogram With Six Variables Is Useful to Predict the Risk of Acquiring Carbapenem-Resistant Microorganism Infection in ICU Patients. Front Cell Infect Microbiol 2022; 12:852761. [PMID: 35402310 PMCID: PMC8990894 DOI: 10.3389/fcimb.2022.852761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Carbapenem-resistant microorganism (CRO) transmission in the medical setting confers a global threat to public health. However, there is no established risk prediction model for infection due to CRO in ICU patients. This study aimed to develop a nomogram to predict the risk of acquiring CRO infection in patients with the first ICU admission and to determine the length of ICU stay (ICU-LOS) and 28-day survival. Methods Patient data were retrieved from the Medical Information Mart for Intensive Care (MIMIC-IV) database based on predetermined inclusion and exclusion criteria. A CRO was defined as a bacterium isolated from any humoral microbial culture that showed insensitivity or resistance to carbapenems. The characteristics of CRO and non-CRO patients in the first ICU admission were compared. Propensity score matching was applied to balance the differences between the CRO and non-CRO cohorts. Kaplan–Meier curves were constructed to determine the 28-day survival rate and ICU-LOS. Furthermore, after randomization of the CRO cohort into the training and validation sets, a predictive nomogram was constructed based on LASSO regression and Logistic regression analysis, and its performance was verified by internal validation. Results Overall, 4531 patients who had first ICU admission as recorded in MIMIC-IV were enrolled, 183 (4.04%) of whom were diagnosed with CRO infection. Moreover, CRO infection was independently associated with 28-day survival and ICU-LOS in ICU patients. Parameters eligible for inclusion in this nomogram were male sex, hemoglobin-min, temperature-max, use of a peripherally inserted central catheter line, dialysis treatment, and use of carbapenems. This nomogram showed a better performance as indicated by the area under the receiver operating characteristic curve values of 0.776 (95% confidence interval [CI] 0.667-0.750) and 0.723 (95% CI 0.556-0.855) in the training and validation sets, respectively, in terms of predicting the risk of acquiring CRO infection. Conclusions CRO infection was independently associated with ICU-LOS and 28-day survival in patients with first ICU admission. The nomogram showed the best prediction of the risk of acquiring CRO infection in ICU patients. Based on the nomogram-based scoring, we can management the risk factors and guide individualized prevention and control of CRO.
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Affiliation(s)
- Jin Zhang
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wanjun Liu
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Shi
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xuanxuan Cui
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yu Liu
- Key Laboratory of Intelligent Computing and Signal Processing, Ministry of Education, Anhui University, Hefei, China
| | - Zongqing Lu
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wenyan Xiao
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tianfeng Hua
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Min Yang
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Min Yang,
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WHO Critical Priority Escherichia coli as One Health Challenge for a Post-Pandemic Scenario: Genomic Surveillance and Analysis of Current Trends in Brazil. Microbiol Spectr 2022; 10:e0125621. [PMID: 35234515 PMCID: PMC8941879 DOI: 10.1128/spectrum.01256-21] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The dissemination of carbapenem-resistant and third generation cephalosporin-resistant pathogens is a critical issue that is no longer restricted to hospital settings. The rapid spread of critical priority pathogens in Brazil is notably worrying, considering its continental dimension, the diversity of international trade, livestock production, and human travel. We conducted a nationwide genomic investigation under a One Health perspective that included Escherichia coli strains isolated from humans and nonhuman sources, over 45 years (1974–2019). One hundred sixty-seven genomes were analyzed extracting clinically relevant information (i.e., resistome, virulome, mobilome, sequence types [STs], and phylogenomic). The endemic status of extended-spectrum β-lactamase (ESBL)-positive strains carrying a wide diversity of blaCTX-M variants, and the growing number of colistin-resistant isolates carrying mcr-type genes was associated with the successful expansion of international ST10, ST38, ST115, ST131, ST354, ST410, ST648, ST517, and ST711 clones; phylogenetically related and shared between human and nonhuman hosts, and polluted aquatic environments. Otherwise, carbapenem-resistant ST48, ST90, ST155, ST167, ST224, ST349, ST457, ST648, ST707, ST744, ST774, and ST2509 clones from human host harbored blaKPC-2 and blaNDM-1 genes. A broad resistome to other clinically relevant antibiotics, hazardous heavy metals, disinfectants, and pesticides was further predicted. Wide virulome associated with invasion/adherence, exotoxin and siderophore production was related to phylogroup B2. The convergence of wide resistome and virulome has contributed to the persistence and rapid spread of international high-risk clones of critical priority E. coli at the human-animal-environmental interface, which must be considered a One Health challenge for a post-pandemic scenario. IMPORTANCE A One Health approach for antimicrobial resistance must integrate whole-genome sequencing surveillance data of critical priority pathogens from human, animal and environmental sources to track hot spots and routes of transmission and developing effective prevention and control strategies. As part of the Grand Challenges Explorations: New Approaches to Characterize the Global Burden of Antimicrobial Resistance Program, we present genomic data of WHO critical priority carbapenemase-resistant, ESBL-producing, and/or colistin-resistant Escherichia coli strains isolated from humans and nonhuman sources in Brazil, a country with continental proportions and high levels of antimicrobial resistance. The present study provided evidence of epidemiological and clinical interest, highlighting that the convergence of wide virulome and resistome has contributed to the persistence and rapid spread of international high-risk clones of E. coli at the human-animal-environmental interface, which must be considered a One Health threat that requires coordinated actions to reduce its incidence in humans and nonhuman hosts.
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Martins WM, Lenzi MH, Narciso AC, Dantas P, Andrey DO, Yang QE, Sands K, Medeiros EA, Walsh TR, Gales AC. Silent Circulation of BKC-1-producing Klebsiella pneumoniae ST442: Molecular and Clinical Characterisation of an Early and Unreported Outbreak. Int J Antimicrob Agents 2022; 59:106568. [DOI: 10.1016/j.ijantimicag.2022.106568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 01/25/2022] [Accepted: 03/06/2022] [Indexed: 11/29/2022]
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Acquisition of carbapenem-resistant gram-negative bacilli among intensive care unit (ICU) patients with no previous use of carbapenems: Indirect population impact of antimicrobial use. Infect Control Hosp Epidemiol 2022; 43:1575-1579. [DOI: 10.1017/ice.2021.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Objective:
To measure the impact of exposure to patients using carbapenem on the acquisition of carbapenem-resistant gram-negative bacilli (CR-GNB) among patients not using carbapenems.
Design:
An ecological study and a cohort study.
Setting:
Two medical surgical intensive care units (ICUs) in inner Brazil.
Participants:
Patients admitted to 2 ICUs from 2013 through 2018 to whom carbapenem was not prescribed.
Methods:
In the ecologic study, the monthly use of carbapenems (days of therapy [DOT] per 1,000 patient days) was tested for linear correlation with the 2-month moving average of incidence CR-GNB among patients to whom carbapenem was not prescribed. In the cohort study, those patients were addressed individually for risk factors (demographics, invasive interventions, use of antimicrobials) for acquisition of CR-GNB, including time at risk and the “carbapenem pressure,” described as the aggregate DOT among other ICU patients during time at risk. The analysis was performed in univariate and multivariable Poisson regression models.
Results:
The linear regression model revealed an association of total carbapenem use and incidence of CR-GNB (coefficient, 0.04; 95% confidence interval [CI], 0.02–0.06; P = .001). In the cohort model, the adjusted rate ratio (RR) for carbapenem DOT was 1.009 (95% CI, 1.001–1.018; P = .03). Other significant risk factors were mechanical ventilation and the previous use of ceftazidime (with or without avibactam).
Conclusions:
Every additional DOT of total carbapenem use increased the risk of CR-GNB acquisition by patients not using carbapenems by nearly 1%. We found evidence for a population (“herd effect”-like) impact of antimicrobial use in the ICUs.
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Ledger EVK, Sabnis A, Edwards AM. Polymyxin and lipopeptide antibiotics: membrane-targeting drugs of last resort. MICROBIOLOGY (READING, ENGLAND) 2022; 168. [PMID: 35118938 PMCID: PMC8941995 DOI: 10.1099/mic.0.001136] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The polymyxin and lipopeptide classes of antibiotics are membrane-targeting drugs of last resort used to treat infections caused by multi-drug-resistant pathogens. Despite similar structures, these two antibiotic classes have distinct modes of action and clinical uses. The polymyxins target lipopolysaccharide in the membranes of most Gram-negative species and are often used to treat infections caused by carbapenem-resistant species such as Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa. By contrast, the lipopeptide daptomycin requires membrane phosphatidylglycerol for activity and is only used to treat infections caused by drug-resistant Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. However, despite having distinct targets, both antibiotic classes cause membrane disruption, are potently bactericidal in vitro and share similarities in resistance mechanisms. Furthermore, there are concerns about the efficacy of these antibiotics, and there is increasing interest in using both polymyxins and daptomycin in combination therapies to improve patient outcomes. In this review article, we will explore what is known about these distinct but structurally similar classes of antibiotics, discuss recent advances in the field and highlight remaining gaps in our knowledge.
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Affiliation(s)
- Elizabeth V K Ledger
- MRC Centre for Molecular Bacteriology and Infection, Imperial College London, Armstrong Rd, London, SW7 2AZ, UK
| | - Akshay Sabnis
- MRC Centre for Molecular Bacteriology and Infection, Imperial College London, Armstrong Rd, London, SW7 2AZ, UK
| | - Andrew M Edwards
- MRC Centre for Molecular Bacteriology and Infection, Imperial College London, Armstrong Rd, London, SW7 2AZ, UK
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Azyzov IS, Martinovich А. Detection of mcr-1-mediated resistance to polymyxins in Enterobacterales using colistin disk chelator application. CLINICAL MICROBIOLOGY AND ANTIMICROBIAL CHEMOTHERAPY 2022. [DOI: 10.36488/cmac.2022.3.254-260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective.
To evaluate the possibility of using the colistin disk chelator application (CDCA) method as simple and available screening tool for detection of mcr-1-mediated resistance to polymyxins in Enterobacterales.
Materials and Methods.
A total of 47 colistin-resistant Enterobacterales isolates obtained in 2014–2020 within multicenter MARATHON study were included in the experiment. Colistin susceptibility testing was performed using Mueller–Hinton broth microdilution method according to ISO 20776-1:2006. Interpretation of the results was performed according to EUCAST v.12.0 clinical breakpoints. MCR-genes were detected by multiplex real-time PCR. Phenotypic screening for mcr-expression was performed on Mueller–Hinton agar by application of dipicolinic acid in concentration of 1,000 mcg/disk in 10 µL volume per disk and 0.5 M solution of EDTA in 5 µL volume per disk. Chelating effect was registered by differences in zone of growth inhibition around colistin disks with and without chelator. Measurements were performed with the help of caliper in millimeters. Statistical data processing was carried out in accordance with guidelines for statistical analysis in medical researches using MS-Excel tool.
Results.
In 25 of 47 included in the experiment enterobacteria isolates mcr-genes were detected by molecular method. MCR-detection by CDCA method identified the average difference value of the zones of growth inhibition for colistin and its combination with EDTA and DPA as 4.1 mm and 3.7 mm respectively for mcr-positive isolates and 1.7 mm and 1.2 mm respectively for mcr-negative isolates. Statistical analysis estimated that a difference of ≥ 3 mm in zone of growth inhibition for combination of colistin with one of the chelating agents when compared to colistin only allows us to conclude that a studied isolated carries mcr-1-mediated resistance to polymyxins. In addition, sensitivity of the test was 96% and specificity was 91% if DPA is used, while EDTA showed only 88% sensitivity and 77% specificity.
Conclusions.
Proposed method appears as available technique for phenotypic screening of the Enterobacterales order for mcr-1-mediated resistance to polymyxins for practical laboratories in present conditions. The use of DPA is preferred because of better specificity and sensitivity rates.
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Silva KED, Rossato L, Leite AF, Simionatto S. Overview of polymyxin resistance in Enterobacteriaceae. Rev Soc Bras Med Trop 2022; 55:e0349. [PMID: 35239902 PMCID: PMC8909443 DOI: 10.1590/0037-8682-0349-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/12/2021] [Indexed: 11/21/2022] Open
Abstract
Polymyxin antibiotics are disfavored owing to their potential clinical toxicity, especially nephrotoxicity. However, the dry antibiotic development pipeline, together with the increasing global prevalence of infections caused by multidrug-resistant (MDR) gram-negative bacteria, have renewed clinical interest in these polypeptide antibiotics. This review highlights the current information regarding the mechanisms of resistance to polymyxins and their molecular epidemiology. Knowledge of the resistance mechanisms and epidemiology of these pathogens is critical for the development of novel antibacterial agents and rapid treatment choices.
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The Spread of NDM-1 and NDM-7-Producing Klebsiella pneumoniae Is Driven by Multiclonal Expansion of High-Risk Clones in Healthcare Institutions in the State of Pará, Brazilian Amazon Region. Antibiotics (Basel) 2021; 10:antibiotics10121527. [PMID: 34943739 PMCID: PMC8698286 DOI: 10.3390/antibiotics10121527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
Carbapenem resistance among Klebsiella pneumoniae isolates is often related to carbapenemase genes, located in genetic transmissible elements, particularly the blaKPC gene, which variants are spread in several countries. Recently, reports of K. pneumoniae isolates harboring the blaNDM gene have increased dramatically along with the dissemination of epidemic high-risk clones (HRCs). In the present study, we report the multiclonal spread of New Delhi metallo-beta-lactamase (NDM)-producing K. pneumoniae in different healthcare institutions in the state of Pará, Northern Brazil. A total of 23 NDM-producing isolates were tested regarding antimicrobial susceptibility testing features, screening of carbapenemase genes, and genotyping by multilocus sequencing typing (MLST). All K. pneumoniae isolates were determined as multidrug-resistant (MDR), being mainly resistant to carbapenems, cephalosporins, and fluoroquinolones. The blaNDM-7 (60.9%-14/23) and blaNDM-1 (34.8%-8/23) variants were detected. MLST genotyping revealed the predomination of HRCs, including ST11/CC258, ST340/CC258, ST15/CC15, ST392/CC147, among others. To conclude, the present study reveals the contribution of HRCs and non-HRCs in the spread of NDM-1 and NDM-7-producing K. pneumoniae isolates in Northern (Amazon region) Brazil, along with the first detection of NDM-7 variant in Latin America and Brazil, highlighting the need for surveillance and control of strains that may negatively impact healthcare and antimicrobial resistance.
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Binsker U, Käsbohrer A, Hammerl JA. Global colistin use: A review of the emergence of resistant Enterobacterales and the impact on their genetic basis. FEMS Microbiol Rev 2021; 46:6382128. [PMID: 34612488 PMCID: PMC8829026 DOI: 10.1093/femsre/fuab049] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/04/2021] [Indexed: 02/06/2023] Open
Abstract
The dramatic global rise of MDR and XDR Enterobacterales in human medicine forced clinicians to the reintroduction of colistin as last-resort drug. Meanwhile, colistin is used in the veterinary medicine since its discovery, leading to a steadily increasing prevalence of resistant isolates in the livestock and meat-based food sector. Consequently, transmission of resistant isolates from animals to humans, acquisition via food and exposure to colistin in the clinic are reasons for the increased prevalence of colistin-resistant Enterobacterales in humans in the last decades. Initially, resistance mechanisms were caused by mutations in chromosomal genes. However, since the discovery in 2015, the focus has shifted exclusively to mobile colistin resistances (mcr). This review will advance the understanding of chromosomal-mediated resistance mechanisms in Enterobacterales. We provide an overview about genes involved in colistin resistance and the current global situation of colistin-resistant Enterobacterales. A comparison of the global colistin use in veterinary and human medicine highlights the effort to reduce colistin sales in veterinary medicine under the One Health approach. In contrast, it uncovers the alarming rise in colistin consumption in human medicine due to the emergence of MDR Enterobacterales, which might be an important driver for the increasing emergence of chromosome-mediated colistin resistance.
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Affiliation(s)
- Ulrike Binsker
- Department Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Annemarie Käsbohrer
- Department Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany.,Department for Farm Animals and Veterinary Public Health, Institute of Veterinary Public Health, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Jens A Hammerl
- Department Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
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Screening of Epidemiologically Significant Mechanisms of Antibiotics to β-Lactams in Enterobacteriaceae - Pathogens of Zoonoses. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2021. [DOI: 10.22207/jpam.15.3.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Among the acquired mechanisms of resistance to antibiotics of microorganisms, the production of beta-lactamases, enzymes that inactivate penicillins, cephalosporins, carbapenems, and monobactams, is widespread. Most often, such beta-lactamases, in particular ESBL (extended-spectrum beta-lactamases), are capable of destroying III and IV generations of cephalosporins. One of the important ESBL producers is Escherichia coli and, to a lesser extent, Salmonella enteritidis, which are clinically significant in animals and humans. The purpose of the study was to screen ESBL DDM using cephalosporin markers and screening of mobile extrachromosomal factors of bacterial heredity – plasmids (potentially dangerous factors of genetic transport) in isolates of E. coli and S. enteritidis, polyresistant to aminoderms, from environmental objects, patho- and biological material, raw materials and products of animal origin. Results of our studies have shown the level of their distribution among animals, poultry, since from 13 field isolates of E. coli isolated from the milk of cows with mastitis and pathological material from pigs, ESBL production was found in 3 strains (23.1%) and from 18 field isolates of S. enteritidis isolated from pathological material from poultry, ESBL production was found in 2 strains (11.1%). Based on the results of molecular genetics studies, the presence of resistance plasmids (R-plasmids) in 9 field E. coli isolates was confirmed, 4 of which produced acquired beta-lactamases, incl. ESBL and 8 field isolates of S. enteritidis, 7 of which confirmed the presence of acquired carbapenemases.
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Carramaschi IN, Lopes JCO, Leite JA, Carneiro MT, Barbosa RR, Boas MHV, Rangel K, Chagas TPG, Queiroz MM, Zahner V. Surveillance of antimicrobial resistant bacteria in flies (Diptera) in Rio de Janeiro city. Acta Trop 2021; 220:105962. [PMID: 34029528 DOI: 10.1016/j.actatropica.2021.105962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/11/2022]
Abstract
Antimicrobial-resistant bacteria were isolated from muscoid dipterans collected at five different areas of Rio de Janeiro city, in proximity to hospitals. Extracts obtained by maceration of flies were diluted and used as inocula for different culture media, with or without antibiotic (ceftriaxone 1 mg/L) supplementation. Purified isolates were submitted to antimicrobial susceptibility testing (AST). Bacterial identification was performed by MALDI TOF Microflex LT (Bruker Daltonics). A total of 197 bacterial strains were obtained from 117 dipterous muscoids. Forty-two flies (35.9%) carried bacteria resistant to at least one antimicrobial, while 7 insects (5.9%) carried multidrug-resistant bacteria (MDR), which were all members of the family Enterobacteriaceae. Among 10 MDR bacteria (5%), 5 strains (2,5%) were positive by PCR for one or more of the following antibiotic resistance genes: aac(6')-Ib, blaTEM-1, blaCTX-M-15, blaKPC-2 and blaNDM-1. Analysis of variance (ANOVA) and cluster analysis compared the number of resistant isolates per collection point and showed that a single location was statistically different from the others with regard to resistance. Although there are still no criteria to determine the environmental contamination by resistant bacteria the fact that they have been isolated from flies is an indication of a disseminated contamination. As such, these insects may be useful in monitoring programs of antibiotic resistance in non-hospital environments, where they could function as sentinels.
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Affiliation(s)
- Isabel Nogueira Carramaschi
- Laboratório de Entomologia Médica e Forense, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Manguinhos, Cep, Rio de Janeiro 21040-360, Brazil
| | - Jonathan Christian O Lopes
- Laboratório de Entomologia Médica e Forense, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Manguinhos, Cep, Rio de Janeiro 21040-360, Brazil
| | - Jéssica Albuquerque Leite
- Laboratório de Entomologia Médica e Forense, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Manguinhos, Cep, Rio de Janeiro 21040-360, Brazil
| | - Marcos Tavares Carneiro
- Laboratório de Microbiologia do Departamento de Saneamento e Saúde Ambiental, Escola Nacional de Saúde Pública Sérgio Arouca, R. Leopoldo Bulhões, 1480 - Manguinhos, Rio de Janeiro 21041-210, Brazil
| | - Rodrigo Rocha Barbosa
- Laboratório de Entomologia Médica e Forense, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Manguinhos, Cep, Rio de Janeiro 21040-360, Brazil; Centro Universitário de Volta Redonda. Av. Paulo Erlei Alves Abrantes, 1325 - Três Poços, Volta Redonda - RJ 27240-560, Brazil
| | - Maria Helena Villas Boas
- Laboratório de Saneantes, Instituto Nacional de Controle de Qualidade em Saúde, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Manguinhos, Cep, Rio de Janeiro 21040-360, Brazil
| | - Karyne Rangel
- Laboratório de Bioquímica de Proteínas e Peptídeos, Centro de Desenvolvimento Tecnológico em Saúde Fiocruz, Avenida Brasil, 4365, Manguinhos, Cep, Rio de Janeiro 21040-360, Brazil
| | - Thiago Pavoni Gomes Chagas
- Departamento de Patologia, Faculdade de Medicina, Universidade Federal Fluminense. Rua Marquês de Paraná, 303, Centro, Cep, Niterói 24220-000, Brazil
| | - Margareth Mc Queiroz
- Laboratório de Entomologia Médica e Forense, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Manguinhos, Cep, Rio de Janeiro 21040-360, Brazil
| | - Viviane Zahner
- Laboratório de Entomologia Médica e Forense, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Manguinhos, Cep, Rio de Janeiro 21040-360, Brazil.
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The Carbapenemase BKC-1 from Klebsiella pneumoniae Is Adapted for Translocation by Both the Tat and Sec Translocons. mBio 2021; 12:e0130221. [PMID: 34154411 PMCID: PMC8262980 DOI: 10.1128/mbio.01302-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The cell envelope of Gram-negative bacteria consists of two membranes surrounding the periplasm and peptidoglycan layer. β-Lactam antibiotics target the periplasmic penicillin-binding proteins that synthesize peptidoglycan, resulting in cell death. The primary means by which bacterial species resist the effects of β-lactam drugs is to populate the periplasmic space with β-lactamases. Resistance to β-lactam drugs is spread by lateral transfer of genes encoding β-lactamases from one species of bacteria to another. However, the resistance phenotype depends in turn on these “alien” protein sequences being recognized and exported across the cytoplasmic membrane by either the Sec or Tat protein translocation machinery of the new bacterial host. Here, we examine BKC-1, a carbapenemase from an unknown bacterial source that has been identified in a single clinical isolate of Klebsiella pneumoniae. BKC-1 was shown to be located in the periplasm, and functional in both K. pneumoniae and Escherichia coli. Sequence analysis revealed the presence of an unusual signal peptide with a twin arginine motif and a duplicated hydrophobic region. Biochemical assays showed this signal peptide directs BKC-1 for translocation by both Sec and Tat translocons. This is one of the few descriptions of a periplasmic protein that is functionally translocated by both export pathways in the same organism, and we suggest it represents a snapshot of evolution for a β-lactamase adapting to functionality in a new host.
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33
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Raro OHF, Collar GS, da Silva RMC, Vezzaro P, Mott MP, da Cunha GR, Riche CVW, Dias C, Caierão J. Performance of polymyxin B agar-based tests among carbapenem-resistant Enterobacterales. Lett Appl Microbiol 2021; 72:767-773. [PMID: 33629416 DOI: 10.1111/lam.13467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 01/10/2023]
Abstract
Therapeutic options for infections caused by Carbapenem-resistant Enterobacterales (CRE) are restricted and include polymyxins-centred schemes. Evaluation of in vitro susceptibility is difficult and time consuming. Agar-based methodologies are an alternative to broth microdilution (BMD) and we aimed to evaluate the accuracy of those methods among Enterobacterales. A total of 137 non-duplicated CRE were subjected to polymyxin B BMD, agar screening test (Mueller Hinton plates containing 3 µg ml-1 of polymyxin B) and agar dilution (antibiotic serially diluted 0·25-64 µg ml-1 ). CRE of 42·3% were resistant to polymyxin B (MICs range: 0·25->64 µg ml-1 ) and 16·8% presented borderline MICs. Sensitivity, specificity, PPV and NPV were 86·2, 98·7, 98 and 90·7% for screening test and 86·2, 97·5, 96·1 and 90·6% for agar dilution. ME was 0·73 and 1·5% for screening and agar dilution respectively; VME was 5·8% for both techniques. In general, agar-based methods had a good performance. As far as we know, this is the first study to propose an agar screening test using polymyxin B instead of colistin.
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Affiliation(s)
- O H F Raro
- Department of Basic Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - G S Collar
- Department of Analysis, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - R M C da Silva
- Department of Basic Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - P Vezzaro
- Department of Basic Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - M P Mott
- Department of Basic Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.,Department of Microbiology, Ernesto Dornelles Hospital, Porto Alegre, Brazil
| | - G R da Cunha
- Department of Microbiology, Ernesto Dornelles Hospital, Porto Alegre, Brazil
| | - C V W Riche
- Department of Basic Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.,Department of Microbiology, Ernesto Dornelles Hospital, Porto Alegre, Brazil
| | - C Dias
- Department of Basic Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - J Caierão
- Department of Analysis, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Post-Graduation Program of Pharmaceutical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Prevalence of blaKPC-2, blaKPC-3 and blaKPC-30-Carrying Plasmids in Klebsiella pneumoniae Isolated in a Brazilian Hospital. Pathogens 2021; 10:pathogens10030332. [PMID: 33809215 PMCID: PMC7998191 DOI: 10.3390/pathogens10030332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
Klebsiella pneumoniae carbapenemase (KPC) actively hydrolyzes carbapenems, antibiotics often used a last-line treatment for multidrug-resistant bacteria. KPC clinical relevance resides in its widespread dissemination. In this work, we report the genomic context of KPC coding genes blaKPC-2, blaKPC-3 and blaKPC-30 in multidrug-resistant Klebsiellapneumoniae isolates from Brazil. Plasmids harboring blaKPC-3 and blaKPC-30 were identified. Fifteen additional carbapenem-resistant K. pneumoniae isolates were selected from the same tertiary hospital, collected over a period of 8 years. Their genomes were sequenced in order to evaluate the prevalence and dissemination of blaKPC-harboring plasmids. We found that blaKPC genes were mostly carried by one of two isoforms of transposon Tn4401 (Tn4401a or Tn4401b) that were predominantly located on plasmids highly similar to the previously described plasmid pKPC_FCF3SP (IncN). The identified pKPC_FCF3SP-like plasmids carried either blaKPC-2 or blaKPC-30. Two K. pneumoniae isolates harbored pKpQIL-like (IncFII) plasmids, only recently identified in Brazil; one of them harbored blaKPC-3 in a Tn4401a transposon. Underlining the risk of horizontal spread of KPC coding genes, this study reports the prevalence of blaKPC-2 and the recent spread of blaKPC-3, and blaKPC-30, in association with different isoforms of Tn4401, together with high synteny of plasmid backbones among isolates studied here and in comparison with previous reports.
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Endophytic Lifestyle of Global Clones of Extended-Spectrum β-Lactamase-Producing Priority Pathogens in Fresh Vegetables: a Trojan Horse Strategy Favoring Human Colonization? mSystems 2021; 6:6/1/e01125-20. [PMID: 33563779 PMCID: PMC7883542 DOI: 10.1128/msystems.01125-20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The global spread of antibiotic-resistant bacteria and their resistance genes is a critical issue that is no longer restricted to hospital settings, but also represents a growing problem involving environmental and food safety. In this study, we have performed a microbiological and genomic investigation of critical priority pathogens resistant to broad-spectrum cephalosporins and showing endophytic lifestyles in fresh vegetables sold in a country with high endemicity of extended-spectrum β-lactamases (ESBLs). We report the isolation of international high-risk clones of CTX-M-15-producing Escherichia coli, belonging to clonal complexes CC38 and CC648, and Klebsiella pneumoniae of complex CC307 from macerated tissue of surface-sterilized leaves of spinach, cabbage, arugula, and lettuce. Regardless of species, all ESBL-positive isolates were able to endophytically colonize common bean (Phaseolus vulgaris) seedlings, showed resistance to acid pH, and had a multidrug-resistant (MDR) profile to clinically relevant antibiotics (i.e., broad-spectrum cephalosporins, aminoglycosides, and fluoroquinolones). Genomic analysis of CTX-M-producing endophytic Enterobacterales revealed a wide resistome (antibiotics, biocides, disinfectants, and pesticides) and virulome, and genes for endophytic fitness and for withstanding acidic conditions. Transferable IncFIB and IncHI2A plasmids carried bla CTX-M-15 genes and, additionally, an IncFIB plasmid (named pKP301cro) also harbored genes encoding resistance to heavy metals. These data support the hypothesis that fresh vegetables marketed for consumption can act as a figurative Trojan horse for the hidden spread of international clones of critical WHO priority pathogens producing ESBLs, and/or their resistance genes, to humans and other animals, which is a critical issue within a food safety and broader public and environmental health perspective.IMPORTANCE Extended-spectrum β-lactamases (ESBL)-producing Enterobacterales are a leading cause of human and animal infections, being classified as critical priority pathogens by the World Health Organization. Epidemiological studies have shown that spread of ESBL-producing bacteria is not a problem restricted to hospitals, but also represents a growing problem involving environmental and food safety. In this regard, CTX-M-type β-lactamases have become the most widely distributed and clinically relevant ESBLs worldwide. Here, we have investigated the occurrence and genomic features of ESBL-producing Enterobacterales in surface-sterilized fresh vegetables. We have uncovered that international high-risk clones of CTX-M-15-producing Escherichia coli and Klebsiella pneumoniae harboring a wide resistome and virulome, carry additional genes for endophytic fitness and resistance to acidic conditions. Furthermore, we have demonstrated that these CTX-M-15-positive isolates are able to endophytically colonize plant tissues. Therefore, we believe that fresh vegetables can act as a figurative Trojan horse for the hidden spread of critical priority pathogens exhibiting endophytic lifestyles.
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Liu Y, Jiang J, Ed-Dra A, Li X, Peng X, Xia L, Guo Q, Yao G, Yue M. Prevalence and genomic investigation of Salmonella isolates recovered from animal food-chain in Xinjiang, China. Food Res Int 2021; 142:110198. [PMID: 33773671 DOI: 10.1016/j.foodres.2021.110198] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/15/2021] [Accepted: 01/27/2021] [Indexed: 02/07/2023]
Abstract
Salmonella is a major foodborne pathogen worldwide, causing serious cases of morbidity and mortality due to the consumption of contaminated foods. Animal-borne foods were considered the main source of transferring Salmonella to humans; however, route surveillance by genomic platforms along the food-chain is limited in China. Here, we proceeded to the application of whole genome sequencing in the epidemiological analysis of Salmonella isolated along the food-chain in Xinjiang, China. A total of 2408 samples were collected from farms, slaughterhouses, and markets, and subjected to the isolation of Salmonella strains. 314 (13.04%) of the samples were positive for Salmonella. Phenotypic antimicrobial resistance was conducted by the broth dilution method using 14 antimicrobial agents belonging to ten classes for all 314 isolates. A selection of representative 103 isolates was subjected to whole-genome sequencing for understanding the Salmonella diversity, including serovars, antimicrobial and virulence genes, plasmid types, multi-locus sequence types, and allelic types. We found that S. Agona was the dominant serovar and O:4(B) was the dominant serogroup. The dominant genotype was ST13 and each serovar has a unique MLST pattern. Plasmids prediction reported Col(MGD2)_1 and Col(Ye4449)_1 as the dominant plasmids, in addition to the detection of IncFII(S)_1 and IncFIB(S)_1 carried by all S. Enteritidis isolates. Importantly, virulence genes prediction showed the presence of cdtB gene encoding typhoid toxins, spv genes, and pef gene cluster encoding fimbriae in the genomes of S. Indiana and S. Enteritidis. Phenotypic antimicrobial resistance identified 92.04% of the sampled isolates as multi-drug resistance (MDR), with high resistance to tetracycline (78.03%; 245/314), amoxicillin/ clavulanic acid (75.80%; 238/314), and ampicillin (70.70%; 222/314). Together, we firstly reported the prevalence of MDR Salmonella isolates harboring critical virulence factors transmission via animal-borne food-chain in Xinjiang, hence route surveillance by whole-genome sequencing platform could facilitate recognition and project early warning for the emerging MDR clones along the food-chain.
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Affiliation(s)
- Yingyu Liu
- College of Veterinary Medicine, Xinjiang Agricultural University, Urumqi, China
| | - Jindou Jiang
- College of Veterinary Medicine, Xinjiang Agricultural University, Urumqi, China
| | - Abdelaziz Ed-Dra
- Department of Veterinary Medicine & Institute of Preventive Veterinary Sciences, Zhejiang University College of Animal Sciences, Hangzhou, China
| | - Xiaomeng Li
- Department of Veterinary Medicine & Institute of Preventive Veterinary Sciences, Zhejiang University College of Animal Sciences, Hangzhou, China
| | - Xianqi Peng
- Department of Veterinary Medicine & Institute of Preventive Veterinary Sciences, Zhejiang University College of Animal Sciences, Hangzhou, China
| | - Lining Xia
- College of Veterinary Medicine, Xinjiang Agricultural University, Urumqi, China
| | - Qingyong Guo
- College of Veterinary Medicine, Xinjiang Agricultural University, Urumqi, China
| | - Gang Yao
- College of Veterinary Medicine, Xinjiang Agricultural University, Urumqi, China.
| | - Min Yue
- Department of Veterinary Medicine & Institute of Preventive Veterinary Sciences, Zhejiang University College of Animal Sciences, Hangzhou, China; Zhejiang Provincial Key Laboratory of Preventive Veterinary Medicine, Hangzhou, China; State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Hainan Institute of Zhejiang University, Sanya, China.
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37
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Sellera FP, Fuga B, Fontana H, Esposito F, Cardoso B, Konno S, Berl C, Cappellanes MH, Cortez M, Ikeda M, de Souza CM, Cerdeira L, Lincopan N. Detection of IncN-pST15 one-health plasmid harbouring bla KPC-2 in a hypermucoviscous Klebsiella pneumoniae CG258 isolated from an infected dog, Brazil. Transbound Emerg Dis 2021; 68:3083-3088. [PMID: 33507616 PMCID: PMC9290030 DOI: 10.1111/tbed.14006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 12/14/2022]
Abstract
The emergence and rapid spread of carbapenemase‐producing Enterobacterales represents a serious public health concern. Critically, these global priority bacteria have begun to be reported in companion animals, implying a potential risk of cross‐transmission between humans and pets. Using long‐read (MinION) and short‐read (Illumina) sequencing technologies, we have identified and characterized a hypermucoviscous KPC‐2‐producing Klebsiella pneumoniae strain belonging to the high‐risk international clone ST11/CG258, in a dog with urinary tract infection. Strikingly, the blaKPC‐2 gene was carried by a 54‐kb IncN plasmid assignated to ST15, which shared 99.8 and 96.8% pairwise identity with IncN‐pST15 plasmids from human and environmental K. pneumoniae strains, respectively; all come from an area with high endemicity of KPC‐2. Our findings suggest that IncN‐pST15 plasmids conferring carbapenem resistance can play as important a role as clonal transmission of K. pneumoniae, representing another major challenge for One Health.
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Affiliation(s)
- Fábio P Sellera
- Department of Internal Medicine, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil.,One Health Brazilian Resistance Project (OneBR), São Paulo, Brazil
| | - Bruna Fuga
- One Health Brazilian Resistance Project (OneBR), São Paulo, Brazil.,Department of Clinical Analysis, School of Pharmacy, Universidade de São Paulo, São Paulo, Brazil.,Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Herrison Fontana
- One Health Brazilian Resistance Project (OneBR), São Paulo, Brazil
| | - Fernanda Esposito
- One Health Brazilian Resistance Project (OneBR), São Paulo, Brazil.,Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Brenda Cardoso
- Department of Clinical Analysis, School of Pharmacy, Universidade de São Paulo, São Paulo, Brazil.,Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | | | - Carla Berl
- PetCare Veterinary Hospital, São Paulo, Brazil
| | | | | | | | - César M de Souza
- Department of Internal Medicine, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | - Louise Cerdeira
- Department of Infectious Diseases, Central Clinical School, Monash University, Clayton, Vic., Australia
| | - Nilton Lincopan
- One Health Brazilian Resistance Project (OneBR), São Paulo, Brazil.,Department of Clinical Analysis, School of Pharmacy, Universidade de São Paulo, São Paulo, Brazil.,Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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38
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Pillonetto M, Jordão RTDS, Andraus GS, Bergamo R, Rocha FB, Onishi MC, de Almeida BMM, Nogueira KDS, Dal Lin A, Dias VMDCH, de Abreu AL. The Experience of Implementing a National Antimicrobial Resistance Surveillance System in Brazil. Front Public Health 2021; 8:575536. [PMID: 33520909 PMCID: PMC7841397 DOI: 10.3389/fpubh.2020.575536] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/07/2020] [Indexed: 01/16/2023] Open
Abstract
Antimicrobial resistance (AMR) is a major public health threat of global proportions, which has the potential to lead to approximately ten million deaths per year by 2050. Pressured by this wicked problem, in 2014, the World Health Organization launched a call for member states to share AMR data through the implementation of the Global Antimicrobial Resistance Surveillance System (GLASS), to appropriately scale and monitor the general situation world-widely. In 2017, Brazil joined GLASS and, in 2018, started its own national antimicrobial surveillance program (BR-GLASS) to understand the impact of resistance in the country. We compiled data obtained from the complete routine of three hospitals' microbiology labs during the year of 2018. This pilot data sums up to 200,874 antimicrobial susceptibility test results from 11,347 isolates. It represents 119 different microorganisms recovered from 44 distinct types of clinical samples. Specimens came from patients originating from 301 Brazilian cities, with 4,950 of these isolates from presumed Healthcare-Associated Infections (HAIs) and the other 6,397 community-acquired cases. The female population offered 58% of the collected samples, while the other 42% were of male origin. The urinary tract was the most common topography (6,372/11,347 isolates), followed by blood samples (2,072/11,347). Gram-negative predominated the bacterial isolates: Escherichia coli was the most prevalent in general, representing 4,030 isolates (89.0% of these from the urinary tract). Coagulase-negative Staphylococci were the most prevalent bacteria in blood samples. Besides these two species, the ESKAPE group have consolidated their prevalence. Regarding drug susceptibility results, 141,648 (70.5%) were susceptible, 9,950 (4.9%) intermediate, and 49,276 (24.5%) resistant. Acinetobacter baumannii was the most worrisome microorganism, with 65.3% of the overall antimicrobial susceptibility tests showing resistance, followed by ESBL-producing Klebsiella pneumoniae, with a global resistance rate of 59%. Although this is a pilot project (still limited to one state), this database shows the importance of a nation-wide surveillance program,[153mm][-12mm] Q14 especially considering it already had patients coming from 301 distinct counties and 18 different states. The BR-GLASS Program is an ongoing project that intends to encompass at least 95 hospitals distributed in all five geographical regions in Brazil within the next 5 years.
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Affiliation(s)
- Marcelo Pillonetto
- State Laboratory for Public Health, Department of Health Assistance and Surveillance, Secretary of Health, Curitiba, Brazil.,Laboratory of Medical Microbiology, School of Medicine, Pontifical Catholic University, Curitiba, Brazil
| | | | - Gabriel Savogin Andraus
- Laboratory of Medical Microbiology, School of Medicine, Pontifical Catholic University, Curitiba, Brazil
| | - Ricardo Bergamo
- State Laboratory for Public Health, Department of Health Assistance and Surveillance, Secretary of Health, Curitiba, Brazil
| | - Fabiano Barreto Rocha
- General Coordination for Public Health Laboratories, Health Surveillance Secretary, Ministry of Health, Brasília, Brazil
| | - Mayara Caroline Onishi
- Infection Control Team and Clinical Microbiology Laboratory, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | | | - Keite da Silva Nogueira
- Infection Control Team and Clinical Microbiology Laboratory, Hospital de Clínicas, Federal University of Parana, Curitiba, Brazil
| | - Amanda Dal Lin
- Infection Control Team and Clinical Microbiology Laboratory, Hospital Marcelino Champagnat, Marista Group, Curitiba, Brazil
| | - Viviane Maria de Carvalho Hessel Dias
- Infection Control Team and Clinical Microbiology Laboratory, Hospital Nossa Senhora das Graças, Curitiba, Brazil.,Infection Control Team and Clinical Microbiology Laboratory, Hospital Marcelino Champagnat, Marista Group, Curitiba, Brazil
| | - André Luiz de Abreu
- General Coordination for Public Health Laboratories, Health Surveillance Secretary, Ministry of Health, Brasília, Brazil
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Wink PL, Martins AS, Volpato F, Zavascki AP, Barth AL. Increased frequency of bla NDM in a tertiary care hospital in southern Brazil. Braz J Microbiol 2021; 52:299-301. [PMID: 33392936 DOI: 10.1007/s42770-020-00412-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/18/2020] [Indexed: 11/25/2022] Open
Abstract
Resistance to carbapenems due to metallo-beta-lactamase NDM-1 was first described in Brazil in 2013. To date, only a few scattered reports of the prevalence of NDM-1 in the country have been reported, and most of them indicated a very low prevalence of this metalloenzyme. In the present study, we report a steady increase in the frequency of NDM among Enterobacterales resistant to carbapenems in a tertiary care hospital in southern Brazil. Carbapenemase genes were evaluated by multiplex real-time polymerase chain using high-resolution melting analysis among 3501 isolates of 8 different species of Enterobacterales recovered from January 2015 to May 2020. The blaKPC-like was identified in 3003 isolates (85.8%) and the blaNDM-like was the second most common gene (351 isolates-10%). There was a steady increase in frequency of blaNDM-like, from 4.2% in 2015 to 24% in 2020. The increase of blaNDM frequency raises an important matter as novel therapeutic options are currently very limited for the treatment of patients infected by bacteria carrying the blaNDM.
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Affiliation(s)
- Priscila Lamb Wink
- LABRESIS - Laboratório de Pesquisa em Resistência Bacteriana, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90.035-903, Brazil.
- Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Amanda Silva Martins
- LABRESIS - Laboratório de Pesquisa em Resistência Bacteriana, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90.035-903, Brazil
| | - Fabiana Volpato
- LABRESIS - Laboratório de Pesquisa em Resistência Bacteriana, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90.035-903, Brazil
- Programa de Pós-Graduação em Ciências Médicas (PPGCM), Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Alexandre P Zavascki
- LABRESIS - Laboratório de Pesquisa em Resistência Bacteriana, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90.035-903, Brazil
- Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Afonso L Barth
- LABRESIS - Laboratório de Pesquisa em Resistência Bacteriana, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90.035-903, Brazil
- Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Programa de Pós-Graduação em Ciências Médicas (PPGCM), Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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40
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First Insights into Clinical and Resistance Features of Infections by Klebsiella pneumoniae among Oncological Patients from a Referral Center in Amazon Region, Brazil. Infect Dis Rep 2020; 12:110-120. [PMID: 33287355 PMCID: PMC7768515 DOI: 10.3390/idr12030021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/25/2022] Open
Abstract
Klebsiella pneumoniae appears as one of the most prevalent pathogens among cancer patients. The present study investigates the clinical, epidemiological and microbiological aspects related to infections caused by K. pneumoniae in cancer patients treated at an oncology referral center in the state of Pará, Amazon region, Brazil. Between July 2017 to July 2019, an epidemiological, observational, cross-sectional study, with a descriptive and analytical approach was conducted, including patients with confirmed diagnosis of cancer who acquired infection by K. pneumoniae 72 h after hospital admission. K. pneumoniae isolates included in the study were obtained from different clinical materials (blood, urine, catheter tip and bladder catheter, orotracheal secretions, oncological and surgical wounds). Antimicrobial susceptibility testing and molecular detection of the carbapenemase-encoding genes were performed. A high prevalence of MDR K. pneumoniae isolates was observed, including two colistin-resistant isolates and seven isolates harboring blaKPC-1 gene. To conclude, our findings provide the firsts insights into the epidemiology and infection by K. pneumoniae in the state of Pará, Brazil, and may be useful on treatment guidance and establishment of strategies to control the spread of resistance strains of K. pneumoniae in the region.
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41
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Silva DMD, Faria-Junior C, Nery DR, Oliveira PMD, Silva LDOR, Alves EG, Lima GRDCEC, Pereira AL. Insertion sequences disrupting mgrB in carbapenem-resistant Klebsiella pneumoniae strains in Brazil. J Glob Antimicrob Resist 2020; 24:53-57. [PMID: 33246210 DOI: 10.1016/j.jgar.2020.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES This study aimed to characterise insertional mutations disturbing themgrB gene in carbapenem-resistant Klebsiella pneumoniae (CRKp). METHODS A total of 118 clinical CRKp isolates were surveyed for polymyxin resistance and insertion sequence (IS) elements disruptingmgrB. RESULTS Of the 118 isolates, 78 (66.1%) displayed polymyxin resistance, of which 54% (42/78) hadmgrB::IS inserts. Sequencing analyses showed 13 insertion sites in mgrB. mgrB::ISSen4(IS3) was observed for the first time in CRKp. CONCLUSIONS Ten different IS elements disruptedmgrB, with a predominance (76%) of IS5 sequences.
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Affiliation(s)
- Daniely Martins da Silva
- Campus of Ceilândia, University of Brasília, Centro Metropolitano, Conjunto A, Ceilândia Sul, Brasília (DF), CEP: 72220-275, Brazil
| | - Célio Faria-Junior
- Central Laboratory for Public Health (LACEN-DF), SGAN 601, Asa Norte, Brasília (DF), CEP: 70830-010, Brazil
| | - Danielly Rocha Nery
- Campus of Ceilândia, University of Brasília, Centro Metropolitano, Conjunto A, Ceilândia Sul, Brasília (DF), CEP: 72220-275, Brazil
| | - Pâmela Maria de Oliveira
- Campus of Ceilândia, University of Brasília, Centro Metropolitano, Conjunto A, Ceilândia Sul, Brasília (DF), CEP: 72220-275, Brazil
| | | | - Everton Giovanni Alves
- Central Laboratory for Public Health (LACEN-DF), SGAN 601, Asa Norte, Brasília (DF), CEP: 70830-010, Brazil
| | | | - Alex Leite Pereira
- Campus of Ceilândia, University of Brasília, Centro Metropolitano, Conjunto A, Ceilândia Sul, Brasília (DF), CEP: 72220-275, Brazil.
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42
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Collar GDS, Raro OHF, da Silva RMC, Vezzaro P, Mott MP, Cunha GRD, Riche CVW, Dias C, Caierão J. Polymyxin NP tests (from colonies and directly from blood cultures): accurate and rapid methodologies to detect polymyxin B susceptibility among Enterobacterales. Diagn Microbiol Infect Dis 2020; 99:115264. [PMID: 33453545 DOI: 10.1016/j.diagmicrobio.2020.115264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/28/2020] [Accepted: 11/08/2020] [Indexed: 10/23/2022]
Abstract
Detection of polymyxins susceptibility is challenging. We aimed to evaluate Rapid Polymyxin NP from colonies (NP-colony) and directly from positive blood bottles (NP-bottle), using polymyxin B instead of colistin among Enterobacterales. Both had similar and acceptable accuracy. This is the first study performing NP-bottle using polymyxin B instead of colistin.
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Affiliation(s)
- Gabriela da S Collar
- Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Otávio H F Raro
- Departamento de Ciências Básicas, Universidade Federal de Ciências Básicas da Saúde de Porto Alegre, Brasil
| | - Ravena M C da Silva
- Departamento de Ciências Básicas, Universidade Federal de Ciências Básicas da Saúde de Porto Alegre, Brasil
| | - Priscila Vezzaro
- Departamento de Ciências Básicas, Universidade Federal de Ciências Básicas da Saúde de Porto Alegre, Brasil
| | | | | | | | - Cícero Dias
- Departamento de Ciências Básicas, Universidade Federal de Ciências Básicas da Saúde de Porto Alegre, Brasil
| | - Juliana Caierão
- Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil.
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da Silva KE, Thi Nguyen TN, Boinett CJ, Baker S, Simionatto S. Molecular and epidemiological surveillance of polymyxin-resistant Klebsiella pneumoniae strains isolated from Brazil with multiple mgrB gene mutations. Int J Med Microbiol 2020; 310:151448. [PMID: 33092694 DOI: 10.1016/j.ijmm.2020.151448] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Abstract
The prevalence of polymyxin-resistant Enterobacteriaceae is increasing worldwide. Their emergence is worrisome and limits therapeutic options for severely ill patients. We aimed to investigate the molecular and epidemiological characteristics of polymyxin-resistant Klebsiella pneumoniae circulating in Brazilian hospitals. Polymyxin-resistant K. pneumoniae isolates from two Brazilian healthcare facilities were characterized phenotypically and subjected to whole genome sequencing (WGS). Using the WGS data we determined their sequence type, resistance gene content (resistome), their composition of virulence genes and plasmids. ST11 was the most common (80 %) sequence type among the isolates followed by ST345, ST15 and ST258. A resistome analysis revealed the common presence of blaKPC-2 and less frequently blaSHV-11, blaTEM-1, blaCTX-M-15, and blaOXA-9. Genes conferring resistance to aminoglycosides, fluoroquinolones, phenicols, sulphonamides, tetracyclines, trimethoprim and macrolide-lincosamide-streptogramin were also detected. We observed a clonal spread of polymyxin-resistant K. pneumoniae isolates, with polymyxin-resistance associated with various alterations in the mgrB gene including inactivation by an insertion sequence and nonsense point mutations. We additionally identified a novel 78-bp repeat sequence, encoding a MgrB protein with 26 amino acids duplicated in six isolates. This is the first observation of this type of alteration being associated with polymyxin resistance. Our findings demonstrate that mgrB alterations were the most common source of polymyxin-resistance in Brazilian clinical settings. Interestingly, distinct genetic events were identified among clonally related isolates, including a new amino acid alteration. The clinical implications and investigation of the resistance mechanisms is of great importance to patient safety and control of these infections, particularly in long-term care facilities.
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Affiliation(s)
- Kesia Esther da Silva
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados - UFGD, Dourados, MS, Brazil
| | - To Nguyen Thi Nguyen
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Viet Nam
| | - Christine J Boinett
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Stephen Baker
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK; Department of Medicine, Cambridge University, Cambridge, UK
| | - Simone Simionatto
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados - UFGD, Dourados, MS, Brazil.
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Andrade VC, Caetano T, Mendo S, Oliveira AJFCD. Carbapenem resistant Enterobacteriaceae from port areas in São Paulo State (Brazil): Isolation and molecular characterization. MARINE POLLUTION BULLETIN 2020; 159:111329. [PMID: 32777543 DOI: 10.1016/j.marpolbul.2020.111329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
Coastal areas with important economic activities have high levels of contamination by metals, pathogenic bacteria, among other contaminants. The emergence of antibiotic-resistant bacteria is a global problem of public health. Carbapenem resistant Enterobacteriaceae (CRE) are a serious threat. The occurrence of carbapenem resistant bacteria was investigated in waters and sediments of a Brazilian coastal area, characterized by high levels of contamination. The samples of water and sediment were collected in two areas of the coast of São Paulo (Brazil). The study involved the characterization of the molecular mechanisms associated with the carbapenem resistance phenotype. No genes were detected for β-lactamases but the absence and/or presence of mutations in outer membrane proteins (OMPs) may justify the detected phenotype. The presented results show the need for further studies that allow a review of the current legislation and the importance of the reevaluation of monitoring policies of these environments.
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Affiliation(s)
- Vanessa Costa Andrade
- Departament of Biochemistry and Microbiology, São Paulo State University (UNESP), Rio Claro, Brazil; Marine and Environmental Microbiology Laboratory, São Paulo State University (UNESP), Biosciences Institute, São Vicente, Brazil.
| | - Tânia Caetano
- CESAM & Department of Biology, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Sónia Mendo
- CESAM & Department of Biology, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Ana Júlia Fernandes Cardoso de Oliveira
- Departament of Biochemistry and Microbiology, São Paulo State University (UNESP), Rio Claro, Brazil; Marine and Environmental Microbiology Laboratory, São Paulo State University (UNESP), Biosciences Institute, São Vicente, Brazil
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45
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Yang Q, Pogue JM, Li Z, Nation RL, Kaye KS, Li J. Agents of Last Resort: An Update on Polymyxin Resistance. Infect Dis Clin North Am 2020; 34:723-750. [PMID: 33011049 DOI: 10.1016/j.idc.2020.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Polymyxin resistance is a major public health threat, because the polymyxins represent last-line therapeutics for gram-negative pathogens resistant to essentially all other antibiotics. Minimizing any potential emergence and dissemination of polymyxin resistance relies on an improved understanding of mechanisms of and risk factors for polymyxin resistance, infection prevention and stewardship strategies, together with optimization of dosing of polymyxins (eg, combination regimens).
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Affiliation(s)
- Qiwen Yang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.9 Dongdan Santiao, Dongcheng District, Beijing, China.
| | - Jason M Pogue
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, 428 Church Street, Ann Arbor, MI 48109, USA
| | - Zekun Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.9 Dongdan Santiao, Dongcheng District, Beijing, China
| | - Roger L Nation
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Victoria 3052, Australia
| | - Keith S Kaye
- Department of Internal Medicine, University of Michigan Medical School, 1301 Catherine Street, Ann Arbor, MI 48109, USA
| | - Jian Li
- Laboratory of Antimicrobial Systems Pharmacology, Department of Microbiology, Monash University, Victoria 3800, Australia
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Aleidan FAS, Alkhelaifi H, Alsenaid A, Alromaizan H, Alsalham F, Almutairi A, Alsulaiman K, Abdel Gadir AG. Incidence and risk factors of carbapenem-resistant Enterobacteriaceae infection in intensive care units: a matched case-control study. Expert Rev Anti Infect Ther 2020; 19:393-398. [PMID: 32930620 DOI: 10.1080/14787210.2020.1822736] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Carbapenem-resistant Enterobacteriaceae (CRE) infection is associated with intensive care admissions, morbidity, and mortality. Our study aimed to determine the incidence, risk factors, and patient outcomes of CRE in the ICU units. METHODS This was a retrospective matched case-control study of patients admitted to ICUs. Patients who have positive cultures of CRE and carbapenem-susceptible Enterobacteriaceae (CSE) were included in the study. Patients were randomly selected from a pool of CSE subjects in a ratio of 1:1 of CRE to CSE as control patients. RESULTS The infection rate with CRE among all patients admitted to ICUs was 7.6% and the incidence of CRE infection was 5.6 per 1,000 person-day. The risk factors independently associated with CRE infection were: Higher Sequential Organ Failure Assessment (SOFA) and Nutrition Risk in Critically ill (NUTRIC) scores, prolonged ICU length of stay (LOS), previous surgery, dialysis and mechanical ventilation during ICU stay, and previous use of aminoglycoside and carbapenems. CONCLUSION In this retrospective study, the incidence of CRE infection was relatively elevated in patients admitted to ICU. Patients with high SOFA and NUTRIC scores, prolonged ICU LOS, previous surgery, dialysis and mechanical ventilation, and prior aminoglycosides and carbapenems use, may have an increased risk of CRE infection.
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Affiliation(s)
- Fahad A S Aleidan
- College of Medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia.,Clinical Pharmacy, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hind Alkhelaifi
- Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | - Haya Alromaizan
- Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Fajer Alsalham
- Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | - Khalid Alsulaiman
- Clinical Pharmacy, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdel Galil Abdel Gadir
- College of Medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
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47
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Santos AL, dos Santos AP, Ito CRM, de Queiroz PHP, de Almeida JA, de Carvalho Júnior MAB, de Oliveira CZ, Avelino MAG, Wastowski IJ, Gomes GPLA, Souza ACSE, Vasconcelos LSNDOL, Santos MDO, da Silva CA, Carneiro LC. Profile of Enterobacteria Resistant to Beta-Lactams. Antibiotics (Basel) 2020; 9:E410. [PMID: 32679663 PMCID: PMC7400480 DOI: 10.3390/antibiotics9070410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/04/2022] Open
Abstract
A serious emerging problem worldwide is increased antimicrobial resistance. Acquisition of coding genes for evasion methods of antimicrobial drug mechanisms characterizes acquired resistance. This phenomenon has been observed in Enterobacteriaceae family. Treatment for bacterial infections is performed with antibiotics, of which the most used are beta-lactams. The aim of this study was to correlate antimicrobial resistance profiles in Enterobacteriaceae by phenotypic methods and molecular identification of 14 beta-lactamase coding genes. In this study, 70 exclusive isolates from Brazil were used, half of which were collected in veterinary clinics or hospitals Phenotypic methodologies were used and real-time PCR was the molecular methodology used, through the Sybr Green system. Regargding the results found in the tests it was observed that 74.28% were resistant to ampicillin, 62.85% were resistant to amoxicillin associated with clavalunate. The mechanism of resistance that presented the highest expression was ESBL (17.14%). The genes studied that were detected in a greater number of species were blaGIM and blaSIM (66.66% of the samples) and the one that was amplified in a smaller number of samples was blaVIM (16.66%). Therefore, high and worrying levels of antimicrobial resistance have been found in enterobacteria, and a way to minimize the accelerated emergence of their resistance includes developing or improving techniques that generate diagnoses with high efficiency and speed.
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Affiliation(s)
- Andressa Liberal Santos
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, 235 Street, Goiânia 74605-050, Brazil; (A.L.S.); (A.P.d.S.); (C.R.M.I.); (P.H.P.d.Q.); (J.A.d.A.); (M.A.B.d.C.J.); (L.S.N.d.O.L.V.); (C.A.d.S.)
| | - Adailton Pereira dos Santos
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, 235 Street, Goiânia 74605-050, Brazil; (A.L.S.); (A.P.d.S.); (C.R.M.I.); (P.H.P.d.Q.); (J.A.d.A.); (M.A.B.d.C.J.); (L.S.N.d.O.L.V.); (C.A.d.S.)
| | - Célia Regina Malveste Ito
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, 235 Street, Goiânia 74605-050, Brazil; (A.L.S.); (A.P.d.S.); (C.R.M.I.); (P.H.P.d.Q.); (J.A.d.A.); (M.A.B.d.C.J.); (L.S.N.d.O.L.V.); (C.A.d.S.)
| | - Pedro Henrique Pereira de Queiroz
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, 235 Street, Goiânia 74605-050, Brazil; (A.L.S.); (A.P.d.S.); (C.R.M.I.); (P.H.P.d.Q.); (J.A.d.A.); (M.A.B.d.C.J.); (L.S.N.d.O.L.V.); (C.A.d.S.)
| | - Juliana Afonso de Almeida
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, 235 Street, Goiânia 74605-050, Brazil; (A.L.S.); (A.P.d.S.); (C.R.M.I.); (P.H.P.d.Q.); (J.A.d.A.); (M.A.B.d.C.J.); (L.S.N.d.O.L.V.); (C.A.d.S.)
| | - Marcos Antonio Batista de Carvalho Júnior
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, 235 Street, Goiânia 74605-050, Brazil; (A.L.S.); (A.P.d.S.); (C.R.M.I.); (P.H.P.d.Q.); (J.A.d.A.); (M.A.B.d.C.J.); (L.S.N.d.O.L.V.); (C.A.d.S.)
| | | | - Melissa Ameloti G. Avelino
- Medicine College, Federal University of Goiás, 235 Street, Goiânia 74690-900, Brazil; (M.A.G.A.); (M.d.O.S.)
| | | | - Giselle Pinheiro Lima Aires Gomes
- Department of Biology, Federal University of Tocantins, Square 109 North, NS15 Avenue, ALCNO-14-Plano Director North, Palmas 77001-090, Brazil;
| | | | - Lara Stefânia Netto de Oliveira Leão Vasconcelos
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, 235 Street, Goiânia 74605-050, Brazil; (A.L.S.); (A.P.d.S.); (C.R.M.I.); (P.H.P.d.Q.); (J.A.d.A.); (M.A.B.d.C.J.); (L.S.N.d.O.L.V.); (C.A.d.S.)
| | - Mônica de Oliveira Santos
- Medicine College, Federal University of Goiás, 235 Street, Goiânia 74690-900, Brazil; (M.A.G.A.); (M.d.O.S.)
| | - Carla Afonso da Silva
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, 235 Street, Goiânia 74605-050, Brazil; (A.L.S.); (A.P.d.S.); (C.R.M.I.); (P.H.P.d.Q.); (J.A.d.A.); (M.A.B.d.C.J.); (L.S.N.d.O.L.V.); (C.A.d.S.)
| | - Lilian Carla Carneiro
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, 235 Street, Goiânia 74605-050, Brazil; (A.L.S.); (A.P.d.S.); (C.R.M.I.); (P.H.P.d.Q.); (J.A.d.A.); (M.A.B.d.C.J.); (L.S.N.d.O.L.V.); (C.A.d.S.)
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48
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Rosini R, Nicchi S, Pizza M, Rappuoli R. Vaccines Against Antimicrobial Resistance. Front Immunol 2020; 11:1048. [PMID: 32582169 PMCID: PMC7283535 DOI: 10.3389/fimmu.2020.01048] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/30/2020] [Indexed: 12/29/2022] Open
Abstract
In the last century, life expectancy has increased considerably, thanks to the introduction of antibiotics, hygiene and vaccines that have contributed to the cure and prevention of many infectious diseases. The era of antimicrobial therapy started in the nineteenth century with the identification of chemical compounds with antimicrobial properties. However, immediately after the introduction of these novel drugs, microorganisms started to become resistant through different strategies. Although resistance mechanisms were already present before antibiotic introduction, their large-scale use and mis-use have increased the number of resistant microorganisms. Rapid spreading of mobile elements by horizontal gene transfer such as plasmids and integrative conjugative elements (ICE) carrying multiple resistance genes has dramatically increased the worldwide prevalence of relevant multi drug-resistant human pathogens such as Staphylococcus aureus, Neisseria gonorrhoeae, and Enterobacteriaceae. Today, antimicrobial resistance (AMR) remains one of the major global concerns to be addressed and only global efforts could help in finding a solution. In terms of magnitude the economic impact of AMR is estimated to be comparable to that of climate global change in 2030. Although antibiotics continue to be essential to treat such infections, non-antibiotic therapies will play an important role in limiting the increase of antibiotic resistant microorganisms. Among non-antibiotic strategies, vaccines and therapeutic monoclonal antibodies (mAbs) play a strategic role. In this review, we will summarize the evolution and the mechanisms of antibiotic resistance, and the impact of AMR on life expectancy and economics.
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Affiliation(s)
| | - Sonia Nicchi
- GSK, Siena, Italy
- Department of Pharmacy and Biotechnology (FaBiT), University of Bologna, Bologna, Italy
| | | | - Rino Rappuoli
- GSK, Siena, Italy
- vAMRes Lab, Toscana Life Sciences, Siena, Italy
- Faculty of Medicine, Imperial College London, London, United Kingdom
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49
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Christoff AP, Sereia AFR, Cruz GNF, de Bastiani DC, Silva VL, Hernandes C, Nascente APM, dos Reis AA, Viessi RG, Marques ADSP, Braga BS, Raduan TPL, Martino MDV, de Menezes FG, de Oliveira LFV. One year cross-sectional study in adult and neonatal intensive care units reveals the bacterial and antimicrobial resistance genes profiles in patients and hospital surfaces. PLoS One 2020; 15:e0234127. [PMID: 32492060 PMCID: PMC7269242 DOI: 10.1371/journal.pone.0234127] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/19/2020] [Indexed: 01/10/2023] Open
Abstract
Several studies have shown the ubiquitous presence of bacteria in hospital surfaces, staff, and patients. Frequently, these bacteria are related to HAI (healthcare-associated infections) and carry antimicrobial resistance (AMR). These HAI-related bacteria contribute to a major public health issue by increasing patient morbidity and mortality during or after hospital stay. Bacterial high-throughput amplicon gene sequencing along with identification of AMR genes, as well as whole genome sequencing (WGS), are biotechnological tools that allow multiple-sample screening for a diversity of bacteria. In this paper, we used these methods to perform a one-year cross sectional profiling of bacteria and AMR genes in adult and neonatal intensive care units (ICU and NICU) in a Brazilian public, tertiary hospital. Our results showed high abundances of HAI-related bacteria such as S. epidermidis, S. aureus, K. pneumoniae, A. baumannii complex, E. coli, E. faecalis, and P. aeruginosa in patients and hospital surfaces. Most abundant AMR genes detected throughout ICU and NICU were mecA, blaCTX-M-1 group, blaSHV-like, and blaKPC-like. We found that NICU environment and patients were more widely contaminated with pathogenic bacteria than ICU. Patient samples, despite the higher bacterial load, have lower bacterial diversity than environmental samples in both units. Finally, we also identified contamination hotspots in the hospital environment showing constant frequencies of bacterial and AMR contamination throughout the year. Whole genome sequencing (WGS), 16S rRNA oligotypes, and AMR identification allowed a high-resolution characterization of the hospital microbiome profile.
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MESH Headings
- Adult
- Anti-Bacterial Agents/pharmacology
- Anti-Infective Agents/pharmacology
- Bacteria/drug effects
- Bacteria/genetics
- Bacteria/isolation & purification
- Bacterial Load
- Brazil
- Cross Infection/microbiology
- Cross Infection/pathology
- Cross-Sectional Studies
- Drug Resistance, Bacterial/drug effects
- Drug Resistance, Bacterial/genetics
- Escherichia coli/drug effects
- Escherichia coli/genetics
- Escherichia coli/isolation & purification
- Humans
- Infant, Newborn
- Intensive Care Units
- Intensive Care Units, Neonatal
- RNA, Ribosomal, 16S/chemistry
- RNA, Ribosomal, 16S/genetics
- RNA, Ribosomal, 16S/metabolism
- Staphylococcus aureus/drug effects
- Staphylococcus aureus/genetics
- Staphylococcus aureus/isolation & purification
- Tertiary Care Centers
- Whole Genome Sequencing
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50
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Zagui GS, de Andrade LN, Moreira NC, Silva TV, Machado GP, da Costa Darini AL, Segura-Muñoz SI. Gram-negative bacteria carrying β-lactamase encoding genes in hospital and urban wastewater in Brazil. ENVIRONMENTAL MONITORING AND ASSESSMENT 2020; 192:376. [PMID: 32417981 DOI: 10.1007/s10661-020-08319-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/28/2020] [Indexed: 06/11/2023]
Abstract
Multidrug resistance mediated by β-lactamase in Gram-negative bacilli is a serious public health problem. Sewers are considered reservoirs of multiresistant bacteria due to presence of antibiotics that select them and favor their dissemination. The present study evaluated the antibiotic resistance profile and β-lactamases production in Gram-negative bacilli isolates from hospital sewage and urban wastewater treatment plants (UWWTP) in Brazil. Bacteria were isolated and identified with biochemical tests. Antibiotic susceptibility testing was performed by the disk-diffusion method and detection of extended-spectrum β-lactamase and carbapenemases by enzymatic inhibitor and conventional PCR. Differences in resistance to amoxicillin clavulanic, aztreonam, cefepime, and cefotaxime were observed in hospital sewage compared with urban sewage (p < 0.05). The multidrug-resistant phenotype was observed in 33.3% of hospital sewage isolates (p = 0.0025). β-lactamases genes were found in 35.6% of isolates, with the most frequent being blaKPC and blaTEM (17.8%), and blaSHV and blaCTX-M (13.3% and 8.9%, respectively). The data obtained are relevant, since the bacteria detected are on the priority pathogens list from the World Health Organization and hospital sewage could be released untreated into the municipal collection system, which may favor the spread of resistance. Changes in hospital sewage discharge practices, as well as additional technologies regarding effluent disinfection in the UWWTP, can prevent the spread of these bacteria into the environment and negative impact on water resources.
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Affiliation(s)
| | | | | | - Thaís Vilela Silva
- College of Nursing of Ribeirao Preto, University of São Paulo, São Paulo, Brazil
| | | | | | - Susana Inés Segura-Muñoz
- College of Nursing of Ribeirao Preto, University of São Paulo, São Paulo, Brazil.
- Laboratory of Ecotoxicology and Environmental Parasitology, Department of Maternal-Infant Nursing and Public Health, College of Nursing of Ribeirao Preto, University of São Paulo, São Paulo, Brazil.
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