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Guidone GHM, Cardozo JG, Silva LC, Sanches MS, Galhardi LCF, Kobayashi RKT, Vespero EC, Rocha SPD. Epidemiology and characterization of Providencia stuartii isolated from hospitalized patients in southern Brazil: a possible emerging pathogen. Access Microbiol 2023; 5:000652.v4. [PMID: 37970084 PMCID: PMC10634494 DOI: 10.1099/acmi.0.000652.v4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/08/2023] [Indexed: 11/17/2023] Open
Abstract
This study aimed to characterize the virulence factors and antimicrobial resistance of Providencia stuartii , an opportunistic pathogen that causes human infections. We examined 45 isolates of P. stuartii both genotypically and phenotypically by studying their adherence to HeLa cells, biofilm formation, cytotoxicity and antimicrobial resistance, and analysed their genomes for putative virulence and resistance genes. This study found that most isolates possessed multiple virulence genes, including fimA, mrkA, fptA, iutA, ireA and hlyA, and were cytotoxic to Vero cells. All the isolates were resistant to amoxicillin plus clavulanic acid, levofloxacin and sulfamethoxazole plus trimethoprim, and most were resistant to ceftriaxone and cefepime. All isolates harboured extended-spectrum beta-lactamase coding genes such as bla CTX-M-2 and 23/45(51.11 %) of them also harboured bla CTX-M-9. The gene KPC-2 (carbapenemase) was detected in 8/45(17.77 %) isolates. This study also found clonality among the isolates, indicating the possible spread of the pathogen among patients at the hospital. These results have significant clinical and epidemiological implications and emphasize the importance of a continued understanding of the virulence and antimicrobial resistance of this pathogen for the prevention and treatment of future infections.
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Affiliation(s)
| | - Jennifer Germiniani Cardozo
- Laboratory of Basic and Applied Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Luana Carvalho Silva
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Matheus Silva Sanches
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Ligia Carla Faccin Galhardi
- Virology Laboratory, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Renata Katsuko Takayama Kobayashi
- Laboratory of Basic and Applied Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Eliana Carolina Vespero
- Department of Pathology, Clinical and Toxicological Analysis, Health Sciences Center, University Hospital of Londrina, State University of Londrina, Paraná, Brazil
| | - Sergio Paulo Dejato Rocha
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
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Capitani V, Arcari G, Oliva A, Sacco F, Menichincheri G, Fenske L, Polani R, Raponi G, Antonelli G, Carattoli A. Genome-Based Retrospective Analysis of a Providencia stuartii Outbreak in Rome, Italy: Broad Spectrum IncC Plasmids Spread the NDM Carbapenemase within the Hospital. Antibiotics (Basel) 2023; 12:antibiotics12050943. [PMID: 37237846 DOI: 10.3390/antibiotics12050943] [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: 04/19/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Providencia stuartii is a member of the Morganellaceae family, notorious for its intrinsic resistance to several antibiotics, including last-resort drugs such as colistin and tigecycline. Between February and March 2022, a four-patient outbreak sustained by P. stuartii occurred in a hospital in Rome. Phenotypic analyses defined these strains as eXtensively Drug-Resistant (XDR). Whole-genome sequencing was performed on the representative P. stuartii strains and resulted in fully closed genomes and plasmids. The genomes were highly related phylogenetically and encoded various virulence factors, including fimbrial clusters. The XDR phenotype was primarily driven by the presence of the blaNDM-1 metallo-β-lactamase alongside the rmtC 16S rRNA methyltransferase, conferring resistance to most β-lactams and every aminoglycoside, respectively. These genes were found on an IncC plasmid that was highly related to an NDM-IncC plasmid retrieved from a ST15 Klebsiella pneumoniae strain circulating in the same hospital two years earlier. Given its ability to acquire resistance plasmids and its intrinsic resistance mechanisms, P. stuartii is a formidable pathogen. The emergence of XDR P. stuartii strains poses a significant public health threat. It is essential to monitor the spread of these strains and develop new strategies for their control and treatment.
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Affiliation(s)
- Valerio Capitani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Gabriele Arcari
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Federica Sacco
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Gaia Menichincheri
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Linda Fenske
- Bioinformatics and Systems Biology, Justus-Liebig-University Giessen, 35390 Giessen, Germany
| | - Riccardo Polani
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Giammarco Raponi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Guido Antonelli
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Alessandra Carattoli
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy
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Vargas JM, Moreno Mochi MP, Nuñez JM, Mochi S, Cáceres M, Del Campo R, Jure MA. Emergence and clonal spread of KPC-2-producing clinical Klebsiella aerogenes isolates in a hospital from northwest Argentina. J Med Microbiol 2023; 72. [PMID: 36748600 DOI: 10.1099/jmm.0.001635] [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: 01/11/2023] Open
Abstract
Introduction. Klebsiella aerogenes is a nosocomial pathogen associated with drug resistance and healthcare-associated infections.Gap Statement. K. aerogenes is associated with hospital-acquired infections with the ability to acquire mechanisms of resistance to reserve antimicrobials; its clinical behaviour has been poorly documented.Objective. We proposed to investigate an outbreak of carbapenem-resistant K. aerogenes in a hospital that persisted for 4 months.Methods. The primary aim was to evaluate the molecular characteristics and the clonal relationships among the isolates. We characterized isolates by polymerase chain reaction (PCR) and pulsed-field gel electrophoresis (PFGE). The information was integrated with clinical and epidemiological data.Results. Fourteen strains were disseminated in an intensive care unit and different wards at the hospital. The overall mortality was 42.8 %, and mortality attributed to infection was 21.4 %; strains showed high rates of resistance to most of the antimicrobials tested and carried bla KPC-2, bla SHV-2 and bla CTXM-15 genes. PFGE analysis indicated 2 PFGE groups; 12/14 isolates were associated with subgroup A and were likely to be primarily responsible for the first isolation and subsequent dissemination. The outbreak characteristics data showed prolonged hospitalization and previous use of antibiotics as potential risk factors.Conclusion. We consider that it is essential to perform phenotypic and genotypic identification of early genetic resistance mechanisms in K. aerogenes isolates, not only from infection sites but also from colonization, to prevent the spread of these multidrug-resistant (MDR) isolates.
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Affiliation(s)
- Juan Martín Vargas
- LABACER, Institute of Microbiology 'Luis C. Verna', Faculty of Biochemistry, Chemistry and Pharmacy, National University of Tucuman, Tucuman, Argentina
| | - Maria Paula Moreno Mochi
- LABACER, Institute of Microbiology 'Luis C. Verna', Faculty of Biochemistry, Chemistry and Pharmacy, National University of Tucuman, Tucuman, Argentina
| | | | | | | | - Rosa Del Campo
- Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, España
| | - María Angela Jure
- LABACER, Institute of Microbiology 'Luis C. Verna', Faculty of Biochemistry, Chemistry and Pharmacy, National University of Tucuman, Tucuman, Argentina
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Knecht CA, García Allende N, Álvarez VE, Prack McCormick B, Massó MG, Piekar M, Campos J, Fox B, Camicia G, Gambino AS, Leguina ACDV, Donis N, Fernández-Canigia L, Quiroga MP, Centrón D. Novel insights related to the rise of KPC-producing Enterobacter cloacae complex strains within the nosocomial niche. Front Cell Infect Microbiol 2022; 12:951049. [DOI: 10.3389/fcimb.2022.951049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
According to the World Health Organization, carbapenem-resistant Enterobacteriaceae (CRE) belong to the highest priority group for the development of new antibiotics. Argentina-WHONET data showed that Gram-negative resistance frequencies to imipenem have been increasing since 2010 mostly in two CRE bacteria: Klebsiella pneumoniae and Enterobacter cloacae Complex (ECC). This scenario is mirrored in our hospital. It is known that K. pneumoniae and the ECC coexist in the human body, but little is known about the outcome of these species producing KPC, and colonizing or infecting a patient. We aimed to contribute to the understanding of the rise of the ECC in Argentina, taking as a biological model both a patient colonized with two KPC-producing strains (one Enterobacter hormaechei and one K. pneumoniae) and in vitro competition assays with prevalent KPC-producing ECC (KPC-ECC) versus KPC-producing K. pneumoniae (KPC-Kp) high-risk clones from our institution. A KPC-producing E. hormaechei and later a KPC-Kp strain that colonized a patient shared an identical novel conjugative IncM1 plasmid harboring blaKPC-2. In addition, a total of 19 KPC-ECC and 58 KPC-Kp strains isolated from nosocomial infections revealed that high-risk clones KPC-ECC ST66 and ST78 as well as KPC-Kp ST11 and ST258 were prevalent and selected for competition assays. The competition assays with KCP-ECC ST45, ST66, and ST78 versus KPC-Kp ST11, ST18, and ST258 strains analyzed here showed no statistically significant difference. These assays evidenced that high-risk clones of KPC-ECC and KPC-Kp can coexist in the same hospital environment including the same patient, which explains from an ecological point of view that both species can exchange and share plasmids. These findings offer hints to explain the worldwide rise of KPC-ECC strains based on the ability of some pandemic clones to compete and occupy a certain niche. Taken together, the presence of the same new plasmid and the fitness results that showed that both strains can coexist within the same patient suggest that horizontal genetic transfer of blaKPC-2 within the patient cannot be ruled out. These findings highlight the constant interaction that these two species can keep in the hospital environment, which, in turn, can be related to the spread of KPC.
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Silva SMD, Ramos BDA, Lima AVA, Sá RACQD, Lima JLDC, Maciel MAV, Paiva PMG, Silva MVD, Correia MTDS, Oliveira MBMD. First report of the aac(6')-Ib-cr gene in Providencia stuartii isolates in Brazil. Rev Soc Bras Med Trop 2020; 54:e20190524. [PMID: 33206872 PMCID: PMC7670762 DOI: 10.1590/0037-8682-0524-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 05/21/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The aac(6')-Ib-cr and bla KPC genes are spreading among Enterobacteriaceae species, including Providencia stuartii, in some countries of world. METHODS These genes were investigated in 28 P. stuartii isolates from a public hospital in Recife, Pernambuco, Brazil, by PCR and sequencing. RESULTS The aac(6')-Ib-cr gene was detected in 16 resistant isolates, and the bla KPC gene was seen in 14. CONCLUSIONS The presence of these genes in P. stuartii multi- and extensively drug-resistant isolates indicates that the resistance arsenal of this species is increasing, thus limiting the therapeutic options.
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Affiliation(s)
- Sivoneide Maria da Silva
- Universidade Federal de Pernambuco, Centro de Biociências, Departamento de Bioquímica, Recife, PE, Brasil
| | - Bárbara de Azevedo Ramos
- Universidade Federal de Pernambuco, Centro de Biociências, Departamento de Bioquímica, Recife, PE, Brasil
| | - Ana Vitória Araújo Lima
- Universidade Federal de Pernambuco, Centro de Biociências, Departamento de Bioquímica, Recife, PE, Brasil
| | | | - Jailton Lobo da Costa Lima
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Departamento de Medicina Tropical, Recife, PE, Brasil
| | - Maria Amélia Vieira Maciel
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Departamento de Medicina Tropical, Recife, PE, Brasil
| | | | - Márcia Vanusa da Silva
- Universidade Federal de Pernambuco, Centro de Biociências, Departamento de Bioquímica, Recife, PE, Brasil
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Hoard A, Montaña S, Moriano A, Fernandez JS, Traglia GM, Quiroga C, Franchi A, Cohen E, Corigliano C, Almuzara M, Ramirez MS. Genomic Analysis of two NDM-1 Providencia stuartii Strains Recovered from a Single Patient. Curr Microbiol 2020; 77:4029-4036. [PMID: 33048176 DOI: 10.1007/s00284-020-02242-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/01/2020] [Indexed: 12/18/2022]
Abstract
In the last years, an increasing number of untreatable infections caused by drug-resistant microbes have impacted the health care system. Worldwide, infections caused by carbapenem-resistant (CR) Gram-negative bacilli have dramatically increased. Among the CR-Gram-negative bacilli, those producing carbapenemases, such as NDM-1, are the main concern. Different Enterobacterales harboring NDM-1 have been reported lately. Providencia stuartii, a member of the Morganellaceae family, is ubiquitous in the environment, but is also known to cause nosocomial infections. Here we describe the genomic analysis of two NDM-1- producing P. stuartii strains recovered from the same patient as well as other carbapenem resistant strains recovered from the same hospital. As a result of the genomic analysis thirteen resistance genes, including three to β-lactams (blaOXA-1, blaTEM-1, blaNDM-1), four to aminoglycosides (aphA6, aac(3)-IId, aac(2')-Ia, aac(6')-Ib-cr5), one to sulfonamides (sul1), two to chloramphenicol (catB3, catA3), one to rifampicin, one to bleomycin (ble), and one to tetracycline (tet(B)) were found. Moreover, a variety of mobile genetic elements, such as insertion sequences, plasmids and phage- related sequences, were found within P. stuartii genomes. The spread of carbapenem-resistant isolates remains a significant clinical and public health concern. Therefore, we considered that the detection of CR isolates is an essential step in addressing this problem.
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Affiliation(s)
- Amparo Hoard
- Center for Applied Biotechnology Studies, Department of Biological Science, California State University Fullerton, Fullerton, CA, USA
| | - Sabrina Montaña
- Laboratorio de Bacteriología Clínica, Departamento de Bioquímica Clínica, Facultad de Farmacia Y Bioquímica, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Alessandro Moriano
- Center for Applied Biotechnology Studies, Department of Biological Science, California State University Fullerton, Fullerton, CA, USA
| | - Jennifer S Fernandez
- Center for Applied Biotechnology Studies, Department of Biological Science, California State University Fullerton, Fullerton, CA, USA
| | - German M Traglia
- Laboratorio de Bacteriología Clínica, Departamento de Bioquímica Clínica, Facultad de Farmacia Y Bioquímica, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Cecilia Quiroga
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas Y Tecnológicas, Instituto de Investigaciones en Microbiología Y Parasitología Médica (IMPAM), Facultad de Medicina, Paraguay 2155- C1121ABG, Buenos Aires, Argentina
| | - Agustina Franchi
- Laboratorio de Bacteriologia, Hospital Interzonal de Agudos Eva Perón, Provincia de Buenos Aires, San Martín, Argentina
| | - Emilia Cohen
- Laboratorio de Bacteriologia, Hospital Interzonal de Agudos Eva Perón, Provincia de Buenos Aires, San Martín, Argentina
| | - Cecilia Corigliano
- Laboratorio de Bacteriologia, Hospital Interzonal de Agudos Eva Perón, Provincia de Buenos Aires, San Martín, Argentina
| | - Marisa Almuzara
- Laboratorio de Bacteriologia, Hospital Interzonal de Agudos Eva Perón, Provincia de Buenos Aires, San Martín, Argentina
| | - Maria Soledad Ramirez
- Center for Applied Biotechnology Studies, Department of Biological Science, California State University Fullerton, Fullerton, CA, USA.
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Lima GJD, Scavuzzi AML, Beltrão EMB, Firmo EF, Oliveira ÉMD, Oliveira SRD, Rezende AM, Lopes ACDS. Identification of plasmid IncQ1 and NTEKPC-IId harboring bla KPC-2 in isolates from Klebsiella pneumoniae infections in patients from Recife-PE, Brazil. Rev Soc Bras Med Trop 2020; 53:e20190526. [PMID: 32578705 PMCID: PMC7310361 DOI: 10.1590/0037-8682-0526-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 04/22/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION: This study investigated the genetic environment of blaKPC-2 in Klebsiella pnemoniae multi-drug resistant clinical isolates. METHODS: Four carbapenemase gene isolates resistant to carbapenems, collected from infected patients from two hospitals in Brazil, were investigated using polymerase chain reaction and plasmid DNA sequencing. RESULTS: The blaKPC-2 gene was located between ISKpn6 and a resolvase tnpR in the non-Tn4401 element (NTEKPC-IId). It was detected on a plasmid belonging to the IncQ1 group. CONCLUSIONS To our knowledge, this is the first report of the presence of the blaKPC-2 gene in the NTEKPC-IId element carried by plasmid IncQ1 from infections in Brazil.
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Affiliation(s)
- Giselle Jucá de Lima
- Universidade Federal de Pernambuco, Departamento de Medicina Tropical, Recife, PE, Brasil
| | | | | | - Elza Ferreira Firmo
- Universidade Federal de Pernambuco, Departamento de Medicina Tropical, Recife, PE, Brasil
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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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Vivas R, Dolabella SS, Barbosa AAT, Jain S. Prevalence of Klebsiella pneumoniae carbapenemase - and New Delhi metallo-beta-lactamase-positive K. pneumoniae in Sergipe, Brazil, and combination therapy as a potential treatment option. Rev Soc Bras Med Trop 2020; 53:e20200064. [PMID: 32401864 PMCID: PMC7269519 DOI: 10.1590/0037-8682-0064-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/02/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Carbapenem-resistant Klebsiella pneumoniae infection lacks treatment options and is associated with prolonged hospital stays and high mortality rates. The production of carbapenemases is one of the most important factors responsible for this multi-resistance phenomenon. METHODS In the present study, we analyzed the presence of genes encoding carbapenemases in K. pneumoniae isolates circulating in one of the public hospitals in the city of Aracaju, Sergipe, Brazil. We also determined the best combination of drugs that display in vitro antimicrobial synergy. First, 147 carbapenem-resistant K. pneumoniae isolates were validated for the presence of blaKPC, bla GES, bla NDM, bla SPM, bla IMP, bla VIM, and bla OXA-48 genes using multiplex polymerase chain reaction. Thereafter, using two isolates (97 and 102), the role of double and triple combinational drug therapy as a treatment option was analyzed. RESULTS Seventy-four (50.3%) isolates were positive for bla NDM, eight (5.4%) for bla KPC, and one (1.2%) for both bla NDM and bla KPC. In the synergy tests, double combinations were better than triple combinations. Polymyxin B and amikacin for isolate 97 and polymyxin B coupled with meropenem for isolate 102 showed the best response. CONCLUSIONS Clinicians in normal practice use multiple drugs to treat infections caused by multi-resistant microorganism; however, in most cases, the benefit of the combinations is unknown. In vitro synergistic tests, such as those described herein, are important as they might help select an appropriate multi-drug antibiotic therapy and a correct dosage, ultimately reducing toxicities and the development of antibiotic resistance.
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Affiliation(s)
- Roberto Vivas
- Universidade Federal de Sergipe, Programa de Pós-Graduação em
Biologia Parasitária, São Cristóvão, SE, Brasil
| | - Silvio Santana Dolabella
- Universidade Federal de Sergipe, Programa de Pós-Graduação em
Biologia Parasitária, São Cristóvão, SE, Brasil
| | - Ana Andréa Teixeira Barbosa
- Universidade Federal de Sergipe, Programa de Pós-Graduação em
Biologia Parasitária, São Cristóvão, SE, Brasil
| | - Sona Jain
- Universidade Federal de Sergipe, Programa de Pós-Graduação em
Biologia Parasitária, São Cristóvão, SE, Brasil
- Universidade Tiradentes, Programa de Pós-Graduação em Biotecnologia
Industrial, Aracaju, SE, Brasil
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Reyes JA, Melano R, Cárdenas PA, Trueba G. Mobile genetic elements associated with carbapenemase genes in South American Enterobacterales. Braz J Infect Dis 2020; 24:231-238. [PMID: 32325019 PMCID: PMC9392046 DOI: 10.1016/j.bjid.2020.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/11/2020] [Accepted: 03/21/2020] [Indexed: 01/04/2023] Open
Abstract
Introduction Carbapenem resistance in members of order Enterobacterales is a growing public health problem causing high mortality in developing and industrialized countries. Its emergence and rapid propagation worldwide was due to both intercontinental spread of pandemic strains and horizontal dissemination via mobile genetic elements (MGE) such as plasmids and transposons. Objective To describe MGE carrying carbapenem resistance genes in Enterobacterales which have been reported in South America. Search strategy and selection criteria A search of the literature in English or Spanish published until 2019 in PubMed, Google Scholar, LILACS and SciELO databases was performed for studies of MGE in Enterobacterales reported in South American countries. Results Seven South American countries reported MGE related to carbapenemases. Carbapenemase-producing Klebsiella pneumoniae belonging to clonal complex 258 were the most prevalent pathogens reported; others carbapenemase-producing Enterobacterales such as Escherichia coli, Serratia marcescens, and Providencia rettgeri also have been reported. The MGE implicated in the spread of the most prevalent carbapenemase genes are Tn4401 and non-Tn4401 elements for blaKPC and ISAba125 for blaNDM, located in different plasmid incompatibility groups, i.e. L/M, A/C, FII and bacterial clones. Conclusion This review indicates that, like in other parts of the world, the most commonly reported carbapenemases in Enterobacterales from South America are being disseminated through clones, plasmids, and transposons which have been previously reported in other parts of the world.
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Leal HF, Azevedo J, Silva GEO, Amorim AML, de Roma LRC, Arraes ACP, Gouveia EL, Reis MG, Mendes AV, de Oliveira Silva M, Barberino MG, Martins IS, Reis JN. Bloodstream infections caused by multidrug-resistant gram-negative bacteria: epidemiological, clinical and microbiological features. BMC Infect Dis 2019; 19:609. [PMID: 31296179 PMCID: PMC6624930 DOI: 10.1186/s12879-019-4265-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/05/2019] [Indexed: 11/12/2022] Open
Abstract
Background Bloodstream infections (BSI) are associated with high morbidity and mortality. This scenario worsens with the emergence of drug-resistant pathogens, resulting in infections which are difficult to treat or even untreatable with conventional antimicrobials. The aim of this study is to describe the epidemiological aspects of BSI caused by multiresistant gram-negative bacilli (MDR-GNB). Methods We conducted a laboratory-based surveillance for gram-negative bacteremia over a 1-year period. The bacterial isolates were identified by MALDI-TOF/MS and the antimicrobial susceptibility testing was performed by VITEK®2. Resistance genes were identified through PCR assays. Results Of the 143 patients, 28.7% had infections caused by MDR-GNB. The risk factors for MDR bacteremia were male sex, age ≥ 60, previous antimicrobial use, liver disease and bacteremia caused by K. pneumoniae. K. pneumoniae was the most frequently observed causative agent and had the highest resistance level. Regarding the resistance determinants, SHV, TEM, OXA-1-like and CTX-M-gp1 were predominant enzymatic variants, whereas CTX-M-gp9, CTX-M-gp2, KPC, VIM, GES, OXA-48-like, NDM and OXA-23-like were considered emerging enzymes. Conclusions Here we demonstrate that clinically relevant antibiotic resistance genes are prevalent in this setting. We hope our findings support the development of intervention measures by policy makers and healthcare professionals to face antibiotic resistance. Electronic supplementary material The online version of this article (10.1186/s12879-019-4265-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helena Ferreira Leal
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Salvador, Bahia, 40296-710, Brazil
| | - Jailton Azevedo
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Salvador, Bahia, 40296-710, Brazil
| | - Giulyana Evelyn Oliveira Silva
- Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Ondina, Salvador, Bahia, 40170-115, Brazil
| | - Angelica Maria Lima Amorim
- Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Ondina, Salvador, Bahia, 40170-115, Brazil
| | - Larissa Rangel Cabral de Roma
- Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Ondina, Salvador, Bahia, 40170-115, Brazil
| | | | | | - Mitermayer Galvão Reis
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Salvador, Bahia, 40296-710, Brazil
| | - Ana Verena Mendes
- São Rafael Hospital, São Marcos, Salvador, Bahia, 41253-190, Brazil.,Bahiana School of Medicine and Public Health of the Bahia Foundation for the Development of Sciences, Salvador, Bahia, Brazil
| | | | | | - Ianick Souto Martins
- Faculty of Medicine, Fluminense Federal University Downtown, 24033-900, Niterói, Rio de Janeiro, Brazil
| | - Joice Neves Reis
- Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Ondina, Salvador, Bahia, 40170-115, Brazil.
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Wilson H, Török ME. Extended-spectrum β-lactamase-producing and carbapenemase-producing Enterobacteriaceae. Microb Genom 2018; 4:e000197. [PMID: 30035710 PMCID: PMC6113871 DOI: 10.1099/mgen.0.000197] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 06/19/2018] [Indexed: 12/12/2022] Open
Abstract
Antimicrobial resistance (AMR) is a global public-health emergency, which threatens the advances made by modern medical care over the past century. The World Health Organization has recently published a global priority list of antibiotic-resistant bacteria, which includes extended-spectrum β-lactamase-producing Enterobacteriaceae and carbapenemase-producing Enterobacteriaceae. In this review, we highlight the mechanisms of resistance and the genomic epidemiology of these organisms, and the impact of AMR.
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Affiliation(s)
- Hayley Wilson
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - M. Estée Török
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Clinical Microbiology and Public Health Laboratory, Public Health England, Cambridge, UK
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Abdallah M, Balshi A. First literature review of carbapenem-resistant Providencia. New Microbes New Infect 2018; 25:16-23. [PMID: 29983987 PMCID: PMC6031241 DOI: 10.1016/j.nmni.2018.05.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/22/2018] [Accepted: 05/29/2018] [Indexed: 01/22/2023] Open
Abstract
Providencia species are Gram-negative bacteria that belong to the Enterobacteriaceae family. They have intrinsic resistance to colistin and tigecycline, which makes treatment of the multidrug-resistant strains of Providencia challenging. Carbapenem-resistant Providencia species are increasingly reported. In this review, patients' characteristics, resistance mechanisms, treatment and infection control measures of carbapenem-resistant Providencia species in the literature are described.
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Affiliation(s)
- M Abdallah
- Pharmaceutical Care Services, Riyadh, Saudi Arabia
| | - A Balshi
- Intensive Care Unit, King Saud Medical City, Riyadh, Saudi Arabia
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14
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15
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Ovejero CM, Delgado-Blas JF, Calero-Caceres W, Muniesa M, Gonzalez-Zorn B. Spread of mcr-1-carrying Enterobacteriaceae in sewage water from Spain. J Antimicrob Chemother 2017; 72:1050-1053. [PMID: 28073965 DOI: 10.1093/jac/dkw533] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 11/11/2016] [Indexed: 12/11/2022] Open
Abstract
Objectives The mobile colistin resistance gene mcr-1 has been identified worldwide in human and animal sources, while its occurrence in the environment is still largely unknown. The aim of this study was to investigate the presence of mcr-1 -harbouring Enterobacteriaceae in water samples obtained from rivers and waste water treatment plants in the area of Barcelona, Spain. Methods The presence of mcr-1 was detected by PCR. Bacterial identification was performed via MALDI-TOF MS. Resistance to colistin was determined by a broth dilution method. The epidemiological relationship between the positive isolates was assessed with PFGE and ST was determined by MLST. Plasmid characterization was performed by transformation experiments, antimicrobial susceptibility testing and incompatibility group PCR. Results Thirty MDR isolates bearing mcr-1 , 29 Escherichia coli (ST632 and ST479) and 1 Klebsiella pneumoniae (ST526), were identified in sewage from two different waste water treatment plants, whereas the gene was not found in river water. All isolates, including the K. pneumoniae , harboured bla CTX-M-55 and bla TEM-1 . mcr-1 was in all cases associated with an IncI2 plasmid, which only conferred resistance to colistin. mcr-1 was harboured by two predominant E. coli clones that were found in both waste water treatment plants. Conclusions This study showed a high occurrence of mcr-1 in the sewage of Barcelona, mainly due to the dissemination of two E. coli pulsotypes that are circulating in the population. The presence of mcr-1 in the environment is a cause for concern, and suggests high prevalence of mcr-1 in the community.
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Affiliation(s)
- C M Ovejero
- Department of Animal Health and VISAVET, Universidad Complutense de Madrid, Madrid, Spain
| | - J F Delgado-Blas
- Department of Animal Health and VISAVET, Universidad Complutense de Madrid, Madrid, Spain
| | - W Calero-Caceres
- Department of Microbiology, Universitat de Barcelona, Barcelona, Spain
| | - M Muniesa
- Department of Microbiology, Universitat de Barcelona, Barcelona, Spain
| | - B Gonzalez-Zorn
- Department of Animal Health and VISAVET, Universidad Complutense de Madrid, Madrid, Spain
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Cheruvanky A, Stoesser N, Sheppard AE, Crook DW, Hoffman PS, Weddle E, Carroll J, Sifri CD, Chai W, Barry K, Ramakrishnan G, Mathers AJ. Enhanced Klebsiella pneumoniae Carbapenemase Expression from a Novel Tn 4401 Deletion. Antimicrob Agents Chemother 2017; 61:e00025-17. [PMID: 28373185 PMCID: PMC5444142 DOI: 10.1128/aac.00025-17] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/24/2017] [Indexed: 11/20/2022] Open
Abstract
The Klebsiella pneumoniae carbapenemase gene (blaKPC) is typically located within mobile transposon Tn4401 Enhanced KPC expression has been associated with deletions in the putative promoter region upstream of blaKPC Illumina sequences from blaKPC-positive clinical isolates from a single institution were mapped to a Tn4401b reference sequence, which carries no deletions. The novel isoform Tn4401h (188-bp deletion [between istB and blaKPC]) was present in 14% (39/281) of clinical isolates. MICs showed that Escherichia coli strains containing plasmids with Tn4401a and Tn4401h were more resistant to meropenem (≥16 and ≥16, respectively), ertapenem (≥8 and 4, respectively), and cefepime (≥64 and 4, respectively) than E. coli strains with Tn4401b (0.5, ≤0.5, and ≤1, respectively). Quantitative real-time PCR (qRT-PCR) demonstrated that Tn4401a had a 16-fold increase and Tn4401h a 4-fold increase in blaKPC mRNA levels compared to the reference Tn4401b. A lacZ reporter plasmid was used to test the activity of the promoter regions from the different variants, and the results showed that the Tn4401a and Tn4401h promoter sequences generated higher β-galactosidase activity than the corresponding Tn4401b sequence. Further dissection of the promoter region demonstrated that putative promoter P1 was not functional. The activity of the isolated P2 promoter was greatly enhanced by inclusion of the P1-P2 intervening sequence. These studies indicated that gene expression could be an important consideration in understanding resistance phenotypes predicted by genetic signatures in the context of sequencing-based rapid diagnostics.
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Affiliation(s)
- Anita Cheruvanky
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Nicole Stoesser
- Modernizing Medical Microbiology Consortium, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford University, Oxford, United Kingdom
| | - Anna E Sheppard
- Modernizing Medical Microbiology Consortium, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford University, Oxford, United Kingdom
| | - Derrick W Crook
- Modernizing Medical Microbiology Consortium, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford University, Oxford, United Kingdom
| | - Paul S Hoffman
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Erin Weddle
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
- Department of Biologic Sciences, Shenandoah University, Winchester, Virginia, USA
| | - Joanne Carroll
- Clinical Microbiology, Department of Pathology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Costi D Sifri
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Weidong Chai
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Katie Barry
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Girija Ramakrishnan
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Amy J Mathers
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
- Clinical Microbiology, Department of Pathology, University of Virginia Health System, Charlottesville, Virginia, USA
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Rosa JF, Rizek C, Marchi AP, Guimaraes T, Miranda L, Carrilho C, Levin AS, Costa SF. Clonality, outer-membrane proteins profile and efflux pump in KPC- producing Enterobacter sp. in Brazil. BMC Microbiol 2017; 17:69. [PMID: 28302074 PMCID: PMC5356252 DOI: 10.1186/s12866-017-0970-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 03/04/2017] [Indexed: 11/21/2022] Open
Abstract
Background Carbapenems resistance in Enterobacter spp. has increased in the last decade, few studies, however, described the mechanisms of resistance in this bacterium. This study evaluated clonality and mechanisms of carbapenems resistance in clinical isolates of Enterobacter spp. identified in three hospitals in Brazil (Hospital A, B and C) over 7-year. Methods Antibiotics sensitivity, pulsed-field gel electrophoresis (PFGE), PCR for carbapenemase and efflux pump genes were performed for all carbapenems-resistant isolates. Outer-membrane protein (OMP) was evaluated based on PFGE profile. Results A total of 130 isolates of Enterobacter spp were analyzed, 44/105 (41, 9%) E. aerogenes and 8/25 (32,0%) E. cloacae were resistant to carbapenems. All isolates were susceptible to fosfomycin, polymyxin B and tigecycline. KPC was present in 88.6% of E. aerogenes and in all E. cloacae resistant to carbapenems. The carbapenems-resistant E. aerogenes identified in hospital A belonged to six clones, however, a predominant clone was identified in this hospital over the study period. There is a predominant clone in Hospital B and Hospital C as well. The mechanisms of resistance to carbapenems differ among subtypes. Most of the isolates co-harbored blaKPC, blaTEM and /or blaCTX associated with decreased or lost of 35–36KDa and or 39 KDa OMP. The efflux pump AcrAB-TolC gene was only identified in carbapenems-resistant E. cloacae. Conclusions There was a predominant clone in each hospital suggesting that cross-transmission of carbapenems-resistant Enterobacter spp. was frequent. The isolates presented multiple mechanisms of resistance to carbapenems including OMP alteration.
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Affiliation(s)
- Juliana Ferraz Rosa
- Department of Infectious Diseases, University of São Paulo, Laboratory of Medical Investigation 54 (LIM-54), Hospital Das Clínicas FMUSP, São Paulo, Brazil
| | - Camila Rizek
- Department of Infectious Diseases, University of São Paulo, Laboratory of Medical Investigation 54 (LIM-54), Hospital Das Clínicas FMUSP, São Paulo, Brazil
| | - Ana Paula Marchi
- Department of Infectious Diseases, University of São Paulo, Laboratory of Medical Investigation 54 (LIM-54), Hospital Das Clínicas FMUSP, São Paulo, Brazil
| | - Thais Guimaraes
- Department of Infectious Diseases, University of São Paulo, Laboratory of Medical Investigation 54 (LIM-54), Hospital Das Clínicas FMUSP, São Paulo, Brazil
| | - Lourdes Miranda
- Hospital de Itapecerica da Serra, Itapecerica da Serra, SP, Brazil
| | | | - Anna S Levin
- Department of Infectious Diseases, University of São Paulo, Laboratory of Medical Investigation 54 (LIM-54), Hospital Das Clínicas FMUSP, São Paulo, Brazil
| | - Silvia F Costa
- LIM-54, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Cabral AB, Maciel MAV, Barros JF, Antunes MM, Barbosa de Castro CMM, Lopes ACS. Clonal spread and accumulation of β-lactam resistance determinants in Enterobacter aerogenes and Enterobacter cloacae complex isolates from infection and colonization in patients at a public hospital in Recife, Pernambuco, Brazil. J Med Microbiol 2017; 66:70-77. [DOI: 10.1099/jmm.0.000398] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Adriane Borges Cabral
- Universidade Estadual de Ciências da Saúde de Alagoas-UNCISAL, Maceió, Alagoas 57010-300, Brazil
- Universidade Federal de Pernambuco-UFPE, Recife, Pernambuco 50732-970, Brazil
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Cao XL, Cheng L, Zhang ZF, Ning MZ, Zhou WQ, Zhang K, Shen H. Survey of Clinical Extended-Spectrum Beta-Lactamase-Producing Enterobacter cloacae Isolates in a Chinese Tertiary Hospital, 2012–2014. Microb Drug Resist 2017; 23:83-89. [PMID: 27116016 DOI: 10.1089/mdr.2015.0128] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Xiao-Li Cao
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
| | - Li Cheng
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
| | - Zhi-Feng Zhang
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
| | - Ming-Zhe Ning
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
| | - Wan-Qing Zhou
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
| | - Kui Zhang
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
| | - Han Shen
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
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Escandón-Vargas K, Reyes S, Gutiérrez S, Villegas MV. The epidemiology of carbapenemases in Latin America and the Caribbean. Expert Rev Anti Infect Ther 2016; 15:277-297. [PMID: 27915487 DOI: 10.1080/14787210.2017.1268918] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Enterobacteriaceae, Pseudomonas spp., and Acinetobacter spp. infections are major causes of morbidity and mortality, especially due to the emergence and spread of β-lactamases. Carbapenemases, which are β-lactamases with the capacity to hydrolyze or inactivate carbapenems, have become a serious concern as they have the largest hydrolytic spectrum and therefore limit the utility of most β-lactam antibiotics. Areas covered: Here, we present an update of the current status of carbapenemases in Latin America and the Caribbean. Expert commentary: The increased frequency of reports on carbapenemases in Latin America and the Caribbean shows that they have successfully spread and have even become endemic in some countries. Countries such as Brazil, Colombia, Argentina, and Mexico account for the majority of these reports. Early suspicion and detection along with implementation of antimicrobial stewardship programs in all healthcare settings are crucial for the control and prevention of carbapenemase-producing bacteria.
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Affiliation(s)
- Kevin Escandón-Vargas
- a Bacterial Resistance and Hospital Epidemiology Unit , International Center for Medical Research and Training (CIDEIM) , Cali , Colombia
| | - Sergio Reyes
- a Bacterial Resistance and Hospital Epidemiology Unit , International Center for Medical Research and Training (CIDEIM) , Cali , Colombia
| | - Sergio Gutiérrez
- a Bacterial Resistance and Hospital Epidemiology Unit , International Center for Medical Research and Training (CIDEIM) , Cali , Colombia
| | - María Virginia Villegas
- a Bacterial Resistance and Hospital Epidemiology Unit , International Center for Medical Research and Training (CIDEIM) , Cali , Colombia.,b Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics , Universidad El Bosque , Bogotá , Colombia
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Sampaio JLM, Gales AC. Antimicrobial resistance in Enterobacteriaceae in Brazil: focus on β-lactams and polymyxins. Braz J Microbiol 2016; 47 Suppl 1:31-37. [PMID: 27825605 PMCID: PMC5156504 DOI: 10.1016/j.bjm.2016.10.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 12/22/2022] Open
Abstract
During the last 30 years there has been a dissemination of plasmid-mediated β-lactamases in Enterobacteriaceae in Brazil. Extended spectrum β-lactamases (ESBL) are widely disseminated in the hospital setting and are detected in a lower frequency in the community setting. Cefotaximases are the most frequently detected ESBL type and Klebsiella pneumoniae is the predominant species among ESBL producers. Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae became widely disseminated in Brazil during the last decade and KPC production is currently the most frequent resistance mechanism (96.2%) in carbapenem resistant K. pneumoniae. To date KPC-2 is the only variant reported in Brazil. Polymyxin B resistance in KPC-2-producing K. pneumoniae has come to an alarming rate of 27.1% in 2015 in São Paulo, the largest city in Brazil. New Delhi metallo-β-lactamase was detected in Brazil in 2013, has been reported in different Brazilian states but are not widely disseminated. Antimicrobial resistance in Enterobacteriaceae in Brazil is a very serious problem that needs urgent actions which includes both more strict adherence to infection control measures and more judicious use of antimicrobials.
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Affiliation(s)
- Jorge Luiz Mello Sampaio
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas, Departamento de Análises Clínicas e Toxicológicas, São Paulo, SP, Brazil; Fleury Medicina e Saúde, Seção de Microbiologia, São Paulo, SP, Brazil.
| | - Ana Cristina Gales
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina Interna, São Paulo, Brazil.
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Horizontal Transfer of Carbapenemase-Encoding Plasmids and Comparison with Hospital Epidemiology Data. Antimicrob Agents Chemother 2016; 60:4910-9. [PMID: 27270289 DOI: 10.1128/aac.00014-16] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/28/2016] [Indexed: 12/19/2022] Open
Abstract
Carbapenemase-producing organisms have spread worldwide, and infections with these bacteria cause significant morbidity. Horizontal transfer of plasmids carrying genes that encode carbapenemases plays an important role in the spread of multidrug-resistant Gram-negative bacteria. Here we investigate parameters regulating conjugation using an Escherichia coli laboratory strain that lacks plasmids or restriction enzyme modification systems as a recipient and also using patient isolates as donors and recipients. Because conjugation is tightly regulated, we performed a systematic analysis of the transfer of Klebsiella pneumoniae carbapenemase (blaKPC)-encoding plasmids into multiple strains under different environmental conditions to investigate critical variables. We used four blaKPC-carrying plasmids isolated from patient strains obtained from two hospitals: pKpQIL and pKPC-47e from the National Institutes of Health, and pKPC_UVA01 and pKPC_UVA02 from the University of Virginia. Plasmid transfer frequency differed substantially between different donor and recipient pairs, and the frequency was influenced by plasmid content, temperature, and substrate, in addition to donor and recipient strain. pKPC-47e was attenuated in conjugation efficiency across all conditions tested. Despite its presence in multiple clinical species, pKPC_UVA01 had lower conjugation efficiencies than pKpQIL into recipient strains. The conjugation frequency of these plasmids into K. pneumoniae and E. coli patient isolates ranged widely without a clear correlation with clinical epidemiological data. Our results highlight the importance of each variable examined in these controlled experiments. The in vitro models did not reliably predict plasmid mobilization observed in a patient population, indicating that further studies are needed to understand the most important variables affecting horizontal transfer in vivo.
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Global Dissemination of blaKPC into Bacterial Species beyond Klebsiella pneumoniae and In Vitro Susceptibility to Ceftazidime-Avibactam and Aztreonam-Avibactam. Antimicrob Agents Chemother 2016; 60:4490-500. [PMID: 27161636 DOI: 10.1128/aac.00107-16] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/01/2016] [Indexed: 02/06/2023] Open
Abstract
The Klebsiella pneumoniae carbapenemase (KPC), first described in the United States in 1996, is now a widespread global problem in several Gram-negative species. A worldwide surveillance study collected Gram-negative pathogens from 202 global sites in 40 countries during 2012 to 2014 and determined susceptibility to β-lactams and other class agents by broth microdilution testing. Molecular mechanisms of β-lactam resistance among carbapenem-nonsusceptible Enterobacteriaceae and Pseudomonas aeruginosa were determined using PCR and sequencing. Genes encoding KPC enzymes were found in 586 isolates from 22 countries (76 medical centers), including countries in the Asia-Pacific region (32 isolates), Europe (264 isolates), Latin America (210 isolates), and the Middle East (19 isolates, Israel only) and the United States (61 isolates). The majority of isolates were K. pneumoniae (83.4%); however, KPC was detected in 13 additional species. KPC-2 (69.6%) was more common than KPC-3 (29.5%), with regional variation observed. A novel KPC variant, KPC-18 (KPC-3[V8I]), was identified during the study. Few antimicrobial agents tested remained effective in vitro against KPC-producing isolates, with ceftazidime-avibactam (MIC90, 4 μg/ml), aztreonam-avibactam (MIC90, 0.5 μg/ml), and tigecycline (MIC90, 2 μg/ml) retaining the greatest activity against Enterobacteriaceae cocarrying KPC and other β-lactamases, whereas colistin (MIC90, 2 μg/ml) demonstrated the greatest in vitro activity against KPC-positive P. aeruginosa This analysis of surveillance data demonstrated that KPC is widely disseminated. KPC was found in multiple species of Enterobacteriaceae and P. aeruginosa and has now become a global problem.
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Conlan S, Park M, Deming C, Thomas PJ, Young AC, Coleman H, Sison C, Weingarten RA, Lau AF, Dekker JP, Palmore TN, Frank KM, Segre JA. Plasmid Dynamics in KPC-Positive Klebsiella pneumoniae during Long-Term Patient Colonization. mBio 2016; 7:e00742-16. [PMID: 27353756 PMCID: PMC4937214 DOI: 10.1128/mbio.00742-16] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 05/23/2016] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED Carbapenem-resistant Klebsiella pneumoniae strains are formidable hospital pathogens that pose a serious threat to patients around the globe due to a rising incidence in health care facilities, high mortality rates associated with infection, and potential to spread antibiotic resistance to other bacterial species, such as Escherichia coli Over 6 months in 2011, 17 patients at the National Institutes of Health (NIH) Clinical Center became colonized with a highly virulent, transmissible carbapenem-resistant strain of K. pneumoniae Our real-time genomic sequencing tracked patient-to-patient routes of transmission and informed epidemiologists' actions to monitor and control this outbreak. Two of these patients remained colonized with carbapenemase-producing organisms for at least 2 to 4 years, providing the opportunity to undertake a focused genomic study of long-term colonization with antibiotic-resistant bacteria. Whole-genome sequencing studies shed light on the underlying complex microbial colonization, including mixed or evolving bacterial populations and gain or loss of plasmids. Isolates from NIH patient 15 showed complex plasmid rearrangements, leaving the chromosome and the blaKPC-carrying plasmid intact but rearranging the two other plasmids of this outbreak strain. NIH patient 16 has shown continuous colonization with blaKPC-positive organisms across multiple time points spanning 2011 to 2015. Genomic studies defined a complex pattern of succession and plasmid transmission across two different K. pneumoniae sequence types and an E. coli isolate. These findings demonstrate the utility of genomic methods for understanding strain succession, genome plasticity, and long-term carriage of antibiotic-resistant organisms. IMPORTANCE In 2011, the NIH Clinical Center had a nosocomial outbreak involving 19 patients who became colonized or infected with blaKPC-positive Klebsiella pneumoniae Patients who have intestinal colonization with blaKPC-positive K. pneumoniae are at risk for developing infections that are difficult or nearly impossible to treat with existing antibiotic options. Two of those patients remained colonized with blaKPC-positive Klebsiella pneumoniae for over a year, leading to the initiation of a detailed genomic analysis exploring mixed colonization, plasmid recombination, and plasmid diversification. Whole-genome sequence analysis identified a variety of changes, both subtle and large, in the blaKPC-positive organisms. Long-term colonization of patients with blaKPC-positive Klebsiella pneumoniae creates new opportunities for horizontal gene transfer of plasmids encoding antibiotic resistance genes and poses complications for the delivery of health care.
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Affiliation(s)
- Sean Conlan
- National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Morgan Park
- National Institutes of Health Intramural Sequencing Center (NISC), Rockville, Maryland, USA
| | - Clayton Deming
- National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Pamela J Thomas
- National Institutes of Health Intramural Sequencing Center (NISC), Rockville, Maryland, USA
| | - Alice C Young
- National Institutes of Health Intramural Sequencing Center (NISC), Rockville, Maryland, USA
| | - Holly Coleman
- National Institutes of Health Intramural Sequencing Center (NISC), Rockville, Maryland, USA
| | - Christina Sison
- National Institutes of Health Intramural Sequencing Center (NISC), Rockville, Maryland, USA
| | | | - Anna F Lau
- National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - John P Dekker
- National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Tara N Palmore
- National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Karen M Frank
- National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Julia A Segre
- National Human Genome Research Institute, Bethesda, Maryland, USA
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Nested Russian Doll-Like Genetic Mobility Drives Rapid Dissemination of the Carbapenem Resistance Gene blaKPC. Antimicrob Agents Chemother 2016; 60:3767-78. [PMID: 27067320 PMCID: PMC4879409 DOI: 10.1128/aac.00464-16] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/03/2016] [Indexed: 01/01/2023] Open
Abstract
The recent widespread emergence of carbapenem resistance in Enterobacteriaceae is a major public health concern, as carbapenems are a therapy of last resort against this family of common bacterial pathogens. Resistance genes can mobilize via various mechanisms, including conjugation and transposition; however, the importance of this mobility in short-term evolution, such as within nosocomial outbreaks, is unknown. Using a combination of short- and long-read whole-genome sequencing of 281 blaKPC-positive Enterobacteriaceae isolates from a single hospital over 5 years, we demonstrate rapid dissemination of this carbapenem resistance gene to multiple species, strains, and plasmids. Mobility of blaKPC occurs at multiple nested genetic levels, with transmission of blaKPC strains between individuals, frequent transfer of blaKPC plasmids between strains/species, and frequent transposition of blaKPC transposon Tn4401 between plasmids. We also identify a common insertion site for Tn4401 within various Tn2-like elements, suggesting that homologous recombination between Tn2-like elements has enhanced the spread of Tn4401 between different plasmid vectors. Furthermore, while short-read sequencing has known limitations for plasmid assembly, various studies have attempted to overcome this by the use of reference-based methods. We also demonstrate that, as a consequence of the genetic mobility observed in this study, plasmid structures can be extremely dynamic, and therefore these reference-based methods, as well as traditional partial typing methods, can produce very misleading conclusions. Overall, our findings demonstrate that nonclonal resistance gene dissemination can be extremely rapid, presenting significant challenges for public health surveillance and achieving effective control of antibiotic resistance.
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Sader HS, Castanheira M, Flamm RK, Mendes RE, Farrell DJ, Jones RN. Tigecycline activity tested against carbapenem-resistant Enterobacteriaceae from 18 European nations: results from the SENTRY surveillance program (2010–2013). Diagn Microbiol Infect Dis 2015; 83:183-6. [DOI: 10.1016/j.diagmicrobio.2015.06.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/15/2015] [Accepted: 06/19/2015] [Indexed: 02/04/2023]
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Aires CAM, Almeida ACS, Vilela MA, Morais-Junior MA, Morais MMC. Selection of KPC-2-producing Providencia stuartii during treatment for septicemia. Diagn Microbiol Infect Dis 2015; 84:95-96. [PMID: 26527060 DOI: 10.1016/j.diagmicrobio.2015.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/14/2015] [Accepted: 09/17/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Caio A M Aires
- Microbial Resistance Laboratory, University of Pernambuco, Recife, Brazil
| | - Anna C S Almeida
- Microbial Resistance Laboratory, University of Pernambuco, Recife, Brazil; Laboratory of Genetics of Microorganisms, Federal University of Pernambuco, Recife, Brazil; Department of Biology, Federal Rural University of Pernambuco, Recife, Brazil.
| | - Marinalda A Vilela
- Microbial Resistance Laboratory, University of Pernambuco, Recife, Brazil
| | - Marcos A Morais-Junior
- Laboratory of Genetics of Microorganisms, Federal University of Pernambuco, Recife, Brazil
| | - Márcia M C Morais
- Microbial Resistance Laboratory, University of Pernambuco, Recife, Brazil
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