1
|
Mó I, da Silva GJ. Tackling Carbapenem Resistance and the Imperative for One Health Strategies-Insights from the Portuguese Perspective. Antibiotics (Basel) 2024; 13:557. [PMID: 38927223 PMCID: PMC11201282 DOI: 10.3390/antibiotics13060557] [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: 05/19/2024] [Revised: 06/09/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Carbapenemases, a class of enzymes specialized in the hydrolysis of carbapenems, represent a significant threat to global public health. These enzymes are classified into different Ambler's classes based on their active sites, categorized into classes A, D, and B. Among the most prevalent types are IMI/NMC-A, KPC, VIM, IMP, and OXA-48, commonly associated with pathogenic species such as Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The emergence and dissemination of carbapenemase-producing bacteria have raised substantial concerns due to their ability to infect humans and animals (both companion and food-producing) and their presence in environmental reservoirs. Adopting a holistic One Health approach, concerted efforts have been directed toward devising comprehensive strategies to mitigate the impact of antimicrobial resistance dissemination. This entails collaborative interventions, highlighting proactive measures by global organizations like the World Health Organization, the Center for Disease Control and Prevention, and the Food and Agriculture Organization. By synthesizing the evolving landscape of carbapenemase epidemiology in Portugal and tracing the trajectory from initial isolated cases to contemporary reports, this review highlights key factors driving antibiotic resistance, such as antimicrobial use and healthcare practices, and underscores the imperative for sustained vigilance, interdisciplinary collaboration, and innovative interventions to curb the escalating threat posed by antibiotic-resistant pathogens. Finally, it discusses potential alternatives and innovations aimed at tackling carbapenemase-mediated antibiotic resistance, including new therapies, enhanced surveillance, and public awareness campaigns.
Collapse
Affiliation(s)
- Inês Mó
- Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal;
| | - Gabriela Jorge da Silva
- Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal;
- CNC, Center for Neuroscience and Cell Biology, 3004-504 Coimbra, Portugal
| |
Collapse
|
2
|
Liu L, Zhang L, Zhou H, Yuan M, Hu D, Wang Y, Sun H, Xu J, Lan R. Antimicrobial Resistance and Molecular Characterization of Citrobacter spp. Causing Extraintestinal Infections. Front Cell Infect Microbiol 2021; 11:737636. [PMID: 34513738 PMCID: PMC8429604 DOI: 10.3389/fcimb.2021.737636] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/03/2021] [Indexed: 12/19/2022] Open
Abstract
Objectives This prospective study was carried out to investigate molecular characteristics and antimicrobial susceptibility patterns of Citrobacter spp. from extraintestinal infections. Methods Forty-six clinical Citrobacter spp. isolates were isolated from hospital patients with extraintestinal infections and analyzed by multilocus sequence typing (MLST) using seven housekeeping genes. Antimicrobial susceptibility testing was performed by disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) recommendations. Adhesion and cytotoxicity to HEp-2 cells were assessed. Results The 46 clinical Citrobacter spp. isolates were typed into 38 sequence types (STs), 9 of which belonged to four clonal complexes (CCs). None of the isolates shared the same ST or CCs with isolates from other countries or from other parts of China. Over half of the isolates were multidrug-resistant (MDR), with 17/26 C. freundii, 5/6 C. braakii, and 3/14 C. koseri isolates being MDR. Moreover, four isolates were carbapenem resistant with resistance to imipenem or meropenem. Among eight quinolone resistant C. freundii, all had a mutation in codon 59 (Thr59Ile) in quinolone resistance determining region of the gyrA gene. Only a small proportion of the isolates were found to be highly cytotoxic and adhesive with no correlation to sample sources. Conclusions There was a diverse range of Citrobacter isolates causing extraintestinal infections and a high prevalence of MDR.
Collapse
Affiliation(s)
- Liyun Liu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Research Units of Discovery of Unknown Bacteria and Function (2018RU010), Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Zhang
- Microbiology Department, Maanshan Center for Clinical Laboratory, Ma'anshan, China
| | - Haijian Zhou
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Research Units of Discovery of Unknown Bacteria and Function (2018RU010), Chinese Academy of Medical Sciences, Beijing, China
| | - Min Yuan
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Research Units of Discovery of Unknown Bacteria and Function (2018RU010), Chinese Academy of Medical Sciences, Beijing, China
| | - Dalong Hu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Research Units of Discovery of Unknown Bacteria and Function (2018RU010), Chinese Academy of Medical Sciences, Beijing, China
| | - Yonglu Wang
- Microbiology Department, Maanshan Center for Disease Control and Prevention, Ma'anshan, China
| | - Hui Sun
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Research Units of Discovery of Unknown Bacteria and Function (2018RU010), Chinese Academy of Medical Sciences, Beijing, China
| | - Jianguo Xu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Research Units of Discovery of Unknown Bacteria and Function (2018RU010), Chinese Academy of Medical Sciences, Beijing, China
| | - Ruiting Lan
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
3
|
Jia K, Yang N, Zhang X, Cai R, Zhang Y, Tian J, Raza SHA, Kang Y, Qian A, Li Y, Sun W, Shen J, Yao J, Shan X, Zhang L, Wang G. Genomic, Morphological and Functional Characterization of Virulent Bacteriophage IME-JL8 Targeting Citrobacter freundii. Front Microbiol 2020; 11:585261. [PMID: 33329451 PMCID: PMC7717962 DOI: 10.3389/fmicb.2020.585261] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/30/2020] [Indexed: 01/01/2023] Open
Abstract
Citrobacter freundii refers to a fish pathogen extensively reported to be able to cause injury and high mortality. Phage therapy is considered a process to alternatively control bacterial infections and contaminations. In the present study, the isolation of a virulent bacteriophage IME-JL8 isolated from sewage was presented, and such bacteriophage was characterized to be able to infect Citrobacter freundii specifically. Phage IME-JL8 has been classified as the member of the Siphoviridae family, which exhibits the latent period of 30–40 min. The pH and thermal stability of phage IME-JL8 demonstrated that this bacteriophage achieved a pH range of 4–10 as well as a temperature range of 4, 25, and 37°C. As revealed from the results of whole genomic sequence analysis, IME-JL8 covers a double-stranded genome of 49,838 bp (exhibiting 47.96% G+C content), with 80 putative coding sequences contained. No bacterial virulence- or lysogenesis-related ORF was identified in the IME-JL8 genome, so it could be applicable to phage therapy. As indicated by the in vitro experiments, phage IME-JL8 is capable of effectively removing bacteria (the colony count decreased by 6.8 log units at 20 min), and biofilm can be formed in 24 h. According to the in vivo experiments, administrating IME-JL8 (1 × 107 PFU) was demonstrated to effectively protect the fish exhibiting a double median lethal dose (2 × 109 CFU/carp). Moreover, the phage treatment led to the decline of pro-inflammatory cytokines in carp with lethal infections. IME-JL8 was reported to induce efficient lysis of Citrobacter freundii both in vitro and in vivo, thereby demonstrating its potential as an alternative treatment strategy for infections attributed to Citrobacter freundii.
Collapse
Affiliation(s)
- Kaixiang Jia
- College of Animal Science and Technology, Key Laboratory of Animal Production and Product Quality Safety of Ministry of Education, Jilin Agricultural University, Changchun, China
| | - Nuo Yang
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xiuwen Zhang
- Research Management Office, Jilin Academy of Agricultural Sciences, Changchun, China
| | - Ruopeng Cai
- College of Animal Science and Technology, Key Laboratory of Animal Production and Product Quality Safety of Ministry of Education, Jilin Agricultural University, Changchun, China
| | - Yang Zhang
- College of Animal Science and Technology, Key Laboratory of Animal Production and Product Quality Safety of Ministry of Education, Jilin Agricultural University, Changchun, China
| | - Jiaxin Tian
- College of Animal Science and Technology, Key Laboratory of Animal Production and Product Quality Safety of Ministry of Education, Jilin Agricultural University, Changchun, China
| | | | - Yuanhuan Kang
- College of Animal Science and Technology, Key Laboratory of Animal Production and Product Quality Safety of Ministry of Education, Jilin Agricultural University, Changchun, China
| | - Aidong Qian
- College of Animal Science and Technology, Key Laboratory of Animal Production and Product Quality Safety of Ministry of Education, Jilin Agricultural University, Changchun, China
| | - Ying Li
- College of Animal Science and Technology, Key Laboratory of Animal Production and Product Quality Safety of Ministry of Education, Jilin Agricultural University, Changchun, China
| | - Wuwen Sun
- College of Animal Science and Technology, Key Laboratory of Animal Production and Product Quality Safety of Ministry of Education, Jilin Agricultural University, Changchun, China
| | - Jinyu Shen
- Zhejiang Institute of Freshwater Fisheries, Huzhou, China
| | - Jiayun Yao
- Zhejiang Institute of Freshwater Fisheries, Huzhou, China
| | - Xiaofeng Shan
- College of Animal Science and Technology, Key Laboratory of Animal Production and Product Quality Safety of Ministry of Education, Jilin Agricultural University, Changchun, China
| | - Lei Zhang
- College of Animal Science and Technology, Key Laboratory of Animal Production and Product Quality Safety of Ministry of Education, Jilin Agricultural University, Changchun, China
| | - Guiqin Wang
- College of Animal Science and Technology, Key Laboratory of Animal Production and Product Quality Safety of Ministry of Education, Jilin Agricultural University, Changchun, China
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Diversity and Genetic Basis for Carbapenem Resistance in a Coastal Marine Environment. Appl Environ Microbiol 2020; 86:AEM.02939-19. [PMID: 32198174 DOI: 10.1128/aem.02939-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/07/2020] [Indexed: 11/20/2022] Open
Abstract
Resistance to the "last-resort" antibiotics, such as carbapenems, has led to very few antibiotics being left to treat infections by multidrug-resistant bacteria. Spread of carbapenem resistance (CR) has been well characterized for the clinical environment. However, there is a lack of information about its environmental distribution. Our study reveals that CR is present in a wide range of Gram-negative bacteria in the coastal seawater environment, including four phyla, eight classes, and 30 genera. These bacteria were likely introduced into seawater via stormwater flows. Some CR isolates found here, such as Acinetobacter junii, Acinetobacter johnsonii, Brevundimonas vesicularis, Enterococcus durans, Pseudomonas monteilii, Pseudomonas fulva, and Stenotrophomonas maltophilia, are further relevant to human health. We also describe a novel metallo-β-lactamase (MBL) for marine Rheinheimera isolates with CR, which has likely been horizontally transferred to Citrobacter freundii or Enterobacter cloacae In contrast, another MBL of the New Delhi type was likely acquired by environmental Variovorax isolates from Escherichia coli, Klebsiella pneumoniae, or Acinetobacter baumannii utilizing a plasmid. Our findings add to the growing body of evidence that the aquatic environment is both a reservoir and a vector for novel CR genes.IMPORTANCE Resistance against the "last-resort" antibiotics of the carbapenem family is often based on the production of carbapenemases, and this has been frequently observed in clinical samples. However, the dissemination of carbapenem resistance (CR) in the environment has been less well explored. Our study shows that CR is commonly found in a range of bacterial taxa in the coastal aquatic environment and can involve the exchange of novel metallo-β-lactamases from typical environmental bacteria to potential human pathogens or vice versa. The outcomes of this study contribute to a better understanding of how aquatic and marine bacteria can act as reservoirs and vectors for CR outside the clinical setting.
Collapse
|
6
|
Chi X, Guo J, Zhou Y, Xiao T, Xu H, Lv T, Chen C, Chen J, Zheng B. Complete-Genome Sequencing and Comparative Genomic Characterization of an IMP-4 Producing Citrobacter freundii Isolate from Patient with Diarrhea. Infect Drug Resist 2020; 13:1057-1065. [PMID: 32341658 PMCID: PMC7166059 DOI: 10.2147/idr.s244683] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/19/2020] [Indexed: 12/31/2022] Open
Abstract
Background Citrobacter freundii is the most common class of pathogens in the genus Citrobacter and is an important pathogen associated with certain underlying diseases or immune dysfunction. The aim of this study was to elucidate the resistance mechanism of clinically derived carbapenem-resistant C. freundii isolate and to characterize the genetic environment and delivery pattern of the IncN1 plasmid carrying the blaIMP-4 gene from C. freundii isolate. Materials and Methods We identified a clinical isolate of C. freundii L91 carrying blaIMP-4 and performed phylogenetic analysis by whole-genome sequencing. The complete genomic sequence of L91 was obtained using the Illumina HiSeq 4000-PE150 and PacBio RS II platforms. Antimicrobial susceptibility testing was determined by the VITEK 2 system. Plasmid characteristics were presented by S1-pulsed-field gel electrophoresis (PFGE), Southern blotting and conjugation experiments. Results S1-PFGE, Southern blot and conjugation assay confirmed the presence of blaIMP-4 genes on a conjugative plasmid in this isolate. C. freundii L91 and transconjugant L91-E. coli 600 strains both showed resistance to carbapenems. In silico analysis further showed that pIMP-4-L91 is an IncN1 plasmid with a length of 51,042 bp. Furthermore, blaIMP-4 gene was found encoded in the blaIMP-4-qacG2-aacA4-catB3 cassette array within a class 1 integron. A conserved structure sequence (ΔISKpn27-blaIMP-4-ΔISSen2-hp-hp-IS6100) was found in the upstream and downstream of the blaIMP-4. Conclusion We performed a comprehensive phylogenetic analysis of carbapenemase-resistant C. freundii and elucidated the resistance mechanism of clinically derived C. freundii L91. Not only that, we also found that the blaIMP-4 gene is located on the IncN1 plasmid and has a horizontal transfer function and a certain ability to spread. To lower the risk of the dissemination of such C. freundii isolates in clinical settings, more surveillance is needed in the future.
Collapse
Affiliation(s)
- Xiaohui Chi
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China.,Department of Environment and Health, School of Public Health, Shandong University, Jinan, People's Republic of China
| | - Jing Guo
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Yanzi Zhou
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Tingting Xiao
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Hao Xu
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Tao Lv
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Chunlei Chen
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Jian Chen
- Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Beiwen Zheng
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| |
Collapse
|
7
|
Complete Genome Sequence of Citrobacter freundii Siphophage Sazh. Microbiol Resour Announc 2019; 8:8/50/e01317-19. [PMID: 31831614 PMCID: PMC6908799 DOI: 10.1128/mra.01317-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
As an opportunistic pathogen, Citrobacter freundii is involved in a wide spectrum of nosocomial infections. C. freundii phages may prove useful as therapeutics for treating infections caused by multidrug-resistant C. freundii strains. Here, we report the complete genome sequence of C. freundii siphophage Sazh, which is closely related to Enterobacteria phages T1 and TLS. As an opportunistic pathogen, Citrobacter freundii is involved in a wide spectrum of nosocomial infections. C. freundii phages may prove useful as therapeutics for treating infections caused by multidrug-resistant C. freundii strains. Here, we report the complete genome sequence of C. freundii siphophage Sazh, which is closely related to Enterobacteria phages T1 and TLS.
Collapse
|
8
|
Abstract
Abstract
Subinhibitory concentrations of antibiotics and biocides in wastewaters and sewage sludge have a great impact on the development of antibiotic resistance and its spread among bacteria. The aim of this work was to determine the occurrence of coliform bacteria and enterococci resistant to biocide triclosan in samples of sewage sludge. Subsequently, isolated strains of coliform bacteria were identified and characterized in terms of their antibiotic susceptibility and ability to form a biofilm. Occurrence of the studied bacteria was monitored in three samples of stabilized sludge from three different wastewater treatment plants (Vrakuňa, Petržalka, and Senec). The number of triclosan-resistant coliforms was the highest in the sludge sample from the wastewater treatment plant in Senec and the lowest in the sludge sample from the wastewater treatment plant in Petržalka. Triclosan-resistant Enterococcus spp. were not found in any sample of stabilized sludge. Most isolates were identified as Citrobacter freundii and Serratia spp. Triclosan-resistant isolates showed also resistance to antibiotics and the majority of them were strong biofilm producers.
Collapse
|
9
|
Microbiota and potential opportunistic pathogens associated with male and female fruit flies of Malaysian Bactrocera carambolae (Insecta: Tephritidae). Meta Gene 2019. [DOI: 10.1016/j.mgene.2018.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|