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Gonçalves LF, de Oliveira Martins-Júnior P, de Melo ABF, da Silva RCRM, de Paulo Martins V, Pitondo-Silva A, de Campos TA. Multidrug resistance dissemination by extended-spectrum β-lactamase-producing Escherichia coli causing community-acquired urinary tract infection in the Central-Western Region, Brazil. J Glob Antimicrob Resist 2016; 6:1-4. [PMID: 27530830 DOI: 10.1016/j.jgar.2016.02.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/05/2016] [Accepted: 02/12/2016] [Indexed: 11/19/2022] Open
Abstract
The aim of this work was to analyse extended-spectrum β-lactamase (ESBL)-producing Escherichia coli strains isolated from outpatients with signs of cystitis in Hospital Universitário de Brasília (Brasília, Brazil) during the period July 2013 to April 2014. E. coli isolated from urine culture were identified and their antibiotic susceptibility profile was determined by VITEK 2. ESBL-producing strains identified were submitted to PCR for Clermont phylotyping, CTX-M group typing and virulence determinant detection, and clonal relationships were determined by enterobacterial repetitive intergenic consensus (ERIC)-PCR. One strain belonging to each cluster of the dendrogram obtained by ERIC-PCR was selected for multilocus sequence typing (MLST). Among 324 uropathogenic E. coli (UPEC) analysed, 23 (7.1%) were identified as producing ESBL. All ESBL-producing strains were multidrug-resistant (MDR), i.e. presented non-susceptibility to at least one agent in three or more antimicrobial categories. Of the 23 ESBL-producing UPEC strains, 9 were assigned to phylogenetic group B2 and 7 each belonged to phylogenetic groups D and A. Virulence genotyping showed that aer was the most prevalent gene observed among the strains (21/23), followed by traT (18/23), pap (5/23), afa (5/23), PAI (5/23), cnf (3/23) and sfa (1/23). Analysis of the dendrogram showed that multidrug resistance and CTX-M ESBL groups were distributed among all strains, independent of clonality and phylogroup. Sequence types (STs) associated with pandemic resistance clones, such as B2-ST131 and D-ST648, were observed among the isolates. In conclusion, the results showed worrisome evidence of the potential for antibiotic multiresistant dissemination among community-acquired urinary tract infection caused by UPEC.
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Affiliation(s)
- Laura Fernandes Gonçalves
- Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Campus Universitário 'Darcy Ribeiro', Asa Norte, CEP 70910-900 Brasília, DF, Brazil
| | | | | | - Rafaella Christina Rocha Moreira da Silva
- Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Campus Universitário 'Darcy Ribeiro', Asa Norte, CEP 70910-900 Brasília, DF, Brazil
| | - Vicente de Paulo Martins
- Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Campus Universitário 'Darcy Ribeiro', Asa Norte, CEP 70910-900 Brasília, DF, Brazil
| | - André Pitondo-Silva
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Tatiana Amabile de Campos
- Departamento de Biologia Celular, Instituto de Ciências Biológicas, Universidade de Brasília, Campus Universitário 'Darcy Ribeiro', Asa Norte, CEP 70910-900 Brasília, DF, Brazil.
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Liu HC, Hung YP, Lin HJ, Liu HC, Lee JC, Wu YH, Li CW, Li MC, Ko WC. Antimicrobial susceptibility of clinical Enterobacteriaceae isolates at the emergency department in a regional hospital: A threat of extended spectrum beta-lactamase-producers among nursing home residents. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 49:584-90. [PMID: 26692184 DOI: 10.1016/j.jmii.2015.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 05/31/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND/PURPOSE The prevalence of extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae in nursing home residents has rarely been reported in Taiwan. METHODS A retrospective study was performed at medical wards of a district hospital at southern Taiwan between July 2009 and June 2011. Patients were included if they were older than 18 years, admitted via the emergency department, and their blood, sputum, or urine culture revealed the growth of Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis. From each patient only the first isolate from the infection site was included. Antimicrobial susceptibility was determined using the disc diffusion method. RESULTS Overall, 827 patients were included, with 354 (42.8%) coming from the community and 473 (57.2%) referred from a nursing home. Of the isolates acquired in nursing home, 45.5% (215/473) harbored ESBL. By contrast, 20.6% (73) of 354 isolates acquired in the community exhibited the ESBL production phenotype (p < 0.001). Of the isolates obtained from blood, urine, or sputum, 28.2% (37/131), 36.0% (208/578), or 36.4% (43/118) harbored ESBL, respectively, whereas 41% (211) of 515 E. coli isolates, 34.3% (72) of 210 K. pneumoniae, and 4.9% (5) of 102 P. mirabilis had ESBL. In general, the isolates from a nursing home or those with ESBL had lower antimicrobial susceptibility rates than those from the community or those without ESBL production. Only amikacin, piperacillin/tazobactam, ertapenem, and imipenem/meropenem were active against >90% Enterobacteriaceae isolates, irrespective of ESBL production. CONCLUSION ESBL production was common among clinical Enterobacteriaceae isolates, especially E. coli or those isolated from nursing home residents.
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Affiliation(s)
- Hsiu-Chuan Liu
- Department of Experiment and Diagnosis and Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Yuan-Pin Hung
- Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital and Medical Colleague, Tainan, Taiwan; Graduate Institute of Clinical Medicine, National Health Research Institutes, Tainan, Taiwan
| | - Hsiao-Ju Lin
- Department of Experiment and Diagnosis and Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital and Medical Colleague, Tainan, Taiwan; Graduate Institute of Clinical Medicine, National Health Research Institutes, Tainan, Taiwan
| | - Hsiao-Chieh Liu
- Department of Experiment and Diagnosis and Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan; Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Jen-Chieh Lee
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical Colleague, Tainan, Taiwan
| | - Yi-Hui Wu
- Department of Internal Medicine, E-da Hospital, Kaohsiung, Taiwan
| | - Chia-Wen Li
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical Colleague, Tainan, Taiwan
| | - Ming-Chi Li
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical Colleague, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical Colleague, Tainan, Taiwan.
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