Clonal distribution of resistance plasmid-carrying Salmonella typhimurium, mainly in the Middle East

The Complete Nucleotide Sequence of pZM3, a 1970 FIA:FIB:FII Plasmid Carrying Antibiotic Resistance and Virulence Determinants

The multiresistance plasmid, pZM3, from a 1970 Salmonella enterica serovar Wien isolate from Algeria represents the multiresistance FIme-type plasmids conferring resistance to ampicillin, chloramphenicol, kanamycin, neomycin, sulfonamides, streptomycin, spectinomycin, tetracycline, and mercuric ions circulating in the Middle East in the 1970s. pZM3 was sequenced to determine the relationship between IS1936, the IS26-like insertion sequence it carries, and IS26. IS1936 is identical to IS26. pZM3 is a 166.8-kb plasmid with three replicons typed as FIA-1, FIB-1, and FII-1, consistent with other FIme plasmids. However, Tn3, containing the bla_TEM-1a ampicillin resistance gene, disrupts the FII repA gene. pZM3 also contains an IS1-flanked virulence region, including the sit and aerobactin operons, shared with many other FIB-1 virulence plasmids. The remaining resistance genes are located in a 44.7-kb complex resistance island that includes the Tn21-like transposon, Tn1935, identified previously. Relative to Tn21, Tn1935 includes an additional gene cassette, oxa1, and Tn4352 in tniA. Tn1935 is in the same Tn2670 context as Tn21 in NR1, and identity to NR1 extends beyond the IS1 flanking the catA1 gene. On the other side, IS1-mediated events have brought in a Tn10 remnant and inverted part of it, highlighting the role of IS1 in resistance region evolution. The backbone of pZM3 was found to be almost identical to that of pRSB225, recovered in Germany in 2013, and their resistance islands are in the same position. The pRSB225 resistance island has evolved in situ from the pZM3 configuration through an insertion, a replacement, and an inversion.

Early transmissible ampicillin resistance in zoonotic Salmonella enterica serotype Typhimurium in the late 1950s: a retrospective, whole-genome sequencing study

BACKGROUND

Ampicillin, the first semi-synthetic penicillin active against Enterobacteriaceae, was released onto the market in 1961. The first outbreaks of disease caused by ampicillin-resistant strains of Salmonella enterica serotype Typhimurium were identified in the UK in 1962 and 1964. We aimed to date the emergence of this resistance in historical isolates of S enterica serotype Typhimurium.

METHODS

In this retrospective, whole-genome sequencing study, we analysed 288 S enterica serotype Typhimurium isolates collected between 1911 and 1969 from 31 countries on four continents and from various sources including human beings, animals, feed, and food. All isolates were tested for antimicrobial drug susceptibility with the disc diffusion method, and isolates shown to be resistant to ampicillin underwent resistance-transfer experiments. To provide insights into population structure and mechanisms of ampicillin resistance, we did whole-genome sequencing on a subset of 225 isolates, selected to maximise source, spatiotemporal, and genetic diversity.

FINDINGS

11 (4%) of 288 isolates were resistant to ampicillin because of acquisition of various β lactamase genes, including bla_TEM-1, carried by various plasmids, including the virulence plasmid of S enterica serotype Typhimurium. These 11 isolates were from three phylogenomic groups. One isolate producing TEM-1 β lactamase was isolated in France in 1959 and two isolates producing TEM-1 β lactamase were isolated in Tunisia in 1960, before ampicillin went on sale. The vectors for ampicillin resistance were different from those reported in the strains responsible for the outbreaks in the UK in the 1960s.

INTERPRETATION

The association between antibiotic use and selection of resistance determinants is not as direct as often presumed. Our results suggest that the non-clinical use of narrow-spectrum penicillins (eg, benzylpenicillin) might have favoured the diffusion of plasmids carrying the bla_TEM-1 gene in S enterica serotype Typhimurium in the late 1950s.

FUNDING

Institut Pasteur, Santé publique France, the French Government's Investissement d'Avenir programme, the Fondation Le Roch-Les Mousquetaires.

Analysis of pCERC7, a small antibiotic resistance plasmid from a commensal ST131 Escherichia coli, defines a diverse group of plasmids that include various segments adjacent to a multimer resolution site and encode the same NikA relaxase accessory protein enabling mobilisation

The ampicillin resistance plasmid pCERC7, carrying transposon Tn2 with an IS4 insertion, was detected in the draft genome of a commensal Escherichia coli isolate. The genome data also revealed that this isolate belongs to ST131, clade B. pCERC7 is 9712bp comprised of a 3319bp backbone, Tn2::IS4 (6388bp) and 5bp of target site duplication, and was present at a copy number of 40. pCERC7 is related to several plasmids composed of only the backbone, or the backbone with the Tn2 insertion in the same position. These plasmids have been found previously in Escherichia coli or Salmonella enterica recovered in several different countries from as early as the 1970s. This group was named the NTP16 group after the best studied example. pCERC7 was annotated using available information about plasmids in this group and additional analyses. The backbone includes genes for RNA I and RNA II to initiate replication and the Tn2 interrupts a gene found here to encode a protein 66% identical to the Rom regulatory protein of ColE1. NTP16 family plasmids include a gene, previously designated mobA, that was found to encode a homologue (53% identical) of the NikA relaxase accessory protein of the conjugative IncI1 plasmid R64, which is known to bind to the R64 oriT. However, a nikB relaxase gene is not present, indicating that a relaxase must be supplied in trans for mobilisation by R64 to occur, as demonstrated previously for NTP16. Hence, MobA of NTP16 and relatives was renamed NikA. Upstream of nikA, we found a region closely related to the oriT of R64. pCERC7 and all members of the NTP16 family also include a multimer resolution site, nmr, similar to the cer site of ColE1. The backbone of the NTP16 family also includes genes for a demonstrated toxin-antitoxin system, LsoAB. Several more distantly related groups of plasmids that include a very closely related nmr-nikA-oriT segment (99.4-93.7% DNA identity) were identified in the GenBank non-redundant DNA database. All use an RNA I/RNA II-Rom system for replication initiation, but each contains a unique fragment adjacent to the nmr site. The segment of the NTP16/pCERC7 group that encodes the LsoAB toxin-antitoxin system is replaced by a different segment in other family groups. The point at which the sequences diverge is between the XerC and XerD sites of the dif site at one end of nmr, suggesting that the evolution of this broad group of plasmids involves XerC/XerD recombination.

Molecular characteristics of extended-spectrum β-lactamase-producing Escherichia coli in a university teaching hospital

The prevalence of extended-spectrum β-lactamases (ESBLs) has been increasing worldwide. Recently, a pandemic clone of Escherichia coli O25:H4, sequence type 131 (ST131), producing ESBL-type CTX-M-15 has been reported as a major problem. In this study, we investigated the molecular characteristics of 72 ESBL-producing E. coli isolates. We detected the ESBL blaCTX-M gene and nine virulence factor genes (papC, papEF, fimH, hlyA, iutA, sfa, eaeA, bfpA, and aggR) by PCR and DNA sequencing, plasmid replicon typing, phylogenetic grouping, repetitive-sequence-based PCR (rep-PCR), and multilocus sequence typing. All strains were positive for blaCTX-M. Twenty-two (30.6%) strains in CTX-M-1 group included 9 (12.5%) of CTX-M-15, 3 (4.2%) in CTX-M-2 group, and 47 (65.3%) strains in CTX-M-9 group. The CTX-M-15-producing E. coli O25:H4 ST131 was derived from phylogenetic group B2 and rep-PCR pattern d. The most prevalent virulence factor was fimH (72 strains; 100%) and the most common replicon type was the IncF type (65 strains; 90.3%). The CTX-M-9 group was significantly associated with the presence of papC and papEF [OR (95% CI)=9.22 (1.32-64.7), p=0.025] or hlyA [OR (95% CI)=5.57 (1.17-26.4), p=0.031]. In conclusion, we confirmed that CTX-M-15-producing E. coli O25:H4 ST131 has emerged in Japan and found significant virulence factors with CTX-M-9 group.

Genetic relationships of phage types and single nucleotide polymorphism typing of Salmonella enterica Serovar Typhimurium

Salmonella enterica serovar Typhimurium is one of the leading causes of gastroenteritis in humans. Phage typing has been used for the epidemiological surveillance of S. Typhimurium for over 4 decades. However, knowledge of the evolutionary relationships between phage types is very limited. In this study, we used single nucleotide polymorphisms (SNPs) as molecular markers to determine the relationships between common S. Typhimurium phage types. Forty-four SNPs, including 24 identified in a previous study and 20 from 6 available whole-genome sequences, were used to analyze 215 S. Typhimurium isolates belonging to 45 phage types. Altogether, 215 isolates and 6 genome strains were differentiated into 33 SNP profiles and four distinctive phylogenetic clusters. Fourteen phage types, including DT9, one of the most common phage types in Australia, were differentiated into multiple SNP profiles. These SNP profiles were distributed into different phylogenetic clusters, indicating that they have arisen independently multiple times. This finding suggests that phage typing may not be useful for long-term epidemiological studies over long periods (years) and diverse localities (different countries or continents). SNP typing provided a discriminative power similar to that of phage typing. However, 12 SNP profiles contained more than one phage type, and more SNPs would be needed for further differentiation. SNP typing should be considered as a replacement for phage typing for the identification of S. Typhimurium strains.

Characteristics of non-typhoidal Salmonella isolates from human and broiler-chickens in southwestern Seoul, Korea

Non-typhoidal Salmonella (NTS) is an important commensal microorganism. The purpose of this study was to determine the epidemiological relation between NTS isolates from livestock and NTS isolates from human by analyzing antimicrobial susceptibilities and performing molecular typing. We determined the serotypes of 36 human clinical isolates and 64 livestock isolates, performed antimicrobial susceptibility testing against 8 antibiotics, and determined the molecular types of isolated NTS spp. by pulsed field gel electrophoresis (PFGE). In human isolates, S. enteritidis was the most common serotype (17 isolates; 47.2%) and S. typhimurium the second most (8 isolates; 22.2%). In livestock isolates, S. typhimurium was the most common serotype (15 isolates; 23.44%), and S. enteritidis was the second most (14 isolates; 21.88%). Ampicillin and tetracycline resistance were 50% (32/64 isolates) each among broiler-chicken NTS isolates. No human or livestock NTS isolates showed resistance to ciprofloxacin, TMP-SMX, or ceftriaxone. However, 19.4% (7/36) and 46.8% (30/64) of the human and livestock NTS isolates were resistant to nalidixic acid (MIC > or = 16 mg/mL), respectively. The presence of the three identical PFGE molecular types from human and broiler-chicken NTS isolates suggests the possibility of transmission from livestock to humans.

Identification of specific gene sequences conserved in contemporary epidemic strains of Salmonella enterica

Genetic elements specific to recent and contemporary epidemic strains of Salmonella enterica were identified using comparative genomic analysis. Two epidemic multidrug-resistant (MDR) strains, MDR Salmonella enterica serovar Typhimurium definitive phage type 104 (DT104) and cephalosporin-resistant MDR Salmonella enterica serovar Newport, and an epidemic pansusceptible strain, Salmonella serovar Typhimurium DT160, were subjected to Salmonella gene microarray and suppression subtractive hybridization analyses. Their genome contents were compared with those of coexisting sporadic strains matched by serotype, geographic and temporal distribution, and host species origin. These paired comparisons revealed that epidemic strains of S. enterica had specific genes and gene regions that were shared by isolates of the same subtype. Most of these gene sequences are related to mobile genetic elements, including phages, plasmids, and plasmid-like and transposable elements, and some genes may encode proteins conferring growth or survival advantages. The emergence of epidemic MDR strains may therefore be associated with the presence of fitness-associated genetic factors in addition to their antimicrobial resistance genes.

Identification of plasmids by PCR-based replicon typing

The epidemiological importance of tracing plasmids conferring drug resistance prompted us to develop a PCR method based on replicons (inc/rep PCR) of the major plasmid incompatibility groups among Enterobacteriaceae. Eighteen pairs of primers were designed to perform 5 multiplex- and 3 simplex-PCRs, recognizing FIA, FIB, FIC, HI1, HI2, I1-Igamma, L/M, N, P, W, T, A/C, K, B/O, X, Y, F, and FIIA. The specificity of the method was tested on a collection of 61 reference plasmids and on 20 Salmonella enterica strains of different serotypes isolated in Italy. Results indicated that the inc/rep PCR method demonstrates high specificity and sensitivity in detecting replicons on reference plasmids and also revealed the presence of recurrent and common plasmids in epidemiologically unrelated Salmonella isolates of different serotypes. These results suggest that the method is potentially applicable to a large number of strains to trace the diffusion of specific multi-drug resistance plasmids in different environments.

Fluorescent amplified fragment length polymorphism analysis of Salmonella enterica serovar typhimurium reveals phage-type- specific markers and potential for microarray typing

Fluorescent amplified fragment length polymorphism (AFLP) was applied to 46 Salmonella enterica serovar Typhimurium isolates of Australian origin comprising nine phage types, by using the restriction enzymes MseI and EcoRI and all 16 possible MseI +1-EcoRI +1 primer pair combinations. AFLP in the present study showed a very good discrimination power with a Simpson index of diversity of 0.98, and 35 different AFLP patterns were observed in the 46 isolates. AFLP grouped most serovar Typhimurium isolates by phage type and enabled differentiation of phage types. Furthermore, 84 phage-type-specific polymorphic AFLP fragments, for which presence or absence correlated with phage type (including 25 with one exception to phage type specificity) were observed in the 46 strains studied. Eighteen phage-type-specific AFLP fragments were cloned and sequenced. Fifteen are of known genes or have a homologue in the databases. Three sequences are plasmid related, eight are phage related, and four relate to chromosomal genes. Twelve of the 18 fragments are polymorphic because the DNA is present or absent as indicated by Southern hybridization, and we see good potential to use sequences of these fragments as the basis for multiplex PCR and development of a microarray-based molecular phage-typing method for serovar Typhimurium.

Composite integron array generated by insertion of an ORF341-type integron within a Tn21-like element

Two class 1 integrons, In-t1 and In-t2, were previously identified in IncFI plasmids of Salmonella enterica serotype Typhimurium. Molecular analysis revealed a close physical link between the two integrons. In-t1 is preceded by the transposase genes of Tn21, whereas In-t2 is located downstream the 3'-conserved segment (3'-CS) of In-t1, in a head-to-tail configuration. In-t1 shows a peculiar sequence downstream the 3'-CS, containing an extended version of the open reading frame known as ORF341 (referred to as ORF341E) and a novel trimethoprim resistance gene, designated dfrA18. Retrospective analysis provided evidence for In-t1 insertion within Tn1935, a Tn21-related transposon identified in IncFI plasmids circulating among epidemic clones of multidrug-resistant S. enterica during the 1970s. Structural comparison between Tn21 derivatives from recent and ancestor IncFI plasmids showed that In-t2 has been conserved by these replicons. In-t1 belongs to a novel family of class 1 integrons containing the ORF341E sequence, and appears to have been acquired by IncFI plasmids after the assembly of Tn1935. In-t1 insertion occurred within the 5'-conserved segment (5'-CS) proximal region of the resident In-t2.

Non-typhoidal salmonellosis: emerging problems

Two major changes in the epidemiology of non-typhoidal salmonellosis have occurred during the second half of the 20th century. First, Salmonella typhimurium strains resistant to multiple antibiotics have emerged and spread within populations of food animals. Secondly, Salmonella enteritidis has emerged as a major egg-associated pathogen. This article reviews available data on the origins of the human epidemics.

Expanding drug resistance through integron acquisition by IncFI plasmids of Salmonella enterica Typhimurium

We conducted a 30-year retrospective analysis of IncFI plasmids from Salmonella enterica serotype Typhimurium. These plasmids have been associated with the emergence of epidemic clones of multidrug-resistant Salmonella. Molecular and genetic evidence indicates that IncFI plasmids are evolving through sequential acquisition of integrons carrying different arrays of antibiotic- resistance genes.

Class 1 integron-borne multiple-antibiotic resistance carried by IncFI and IncL/M plasmids in Salmonella enterica serotype typhimurium

The presence and genetic content of integrons were investigated for 37 epidemiologically unrelated multiple-drug-resistant strains of Salmonella enterica serotype Typhimurium from humans. All isolates were resistant to ampicillin, chloramphenicol, kanamycin, streptomycin, sulfonamides, and trimethoprim, as well as to tetracycline and/or nalidixic acid; 20% of them were also resistant to gentamicin and amikacin. Three different class 1 integrons (In-t1, In-t2, and In-t3) were identified by Southern blot hybridization, PCR, and DNA sequencing, and these integrons were found to carry the aadB, catB3, oxa1, aadA1a, aacA4, and aacC1 gene cassettes. Integrons In-t1 (aadB and catB3) and In-t2 (oxa1 and aadA1a) were both located on a conjugative IncFI plasmid of 140 kb. In-t3 (aacA4, aacC1, and aadAIa) was located on an IncL/M plasmid of 100 kb which was present, in association with the IncFI plasmid, in gentamicin- and amikacin-resistant isolates. Despite the extensive similarity at the level of the antibiotic resistance phenotype, integrons were not found on the prototypic IncFI plasmids carried by epidemic Salmonella strains isolated during the late 1970s. The recent appearance and the coexistence of multiple integrons on two conjugative plasmids in the same Salmonella isolate are examples of how mobile gene cassettes may contribute to the acquisition and dissemination of antibiotic resistance.

Characterization of non-virulence plasmids with homology to the virulence plasmid of Salmonella dublin

Six wild-type (wt) strains of Salmonella typhimurium, one wt strain of S. heidelberg and 12 wt strains of Escherichia coli were isolated based on both hybridization to a 6-kb HindIII fragment of the non-virulence coding part of the S. dublin serovar-specific virulence plasmid and the absence of hybridization to the virulence genes (spv genes) of the same plasmid. Such hybridization was shown to be caused by resident plasmids in all strains and to involve the same region of 30 to 37 kb of consecutive HindIII fragments on the S. dublin virulence plasmid, suggesting a common origin of this plasmid DNA. Nine of the plasmids were selected for detailed characterization and were shown not to be of the same plasmid species. They varied in size between 44 and 88 kb, they showed incompatibility with the plasmid K-MP10, or belonged to incompatibility group X, and with the exception of five plasmids from E. coli, they showed different HindIII restriction profile patterns.

Occurrence of FIme plasmids in multiply antimicrobial-resistant Escherichia coli isolated from urinary tract infection

Plasmids belonging to the FIme incompatibility group were found in seven different serogroups of multiply antimicrobial-resistant Escherichia coli isolated from patients with urinary tract infection (UTI) and living in south-east London. Although widespread in Salmonella spp., FIme plasmids have only previously been described in E. coli in a strain of serogroup O15 K52 H1 responsible for an extensive and protracted outbreak of invasive community-acquired infection in south-east London in 1986. Our findings suggest either a wider background occurrence of FIme plasmids in E. coli associated with UTI than previously reported or alternatively, the dissemination and subsequent molecular diversification of the FIme plasmid associated with the epidemic strain of serogroup O15 K52 H1.

Dissection of pathogenetic determinants and their genomic positions for the evaluation of epidemic strains and infection routes

The epidemiology of infectious diseases intends to disclose the infection routes and sources of the respective diseases in order to provide preventive measures. The success of such a task is directly dependent on the knowledge about the special biological quality and the environmental distribution of the causative agents. This will imply extensive laboratory analysis rather than statistical surveys. The laboratory analysis for epidemiological purposes comprises a set of sophisticated methods for the subdifferentiation of the isolates (e.g. serofermentative and electrotyping, genomic fingerprinting). These methods provide circumstantial evidence of genetic and thus, epidemiological relatedness. Also the dissection of the pathogenic personality of the respective infectious agents was shown to have epidemiologic implications. However, the virulence pattern and the pattern of the genomic position of the respective determinants were found to be well conserved. For this reason, the dissection of virulence factors in comparison to other clonal properties must be regarded only as an additional marker for epidemiological discrimination. Moreover, any form of epidemic virulence remains to be detected by future analysis.

Epidemic potential and pathogenicity in outbreaks of infection with EMRSA and EMREC

Multiply antibiotic-resistant Staphylococcus aureus and Escherichia coli have both caused outbreaks in London in recent years, and for this reason have been referred to as E(epidemic)MRSA and EMREC respectively. In each case it has been questioned whether either organism has properties other than antibiotic resistance that distinguish them from other strains. Evidence is adduced to suggest that EMRSA has properties that enable it to spread particularly well, and that EMREC is particularly virulent. Both were introduced into our environment by chance, and were helped by their antibiotic resistance to become involved in a train of events--different in each case--that culminated in severe infection in a small number of patients, and thus to further investigation. The organisms involved in such outbreaks are worthy of investigation and control, if only because of the difficulty of treating clinical infections when they develop.

Instability of multiple drug resistance plasmids in Salmonella typhimurium isolated from poultry

Plasmids in five strains of Salmonella typhimurium resistant to ampicillin, chloramphenicol, gentamicin, neomycin/kanamycin, streptomycin, sulphonamides, tetracyclines and trimethoprim (ACGKSSuTTm), CGKSSuTTm, ACSSuT or CSSuT which had been isolated from poultry in the first 3 months of 1989 have been characterized and compared with plasmids in two strains of R-types ACGKSSuTTm and ASSuTTm isolated from two patients later in the year. With the exception of the human isolate of R-type ASSuTTm, all strains carried two non-conjugative plasmids, one coding for SSu and belonging to incompatibility group Q, and a second coding for multiple resistance and belonging to the FIme incompatibility group. The human isolate of R-type ASSuTTm did not carry the IncQ SSu plasmid but like the poultry isolates, carried a non-conjugative FIme plasmid. Restriction endonuclease digestion with the enzymes EcoR I, Pst I and Hind III demonstrated that the FIme plasmids from strains of different R-types showed a high degree of homology but exhibited numerous fragment size polymorphisms. The restriction digest fingerprint of plasmids in the human isolate of R-type ACGKSSuTTm was indistinguishable from a poultry isolate of the same R-type. Analysis of segregants of one of the poultry isolates of R-type ACGKSSuTTm demonstrated that resistance determinants could be rapidly lost from the FIme plasmid to give rise to a number of R-types and fingerprint patterns. Loss of tetracycline resistance from this plasmid appeared to be correlated with the integration of other plasmid-mediated resistances into the bacterial chromosome. Evidence is presented for the rapid loss of antimicrobial resistance determinants from a multiple resistance plasmid of the FIme incompatibility group in response to withdrawal of antibiotic selective pressure.

Clonal groups of Salmonella typhimurium in New York State

The epidemiology of 278 strains of Salmonella typhimurium isolated from 1973 to 1981 from animals in New York State was studied by using four "fingerprinting" techniques, bacteriophage type (B.R. Callow, J. Hyg. 57:346-359, 1959), biotype (J. P. Duguid, E. S. Anderson, G. A. Alfredsson, R. Barker, and D. C. Old, J. Med. Microbiol. 8:149-166, 1975), plasmid profile, and antibiogram. Phage type with biotype was the most useful marker for distinguishing clonal groups of S. typhimurium. Four clones of S. typhimurium predominated, i.e., phage type/biotypes U275/26, 49/26, 10/3, and 2/3. U275/26 and 49/26 were commonly found until 1976, but clones 10/3 and 2/3 were predominant after 1976. Comparison of results with data from Canada suggested a dissemination of strains of S. typhimurium between Canada and New York. Cattle were a common source of phage type 49, as has been observed in other countries.

The Salmonella wien virulence plasmid pZM3 carries Tn1935, a multiresistance transposon containing a composite IS1936-kanamycin resistance element

Tn1935, a 23.5-kb transposon mediating resistance to ampicillin, kanamycin, mercury, spectinomycin, and sulfonamide was isolated from pZM3, an IncFIme virulence plasmid from Salmonella wien. Tn1935 possesses the entire sequence of Tn21 and contains two additional DNA segments of 0.95 and 2.7 kb carrying the ampicillin and kanamycin resistance genes, respectively. The latter is part of a composite element since it is flanked by two IS15-like insertion sequences (IS1936) in direct orientation. IS1936 is about 800 bp long and is closely related to IS15 delta, IS26, IS46, IS140, and IS176. Functional analysis of IS1936-mediated cointegrates shows that both insertion sequences are active and able to form cointegrates at the same frequency. Resolution of the cointegrates requires the presence of the host Rec system. The presence of the composite IS1936-element within Tn1935 supports the hypothesis that multidrug resistance transposons evolved by insertion of antibiotic determinants which are themselves transposable.

Aerobactin production as a virulence factor: a reevaluation

Iron starvation is one of the major barriers that virulent bacteria must overcome in order to proliferate in the host. Virtually all microorganisms possess high affinity iron (III) transport systems mediated by low molecular weight iron specific chelators called siderophores, the synthesis of which is activated under iron-limiting conditions. Siderophore aerobactin is frequently produced by enterobacteria which cause various types of infections in humans and animals. The status of aerobactin production as a virulence factor is evaluated both from data derived from experimental infection systems and the actual presence of this siderophore in clinical isolates. Aerobactin appears to be an important contributor to extracellular pathogenesis (mostly, that of Escherichia coli strains causing septicaemia and urinary tract infections) and to the extracellular stages of growth of intracellular pathogens like Shigella. When invasive bacteria actually enter target cells, acquisition of iron seems to occur independently of siderophore production. The feasibility of an antimicrobial therapy aimed at interfering with siderophore functioning is discussed.

Composite IS1-tetracycline resistance elements in aerobactin-encoding FIme plasmids from epidemic Salmonella wien

Class B tetracycline resistance determinants have been identified in two aerobactin-encoding FIme plasmids representative of those isolated from epidemic Salmonella wien. Genetic data, restriction enzyme analysis of recombinant and mutant plasmids, and Southern blot hybridizations indicate that in both plasmids the class B determinant so far found and described only on Tn10-like transposons is part of a different genetic element. This composite insertion sequence element is about 7 kilobases long and has copies of insertion sequence IS1 at the ends.

Genetic and molecular characterization of an epidemic plasmid coding for multidrug resistance in Salmonella typhimurium of human origin

All 201 multidrug resistant Salmonella typhimurium strains isolated from epidemics in India contained nonconjugative (157 strains) or conjugative (44 strains) Inc F1me multiresistance plasmids. Two small R-plasmids of 7 MDa which coded for resistance to either ampicillin or streptomycin and sulfamethoxazole were also detected along with other plasmids. The small plasmids were members of group 1 and group 2 incompatibility groups. Restriction endonuclease analysis of conjugative (96 MDa) and nonconjugative (88 MDa) Inc F1me plasmids showed considerable similarity except for the presence of unique fragments among both the groups and the loss of fragments corresponding to the smaller size of the nonconjugative plasmid. A single Inc F1me plasmid appears responsible for various outbreaks of multiresistant S. typhimurium in different parts of India.

Epidemic multiresistant Escherichia coli infection in West Lambeth Health District

A year-long outbreak of multiresistant Escherichia coli K52 H1, predominantly serogroup O15, is reported from south east London. Most patients had urinary tract infections, some with septicaemia; but some cases of septicaemia were associated with pneumonia, meningitis, and endocarditis--unusual infections for E coli. 3 of these patients died. The organism was acquired in the community, and its source is still being investigated.

Incidence of plasmids in multiply-resistant Salmonella isolates from diarrhoeal patients in Hong Kong from 1973-82

Plasmids present in multiply-resistant salmonella strains including Salmonella typhimurium, S. johannesburg, S. wandsworth, S. derby, S. newport, S. london and S. choleraesuis causing diarrhoea in patients in Queen Mary Hospital in Hong Kong from 1973-82 were studied. In multiply-resistant S. typhimurium, plasmids belonging to groups FIme, H1 or H2 and plasmids encoding trimethoprim-resistance which were compatible with standard plasmids of testable incompatibility groups were detected. In S. johannesburg, both the ASTCKSu- and ASCKSu-resistant strains which were predominant in two consecutive periods of an outbreak were found to harbour the same plasmid which belonged to the incompatibility group FIme. S. wandsworth strains isolated from a hospital outbreak in 1980 harboured an identical R-plasmid belonging to group N. A few strains of the other salmonellae showing resistance to multiple antibiotics were found to harbour R-plasmids belonging to groups H1, H2 and FIme. The only salmonella of the enteric fever group resistant to ampicillin, chloramphenicol and trimethoprim was an S. paratyphi B strain. The resistances were encoded on a plasmid of an unknown incompatibility group. The occurrence and distribution of plasmids in these salmonellae isolated within the 10-year period are discussed.

Conjugal mobility of the multicopy plasmids NTP1 and NTP16

Mobilization of the multicopy plasmid NTP16, like that of ColE1, is promoted by a range of conjugal plasmids. However, the mechanisms employed for NTP16 mobilization differ between groups. Mobilization by the IncI1 plasmid R64 requires trans-acting products from NTP16 plus a cis-acting region of the small plasmid. In contrast, this system is used inefficiently by the F plasmid and instead, a high-frequency conduction process occurs. Analysis of exconjugant cells reveals that F-mediated mobilization of NTP16 frequently involves rearrangements of NTP16 DNA, promoted by the Tn1000 transposon of F and/or by the kanamycin resistance transposon (Tn4352) of NTP16. Possible mechanisms for the high-frequency F-mediated mobilization of NTP16 are discussed. The plasmid NTP1, which is closely related to NTP16, is also mobilized efficiently by R64. It is not however efficiently mobilized by F, demonstrating the requirement for the Tn4352 element, which is not present in this plasmid, for effective F-mediated transfer.

Occurrence of multiple antibiotic resistance and R-plasmids in gram-negative bacteria isolated from faecally contaminated fresh-water streams in Hong Kong

The bacterial populations of six freshwater streams in populated areas of the Hong Kong New Territories were studied. There is considerable faecal contamination of these streams, with coliform counts as high as 10(5) c.f.u./ml and the contaminating organisms show a high prevalence of antibiotic resistance and multiple resistance. With direct plating of water samples onto antibiotic-containing media, an average of 49% of the gram-negative bacteria were ampicillin-resistant, 3% chloramphenicol-resistant and 1% gentamicin-resistant. At individual sites resistance to these drugs was as high as 98%, 8% and 3% respectively. More than 70% of strains were resistant to two or more antibiotics, 29% to five or more and 2% to eight or more. A total of 98 patterns of antibiotic resistance were detected with no one pattern predominating. Twenty-eight gram-negative bacterial species were identified as stream contaminants. Escherichia coli was the commonest bacterial species isolated and other frequent isolates were Enterobacter sp., Klebsiella sp. and Citrobacter sp., but no enteric pathogens were detected. The greatest prevalence of resistance and multiple resistance was associated with the heaviest contamination by E. coli. Analysis of selected stream isolates revealed multiple plasmid bands arranged in many different patterns, but multiple antibiotic resistances were shown to be commonly mediated by single transferable plasmids. Faecally-contaminated freshwater streams in Hong Kong may be reservoirs of antibiotic resistance plasmids for clinically-important bacteria.

Characterization of self-transmissible plasmids determining lactose fermentation and multiple antibiotic resistance in clinical strains of Klebsiella pneumoniae

The lactose fermentation (Lac+) and antibiotic resistance (R+) phenotypes were conjugally transferred from Klebsiella pneumoniae strains (K166, K182, K186, K218, and K220) to Salmonella typhi, S. typhimurium, Shigella flexneri, and Vibrio cholerae. The genes for lactose fermentation and antibiotic resistance were located on the plasmids. Further analysis of plasmid DNA from these isolates indicated the presence of multiple plasmids (Mr ranged less than 2.7 to 70 X 10(6)). The Lac+R+ plasmids p166 and p182 were members of the FII incompatibility group. The fertility inhibition property of plasmids, p182, p218, and p220 was fi+ type. Furthermore, phage typing experiments showed that plasmids p166 and p218 (Lac+R+) conferred the ability to inhibit the multiplication of bacteriophages 12 and 13 in S. typhimurium. However, the plasmids p182, p186, and p220 (Lac+R+) could inhibit the visible lysis of all the 30 phages in S. typhimurium. This study describes the characterization of Lac+R+ plasmids and the medical significance of an intergeneric transfer of lactose fermentation to non-lactose-fermenting pathogens.

Characterization of the drug resistance plasmid NTP16

A functional and physical analysis of the multicopy plasmid NTP16 is presented. The plasmid-encoded drug resistance determinants are located, as are regions encoding the origin of replication, incompatibility functions, copy number determinants, and mobility functions. It is demonstrated that NTP16 probably arose from the closely related plasmid NTP1 by the acquisition of a novel kanamycin resistance transposon, Tn4352, followed by deletion of some NTP1 sequences. The incompatibility behavior of NTP16 derivatives indicates a system of control rather more complex than that which operates in ColE1. In addition to the RNA I/primer RNA system, the production of a further trans-acting product is demonstrated and its site of action located. A series of derivative plasmids have been created which may prove useful as vectors for genetic engineering.

A pathway for the evolution of the plasmid NTP16 involving the novel kanamycin resistance transposon Tn4352

The kanamycin resistance determinant of the drug resistance plasmid NTP16 has been characterized by DNA sequencing and has been shown to possess all of the structural features of a transposable element. It is made up of a 1040-bp central region encoding a protein identical to the aminoglycoside 3'-phosphotransferase of Tn903, flanked by direct repeats of an element identical to IS26. This novel transposon has been designated Tn4352. Analysis of the host sequences flanking the transposon reveal that they are derived from a Tn3-like element, and contain no 8 base pair target size duplications which are normally created by the insertion of IS26-like elements. Comparison to the Tn3 sequence shows that the flanking sequences are noncontiguous within Tn3, with the clear implication that NTP16 has evolved from a similar plasmid encoding only ampicillin resistance (presumably NTP1) by the insertion of Tn4352 into the Tn3-like element, followed by a substantial deletion. The sequence analysis suggests that the initial insertion was into the tnpR gene of the ampicillin transposon, followed by a deletion extending to a specific site within tnpA.

Tracing Salmonella typhimurium infections

Since the low point of 1977 the incidence of infection attributed toSalmonella typhimuriumin England and Wales has shown a steady increase with a total of 4956 cases reported in 1982 (OPCS, 1985). Although the number of general outbreaks and family outbreaks increased by 24 % and 54 % respectively between 1981 and 1982, the greatest increase (55%) was in the number of sporadic cases reported (PHLS, 1984). The cause of the recent increase in human infection is not known but may be associated with bovine infection and an explanation for the rise in sporadic cases could be that they comprise unrecognized outbreaks due to common food products distributed over wide geographical areas for long periods of time because of deep freezing (Galbraith, 1985). This hypothesis has prompted the Communicable Disease Surveillance Centre to mount a case-control study comparing sporadic cases ofS. typhimuriuminfection with an unaffected control group in several parts of the country to find the vehicles of infection. Such an approach requires precise strain identification and detailed epidemiological information.

Clonal relationships among naturally occurring nicotinamide-requiring Salmonella typhimurium

Salmonella typhimuriumstrains of biotype 25x have been shown in transductional cross experiments to be clonal in the Nad character. The ancestral bacterium, probably of biotype 25a, mutated to a requirement for nicotinamide and subsequently diversified in phage type and secondary biotype characters. Such a sequence of events indicates interconversion among phage types 6, 16, 46, 49, 73, 76 and 135. Strains in biotypes 1x, 9ix, 17x, 17dx, 19dx and 25hix yielded Nad+recombinants in interbiotype crosses, suggesting that each originated as an independent mutant line.

Intercontinental spread of a new antibiotic resistance gene on an epidemic plasmid

Bacteria of different genera isolated at nine medical centers in different parts of the United States and at one center in Venezuela during the first decade of gentamicin usage carried the gentamicin resistance gene 2"-aminoglycoside nucleotidyltransferase on the same transferable plasmid. Such widespread dissemination of a newly observed resistance gene on one plasmid suggests that a new resistance gene may emerge once on a single plasmid, which then carries it to other centers and other plasmids. The resistance gene might, therefore, be contained if detected early.

Transferable resistance to trimethoprim in enteric pathogens isolated in Kuwait

Trimethoprim resistance was seen in 14.8% of 500 strains of salmonella, 43.1% of 153 strains of shigella and 59% of 27 strains of Escherichia coli isolated from stools of patients with diarrhoea. Strains with a high level of trimethoprim resistance (MIC of much greater than 512 micrograms) were subjected to conjugal transfer. Trimethoprim resistance was plasmid-mediated in all of 42 strains of shigella and 12 strains of E. coli examined. However, 2 of the 47 strains of salmonella could not transfer their trimethoprim resistance either directly or by mobilization with the transfer factors X and delta both at 37 and 25 degrees C overnight incubation.

Plasmid characterization of drug-resistant Shigella dysenteriae 1 from an epidemic in Central Africa

A widespread epidemic of severe dysentery in Zaire and neighbouring Central African countries was caused by a multiply drug-resistant strain of Shigella dysenteriae 1. Early isolations were resistant to ampicillin, chloramphenicol, streptomycin, sulphonamides and tetracyclines (R-type = ACSSuT). Later in the epidemic strains resistant to trimethoprim (Tm) became prevalent and a few strains resistant to kanamycin (K) or nalidixic acid were also isolated. All resistances except nalidixic acid were encoded by plasmids of incompatibility groups X (ACT) or I1 (ACSSuTTm) and the epidemic strain also carried an SSu plasmid and a number of cryptic plasmids. The Inc X plasmid from this epidemic is the same as that in Sh. dysenteriae 1 strains isolated in Somalia in 1976 whereas the epidemic strains from the Shiga outbreaks in Central America, 1969 to 1971, and Sri Lanka, 1979, carried plasmids of group B. This epidemic demonstrates that when a multiresistant strain includes resistance to trimethoprim, nalidixic acid is a suitable alternative therapeutic agent.

Composite IS1 elements encoding hydroxamate-mediated iron uptake in FIme plasmids from epidemic Salmonella spp

Eleven FIme plasmids representative of those identified in epidemic strains of Salmonella wien and Salmonella typhimurium isolated in North Africa, Europe, and the Middle East have been examined for the presence of determinants of toxigenicity, adherence, and iron-sequestering mechanisms. Chemical and genetic data indicated that all plasmids code for a hydroxamate-mediated iron assimilation system. Detailed analysis of derivative plasmids and cloned fragments of FIme plasmid pZM61 demonstrated that the general genetic and structural organization of the DNA region containing the genes for hydroxamate biosynthesis and cloacin DF13 receptor was virtually identical to that described for the aerobactin-mediated iron uptake system of pColV-K30. This DNA region is part of a composite element that is 16.7 kilobases long and carries its IS1 modules as inverted repeats. A very similar element is present in either orientation in all nine FIme plasmids analyzed.

Stability of plasmid content in Salmonella wien in late phases of the epidemic history

Prevalence, genetic characteristics, and EcoRI cleavage analysis of plasmids identified in clinical strains of Salmonella wien isolated in recent years showed that the plasmid content in this serotype has remained uniform and stable over more than a decade and also late in the epidemic history. No correlation between decrease in S. wien isolations and naturally occurring systematic changes in the DNA of its most common FIme plasmid was structurally detectable.

Plasmid pattern analysis of natural bacterial isolates and its epidemiological implication

Natural isolates of Escherichia coli, Salmonella typhimurium, Klebsiella pneumoniae, and Providencia stuartii were analysed to determine their plasmid content. This data allowed the identification of nosocomial strains of K. pneumoniae and P. stuartii and helped in the differentiation of epidemic strains of E. coli 0111 and S. typhimurium. Phenotypically similar isolates of S. typhimurium could be shown to be of independent origin using plasmid pattern analysis. The dissemination of a particular plasmid through different strains of S. typhimurium resulted in a simulation of a very widely distributed epidemic strain, because the plasmid interfered with the phage type of its host strain in addition to determining resistance properties. Plasmid pattern analysis disclosed two independently existing but interacting epidemic processes: a bacterial 'epidemic' strain may become disseminated over a large territory and may predominate there for a long time; a single plasmid, however, may also become distributed through many different bacterial strains and may spread over a large territory. Plasmid pattern analysis provides a valuable and universal epidemiological laboratory method.

Plasmid-determined antibiotic resistance in Shigella flexneri isolated in England and Wales between 1974 and 1978

The majority of Shigella flexneri strains isolated in England and Wales are from infections contracted abroad. Most of these strains are drug-resistant, over 75% being resistant to streptomycin and sulphonamides, sulphonamides alone or streptomycin, sulphonamides and tetracyclines. A selection of resistant strains was tested for resistance transfer and the plasmids identified were characterized by compatibility grouping. Streptomycin and sulphonamide resistance was usually determined by a non-autotransferring plasmid which may be mobilized by standard transfer factors, or by the plasmid which conferred tetracycline resistance where this was present. The remaining resistant strains were predominantly resistant to four or more drugs. These strains carried autotransferring plasmids of a variety of compatibility groups, of which groups B, I1 and FII were the most common.

Antimicrobial resistance and incompatibility groups of R plasmids in Salmonella typhimurium isolated from human sources in Bombay from 1978 to 1980

Salmonella typhimurium isolated in Bombay from fecal samples of 145 patients suffering from gastroenteritis (group 1) and from the cerebrospinal fluid, feces, or blood of 42 patients with systemic salmonellosis (group 2) were examined for the antimicrobial resistance and incompatibility groups of their R plasmids. Multiple drug resistance was encountered in 88.9% of the isolates from group 1 and in all the isolates from group 2. The resistance found was mainly against ampicillin, chloramphenicol, kanamycin, streptomycin, sulfonamides, and tetracycline. In addition to these resistances, a number of isolates were also resistant to sulfamethoxazole-trimethoprim and gentamicin. The overall isolation frequency of strains resistant to these last drugs was significantly higher in group 2. The drug resistance in 95.3% of the isolates from group 1 and in all the isolates from group 2 was plasmid mediated. Incompatibility grouping of the R plasmids and phage typing of the isolates indicated that a clone of S. typhimurium with phage type pattern 66/122/untypable carrying Tra- IncF1me, Tra- Inc1, and Tra- Inc2 plasmids was most prevalent in Bombay from 1978 to 1980, and examples of this clone, especially those resistant to sulfamethoxazole-trimethoprim and gentamicin, were most often responsible for severe septicemic infection. A majority of the remaining S. typhimurium isolates were untypable and harbored plasmids of groups IncC, IncF1me, IncFII, IncH1, IncH2, IncI1 and IncI2; these isolates were rarely associated with systemic infection.

Characterization of conjugative plasmids belonging to a new incompatibility group (IncZ)

More than 30 conjugative R plasmids between 60 and 70 Md in size were identified in wild type strains of Enterobacteriaceae isolated in German Democratic Republic, Bulgaria, Mongolia, Poland, Ethiopia, Iraque, and Soviet Union. They have been characterized by means of several genetic and molecular techniques as members of a new incompatibility group, termed IncZ. The properties of these plasmids including digestion pattern after EcoRI treatment demonstrate a phylogenetic relatedness.

Genetic and molecular studies of plasmids coding for colonization factor antigen I and heat-stable enterotoxin in several escherichia coli serotypes

Plasmids coding for colonization factor antigen I (CFA/I) and heat-stable enterotoxin (ST) were identified in 10 strains of human enterotoxigenic Escherichia coli. The strains, which belonged to serogroups O63, O114, O128, and O153, were isolated in Bangladesh, Latin America, Spain, and South Africa. Two strains produced heat-labile enterotoxin in addition to ST. CFA/I-ST plasmids were mobilized from two O128 strains into E. coli K-12 with the R factor R1-19K-. Like the prototype CFA/I-ST plasmid NTP113, mobilized previously from an E. coli O78 strain into K-12, these two plasmids were non-autotransferring. All 10 CFA/I-ST plasmids were incompatible with NTP113 and had molecular weights ranging from 59 X 10(6) to 72 X 10(6). The molecular properties of seven of these plasmids were compared with those of six CFA/I-ST plasmids previously mobilized from O78 strains from Ethiopia, South Africa, and Bangladesh and with those of one plasmid coding for CFA/I, ST and heat-labile enterotoxin from a South African strain of serogroup O63. Digestion with the restriction endonuclease HindIII showed that several plasmids had very similar fragment patterns and two were identical. Generally, a larger proportion of HindIII fragments were of common size in digests of plasmids identified in strains from related geographical areas, regardless of serogroup. However, all except one plasmid shared five or six HindIII fragments of the same size, one of which had been shown previously to be involved in CFA/I production. There was at least 90% DNA homology between CFA/I-ST plasmids with a molecular weight of about 58 X 10(6) from O78 strains from different sources. Most of the DNA sequences of these plasmids were present in a larger CFA/I-ST plasmid (72 X 10(6) from an O128 strain. The results of genetic and molecular studies suggest that CFA/I and ST production is determined by very similar plasmids in different serogroups of human enterotoxigenic E. coli from several sources.