R plasmids conferring multiple drug resistance from shigella isolated in Korea

Molecular epidemiology of multiply antibiotic-resistant Shigella flexneri in Fortaleza, Brazil

In northeastern Brazil, strains of Shigella flexneri resistant to multiple antibiotics are often found in patients in both urban areas and community hospitals. This study used pulsed-field gel electrophoresis (PFGE) and plasmid analysis to further analyze the molecular epidemiology of Shigella flexneri strains isolated from hospitals and an urban community in Fortaleza, Brazil. Twenty-six strains of S. flexneri from three distinct areas in the city of Fortaleza, Brazil, were examined: 14 strains from people with diarrhea who lived in an urban community of 2,000 persons, 5 strains from patients in the university hospital, and 7 strains from children in a pediatric hospital. PFGE identified six unique groups of S. flexneri circulating among patients during the 45-month study. Seven strains were further studied for antibiotic resistance plasmid profiles. Three unique antibiotic resistance plasmid profiles were found. Strains collected from the hospitalized patients demonstrated the variety of PFGE and antibiotic resistance patterns in the area. Strains collected from the patients living in the urban community setting demonstrated the persistence of certain PFGE patterns as well as the acquisition of multiple antibiotic resistance plasmids. Effective interventional strategies for such geographic locations as Fortaleza, Brazil, will be more complex than those for single-strain outbreak situations.

Molecular studies of plasmids of multiply-resistant Shigella spp. in Hong Kong

One hundred and two Shigella spp. isolated in two hospitals in Hong Kong were analysed for antibiotic resistances, resistance plasmids and plasmid profiles. Three quarters of the isolates were S. flexneri. All isolates harboured plasmids, up to a maximum of ten within one strain. Plasmids of 220 kb encoding resistances to tetracycline, chloramphenicol and sulphonamide and probably also associated with invasiveness in the Sereny test were found in 80 strains and were transferable in 18% of cases. Resistance plasmids of 92 and 99 kb were found in 27 and 15 strains respectively and encoded resistances to ampicillin, tetracycline, chloramphenicol, kanamycin, sulphonamide, trimethoprim, cotrimoxazole and gentamicin; these plasmids were usually transferable. Four plasmids of 3.9, 2.8, 2.2 and 1.8 kb were commonly found in S. flexneri strains, but were rare in other species. In contrast, there was no predominant plasmid profile in S. sonnei. S. flexneri is endemic in Hong Kong and these plasmid studies suggest that the strains in circulation are derived from only a few clones.

Molecular characterization of trimethoprim resistance in Shigella sonnei in Sicily

During the 3-year period 1985-7, all strains of Shigella sonnei isolated in Catania, Sicily, showed a high level of resistance to trimethoprim (Tp) which was invariably associated with resistance to other antibiotics. Plasmid analysis showed 18 different electropherotypes: 35 of 37 strains harboured a plasmid of 70 Megadaltons (MDa), and 29 of 37 strains a plasmid of 130 MDa. Restriction endonuclease fingerprinting of purified 70 MDa plasmid DNA from different strains demonstrated that these plasmids were similar but not identical. In some strains with transferable Tp resistance, DNA hybridization analysis demonstrated the presence of gene coding for the production of dihydrofolate reductase (DHFR) type V. In contrast, there was no detectable hybridization with DNA probes specific for genes coding for DHFR types I, II and IV. This is the first report of the DHFR type V gene outside Sri Lanka.

Susceptibilities of Hong Kong isolates of multiply resistant Shigella spp. to 25 antimicrobial agents, including ampicillin plus sulbactam and new 4-quinolones

Seventy-two percent of 129 shigella isolates from two Hong Kong hospitals were Shigella flexneri. Twenty-six percent were S. sonnei, and there was only one isolate each of S. dysenteriae and S. boydii. Ninety-six percent of the isolates were resistant to two or more antibiotics, and up to 11 resistances were seen in a single isolate. Fifty-seven percent or more of these isolates were resistant to ampicillin, streptomycin, tetracycline, chloramphenicol, and sulfamethoxazole; and up to twenty-three percent were resistant to kanamycin, trimethoprim, trimethoprim-sulfamethoxazole, and gentamicin. All the isolates were susceptible to amikacin, nalidixic acid, and the newer 4-quinolone agents; and all but one were susceptible to the cephalosporins tested. Only three isolates remained resistant to ampicillin in the presence of sulbactam. Ampicillin plus sulbactam or the newer 4-quinolone agents may be alternatives for the treatment of severe infections caused by multiply resistant shigellas.

Evolution and spread of IncFIV plasmids conferring resistance to trimethoprim

Twenty-one IncFIV-group plasmids conferring trimethoprim resistance in Escherichia coli isolates from humans and pigs were examined. Three evolutionary lines of plasmids were identified on the basis of restriction enzyme analysis. One was found exclusively in human isolates and another was found in pig isolates, while the third line consisted of plasmids from both sources. All R plasmids readily transferred to laboratory strains, and evidence was found for transfer to other biotypes of E. coli in the environment. The Tpr genes from representatives of the plasmid lines were cloned and compared by restriction analysis and by hybridization with two characterized Tpr dihydrofolate reductase genes. The sequences flanking the Tpr genes were different for each line, but all showed homology with the type 2 dihydrofolate reductase gene, irrespective of whether they were of human or animal origin. There was no hybridization to the type 1 gene. The remarkable degree of similarity among plasmids of the third line provided clear evidence of the exchange of plasmid-bearing E. coli between humans and pigs.

A restriction map of IncFIV plasmid R124

A physical and genetic map of the 125.7-kb IncFIV plasmid R124 was constructed using the restriction enzymes Sal1 and EcoR1. Two discrete regions involved in plasmid replication were identified on the plasmid genome. One region was located on a 4.66-kb segment of an EcoR1 fragment at map coordinates 73.87 to 78.53 kb. Another was located within an 8.05-kb segment of an EcoR1 fragment at map coordinates 113.40 to 121.45. This region was very unstable but, when ligated to the 3.21-kb EcoR1 fragment E13 located at map coordinates 18.83 to 22.06 kb, replication was stable. Thus, at least three regions of R124 widely separated around the genome are associated with plasmid replication and stable maintenance. Each of these three regions expressed incompatibility with R124. The Tc resistance gene of R124 was located on the contiguous EcoR1 fragments E8 and E12 located at map coordinates 100.49 to 113.40.

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.