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Cremers AJH, Mobegi FM, van der Gaast-de Jongh C, van Weert M, van Opzeeland FJ, Vehkala M, Knol MJ, Bootsma HJ, Välimäki N, Croucher NJ, Meis JF, Bentley S, van Hijum SAFT, Corander J, Zomer AL, Ferwerda G, de Jonge MI. The Contribution of Genetic Variation of Streptococcus pneumoniae to the Clinical Manifestation of Invasive Pneumococcal Disease. Clin Infect Dis 2020; 68:61-69. [PMID: 29788414 DOI: 10.1093/cid/ciy417] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 05/10/2018] [Indexed: 01/02/2023] Open
Abstract
Background Different clinical manifestations of invasive pneumococcal disease (IPD) have thus far mainly been explained by patient characteristics. Here we studied the contribution of pneumococcal genetic variation to IPD phenotype. Methods The index cohort consisted of 349 patients admitted to 2 Dutch hospitals between 2000-2011 with pneumococcal bacteremia. We performed genome-wide association studies to identify pneumococcal lineages, genes, and allelic variants associated with 23 clinical IPD phenotypes. The identified associations were validated in a nationwide (n = 482) and a post-pneumococcal vaccination cohort (n = 121). The contribution of confirmed pneumococcal genotypes to the clinical IPD phenotype, relative to known clinical predictors, was tested by regression analysis. Results Among IPD patients, the presence of pneumococcal gene slaA was a nationwide confirmed independent predictor of meningitis (odds ratio [OR], 10.5; P = .001), as was sequence cluster 9 (serotype 7F: OR, 3.68; P = .057). A set of 4 pneumococcal genes co-located on a prophage was a confirmed independent predictor of 30-day mortality (OR, 3.4; P = .003). We could detect the pneumococcal variants of concern in these patients' blood samples. Conclusions In this study, knowledge of pneumococcal genotypic variants improved the clinical risk assessment for detrimental manifestations of IPD. This provides us with novel opportunities to target, anticipate, or avert the pathogenic effects related to particular pneumococcal variants, and indicates that information on pneumococcal genotype is important for the diagnostic and treatment strategy in IPD. Ongoing surveillance is warranted to monitor the clinical value of information on pneumococcal variants in dynamic microbial and susceptible host populations.
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Affiliation(s)
- Amelieke J H Cremers
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands.,Department of Medical Microbiology, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands
| | - Fredrick M Mobegi
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands.,Bacterial Genomics Group, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands
| | - Christa van der Gaast-de Jongh
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands
| | - Michelle van Weert
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands
| | - Fred J van Opzeeland
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands
| | - Minna Vehkala
- Department of Mathematics and Statistics, University of Helsinki, Finland
| | - Mirjam J Knol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Hester J Bootsma
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Niko Välimäki
- Department of Mathematics and Statistics, University of Helsinki, Finland
| | - Nicholas J Croucher
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Stephen Bentley
- Wellcome Trust Sanger Institute, Pathogen Genomics Group, Hinxton, Cambridge, United Kingdom
| | - Sacha A F T van Hijum
- Radboud Center for Infectious Diseases, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands.,Bacterial Genomics Group, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands.,NIZO, Ede, The Netherlands
| | - Jukka Corander
- Department of Mathematics and Statistics, University of Helsinki, Finland.,Wellcome Trust Sanger Institute, Pathogen Genomics Group, Hinxton, Cambridge, United Kingdom.,Department of Biostatistics, University of Oslo, Norway
| | - Aldert L Zomer
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, The Netherlands
| | - Gerben Ferwerda
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands
| | - Marien I de Jonge
- Section of Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Center for Molecular and Biomolecular Informatics, Radboudumc, Nijmegen, The Netherlands
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Muller B, Mollon P, Santiago-Allexant E, Javerliat F, Kaneko G. In-depth comparison of library pooling strategies for multiplexing bacterial species in NGS. Diagn Microbiol Infect Dis 2019; 95:28-33. [DOI: 10.1016/j.diagmicrobio.2019.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 11/26/2022]
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Lee SH, Healy JE, Lambert JS. Single Core Genome Sequencing for Detection of both Borrelia burgdorferi Sensu Lato and Relapsing Fever Borrelia Species. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101779. [PMID: 31137527 PMCID: PMC6571920 DOI: 10.3390/ijerph16101779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/20/2019] [Accepted: 05/16/2019] [Indexed: 01/05/2023]
Abstract
Lyme disease, initially described as Lyme arthritis, was reported before nucleic-acid based detection technologies were available. The most widely used diagnostic tests for Lyme disease are based on the serologic detection of antibodies produced against antigens derived from a single strain of Borrelia burgdorferi. The poor diagnostic accuracy of serological tests early in the infection process has been noted most recently in the 2018 Report to Congress issued by the U.S. Department of Health and Human Services Tick-Borne Disease Working Group. Clinical Lyme disease may be caused by a diversity of borreliae, including those classified as relapsing fever species, in the United States and in Europe. It is widely accepted that antibiotic treatment of Lyme disease is most successful during this critical early stage of infection. While genomic sequencing is recognized as an irrefutable direct detection method for laboratory diagnosis of Lyme borreliosis, development of a molecular diagnostic tool for all clinical forms of borreliosis is challenging because a “core genome” shared by all pathogenic borreliae has not yet been identified. After a diligent search of the GenBank database, we identified two highly conserved segments of DNA sequence among the borrelial 16S rRNA genes. We further developed a pair of Borrelia genus-specific PCR primers for amplification of a segment of borrelial 16S rRNA gene as a “core genome” to be used as the template for routine Sanger sequencing-based metagenomic direct detection test. This study presented examples of base-calling DNA sequencing electropherograms routinely generated in a clinical diagnostic laboratory on DNA extracts of human blood specimens and ticks collected from human skin bites and from the environment. Since some of the tick samples tested were collected in Ireland, borrelial species or strains not known to exist in the United States were also detected by analysis of this 16S rRNA “core genome”. We recommend that hospital laboratories located in Lyme disease endemic areas begin to use a “core genome” sequencing test to routinely diagnose spirochetemia caused by various species of borreliae for timely management of patients at the early stage of infection.
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Affiliation(s)
- Sin Hang Lee
- Milford Molecular Diagnostics, Milford, CT 06460, USA.
| | - John Eoin Healy
- School of Biological, Earth and Environmental Sciences, University College Cork, T23 N73K Cork, Ireland.
| | - John S Lambert
- Department of medicine, University College Dublin, D04 V1W8 Dublin, Ireland.
- Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland.
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Smartphone-based pathogen diagnosis in urinary sepsis patients. EBioMedicine 2018; 36:73-82. [PMID: 30245056 PMCID: PMC6197494 DOI: 10.1016/j.ebiom.2018.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/01/2018] [Accepted: 09/03/2018] [Indexed: 11/22/2022] Open
Abstract
Background There is an urgent need for rapid, sensitive, and affordable diagnostics for microbial infections at the point-of-care. Although a number of innovative systems have been reported that transform mobile phones into potential diagnostic tools, the translational challenge to clinical diagnostics remains a significant hurdle to overcome. Methods A smartphone-based real-time loop-mediated isothermal amplification (smaRT-LAMP) system was developed for pathogen ID in urinary sepsis patients. The free, custom-built mobile phone app allows the phone to serve as a stand-alone device for quantitative diagnostics, allowing the determination of genome copy-number of bacterial pathogens in real time. Findings A head-to-head comparative bacterial analysis of urine from sepsis patients revealed that the performance of smaRT-LAMP matched that of clinical diagnostics at the admitting hospital in a fraction of the time (~1 h vs. 18–28 h). Among patients with bacteremic complications of their urinary sepsis, pathogen ID from the urine matched that from the blood – potentially allowing pathogen diagnosis shortly after hospital admission. Additionally, smaRT-LAMP did not exhibit false positives in sepsis patients with clinically negative urine cultures. Interpretation The smaRT-LAMP system is effective against diverse Gram-negative and -positive pathogens and biological specimens, costs less than $100 US to fabricate (in addition to the smartphone), and is configurable for the simultaneous detection of multiple pathogens. SmaRT-LAMP thus offers the potential to deliver rapid diagnosis and treatment of urinary tract infections and urinary sepsis with a simple test that can be performed at low cost at the point-of-care. Fund National Institutes of Health, Chan-Zuckerberg Biohub, Bill and Melinda Gates Foundation.
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Garcia-Rubio R, Monzon S, Alcazar-Fuoli L, Cuesta I, Mellado E. Genome-Wide Comparative Analysis of Aspergillus fumigatus Strains: The Reference Genome as a Matter of Concern. Genes (Basel) 2018; 9:E363. [PMID: 30029559 PMCID: PMC6071029 DOI: 10.3390/genes9070363] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022] Open
Abstract
Aspergillus fumigatus is a ubiquitous saprophytic mold and a major pathogen in immunocompromised patients. The effectiveness of triazole compounds, the A. fumigatus first line treatment, is being threatened by a rapid and global emergence of azole resistance. Whole genome sequencing (WGS) has emerged as an invaluable tool for the analysis of genetic differences between A. fumigatus strains, their genetic background, and antifungal resistance development. Although WGS analyses can provide a valuable amount of novel information, there are some limitations that should be considered. These analyses, based on genome-wide comparative data and single nucleotide variant (SNV) calling, are dependent on the quality of sequencing, assembling, the variant calling criteria, as well as on the suitable selection of the reference genome, which must be genetically close to the genomes included in the analysis. In this study, 28 A. fumigatus genomes sequenced in-house and 73 available in public data bases have been analyzed. All genomes were distributed in four clusters and showed a variable number of SNVs depending on the genome used as reference (Af293 or A1163). Each reference genome belonged to a different cluster. The results highlighted the importance of choosing the most suitable A. fumigatus reference genome to avoid misleading conclusions.
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Affiliation(s)
- Rocio Garcia-Rubio
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Majadahonda, 28220 Madrid, Spain.
| | - Sara Monzon
- Bioinformatics Unit, Common Scientific Technical Units, ISCIII, Majadahonda, 28220 Madrid, Spain.
| | - Laura Alcazar-Fuoli
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Majadahonda, 28220 Madrid, Spain.
| | - Isabel Cuesta
- Bioinformatics Unit, Common Scientific Technical Units, ISCIII, Majadahonda, 28220 Madrid, Spain.
| | - Emilia Mellado
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Majadahonda, 28220 Madrid, Spain.
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Dobson CM. The Amyloid Phenomenon and Its Links with Human Disease. Cold Spring Harb Perspect Biol 2017; 9:cshperspect.a023648. [PMID: 28062560 DOI: 10.1101/cshperspect.a023648] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The ability of normally soluble proteins to convert into amyloid fibrils is now recognized to be a generic phenomenon. The overall cross-β architecture of the core elements of such structures is closely similar for different amino acid sequences, as this architecture is dominated by interactions associated with the common polypeptide main chain. In contrast, the multiplicity of complex and intricate structures of the functional states of proteins is dictated by specific interactions involving the variable side chains, the sequence of which is unique to a given protein. Nevertheless, the side chains dictate important aspects of the amyloid structure, including the regions of the sequence that form the core elements of the fibrils and the kinetics and mechanism of the conversion process. The formation of the amyloid state of proteins is of particular importance in the context of a range of medical disorders that include Alzheimer's and Parkinson's diseases and type 2 diabetes. These disorders are becoming increasingly common in the modern world, primarily as a consequence of increasing life spans and changing lifestyles, and now affect some 500 million people worldwide. This review describes recent progress in our understanding of the molecular origins of these conditions and discusses emerging ideas for new and rational therapeutic strategies by which to combat their onset and progression.
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Affiliation(s)
- Christopher M Dobson
- Department of Chemistry, University of Cambridge, Cambridge CB2 1EW, United Kingdom
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Cimmino T, Le Page S, Raoult D, Rolain JM. Contemporary challenges and opportunities in the diagnosis and outbreak detection of multidrug-resistant infectious disease. Expert Rev Mol Diagn 2016; 16:1163-1175. [PMID: 27690721 DOI: 10.1080/14737159.2016.1244005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The dissemination of multi-drug resistant bacteria (MDRB) has become a major public health concern worldwide because of the increase in infections caused by MDRB, the difficulty in treating them, and expenditures in patient care. Areas covered: We have reviewed challenges and contemporary opportunities for rapidly confronting infections caused by MDRB in the 21st century, including surveillance, detection, identification of resistance mechanisms, and action steps. Expert commentary: In this context, the first critical point for clinical microbiologists is to be able to rapidly detect an abnormal event, an outbreak and/or the spread of a MDRB with surveillance tools so that healthcare policies and therapies adapted to a new stochastic event that will certainly occur again in the future can be implemented.
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Affiliation(s)
- Teresa Cimmino
- a URMITE UM 63 CNRS 7278 IRD 198 INSERM U1905, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie , Aix-Marseille University , Marseille , France
| | - Stéphanie Le Page
- a URMITE UM 63 CNRS 7278 IRD 198 INSERM U1905, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie , Aix-Marseille University , Marseille , France
| | - Didier Raoult
- a URMITE UM 63 CNRS 7278 IRD 198 INSERM U1905, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie , Aix-Marseille University , Marseille , France
| | - Jean-Marc Rolain
- a URMITE UM 63 CNRS 7278 IRD 198 INSERM U1905, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie , Aix-Marseille University , Marseille , France
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Functional Genome Screening to Elucidate the Colistin Resistance Mechanism. Sci Rep 2016; 6:23156. [PMID: 26988670 PMCID: PMC4796810 DOI: 10.1038/srep23156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/25/2016] [Indexed: 12/17/2022] Open
Abstract
Antibiogram profile of 1590 clinical bacterial isolates based on thirteen different antimicrobial compounds showed that 1.6% of the bacterial isolates are multidrug resistant. Distribution pattern based on 16S rRNA sequence analysis showed that Pseudomonas aeruginosa constituted the largest group (83.6%) followed by Burkholderia pseudomallei sp. A191 (5.17%), Staphylococcus sp. A261 (3.45%). Among the various antibiotics used, colistin appeared to be the most effective against the Gram negative bacteria. Burkholderia pseudomallei sp. A191 and Pseudomonas aeruginosa sp. A111 showed resistance to 1500 μg/ml and 750 μg/ml of colistin respectively which constitutes 7.7% of the bacterial population. A functional genomics strategy was employed to discover the molecular support for colistin resistance in Burkholderia pseudomallei sp. A191. A pUC plasmid-based genomic expression library was constructed with an estimated library size of 2.1 × 107bp. Five colistin resistant clones were obtained after functional screening of the library. Analysis of DNA sequence of five colistin resistant clones showed homology to two component regularity systems (TCRS) encoding for a histidine kinase (mrgS) and its regulatory component (mrgR). Cross complementation assay showed that mutations in mrgS were sufficient enough to confer colistin resistant phenotype in a sensitive strain.
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Amin AN, Deruelle D. Healthcare-associated infections, infection control and the potential of new antibiotics in development in the USA. Future Microbiol 2016; 10:1049-62. [PMID: 26059625 DOI: 10.2217/fmb.15.33] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
ABSTRACT Healthcare-associated infections (HAIs) caused by drug-resistant Gram-negative pathogens are a significant burden on the US healthcare system. This problem has been further compounded by the recent decline in the development of new antibiotics targeting Gram-negative organisms. US healthcare agencies have been working to limit the occurrence of HAIs by several means, including surveillance systems, prevention practices, antimicrobial stewardship policies and financial incentives. Furthermore, efforts have been made to resume the development of antibiotics in the USA, with the US FDA and US government both implementing acts to boost the number of antibiotics in the clinical pipeline. This review discusses the policies instigated by the US government, including healthcare agencies and the FDA, and describes new antibiotics in development against HAIs.
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Affiliation(s)
- Alpesh N Amin
- Department of Medicine, University of California, Irvine, 101 The City Drive South, Orange, CA 92868, USA
| | - Dennis Deruelle
- IPC Healthcare, 4605 Lankershim Blvd, Ste 617, North Hollywood, CA 91602, USA
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10
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References. Antibiotics (Basel) 2015. [DOI: 10.1128/9781555819316.refs] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Dobson CM. Alzheimer’s disease: addressing a twenty-first century plague. RENDICONTI LINCEI-SCIENZE FISICHE E NATURALI 2015. [DOI: 10.1007/s12210-015-0453-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Genomic Context of Azole Resistance Mutations in Aspergillus fumigatus Determined Using Whole-Genome Sequencing. mBio 2015; 6:e00536. [PMID: 26037120 PMCID: PMC4453006 DOI: 10.1128/mbio.00536-15] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A rapid and global emergence of azole resistance has been observed in the pathogenic fungus Aspergillus fumigatus over the past decade. The dominant resistance mechanism appears to be of environmental origin and involves mutations in the cyp51A gene, which encodes a protein targeted by triazole antifungal drugs. Whole-genome sequencing (WGS) was performed for high-resolution single-nucleotide polymorphism (SNP) analysis of 24 A. fumigatus isolates, including azole-resistant and susceptible clinical and environmental strains obtained from India, the Netherlands, and the United Kingdom, in order to assess the utility of WGS for characterizing the alleles causing resistance. WGS analysis confirmed that TR34/L98H (a mutation comprising a tandem repeat [TR] of 34 bases in the promoter of the cyp51A gene and a leucine-to-histidine change at codon 98) is the sole mechanism of azole resistance among the isolates tested in this panel of isolates. We used population genomic analysis and showed that A. fumigatus was panmictic, with as much genetic diversity found within a country as is found between continents. A striking exception to this was shown in India, where isolates are highly related despite being isolated from both clinical and environmental sources across >1,000 km; this broad occurrence suggests a recent selective sweep of a highly fit genotype that is associated with the TR34/L98H allele. We found that these sequenced isolates are all recombining, showing that azole-resistant alleles are segregating into diverse genetic backgrounds. Our analysis delineates the fundamental population genetic parameters that are needed to enable the use of genome-wide association studies to identify the contribution of SNP diversity to the generation and spread of azole resistance in this medically important fungus. Resistance to azoles in the ubiquitous ascomycete fungus A. fumigatus was first reported from clinical isolates collected in the United States during the late 1980s. Over the last decade, an increasing number of A. fumigatus isolates from the clinic and from nature have been found to show resistance to azoles, suggesting that resistance is emerging through selection by the widespread usage of agricultural azole antifungal compounds. Aspergillosis is an emerging clinical problem, with high rates of treatment failures necessitating the development of new techniques for surveillance and for determining the genome-wide basis of azole resistance in A. fumigatus.
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Conlan S, Thomas PJ, Deming C, Park M, Lau AF, Dekker JP, Snitkin ES, Clark TA, Luong K, Song Y, Tsai YC, Boitano M, Dayal J, Brooks SY, Schmidt B, Young AC, Thomas JW, Bouffard GG, Blakesley RW, Mullikin JC, Korlach J, Henderson DK, Frank KM, Palmore TN, Segre JA. Single-molecule sequencing to track plasmid diversity of hospital-associated carbapenemase-producing Enterobacteriaceae. Sci Transl Med 2015; 6:254ra126. [PMID: 25232178 DOI: 10.1126/scitranslmed.3009845] [Citation(s) in RCA: 242] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Public health officials have raised concerns that plasmid transfer between Enterobacteriaceae species may spread resistance to carbapenems, an antibiotic class of last resort, thereby rendering common health care-associated infections nearly impossible to treat. To determine the diversity of carbapenemase-encoding plasmids and assess their mobility among bacterial species, we performed comprehensive surveillance and genomic sequencing of carbapenem-resistant Enterobacteriaceae in the National Institutes of Health (NIH) Clinical Center patient population and hospital environment. We isolated a repertoire of carbapenemase-encoding Enterobacteriaceae, including multiple strains of Klebsiella pneumoniae, Klebsiella oxytoca, Escherichia coli, Enterobacter cloacae, Citrobacter freundii, and Pantoea species. Long-read genome sequencing with full end-to-end assembly revealed that these organisms carry the carbapenem resistance genes on a wide array of plasmids. K. pneumoniae and E. cloacae isolated simultaneously from a single patient harbored two different carbapenemase-encoding plasmids, indicating that plasmid transfer between organisms was unlikely within this patient. We did, however, find evidence of horizontal transfer of carbapenemase-encoding plasmids between K. pneumoniae, E. cloacae, and C. freundii in the hospital environment. Our data, including full plasmid identification, challenge assumptions about horizontal gene transfer events within patients and identify possible connections between patients and the hospital environment. In addition, we identified a new carbapenemase-encoding plasmid of potentially high clinical impact carried by K. pneumoniae, E. coli, E. cloacae, and Pantoea species, in unrelated patients and in the hospital environment.
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Affiliation(s)
- Sean Conlan
- National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Pamela J Thomas
- National Institutes of Health Intramural Sequencing Center (NISC), Bethesda, MD 20852, USA
| | - Clayton Deming
- National Human Genome Research Institute, Bethesda, MD 20892, USA
| | - Morgan Park
- National Institutes of Health Intramural Sequencing Center (NISC), Bethesda, MD 20852, USA
| | - Anna F Lau
- National Institutes of Health Clinical Center, Bethesda, MD 20892, USA
| | - John P Dekker
- National Institutes of Health Clinical Center, Bethesda, MD 20892, USA
| | - Evan S Snitkin
- National Human Genome Research Institute, Bethesda, MD 20892, USA
| | | | - Khai Luong
- Pacific Biosciences, Menlo Park, CA 94025, USA
| | - Yi Song
- Pacific Biosciences, Menlo Park, CA 94025, USA
| | | | | | - Jyoti Dayal
- National Institutes of Health Intramural Sequencing Center (NISC), Bethesda, MD 20852, USA
| | - Shelise Y Brooks
- National Institutes of Health Intramural Sequencing Center (NISC), Bethesda, MD 20852, USA
| | - Brian Schmidt
- National Institutes of Health Intramural Sequencing Center (NISC), Bethesda, MD 20852, USA
| | - Alice C Young
- National Institutes of Health Intramural Sequencing Center (NISC), Bethesda, MD 20852, USA
| | - James W Thomas
- National Institutes of Health Intramural Sequencing Center (NISC), Bethesda, MD 20852, USA
| | - Gerard G Bouffard
- National Institutes of Health Intramural Sequencing Center (NISC), Bethesda, MD 20852, USA
| | - Robert W Blakesley
- National Institutes of Health Intramural Sequencing Center (NISC), Bethesda, MD 20852, USA
| | | | - James C Mullikin
- National Institutes of Health Intramural Sequencing Center (NISC), Bethesda, MD 20852, USA
| | | | - David K Henderson
- National Institutes of Health Clinical Center, Bethesda, MD 20892, USA
| | - Karen M Frank
- National Institutes of Health Clinical Center, Bethesda, MD 20892, USA.
| | - Tara N Palmore
- National Institutes of Health Clinical Center, Bethesda, MD 20892, USA.
| | - Julia A Segre
- National Human Genome Research Institute, Bethesda, MD 20892, USA.
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