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Molecular Characterization of Enterobacter cloacae Isolated from Urinary Tract Infections. Jundishapur J Microbiol 2022. [DOI: 10.5812/jjm-122718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Urinary tract infections represent a major expensive, common public health problem worldwide due to their high prevalence and the difficulties associated with their management. Objectives: This study aimed to characterize the Enterobacter cloacae strains isolated from urinary tract infections in the medical diagnostic laboratories of Shahrekord, Iran. Methods: Urine samples from patients with urinary tract infections from the Shahrekord medical diagnostic laboratories located in Chaharmahal and Bakhtiari Province, Iran, were collected from June 2019 to February 2020. When the samples were cultured, the different isolates of E. cloacae were identified by biochemical tests. Biofilm production capacity was evaluated. Bacterial susceptibility to antibiotics was determined using the Kirby Bauer method, and antibiotic resistance genes were researched by the multiplex PCR technique. Results: In this study, 65 isolates of E. cloacae were obtained. The highest percentage of resistance was observed for co-trimoxazole (84.62%), ampicillin (76.93%), tetracycline (73.85%), and above half of the E. cloacae strain isolates (53,85%) were strongly involved in biofilm production. Some genes, including qnr A, qnr B, qnr S, tetA, tet B, sul1, bla CTXM, bla SHV, and(2)la, ant(3)la, and aac(3)IIa, were detected in the genome of these isolates. Conclusions: The strains are multi-resistant, and their resistance has already reached the carbapenem class. This requires further investigation, and urgent measures must be adopted.
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Scherberich JE, Fünfstück R, Naber KG. Urinary tract infections in patients with renal insufficiency and dialysis - epidemiology, pathogenesis, clinical symptoms, diagnosis and treatment. GMS INFECTIOUS DISEASES 2021; 9:Doc07. [PMID: 35106269 PMCID: PMC8777485 DOI: 10.3205/id000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Epidemiological studies show an increasing number of patients worldwide suffering from chronic kidney diseases (CKD), which are associated with a risk for progression to end-stage kidney disease (ESKD). CKD patients stage 2-5, patients with regular chronic dialysis treatment (hemo- or peritoneal dialysis), and patients suffering from kidney allograft dysfunction are at high risk to develop infections, e.g. urinary tract infections (UTI) and/or sepsis (urosepsis). These groups show metabolic disturbance, chronic inflammation, and impaired immunocompetence. Escherichia coli is still the most common pathogen in UTI. A wide variety of other pathogens may be involved in UTI. Urological interventions, catheterization, as well as repeated courses of antibiotics contribute to an increased challenge of antimicrobial resistance. The diagnosis of UTI in CKD is based on standard clinical and laboratory criteria. Pyuria (≥10 leucocytes/µl) is more often observed in patients with oligoanuria and low bacterial colony counts. The treatment strategies for this population are based on the same principles as in patients with normal renal function. However, drugs cleared by the kidney or by dialysis membranes need dose adjustment. Antimicrobials with potential systemic toxicity and nephrotoxicity should be administered with caution.
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Affiliation(s)
| | | | - Kurt G. Naber
- Department of Urology, Technical University Munich, Germany
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Kaur R, Singh D, Kesavan AK, Kaur R. Molecular characterization and antimicrobial susceptibility of bacterial isolates present in tap water of public toilets. Int Health 2020; 12:472-483. [PMID: 31693132 PMCID: PMC7443727 DOI: 10.1093/inthealth/ihz074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The present study was carried out to investigate the tap water quality of public toilets in Amritsar, Punjab, India. METHODS Water samples from the taps of the public toilets were collected in sterile containers and physicochemical and bacteriological analysis was performed using standard methods. Also, genotypic and phenotypic characterization of the bacterial isolates was performed using different biochemical tests and 16S ribosomal RNA analysis. An antibiotic susceptibility test was performed using antibiotics based on their mode of action. A biofilm assay was performed to assess the adhesion potential of the isolates. RESULTS A total of 25 bacterial isolates were identified from the water samples, including Acinetobacter junii, Acinetobacter pittii, Acinetobacter haemolyticus, Bacillus pumilus, Bacillus megaterium, Bacillus marisflavi, Bacillus flexus, Bacillus oceanisediminis, Pseudomonas otitidis, Pseudomonas sp. RR013, Pseudomonas sp. RR021, Pseudomonas sp. RR022, Escherichia coli and Enterobacter cloacae. The results of the antimicrobial susceptibility test revealed that the antibiotics cefodroxil, aztreonam, nitrofurantoin, cefepime, ceftazidime and amoxyclav were found to be mostly ineffective against various isolates. The biofilm assay revealed the weak, moderate and strong biofilm producers among them. CONCLUSIONS The tap water in the public toilets was microbially contaminated and needs to be monitored carefully. The antibiotic susceptibility profile showed that of 25 bacterial isolates, 5 were multidrug resistant. Bacterial isolates exhibited strong to weak adhesion potential in the biofilm assay.
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Affiliation(s)
- Rajanbir Kaur
- Department of Botanical and Environmental Sciences, Guru Nanak Dev University, Amritsar, Punjab 143005, India
| | - Drishtant Singh
- Department of Molecular Biology and Biochemistry, Guru Nanak Dev University, Amritsar, Punjab 143005, India
| | - Anup Kumar Kesavan
- Department of Molecular Biology and Biochemistry, Guru Nanak Dev University, Amritsar, Punjab 143005, India
| | - Rajinder Kaur
- Department of Botanical and Environmental Sciences, Guru Nanak Dev University, Amritsar, Punjab 143005, India
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Freire MP, de Oliveira Garcia D, Cury AP, Spadão F, Di Gioia TSR, Francisco GR, Bueno MFC, Tomaz M, de Paula FJ, de Faro LB, Piovesan AC, Rossi F, Levin AS, David Neto E, Nahas WC, Pierrotti LC. Outbreak of IMP-producing carbapenem-resistant Enterobacter gergoviae among kidney transplant recipients. J Antimicrob Chemother 2016; 71:2577-85. [PMID: 27197663 DOI: 10.1093/jac/dkw165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/07/2016] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES The objective of this study was to investigate a prolonged outbreak of carbapenem-resistant Enterobacter gergoviae (CREG) involving kidney transplant recipients (KTRs) between 2009 and 2014. METHODS A case-control study was undertaken. Controls (n = 52) were selected from CREG-negative KTRs. Surveillance cultures for CREG were collected weekly. Colonization was defined as isolation of CREG from surveillance samples or from clinical specimens, with no evidence of infection. We also investigated infection control practices at the facility. RESULTS Of 26 identified cases, 13 had had no known contact with another CREG-positive patient before the first positive culture. Seven patients (27%) developed infection. The site most often colonized was the urinary tract. During the study period two clusters were identified, one in 2009 and another in 2013-14. DNA sequencing revealed blaIMP-1 in all CREG tested. No environmental or hand cultures tested positive for CREG. An audit of infection control practices detected flaws in the handling and cleaning of urinary tract devices. Multivariate analysis identified advanced age, ureteral stent use, retransplantation and male gender as risk factors for CREG acquisition. CONCLUSIONS An outbreak among KTRs caused by an unusual species of MDR bacteria may have resulted from a common source of contamination related to urinary tract devices.
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Affiliation(s)
- Maristela Pinheiro Freire
- Working Committee for Hospital Epidemiology and Infection Control, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | | | - Ana Paula Cury
- Microbiology Section, Central Laboratory, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Fernanda Spadão
- Working Committee for Hospital Epidemiology and Infection Control, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | | | | | | | - Mariama Tomaz
- Laboratory for Medical Research 54, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Flavio Jota de Paula
- Renal Transplantation Unit, Department of Urology, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | | | - Affonso C Piovesan
- Renal Transplantation Unit, Department of Urology, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Flavia Rossi
- Microbiology Section, Central Laboratory, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Anna Sara Levin
- Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Elias David Neto
- Renal Transplantation Unit, Department of Urology, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - William C Nahas
- Renal Transplantation Unit, Department of Urology, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Ligia Camera Pierrotti
- Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil
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Kanpiengjai A, Mahawan R, Lumyong S, Khanongnuch C. A soil bacterium Rhizobium borbori and its potential for citrinin-degrading application. ANN MICROBIOL 2015. [DOI: 10.1007/s13213-015-1167-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Subtractive hybridization yields a silver resistance determinant unique to nosocomial pathogens in the Enterobacter cloacae complex. J Clin Microbiol 2012; 50:3249-57. [PMID: 22837330 DOI: 10.1128/jcm.00885-12] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The heterogeneity and the increasing clinical importance of the Enterobacter cloacae complex have often been discussed. However, little is known about molecular factors causing pathogenicity within this nomenspecies. Here, we analyzed the genetic differences between an avirulent plant isolate and a pathogenic strain causing an outbreak with septicemia in three patients. We identified an IncHI-2 plasmid as a major difference between these two strains. Besides resistance to several antibiotics, this plasmid encoded a silver resistance determinant. We further showed that this sil determinant was present not only in the analyzed outbreak strain but also in the vast majority of clinical isolates of the E. cloacae complex, predominantly in (sub)species that frequently cause nosocomial infections. The identified sil determinant was highly conserved within the E. cloacae complex and mediated resistance to up to 600 μM silver nitrate. As silver is often used as a disinfectant and treatment for burn wounds, we present here an important fitness factor within the clinically most prevalent subspecies of the E. cloacae complex. This provides a possible explanation for their unequal involvement in nosocomial and especially burn wound infections.
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Alavi MR, Antonic V, Ravizee A, Weina PJ, Izadjoo M, Stojadinovic A. An Enterobacter plasmid as a new genetic background for the transposon Tn1331. Infect Drug Resist 2011; 4:209-13. [PMID: 22259249 PMCID: PMC3259689 DOI: 10.2147/idr.s25408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Genus Enterobacter includes important opportunistic nosocomial pathogens that could infect complex wounds. The presence of antibiotic resistance genes in these microorganisms represents a challenging clinical problem in the treatment of these wounds. In the authors’ screening of antibiotic-resistant bacteria from complex wounds, an Enterobacter species was isolated that harbors antibiotic-resistant plasmids conferring resistance to Escherichia coli. The aim of this study was to identify the resistance genes carried by one of these plasmids. Methods The plasmids from the Enterobacter isolate were propagated in E. coli and one of the plasmids, designated as pR23, was sequenced by the Sanger method using fluorescent dyeterminator chemistry on a genetic analyzer. The assembled sequence was annotated by search of the GenBank database. Results Plasmid pR23 is composed of the transposon Tn1331 and a backbone plasmid that is identical to the plasmid pPIGDM1 from Enterobacter agglomerans. The multidrug-resistance transposon Tn1331, which confers resistance to aminoglycoside and beta lactam antibiotics, has been previously isolated only from Klebsiella. The Enterobacter plasmid pPIGDM1, which carries a ColE1-like origin of replication and has no apparent selective marker, appears to provide a backbone for propagation of Tn1331 in Enterobacter. The recognition sequence of Tn1331 transposase for insertion into pPIGDM1 is the pentanucleotide TATTA, which occurs only once throughout the length of this plasmid. Conclusion Transposition of Tn1331 into the Enterobacter plasmid pPIGDM1 enables this transposon to propagate in this Enterobacter. Since Tn1331 was previously isolated only from Klebsiella, this report suggests horizontal transfer of this transposon between the two bacterial genera.
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Affiliation(s)
- Mohammad R Alavi
- Division of Wound Biology and Translational Research, Armed Forces Institute of Pathology and American Registry of Pathology, Washington DC
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Hammami S, Boutiba-Ben Boubaker I, Saidani M, Lakhal E, Ben Hassen A, Kamoun A, Ghozzi R, Slim A, Ben Redjeb S. Characterization and molecular epidemiology of extended spectrum beta-lactamase producing Enterobacter cloacae isolated from a Tunisian hospital. Microb Drug Resist 2011; 18:59-65. [PMID: 21823989 DOI: 10.1089/mdr.2011.0074] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In 2009, out of the 66 nonrepetitive Enterobacter cloacae collected at Charles Nicolle hospital in Tunisia, 44 were extended spectrum β-lactamase (ESBL) producers. The aim of the current study was to detect and characterize the genes encoding the ESBLs including blaTEM, blaSHV, and blaCTX-M groups by polymerase chain reaction and sequencing. Pulsed-field gel electrophoresis (PFGE) analysis was used to determine the genetic relatedness between isolates. All strains were susceptible to carbapenems. They were resistant to fluoroquinolones, gentamicin, tobramycin, and trimethoprim+sulfamethoxazole but variably resistant to netilmicin, amikacin, and tetracyclines. Sequence analysis of the polymerase chain reaction products revealed the presence of blaCTX-M-15 (39 strains), blaSHV-12 (6 strains), and blaSHV-27 (1 strain). The coexistence of two ESBLs was observed in two isolates harboring, respectively, SHV-12+CTX-M-15 and SHV-27+CTX-M-15. PFGE revealed 36 unrelated profiles. Diffusion of E. cloacae producing CTX-M-15 ESBL in our hospital is the consequence of dissemination of identical or related plasmids harboring the CTX-M-15 gene.
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Affiliation(s)
- Samia Hammami
- Laboratoire de Recherche Résistance aux Antimicrobiens, Faculté de Médecine de Tunis, Tunis, Tunisie.
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Weese JS. Investigation of Enterobacter cloacae infections at a small animal veterinary teaching hospital. Vet Microbiol 2008; 130:426-8. [DOI: 10.1016/j.vetmic.2008.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 02/14/2008] [Accepted: 02/14/2008] [Indexed: 10/22/2022]
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Vrints M, Bertrand S, Collard JM. A bacterial population study of commercialized wastewater inoculants. J Appl Microbiol 2008; 103:2006-15. [PMID: 17953611 DOI: 10.1111/j.1365-2672.2007.03444.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To assess the bacterial diversity and safety of wastewater inoculants, which are commercially available products used to improve the aerobic digestion processes of the domestic waste compost in the septic tank. METHODS AND RESULTS Eighteen wastewater inoculants were analysed on nonselective and selective media and the cultivable bacteria were identified. In all wastewater inoculants, the number of CFUs were between 10(4) and 10(7) g(-1) powder on nonselective media and Bacillus was the predominant cultivable genus. Culture-independent molecular methods such as sequencing of 16S rRNA clone libraries and denaturating gradient gel electrophoresis demonstrated the high prevalence of interfering chloroplast 16S rRNA from plant material and the presence of Bacillus spp. Only after selective enrichments and cultivation, the presence of one pathogenic strain (Klebsiella pneumoniae subsp. pneumoniae) and one opportunistic strain of (Enterobacter cloacae) bacteria were detected in six different products. CONCLUSION The predominant cultivable species of the wastewater inoculants were Bacillus spp. and after enrichment six products were found to contain opportunistic or pathogenic strains. SIGNIFICANCE AND IMPACT OF THE STUDY The presence of opportunistic pathogenic strains in the inoculants might represent a risk for immunocompromised, the elderly or children. A clear labelling should therefore be displayed on the product.
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Affiliation(s)
- M Vrints
- Bacteriology Division, Scientific Institute of Public Health, Brussels, Belgium.
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Urinary tract infection in the renal transplant patient. ACTA ACUST UNITED AC 2008; 4:252-64. [PMID: 18334970 DOI: 10.1038/ncpneph0781] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Accepted: 01/30/2008] [Indexed: 11/09/2022]
Abstract
Urinary tract infection (UTI) is the most common type of bacterial infection contracted by recipients of renal allografts in the post-transplantation period. Fungi and viruses can also cause UTIs, but infections caused by these organisms are less common than those caused by bacteria. Both the lower and upper urinary tract (encompassing grafted or native kidneys) can be affected. Factors that might contribute to the development of UTIs include excessive immunosuppression, and instrumentation of the urinary tract (e.g. urethral catheters and ureteric stents). Antimicrobials are the mainstays of treatment and should be accompanied by minimization of immunosuppression when possible. The use of long-term antimicrobial prophylaxis is controversial, however, as it might increase the likelihood of infective organisms becoming resistant to treatment. There are conflicting data on the associations of post-transplantation UTI with graft and patient survival.
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