Macrolide and lincosamide resistance in the gram-positive nasal and tonsillar flora of pigs

Rothia spp. infective endocarditis: A systematic literature review

OBJECTIVE

To describe the epidemiological, clinical, microbiological, and therapeutic features and outcomes of Rothia infective endocarditis (RIE) and extracardiac infections (ECRI).

METHODS

We performed a systematic literature review of published cases of RIE and ECRI.

RESULTS

After inclusion of a personal case report, 51 cases of RIE and 215 cases of ECRI were reported. Compared with ECRI patients, RIE patients were significantly more often males (80% versus 59%), intravenous drug users (IVDU) (20% versus 3%), immunocompetent (76% versus 31%), and infected with R. dentocariosa (55% versus 13%) but lacked significant differences with regard to median age (45 years [6-79]), rate of orodental abnormalities (33%), and six-month mortality (14%). Following microbiological documentation, RIE was most often treated with a beta-lactam antibiotic alone (39%) for a median duration of six weeks and required surgery in 39% of cases.

CONCLUSION

RIE is rare and likely secondary to a dental portal of entry or cutaneous inoculation in IVDU. Its prognosis seems to be favorable.

Antibiotic Resistance of LACTOBACILLUS Strains

The study provides phenotypic and molecular analyses of the antibiotic resistance in 20 Lactobacillus strains including 11 strains newly isolated from fermented plant material. According to the results of disc diffusion method, 90% of tested lactobacilli demonstrated sensitivity to clindamycin and 95% of strains were susceptible to tetracycline, erythromycin, and rifampicin. Ampicillin and chloramphenicol were found to inhibit all bacteria used in this study. The vast majority of tested strains revealed phenotypic resistance to vancomycin, ciprofloxacin, and aminoglycosides. Most of Lactobacillus strains showed high minimum inhibitory concentrations (MICs) of cefotaxime, ceftriaxone, and cefazolin and therefore were considered resistant to cephalosporins. All the strains exhibited multidrug resistance. The occurrence of resistance genes was associated with phenotypic resistance, with the exception of phenotypically susceptible strains that contained genes for tetracycline (tetK, tetL) and erythromycin (ermB, mefA) resistance. The vanX gene for vancomycin resistance was among the most frequently identified among the lactobacilli (75% of strains), but the occurrence of the parC gene for ciprofloxacin resistance was sporadic (20% of strains). Our results mainly evidence the intrinsic nature of the resistance to aminoglycosides in lactobacilli, though genes for enzymatic modification of streptomycin aadA and aadE were found in 20% of tested strains. The occurrence of extended spectrum beta-lactamases (ESBL) was unknown in Lactobacillus, but our results revealed the blaTEM gene in 80% of strains, whereas blaSHV and blaOXA-1 genes were less frequent (20% and 15% of strains, respectively).

Antibiotic resistance genes in the Actinobacteria phylum

The Actinobacteria phylum is one of the oldest bacterial phyla that have a significant role in medicine and biotechnology. There are a lot of genera in this phylum that are causing various types of infections in humans, animals, and plants. As well as antimicrobial agents that are used in medicine for infections treatment or prevention of infections, they have been discovered of various genera in this phylum. To date, resistance to antibiotics is rising in different regions of the world and this is a global health threat. The main purpose of this review is the molecular evolution of antibiotic resistance in the Actinobacteria phylum.

Practical implications of erythromycin resistance gene diversity on surveillance and monitoring of resistance

Use of antibiotics in human and animal medicine has applied selective pressure for the global dissemination of antibiotic-resistant bacteria. Therefore, it is of interest to develop strategies to mitigate the continued amplification and transmission of resistance genes in environmental reservoirs such as farms, hospitals and watersheds. However, the efficacy of mitigation strategies is difficult to evaluate because it is unclear which resistance genes are important to monitor, and which primers to use to detect those genes. Here, we evaluated the diversity of one type of macrolide antibiotic resistance gene (erm) in one type of environment (manure) to determine which primers would be most informative to use in a mitigation study of that environment. We analyzed all known erm genes and assessed the ability of previously published erm primers to detect the diversity. The results showed that all known erm resistance genes group into 66 clusters, and 25 of these clusters (40%) can be targeted with primers found in the literature. These primers can target 74%–85% of the erm gene diversity in the manures analyzed.

Antimicrobial Resistance in Corynebacterium spp., Arcanobacterium spp., and Trueperella pyogenes

There is currently only limited information on the antimicrobial susceptibility and resistance of Corynebacterium spp., Arcanobacterium spp., and Trueperella pyogenes from animals. The comparability of the data is hampered by the use of different antimicrobial susceptibility testing methods and interpretive criteria. To date, standard broth microdilution methods and clinical breakpoints that are approved by the Clinical and Laboratory Standards Institute and are applicable to Corynebacterium spp., Arcanobacterium spp., and T. pyogenes are available. The lack of species-specific clinical breakpoints for the different animal species reduces the explanatory power of the data. Among the isolates of the three genera, elevated MICs for different classes of antimicrobial agents (e.g., β-lactams, macrolides, lincosamides, tetracyclines, aminoglycosides, phenicols, sulfonamides/diaminopyrimidines, and fluoroquinolones) have been described. The most comprehensive data set is available for T. pyogenes, which also includes information about genes and mutations involved in antimicrobial resistance. In T. pyogenes isolates, the macrolide-lincosamide-streptogramin B resistance genes erm(B) and erm(X) were identified. Tetracycline resistance in T. pyogenes was based on the resistance genes tet(W), tet(Z), and tet(33), whereas the aminoglycoside resistance genes aacC, aadA1, aadA2, aadA5, aadA24, and aadB have been described in T. pyogenes. So far, only single genes conferring either phenicol resistance (cmlA6), trimethoprim resistance (dfrB2a), or β-lactam resistance (blaP1) are known to occur in T. pyogenes isolates. Various 23S rRNA mutations, including A2058T, A2058G, and G2137C, were identified in macrolide/lincosamide-resistant T. pyogenes.

In vivo spread of macrolide-lincosamide-streptogramin B (MLSB) resistance--a model study in chickens

The influence of specific and non-specific antibiotic pressure on in vivo spread of macrolide-lincosamide-streptogramin B (MLSB) resistance was evaluated in this study. Chickens repeatedly inoculated with Enterococcus faecalis harbouring the plasmid pAMβ1 carrying the erm(B) gene were perorally treated for one week with tylosin, lincomycin (both specific antibiotic pressure) and chlortetracycline (non-specific antibiotic pressure). Antibiotic non-treated but E. faecalis inoculated chickens served as a control. To quantify the erm(B) gene and characterise intestinal microflora, faecal DNA was analysed by qPCR and 454-pyrosequencing. Under the pressure of antibiotics, a significant increase in erm(B) was observed by qPCR. However, at the final stage of the experiment, an increase in erm(B) was also observed in two out of five non-treated chickens. In chickens treated with tylosin and chlortetracycline, the increase in erm(B) was accompanied by an increase in enterococci. However, E. faecalis was at the limit of detection in all animals. This suggests that the erm(B) gene spread among the gut microbiota other than E. faecalis. Pyrosequencing results indicated that, depending on the particular antibiotic pressure, different bacteria could be responsible for the spread of MLSB resistance. Different species of MLSB-resistant enterococci and streptococci were isolated from cloacal swabs during and after the treatment. PFGE analysis of MLSB-resistant enterococci revealed four clones, all differing from the challenge strain. All of the MLSB-resistant isolates harboured a plasmid of the same size as pAMβ1. This study has shown that MLSB resistance may spread within the gut microbiota under specific and non-specific pressure and even in the absence of any antimicrobial pressure. Finally, depending on the particular antibiotic pressure, different bacterial species seems to be involved in the spread of MLSB resistance.

Streptococcus suis, an Emerging Drug-Resistant Animal and Human Pathogen

Streptococcus suis, a major porcine pathogen, has been receiving growing attention not only for its role in severe and increasingly reported infections in humans, but also for its involvement in drug resistance. Recent studies and the analysis of sequenced genomes have been providing important insights into the S. suis resistome, and have resulted in the identification of resistance determinants for tetracyclines, macrolides, aminoglycosides, chloramphenicol, antifolate drugs, streptothricin, and cadmium salts. Resistance gene-carrying genetic elements described so far include integrative and conjugative elements, transposons, genomic islands, phages, and chimeric elements. Some of these elements are similar to those reported in major streptococcal pathogens such as Streptococcus pyogenes, Streptococcus pneumoniae, and Streptococcus agalactiae and share the same chromosomal insertion sites. The available information strongly suggests that S. suis is an important antibiotic resistance reservoir that can contribute to the spread of resistance genes to the above-mentioned streptococci. S. suis is thus a paradigmatic example of possible intersections between animal and human resistomes.

Detection of tetracycline and macrolide resistance determinants in Enterococci of animal and environmental origin using multiplex PCR

An occurrence of resistance to tetracycline (TET) and erythromycin (ERY) was ascertained in 82 isolates of Enterococcus spp. of animal and environmental origin. Using E test, 33 isolates were resistant to TET and three isolates to ERY. Using polymerase chain reaction (PCR; single and multiplex), the TET determinants tet(M) and tet(L) were detected in 35 and 13 isolates, respectively. Twelve isolates carried both tet(M) and tet(L) genes. Eight isolates possessed ermB gene associated with ERY resistance. Multiplex PCR was shown to be a suitable method for simultaneous determination of all three resistance determinants that occurred most frequently in bacteria isolated from poultry. This study also demonstrates that gastrointestinal tract of broilers may be a reservoir of enterococci with acquired resistance to both TET and ERY that can be transferred to humans via food chain.

Species distribution and antimicrobial susceptibility of enterococci isolated from broilers infected experimentally with Eimeria spp and fed with diets containing different supplements

Resistant bacteria in animal can be spread to environment and to humans. Poultry feed and infections caused by Eimeria spp. are important factors in determining the intestinal microbial communities. The aim of this study was to verify the prevalence of species and antimicrobial susceptibility of Enterococcus isolated from broilers fed with different supplements and infected experimentally with Eimeria spp. Broilers were divided in eight groups, fed with diets supplemented with a combination of antimicrobial, ionophore-coccidiostatics, probiotic, essential oil. At 14 days old all birds, except the control, received a solution containing oocysts of Eimeria spp. Samples of cloacal swabs from broilers were collected. A total of 240 Enterococcus sp. strains were isolated, confirmed genus by PCR, classified as species, tested for antimicrobial susceptibility and screened by PCR for the presence of tet(L), tet(M) and erm(B) genes. The overall distribution of species isolated from fecal samples was E. faecalis (40%), followed by E. casseliflavus/E. gallinarum (10.8%), E. mundtii (10.8%), E. faecium (10.8%), E. columbae (5.8%) and E. gallinarum (4.2%). Changes in the composition or frequency of Enterococcus species were observed in all dietary supplementation. Antimicrobial susceptibility tests showed resistance phenotypes a range of antibiotics, especially used in humans such as, streptomycin, penicillin, rifampicin and vancomycin. There was no correlation between different supplementation for broilers and antimicrobial resistance and the presence of tet(M), tet(L) and erm(B) genes. Dietary supplementation had effect on the Enterococcus sp. colonization, but did not have significant effect on the phenotype and genotype of antimicrobial resistance in enterococci.

High prevalence of tetracycline resistance in Enterococcus isolates from broilers carrying the erm(B) gene

A total of 73 isolates of Enterococcus spp. carrying the erm(B) gene were obtained from cloacal swabs of broiler chickens derived from 13 different farms in Belgium. The erm(B) gene encodes resistance to macrolides, lincosamides and streptogramin B antibiotics (MLS(B)). The isolates belonged to eight different species: Enterococcus avium (eight isolates), Enterococcus casseliflavus (11 isolates), Enterococcus cecorum (eight isolates), Enterococcus durans (seven isolates), Enterococcus faecalis (10 isolates), Enterococcus faecium (17 isolates), Enterococcus gallinarum (seven isolates) and Enterococcus hirae (five isolates). Acquired resistance to tetracycline was detected in 68 of the isolates, and in 62 of these it was associated with the presence of the resistance genes tet(L), tet(M), tet(O) or tet(S). In three E. faecium isolates that were phenotypically susceptible to tetracycline, tet(L) or tet(M) was present. The transposon integrase gene (int gene) of the Tn916/Tn1545 transposon family was detected in 18 of the 54 isolates that contained the tet(M) gene. It was concluded that acquired resistance to tetracycline antibiotics is often present in enterococci from poultry carrying the erm(B) gene. The use of tetracyclines in poultry may therefore co-select for resistance to MLS(B) antibiotics, which may be important as alternative therapy for enterococcal infections in humans.

Molecular basis of resistance to macrolides and lincosamides among staphylococci and streptococci from various animal sources collected in the resistance monitoring program BfT-GermVet

In this study, erythromycin- and/or clindamycin-resistant isolates among 248 coagulase-positive and coagulase-variable staphylococci and 500 streptococci, collected all over Germany during 2004-2006 in the resistance monitoring program BfT-GermVet, were investigated for their genetic basis of macrolide and/or lincosamide resistance. Staphylococci were sampled from various disease conditions of dogs/cats or pigs, whereas streptococci were from dogs/cats, pigs or horses. Resistant staphylococci were further identified biochemically to species and subspecies level and tested for the resistance genes erm(A), erm(B), erm(C), erm(TR), msr(A), msr(D), mef(A), mph(C), lnu(A), lnu(B) and lnu(C). The methylase genes erm(A), erm(B) and erm(C) were detected in staphylococci, alone or in different combinations. The erm(B) gene was the predominant gene in Staphylococcus intermedius and streptococci. The efflux gene msr(A) and the genes mph(C) and lnu(A) coding for inactivating enzymes were detected in single staphylococcal isolates. The efflux genes mef(A) and msr(D) were detected in three streptococci, in one of them together with the erm(B) gene. The lnu(B) gene was detected in seven porcine streptococcal isolates with reduced susceptibility to clindamycin. These data confirm that high-level resistance to erythromycin and clindamycin in staphylococci and streptococci was mainly due to rRNA methylases. The lnu(B) gene was detected for the first time in streptococci of animal origin.

Antibiotic resistance in non-enterococcal lactic acid bacteria and bifidobacteria

Over the last 50 years, human life expectancy and quality of life have increased dramatically due to improvements in nutrition and the use of antibiotics in the fight against infectious diseases. However, the heyday of antibiotic treatment is on the wane due to the appearance and spread of resistance among harmful microorganisms. At present, there is great concern that commensal bacterial populations from food and the gastrointestinal tract (GIT) of humans and animals, such as lactic acid bacteria (LAB) and bifidobacteria, could act as a reservoir for antibiotic resistance genes. Resistances could ultimately be transferred to human pathogenic and opportunistic bacteria hampering the treatment of infections. LAB species have traditionally been used as starter cultures in the production of fermented feed and foodstuffs. Further, LAB and bifidobacteria are normal inhabitants of the GIT where they are known to exert health-promoting effects, and selected strains are currently been used as probiotics. Antibiotic resistance genes carried by LAB and bifidobacteria can be transferred to human pathogenic bacteria either during food manufacture or during passage through the GIT. The aim of this review is to address well-stated and recent knowledge on antibiotic resistance in typical LAB and bifidobacteria species. Therefore, the commonest antibiotic resistance profiles, the distinction between intrinsic and atypical resistances, and some of the genetic determinants already discovered will all be discussed.

Resistance to Macrolides, Lincosamides, Streptogramins, and Linezolid among Members of the Staphylococcus sciuri Group

This study aimed to characterize the resistance profiles of the Staphylococcus sciuri group members to macrolides, lincosamides, streptogramins (MLS antibiotics), and linezolid upon analysis of large series of isolates that included 162 S. sciuri isolates, nine S. lentus, and one S. vitulinus. The evaluation of their susceptibility by disk diffusion and agar dilution methods, along with PCR detection of the resistance genes erm(A), erm(B), erm(C), mef(A), lnu(A), and lnu(B), were performed. Resistance to macrolides was detected in 10 (5.8%) tested strains, with three and six isolates exhibiting constitutive and inducible MLS(B) resistance phenotypes, respectively. Resistance mediated by active efflux was detected in one strain. The presence of genes conferring resistance, namely erm(B) or erm(C), was detected in two strains. All tested strains were susceptible to pristinamycin and linezolid. Of 172 tested strains, 70.9% were resistant and 26.2% had intermediary resistance to lincomycin, whereas 1.7% were resistant and 50% had intermediary resistance to clindamycin. The lnu(A) gene was detected in two strains only. The great majority of the tested S. sciuri strains (153 out of 162; 94.4%) presumably exhibited LS(A) phenotype because they did not carry lnu genes nor displayed constitutive MLSB resistance, but still showed intermediate resistance or resistance to lincomycin (MICs of 4, 8, 16, and 32 microg/ml). The results obtained indicate that S. sciuri may be naturally resistant to lincomycin. Expression of a novel type of inducible resistance to lincosamides, induced by erythromycin in erythromycinsusceptible strains, was observed in the S. sciuri group isolates.

Cloacal Lactobacillus isolates from broilers show high prevalence of resistance towards macrolide and lincosamide antibiotics

Eighty-seven Lactobacillus strains isolated from cloacal swabs of broiler chickens derived from 20 different farms in Belgium were identified to species level and tested for susceptibility to macrolide and lincosamide antibiotics. Five different Lactobacillus species were identified as being predominantly present in the cloacae of broilers: Lactobacillus crispatus, Lactobacillus salivarius subsp. salivarius, Lactobacillus amylovorus, Lactobacillus gallinarum and Lactobacillu sreuteri. Acquired resistance prevalence to macrolides and lincosamides was very high in the investigated lactobacilli: 89% of the strains were resistant to either or both lincosamide and macrolide class antibiotics. The vast majority of these resistant strains (96%) displayed constitutive resistance. More than one-half of the macrolide and/or lincosamide resistant strains carried an erm(B), erm(C), mef(A), lnu(A) gene or a combination of these genes.

Presence and mechanism of antimicrobial resistance among enterococci from cats and dogs

The presence and mechanism of acquired resistance to erythromycin, tylosin, lincomycin, quinupristin/dalfopristin, tetracycline, chloramphenicol, gentamicin, kanamycin, and vancomycin were determined in 97 and 104 enterococci isolated from rectal swabs of cats and dogs, respectively. Eleven feline and three canine enterococcal isolates contained the aac(6')-Ie-aph(2'')-Ia gene encoding high-level resistance to gentamicin, an antibiotic often used for treating enterococcal infections in humans. The combination of erm(B) and vat(E) genes encoding resistance to streptogramins was detected in one canine quinupristin/dalfopristin-resistant Enterococcus faecium isolate. Four quinupristin/dalfopristin-resistant enterococci only contained the erm(B) gene. Cross resistance against macrolides and lincosamides (30%) and resistance against tetracyclines (55%) was found to be widely distributed among enterococci from pets. In all of the feline and in 93% of the canine macrolide and lincosamide-resistant isolates, this resistance was encoded by the erm(B) gene. tet(M) was the most prevalent tetracycline resistance gene. It was detected in 91% of the feline and 86% of the canine tetracycline- resistant enterococci. A high occurrence of the Tn916/Tn1545 transposon family was found among these tet(M)-positive isolates. Enterococci from pet animals with resistance against vancomycin were not found. This study shows that enterococci from the intestinal microbiota of cats and dogs may act as a reservoir of resistance genes for animal or human pathogens.