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Extended-Spectrum β-Lactamases among Enterobacteriaceae Isolated from Urinary Tract Infections in Gaza Strip, Palestine. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4041801. [PMID: 31737661 PMCID: PMC6815577 DOI: 10.1155/2019/4041801] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/15/2019] [Accepted: 09/17/2019] [Indexed: 01/20/2023]
Abstract
Background Extended-spectrum β-lactamase-producing organisms causing urinary tract infections are increasing in incidence and pose a major impendence to health-care facility, having limited therapeutic options. This study aimed to assess the prevalence of ESBLs in Enterobacteriaceae isolates causing urinary tract infections in Gaza strip, Palestine, and to characterize β-lactamase types and associated resistance genes. Methods Eighty-five Enterobacteriaceae isolates were recovered from urinary tract infections within three months in Gaza Strip hospitals. The characterization of β-lactamase genes and the genetic environments of CTX-M, the identification of associated resistance genes, and the presence and characterization of integrons were tested by PCR and sequencing. Results The occurrence rate of ESBL among tested isolates was 30 (35.3%), and among ESBL-positive isolates, blaCTX-M was the highest followed by blaTEM. ESBL-CTX-M-1 group was confirmed in 93.3%, and the remaining carried CTX-M-9 group. CTX-M-15, CTX-M-3, CTX-M-1, CTX-M-14, CTX-M-27, and CTX-M-37 enzymes were demonstrated among the isolates with the majority (73%) being CTX-M-15. ISEcp-1 was demonstrated in 27 (90%, high incidence) of ESBL isolates. Class 1 integrons have been detected in higher rates (53.3%) in ESBL-positive isolates in comparison with non-ESBL isolates (6, 33.3%). Cassettes of integron-1 contain (aadA1, aadA2, aadA5, dfrA5, dfrA7, dfrA12, and dfrA17) genes. The aac(6′)-Ib-cr gene was demonstrated in 36.7% of ESBL-positive isolates. Conclusions This study indicates that blaCTX-M-15 was the most prevalent β-lactamase in this region. Our study demonstrates for the first time in Palestine the identification of blaCTX-M-15 in P. rettgeri and S. liquefaciens, also blaCTX-M-37 in E. cloacae. The coexpression of multiple β-lactamase genes with aac(6′)-Ib-cr and qnr in the presence of ISEcp-1 and integrons in individual strains will increase the dissemination of highly resistant strains. ESBL producers were more resistant than non-ESBLs producers for almost all tested antibiotics.
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Rahman M, Prasad KN, Gupta S, Singh S, Singh A, Pathak A, Gupta KK, Ahmad S, Gonzalez-Zorn B. Prevalence and Molecular Characterization of New Delhi Metallo-Beta-Lactamases in Multidrug-Resistant Pseudomonas aeruginosa and Acinetobacter baumannii from India. Microb Drug Resist 2017; 24:792-798. [PMID: 29058515 DOI: 10.1089/mdr.2017.0078] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
New Delhi metallo-beta-lactamase (NDM)-mediated carbapenem resistance in Pseudomonas aeruginosa and Acinetobacter baumannii is a major concern. We investigated the presence of NDM and its variants in P. aeruginosa and A. baumannii at a tertiary hospital in North India. A total of 236 isolates (130 P. aeruginosa and 106 A. baumannii) were included; 38 (29.23%) P. aeruginosa and 20 A. baumannii isolates (18.8%) were resistant to carbapenems and all of them were blaNDM positive. All 38 carbapenem-resistant P. aeruginosa harbored blaNDM-1, while 12 (60%) of 20 A. baumannii harbored blaNDM-2. Pulsed-field gel electrophoresis showed that all 58 isolates were clonally unrelated. By Southern blot analysis, blaNDM-2 was located on chromosome. The blaNDM-2-positive isolates were more frequently recovered from tracheal aspirate (67% vs.16%; p = 0.02) and intensive care unit (67% vs. 20%; p = 0.001) than blaNDM-1. Among other carbapenemases, VIM was significantly associated with blaNDM-1 than blaNDM-2 (61% vs. 17%; p = 0.006). Mortality between blaNDM-1- and blaNDM-2-infected patients was comparable. When expressed in Escherichia coli, blaNDM-2 transformant conferred one doubling dilution higher MIC value for cefotaxime, piperacillin/tazobactam than blaNDM-1. The study shows the emergence of blaNDM-mediated resistance among P. aeruginosa and A. baumannii and rapid evolution of blaNDM-2 in A. baumannii with its chromosomal localization.
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Affiliation(s)
- Mohibur Rahman
- 1 Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Kashi Nath Prasad
- 1 Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Shefali Gupta
- 1 Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Sanjay Singh
- 1 Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Avinash Singh
- 1 Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Ashutosh Pathak
- 1 Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Kamlesh Kumar Gupta
- 1 Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow, India
| | - Saheem Ahmad
- 2 Department of Biosciences, Integral University , Lucknow, India
| | - Bruno Gonzalez-Zorn
- 3 Department of Sanidad Animal, Universidad Complutense de Madrid , Madrid, Spain
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Yang Q, Zhang H, Wang Y, Xu Z, Zhang G, Chen X, Xu Y, Cao B, Kong H, Ni Y, Yu Y, Sun Z, Hu B, Huang W, Wang Y, Wu A, Feng X, Liao K, Luo Y, Hu Z, Chu Y, Lu J, Su J, Gui B, Duan Q, Zhang S, Shao H, Badal RE. Antimicrobial susceptibilities of aerobic and facultative gram-negative bacilli isolated from Chinese patients with urinary tract infections between 2010 and 2014. BMC Infect Dis 2017; 17:192. [PMID: 28264656 PMCID: PMC5340045 DOI: 10.1186/s12879-017-2296-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/28/2017] [Indexed: 01/30/2023] Open
Abstract
Background The objective of this study was to investigate the distribution and susceptibility of aerobic and facultative Gram-negative bacilli isolated from Chinese patients with UTIs collected within 48 h (community acquired, CA) or after 48 h (hospital acquired, HA) of hospital admission. Methods From 2010 to 2014, the minimum inhibitory concentrations (MICs) of 12 antibiotics for 4,332 aerobic and facultative Gram-negative bacilli, sampled in 21 hospitals in 16 cities, were determined by the broth microdilution method. Results Enterobacteriaceae composed 88.5% of the total isolates, with Escherichia coli (E. coli) (63.2%) the most commonly isolated species, followed by Klebsiella pneumoniae (K. pneumoniae) (12.2%). Non-Enterobacteriaceae accounted for only 11.5% of all isolates and included mainly Pseudomonas aeruginosa (P. aeruginosa) (6.9%) and Acinetobacter baumannii (A. baumannii) (3.3%). Among the antimicrobial agents tested, the susceptibility rates of E.coli to the two carbapenems, ertapenem and imipenem as well as amikacin and piperacillin-tazobactam ranged from 92.5 to 98.7%. Against K. pneumonia, the most potent antibiotics were imipenem (92.6% susceptibility), amikacin (89.2% susceptibility) and ertapenem (87.9% susceptibility). Although non-Enterobacteriaceae did not show high susceptibilities to the 12 common antibiotics, amikacin exhibited the highest in vitro activity against P. aeruginosa over the 5-year study period, followed by piperacillin-tazobactam, imipenem, ceftazidime, cefepime, ciprofloxacin, and levofloxacin. The Extended Spectrum Beta-Lactamase (ESBL) rates decreased slowly during the 5 years in E. coli from 68.6% in 2010 to 59.1% in 2014, in K. pneumoniae from 59.7 to 49.2%, and in Proteus mirabilis (P. mirabilis) from 40.0 to 26.1%. However, the ESBL rates were different in 5 regions of China (Northeast, North, East, South and Middle-China). Conclusion E. coli and K. pneumonia were the major pathogens causing UTIs and carbapenems and amikacin retained the highest susceptibility rates over the 5-year study period, indicating that they are good drug choices for empirical therapies, particularly of CA UTIs in China.
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Affiliation(s)
- Qiwen Yang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Hui Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yao Wang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zhipeng Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ge Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xinxin Chen
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yingchun Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Bin Cao
- Department of Respiratory and Critical Care Medicine, Clinical Microbiology and Infectious Disease Lab., China-Japan Friendship Hospital, Beijing, 100029, China
| | - Haishen Kong
- Department of Microbiology, The First Affiliated Hospital of Zhejiang University, Hangzhou, 310003, China
| | - Yuxing Ni
- Division of Microbiology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - Yunsong Yu
- Department of Infectious Diseases, SirRunRun Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Ziyong Sun
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Bijie Hu
- Division of Microbiology, Zhongshan Hospital of Fudan University, Shanghai, 200032, China
| | - Wenxiang Huang
- Division of Microbiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yong Wang
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China
| | - Anhua Wu
- Infection control center, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Xianju Feng
- Division of Microbiology, The First Affiliated Hospital of Zhengzhou University, Zhenzhou, 450052, China
| | - Kang Liao
- Division of Microbiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Yanping Luo
- Department of Microbiology, The Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhidong Hu
- Division of Microbiology, Tianjin Medical University General Hospital, Tianjing, 300052, China
| | - Yunzhuo Chu
- Division of Microbiology, The First Affiliated Hospital of Chinese Medical University, Shenyang, 110001, China
| | - Juan Lu
- Department of Clinical Laboratory, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Jianrong Su
- Department of Clinical Laboratory, Beijing Friendship Hospital of Capital Medical University, Beijing, 100020, China
| | - Bingdong Gui
- Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Qiong Duan
- Microbiology Lab, Jilin Province People's Hospital, Changchun, 130021, China
| | - Shufang Zhang
- Division of Microbiology, Haikou People's Hospital, Haikou, 570208, China
| | - Haifeng Shao
- Division of Microbiology, General Hospital of Nanjing Military Command, Nanjing, 210002, China
| | - Robert E Badal
- Division of Microbiology, International Health Management Associates, Schaumburg, IL, 60173-3817, USA
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Rahman M, Shukla SK, Prasad KN, Ovejero CM, Pati BK, Tripathi A, Singh A, Srivastava AK, Gonzalez-Zorn B. Prevalence and molecular characterisation of New Delhi metallo-β-lactamases NDM-1, NDM-5, NDM-6 and NDM-7 in multidrug-resistant Enterobacteriaceae from India. Int J Antimicrob Agents 2014; 44:30-7. [PMID: 24831713 DOI: 10.1016/j.ijantimicag.2014.03.003] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 03/07/2014] [Accepted: 03/07/2014] [Indexed: 11/20/2022]
Abstract
The growing prevalence of carbapenem resistance in Enterobacteriaceae worldwide is a major concern. New Delhi metallo-β-lactamase (NDM)-mediated carbapenem resistance has been identified in Enterobacteriaceae from numerous countries including those of the Indian subcontinent. Currently, seven NDM β-lactamase variants (NDM-1 to -7) have been identified. This study evaluated the detection and molecular characterisation of NDM variants in Enterobacteriaceae at a tertiary care hospital in India. A total of 464 isolates were tested; 57 (12.3%) were resistant or showed reduced susceptibility to imipenem and meropenem. All carbapenem-resistant isolates were blaNDM-positive by PCR, but 13 isolates bore variants that differed in sequence from blaNDM-1. NDM-5, NDM-6 and NDM-7 were identified in two, eight and three isolates, respectively. blaNDM variants were located on plasmids of >100kb with IncF, IncA/C and untypeable replicon types. Genes encoding the 16S rRNA methyltransferases RmtB, RmtC and ArmA as well as those for AmpC β-lactamases were also located on the same plasmids as blaNDM in different combinations. The prevalence of NDM-5 to -7 variants was significantly higher in Escherichia coli (P=0.015) and they were more frequently isolated from the urology ward (P=0.037) than NDM-1. The mortality rate was comparable between patients infected with isolates positive for blaNDM-1 and blaNDM variants [25% (11/44) vs. 23% (3/13)]. Expression of blaNDM variants in E. coli using the same promoter showed that NDM-7 conferred higher resistance to imipenem. The diverse genotypic features of blaNDM indicate rapid evolution of NDM resulting from their wide spread in the Indian subcontinent.
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Affiliation(s)
- Mohibur Rahman
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India; Department of Biosciences, Integral University, Lucknow, India
| | - Sanket Kumar Shukla
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India
| | - Kashi Nath Prasad
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India.
| | - Cristina M Ovejero
- Department of Animal Health and VISAVET, Universidad Complutense de Madrid, Madrid, Spain
| | - Binod Kumar Pati
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India
| | - Aparna Tripathi
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India
| | - Avinash Singh
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India
| | | | - Bruno Gonzalez-Zorn
- Department of Animal Health and VISAVET, Universidad Complutense de Madrid, Madrid, Spain
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Picozzi S, Ricci C, Gaeta M, Macchi A, Dinang E, Paola G, Tejada M, Costa E, Bozzini G, Casellato S, Carmignani L. Do we really know the prevalence of multi-drug resistant Escherichia coli in the territorial and nosocomial population? Urol Ann 2013; 5:25-9. [PMID: 23662006 PMCID: PMC3643319 DOI: 10.4103/0974-7796.106962] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Accepted: 01/08/2012] [Indexed: 11/08/2022] Open
Abstract
Introduction: The purpose of this work was to evaluate the prevalence of the Quinolones resistant Escherichia coli and/or ESBL producers in the population of our catchment area and hospital component. Materials and Methods: From January 2008 to December 2010, all data concerning urine cultures in patients with suspected urinary tract infection and/or asymptomatic bacteriuria referring at our center located in the south of Milan were prospectively evaluated. Results: In 2008, 2136 outpatient and 1232 hospital urine cultures were analyzed. The presence of quinolone-resistant strains was 21% at a local level and 53% in hospitals. ESBL-producing strains were isolated in 3.5% of cases at a local level and 20.5% in hospitals. In 2009, 2396 outpatient and 1320 hospital urine cultures were analyzed. The presence of quinolone-resistant strains was 21% at a local level and 46% in hospitals. ESBL-producing strains were isolated in 5.4% of cases at a local level and 20% in hospitals. In 2010, 2601 outpatient and 1717 hospital urine cultures were analyzed. The presence of quinolone-resistant strains was 34% at a local level and 26% in hospitals. ESBL-producing strains were isolated in 6.7% of cases at a local level and 20.6% in hospitals. The multidrug resistance was significantly (P < 0.01) higher in ESBL-positive strains. Conclusion: Due to rising antibiotic resistance among uropathogens, it is important to have knowledge of the organisms causing urinary tract infections and their antibiotic sensitivity patterns. In areas with high prevalence of E. Coli resistance, performing urine culture before every surgical procedure became mandatory, in order to prevent fatal sepsis.
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Affiliation(s)
- Stefano Picozzi
- Department of Urology, IRCCS Policlinico San Donato, University of Milan, Via Morandi 30, 20097 - San Donato Milanese, Milan, Italy
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Cantón R, Novais A, Valverde A, Machado E, Peixe L, Baquero F, Coque TM. Prevalence and spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae in Europe. Clin Microbiol Infect 2008; 14 Suppl 1:144-53. [PMID: 18154538 DOI: 10.1111/j.1469-0691.2007.01850.x] [Citation(s) in RCA: 408] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Extended-spectrum beta-lactamases (ESBLs) represent a major threat among resistant bacterial isolates. The first types described were derivatives of the TEM-1, TEM-2 and SHV-1 enzymes during the 1980s in Europe, mainly in Klebsiella pneumoniae associated with nosocomial outbreaks. Nowadays, they are mostly found among Escherichia coli isolates in community-acquired infections, with an increasing occurrence of CTX-M enzymes. The prevalence of ESBLs in Europe is higher than in the USA but lower than in Asia and South America. However, important differences among European countries have been observed. Spread of mobile genetic elements, mainly epidemic plasmids, and the dispersion of specific clones have been responsible for the increase in ESBL-producing isolates, such as those with TEM-4, TEM-24, TEM-52, SHV-12, CTX-M-9, CTX-M-14, CTX-M-3, CTX-M-15 and CTX-M-32 enzymes.
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Affiliation(s)
- R Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
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