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Tang F, Lee CH, Li X, Jiang S, Chow KH, Tse CWS, Ho PL. Evaluation of Two Tests for the Rapid Detection of CTX-M Producers Directly in Urine Samples. Antibiotics (Basel) 2023; 12:1585. [PMID: 37998787 PMCID: PMC10668757 DOI: 10.3390/antibiotics12111585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/26/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023] Open
Abstract
Infections caused by extended-spectrum β-lactamase-producing Enterobacterales have increased rapidly and are mainly attributed to the production of CTX-M enzymes. This study evaluated the NG-Test® CTX-M MULTI lateral flow assay (CTX-M LFA) and the Rapid ESBL NP® test (ESBL NP test) for rapid detection of CTX-M-producing Enterobacterales directly in midstream urine (MSU) samples. Testing was performed on 277 clinical MSU samples in a hospital microbiology laboratory from November 2022 to January 2023; 60 of these samples (30 positive for ESBL producers and 30 positive for non-ESBL producers) were tested retrospectively after the identification and susceptibility results were obtained, and 217 samples were tested prospectively immediately after a Gram stain showing the presence of Gram-negative bacilli. The results were compared against phenotypic detection of ESBL and molecular testing as the reference methods. Overall, 67 of the 277 samples were culture-positive for ESBL-producing Enterobacterales. PCR for the blaCTX-M gene was positive for all ESBL-producing Enterobacterales isolates. All CTX-M LFA results were interpretable, while three of the ESBL NP test results were noninterpretable. The sensitivity of the CTX-M LFA (100%, 95% CI 94.6-100%) was higher than that of the ESBL NP test (86.6%, 95% CI 76.0-93.7%). Both tests had high specificities (CTX-M LFA, 99.1%, 95% CI 96.6-99.9% and ESBL NP test, 100%, 95% CI 98.2-100%). In conclusion, both the CTX-M LFA and the ESBL NP test can deliver rapid results that could improve antimicrobial stewardship for urinary tract infections.
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Affiliation(s)
- Forrest Tang
- Department of Clinical Pathology, Kwong Wah Hospital, Hospital Authority, Hong Kong, China; (F.T.)
| | - Chung-Ho Lee
- Department of Clinical Pathology, Kwong Wah Hospital, Hospital Authority, Hong Kong, China; (F.T.)
| | - Xin Li
- Department of Microbiology, University of Hong Kong, Hong Kong, China
- Carol Yu Centre for Infection, University of Hong Kong, Hong Kong, China
- Department of Microbiology, Queen Mary Hospital, Hospital Authority, Hong Kong, China
| | - Shuo Jiang
- Department of Microbiology, University of Hong Kong, Hong Kong, China
- Carol Yu Centre for Infection, University of Hong Kong, Hong Kong, China
| | - Kin-Hung Chow
- Department of Microbiology, University of Hong Kong, Hong Kong, China
- Carol Yu Centre for Infection, University of Hong Kong, Hong Kong, China
| | - Cindy Wing-Sze Tse
- Department of Clinical Pathology, Kwong Wah Hospital, Hospital Authority, Hong Kong, China; (F.T.)
| | - Pak-Leung Ho
- Department of Microbiology, University of Hong Kong, Hong Kong, China
- Carol Yu Centre for Infection, University of Hong Kong, Hong Kong, China
- Department of Microbiology, Queen Mary Hospital, Hospital Authority, Hong Kong, China
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Girlich D, Bonnin RA, Dortet L, Naas T. Genetics of Acquired Antibiotic Resistance Genes in Proteus spp. Front Microbiol 2020; 11:256. [PMID: 32153540 PMCID: PMC7046756 DOI: 10.3389/fmicb.2020.00256] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/03/2020] [Indexed: 01/30/2023] Open
Abstract
Proteus spp. are commensal Enterobacterales of the human digestive tract. At the same time, P. mirabilis is commonly involved in urinary tract infections (UTI). P. mirabilis is naturally resistant to several antibiotics including colistin and shows reduced susceptibility to imipenem. However higher levels of resistance to imipenem commonly occur in P. mirabilis isolates consecutively to the loss of porins, reduced expression of penicillin binding proteins (PBPs) PBP1a, PBP2, or acquisition of several antibiotic resistance genes, including carbapenemase genes. In addition, resistance to non-β-lactams is also frequently reported including molecules used for treating UTI infections (e.g., fluoroquinolones, nitrofurans). Emergence and spread of multidrug resistant P. mirabilis isolates, including those producing ESBLs, AmpC cephalosporinases and carbapenemases, are being more and more frequently reported. This review covers Proteus spp. with a focus on the different genetic mechanisms involved in the acquisition of resistance genes to multiple antibiotic classes turning P. mirabilis into a dreadful pandrug resistant bacteria and resulting in difficult to treat infections.
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Affiliation(s)
- Delphine Girlich
- EA7361 "Structure, dynamic, function and expression of broad spectrum β-lactamases", LabEx Lermit, Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-producing Enterobacteriaceae, Le Kremlin-Bicêtre, France.,Evolution and Ecology of Resistance to Antibiotics Unit, Institut Pasteur - APHP - Université Paris-Saclay, Paris, France
| | - Rémy A Bonnin
- EA7361 "Structure, dynamic, function and expression of broad spectrum β-lactamases", LabEx Lermit, Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-producing Enterobacteriaceae, Le Kremlin-Bicêtre, France.,Evolution and Ecology of Resistance to Antibiotics Unit, Institut Pasteur - APHP - Université Paris-Saclay, Paris, France
| | - Laurent Dortet
- EA7361 "Structure, dynamic, function and expression of broad spectrum β-lactamases", LabEx Lermit, Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-producing Enterobacteriaceae, Le Kremlin-Bicêtre, France.,Evolution and Ecology of Resistance to Antibiotics Unit, Institut Pasteur - APHP - Université Paris-Saclay, Paris, France
| | - Thierry Naas
- EA7361 "Structure, dynamic, function and expression of broad spectrum β-lactamases", LabEx Lermit, Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-producing Enterobacteriaceae, Le Kremlin-Bicêtre, France.,Evolution and Ecology of Resistance to Antibiotics Unit, Institut Pasteur - APHP - Université Paris-Saclay, Paris, France
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Saravanan M, Ramachandran B, Barabadi H. The prevalence and drug resistance pattern of extended spectrum β–lactamases (ESBLs) producing Enterobacteriaceae in Africa. Microb Pathog 2018; 114:180-192. [DOI: 10.1016/j.micpath.2017.11.061] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 11/27/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
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Kato K, Matsumura Y, Yamamoto M, Nagao M, Takakura S, Ichiyama S. Regional Spread of CTX-M-2-ProducingProteus mirabiliswith the Identical Genetic Structure in Japan. Microb Drug Resist 2017; 23:590-595. [DOI: 10.1089/mdr.2016.0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Karin Kato
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Anesthesia, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasufumi Matsumura
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaki Yamamoto
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Miki Nagao
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shunji Takakura
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoshi Ichiyama
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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The impact of production of extended-spectrum β-lactamases on the 28-day mortality rate of patients with Proteus mirabilis bacteremia in Korea. BMC Infect Dis 2017; 17:327. [PMID: 28468622 PMCID: PMC5415711 DOI: 10.1186/s12879-017-2431-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 04/28/2017] [Indexed: 12/26/2022] Open
Abstract
Background The incidence of Proteus mirabilis antimicrobial resistance, especially that mediated by extended-spectrum β-lactamases (ESBLs), has increased. We investigated the impact of ESBL production on the mortality of patients with P. mirabilis bacteremia in Korea. Methods Patients diagnosed with P. mirabilis bacteremia between November 2005 and December 2013 at a 2000-bed tertiary care center in South Korea were included in this study. Phenotypic and molecular analyses were performed to assess ESBL expression. Characteristics and treatment outcomes were investigated among ESBL-producing and non-ESBL-producing P. mirabilis bacteremia groups. A multivariate analysis of 28-day mortality rates was performed to evaluate the independent impact of ESBLs. Results Among 62 P. mirabilis isolates from 62 patients, 14 expressed ESBLs (CTX-M, 2; TEM, 5; both, 6; other, 1), and the 28-day mortality rate of the 62 patients was 17.74%. No clinical factor was significantly associated with ESBL production. The 28-day mortality rate in the ESBL-producing group was significantly higher than that in the non-ESBL-producing group (50% vs. 8.3%, p = 0.001). A multivariate analysis showed that ESBL production (odds ratio [OR], 11.53, 95% confidence interval [CI], 2.11–63.05, p = 0.005) was independently associated with the 28-day mortality rate in patients with P. mirabilis bacteremia. Conclusions ESBL production is significantly associated with mortality in patients with bacteremia caused by P. mirabilis. Rapid detection of ESBL expression and prompt appropriate antimicrobial therapy are required to reduce mortality caused by P. mirabilis bacteremia.
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Yang L, Yang L, Lü DH, Zhang WH, Ren SQ, Liu YH, Zeng ZL, Jiang HX. Co-prevalance of PMQR and 16S rRNA methylase genes in clinical Escherichia coli isolates with high diversity of CTX-M from diseased farmed pigeons. Vet Microbiol 2015; 178:238-45. [DOI: 10.1016/j.vetmic.2015.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/08/2015] [Accepted: 05/11/2015] [Indexed: 01/23/2023]
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Huang Y, Xu Y, Wang Z, Lin X. Antimicrobial Resistance and Genotype Analysis of Extended-Spectrum-β-Lactamase-Producing Proteus Mirabilis. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojcd.2014.41011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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The assessment of Proteus mirabilis susceptibility to ceftazidime and ciprofloxacin and the impact of these antibiotics at subinhibitory concentrations on Proteus mirabilis biofilms. BIOMED RESEARCH INTERNATIONAL 2013; 2013:930876. [PMID: 24151628 PMCID: PMC3787586 DOI: 10.1155/2013/930876] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 08/13/2013] [Indexed: 11/23/2022]
Abstract
Rods of the Proteus genus are commonly isolated from patients, especially from the urinary tracts of the catheterised patients. The infections associated with biomaterials are crucial therapeutic obstacles, due to the bactericidal resistance of the biofilm. The aim of this study was to assess the susceptibility of P. mirabilis planktonic forms to ciprofloxacin and ceftazidime, the ability to form biofilm, and the impact of chosen sub-MIC concentrations of these antibiotics on biofilm at different stages of its formation. The research included 50 P. mirabilis strains isolated from wounds and the urinary tracts from patients of the University Hospital No. 1 in Bydgoszcz. The assessment of susceptibility to ciprofloxacin and ceftazidime was conducted using micromethods. The impact of sub-MIC concentrations of the chosen antibiotics on the biofilm was measured using the TTC method. The resistance to ciprofloxacin was confirmed for 20 strains (40.0%) while to ceftazidime for 32 (64.0%) of the tested P. mirabilis strains. All of the tested strains formed biofilm: 24.0% weakly, 26.0% moderately, and 50.0% strongly. It was determined that ciprofloxacin and ceftazidime caused eradication of the biofilm. Moreover, the connection between origin of the strains, biofilm maturity level, and resistance to antibiotics was proved.
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Nakano R, Nakano A, Abe M, Inoue M, Okamoto R. Regional outbreak of CTX-M-2 β-lactamase-producing Proteus mirabilis in Japan. J Med Microbiol 2012; 61:1727-1735. [DOI: 10.1099/jmm.0.049726-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ryuichi Nakano
- Department of Microbiology and Immunology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
- Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Akiyo Nakano
- School of Veterinary Medicine Azabu University, 1-17-71 Fuchinobe, Chuoh-ku, Sagamihara, Kanagawa 252-5201, Japan
| | - Michiko Abe
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan
| | - Matsuhisa Inoue
- Department of Microbiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
- Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Ryoichi Okamoto
- Department of Microbiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
- Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
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Lee CC, Lui G, Ip M, Ling TKW, Lee N. Frequent detection of plasmid-mediated quinolone resistance (qnr) genes in multidrug-resistant Enterobacteriaceae blood isolates, Hong Kong. Eur J Clin Microbiol Infect Dis 2012; 31:3183-9. [PMID: 22744730 DOI: 10.1007/s10096-012-1683-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 06/12/2012] [Indexed: 11/28/2022]
Abstract
Plasmid-mediated quinolone resistance (qnr) genes confer low-level resistance but provide background for selection of highly-resistant strains. We investigated their prevalence and significance in clinical Enterobacteriaceae bacteremic isolates in Hong Kong. A prospective, hospital-based study was conducted (January 2008 to March 2009). Consecutive, non-duplicate blood isolates of extended-spectrum-β-lactamase (ESBL) and/or plasmid-mediated AmpC (PMAmpC) β-lactamase-producing Enterobacteriaceae were collected and subjected to qnr genes detection using multiplex PCR. Direct sequencing was performed to characterize the qnr and the co-existing bla genes. Clinical and microbiological variables, including antimicrobial resistance profiles, were compared between infections by 'qnr-positive' and 'qnr-negative' Enterobacteriaceae. Altogether 199 ESBL/PMAmpC-producing Enterobacteriaceae isolates were studied. qnr genes were detected in 20 % (qnrB, n = 24; qnrS, n = 16; qnrA, n = 0), of which 85% were Klebsiella spp. There was a strong association with PMAmpC genes (qnrB and DHA-1; p < 0.001). 'qnr-positive' isolates were more commonly hospital-acquired (60.0% vs 35.8%; adjusted OR 2.68, 95%CI 1.32-5.46) and multidrug-resistant (e.g. amoxicillin-clavulanate 90-100%, piperacillin-tazobactam 40-57%, ceftazidime 53-78%; sulfamethoxazole/trimethoprim 60-70%; ciprofloxacin 53-65%, levofloxacin 35-48%). Patients with 'qnr-positive' Enterobacteriaceae bacteremia had a higher 30-day mortality (45% vs 22%, p = 0.003). High Pitt bacteremia score, development of pneumonia, and failure to receive susceptible fluoroquinolone (adjusted HR 4.27; 95%CI 1.45-12.61) or carbapenem (adjusted HR 3.04; 95%CI 1.49-6.20) treatment were independent factors associated with death. A high proportion of ESBL/PMAmpC-producing Enterobacteriaceae (typically Klebsiella) bacteremic isolates carried qnr. These strains were multidrug-resistant, which was associated with inappropriate treatment and high fatality. Further dissemination of qnr and selection of fluoroquinolone/β-lactam-resistant strains should be closely monitored and controlled.
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Affiliation(s)
- C C Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 9/F, Clinical Sciences Building, Shatin, Hong Kong SAR, China
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Zhao WH, Hu ZQ. Epidemiology and genetics of CTX-M extended-spectrum β-lactamases in Gram-negative bacteria. Crit Rev Microbiol 2012; 39:79-101. [PMID: 22697133 PMCID: PMC4086240 DOI: 10.3109/1040841x.2012.691460] [Citation(s) in RCA: 206] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CTX-M enzymes, the plasmid-mediated cefotaximases, constitute a rapidly growing family of extended-spectrum β-lactamases (ESBLs) with significant clinical impact. CTX-Ms are found in at least 26 bacterial species, particularly in Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis. At least 109 members in CTX-M family are identified and can be divided into seven clusters based on their phylogeny. CTX-M-15 and CTX-M-14 are the most dominant variants. Chromosome-encoded intrinsic cefotaximases in Kluyvera spp. are proposed to be the progenitors of CTX-Ms, while ISEcp1, ISCR1 and plasmid are closely associated with their mobilization and dissemination.
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Affiliation(s)
- Wei-Hua Zhao
- Department of Microbiology and Immunology, Showa University School of Medicine, Tokyo, Japan.
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Kanayama A, Iyoda T, Matsuzaki K, Saika T, Ikeda F, Ishii Y, Yamaguchi K, Kobayashi I. Rapidly spreading CTX-M-type β-lactamase-producing Proteus mirabilis in Japan. Int J Antimicrob Agents 2010; 36:340-2. [DOI: 10.1016/j.ijantimicag.2010.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 05/20/2010] [Accepted: 06/02/2010] [Indexed: 11/28/2022]
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Smet A, Martel A, Persoons D, Dewulf J, Heyndrickx M, Herman L, Haesebrouck F, Butaye P. Broad-spectrum β-lactamases amongEnterobacteriaceaeof animal origin: molecular aspects, mobility and impact on public health. FEMS Microbiol Rev 2010; 34:295-316. [DOI: 10.1111/j.1574-6976.2009.00198.x] [Citation(s) in RCA: 159] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Lo WU, Ho PL, Chow KH, Lai EL, Yeung F, Chiu SS. Fecal carriage of CTXM type extended-spectrum beta-lactamase-producing organisms by children and their household contacts. J Infect 2010; 60:286-92. [DOI: 10.1016/j.jinf.2010.02.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 01/30/2010] [Accepted: 02/02/2010] [Indexed: 11/27/2022]
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15
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Ho PL, Wong RC, Lo SW, Chow KH, Wong SS, Que TL. Genetic identity of aminoglycoside-resistance genes in Escherichia coli isolates from human and animal sources. J Med Microbiol 2010; 59:702-707. [PMID: 20185552 DOI: 10.1099/jmm.0.015032-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A bacterial collection (n=249) obtained in Hong Kong from 2002 to 2004 was used to investigate the molecular epidemiology of aminoglycoside resistance among Escherichia coli isolates from humans and food-producing animals. Of these, 89 isolates were gentamicin-sensitive (human n=60, animal n=29) and 160 isolates were gentamicin-resistant (human n=107, animal n=53). Overall, 84.1% (90/107) and 75.5% (40/53) of the gentamicin-resistant isolates from human and animal sources, respectively, were found to possess the aacC2 gene. The aacC2 gene for 20 isolates (10 each for human and animal isolates) was sequenced. Two alleles were found that were equally distributed in human and animal isolates. PFGE showed that the gentamicin-resistant isolates exhibited diverse patterns with little clonality. In some isolates, the aacC2 gene was encoded on large transferable plasmids of multiple incompatibility groups (IncF, IncI1 and IncN). An IncFII plasmid of 140 kb in size was shared by one human and three animal isolates. In summary, this study showed that human and animal isolates share the same pool of resistance genes.
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Affiliation(s)
- Pak-Leung Ho
- Department of Microbiology and Carol Yu Centre for Infection, University of Hong Kong, Hong Kong SAR
| | - River C Wong
- Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong SAR
| | - Stephanie W Lo
- Department of Microbiology and Carol Yu Centre for Infection, University of Hong Kong, Hong Kong SAR
| | - Kin-Hung Chow
- Department of Microbiology and Carol Yu Centre for Infection, University of Hong Kong, Hong Kong SAR
| | - Samson S Wong
- Department of Microbiology and Carol Yu Centre for Infection, University of Hong Kong, Hong Kong SAR
| | - Tak-Lun Que
- Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong SAR
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Antimicrobial stewardship program directed at broad-spectrum intravenous antibiotics prescription in a tertiary hospital. Eur J Clin Microbiol Infect Dis 2009; 28:1447-56. [PMID: 19727869 DOI: 10.1007/s10096-009-0803-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 08/08/2009] [Indexed: 10/20/2022]
Abstract
The antimicrobial stewardship program (ASP) is a major strategy to combat antimicrobial resistance and to limit its expenditure. We have improved on our existing ASP to implement a sustainable and cost-effective two-stage immediate concurrent feedback (ICF) model, in which the antimicrobial prescription is audited by two part-time infection control nurses at the first stage, followed by "physician ICF" at the second stage. In January 2005, an ASP focused on broad-spectrum intravenous antibiotics was implemented. All in-patients, except from the intensive care, bone marrow transplantation, liver transplantation, pediatric, and private units, being treated with broad-spectrum intravenous antibiotics were included. The compliance to ICF and "physician ICF", antibiotics usage density measured by expenditure and defined daily doses (DDD) were recorded and analyzed before and after the ASP. The overall conformance rate to antibiotic prescription guidelines was 79.4%, while the conformance to ICF was 83.8%. Antibiotics consumption reduced from 73.06 (baseline, year 2004) to 64.01 (year 2007) per 1,000 patient bed-day-occupancy. Our model can be easily applied even in the clinical setting of limited resources.
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Mahrouki S, Ben–Achour N, Chouchani C, Ben–Moussa M, Belhadj O. Identification of plasmid-encoded extended spectrum β-lactamases produced by a clinical strain of Proteus mirabilis. ACTA ACUST UNITED AC 2009; 57:e55-9. [DOI: 10.1016/j.patbio.2008.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 02/28/2008] [Indexed: 11/30/2022]
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Barlow M, Fatollahi J, Salverda M. Evidence for recombination among the alleles encoding TEM and SHV beta-lactamases. J Antimicrob Chemother 2008; 63:256-9. [PMID: 19010826 DOI: 10.1093/jac/dkn475] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The objective of this research was to determine whether recombination occurs in class A beta-lactamases. METHODS We performed chi(2) analysis of the observed and expected numbers of times that beta-lactamases from the TEM, SHV and CTX-M groups co-occurred. Additionally, we performed phylogenetic analysis to detect independent occurrences of silent mutations in bla(TEM) and bla(SHV) variants. RESULTS We found that the distribution of co-occurring bla(TEM), bla(SHV) and bla(CTX-M) alleles in clinical microbial populations is consistent with the regular occurrence of recombination among alleles within the groups. We also found that the distribution of silent mutations in bla(TEM) and bla(SHV) alleles is inconsistent with spontaneous point mutations. CONCLUSIONS Our findings indicate that recombination has an important effect on the sequence evolution and population distribution of the alleles that encode class A beta-lactamases.
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Affiliation(s)
- Miriam Barlow
- School of Natural Sciences, University of California, Merced, CA, USA.
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Barlow M, Reik RA, Jacobs SD, Medina M, Meyer MP, McGowan JE, Tenover FC. High rate of mobilization for blaCTX-Ms. Emerg Infect Dis 2008; 14:423-8. [PMID: 18325257 PMCID: PMC2570810 DOI: 10.3201/eid1403.070405] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The blaCTX-Ms have been mobilized to plasmids more frequently than other class A β-lactamases. We constructed a phylogenetic analysis of class A β-lactamases and found that the blaCTX-Ms have been mobilized to plasmids ≈10 times more frequently than other class A β-lactamases. We also found that the blaCTX-Ms are descended from a common ancestor that was incorporated in ancient times into the chromosome of the ancestor of Kluyvera species through horizontal transfer. Considerable sequence divergence has occurred among the descendents of that ancestral gene sequence since that gene was inserted. That divergence has mainly occurred in the presence of purifying selection, which indicates a slow rate of evolution for blaCTX-Ms in the pre–antimicrobial drug era.
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Affiliation(s)
- Miriam Barlow
- University of California, Merced, California 95344, USA.
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Recombination and selection can remove blaTEM alleles from bacterial populations. Antimicrob Agents Chemother 2008; 52:3408-10. [PMID: 18625770 DOI: 10.1128/aac.00501-08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We passaged cells expressing TEM-1 and TEM-12 from a single plasmid through either ampicillin or ceftazidime. We found that the combined effects of recombination and selection removed the bla(TEM-1) allele from the bacterial population when it was passaged through ceftazidime or the bla(TEM-12) allele when cultures were passaged through ampicillin.
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Abstract
bla(TEM-1) expression results in penicillin resistance, whereas expression of many bla(TEM-1) descendants, called extended-spectrum beta-lactamases (ESBLs), results simultaneously in resistance to penicillins and extended-spectrum cephalosporins. Despite the expanded resistance phenotypes conferred by many ESBLs, bla(TEM-1) is still the most abundant bla(TEM) allele in many microbial populations. This study examines the fitness effects of the two amino acid substitutions, R164S and E240K, that have occurred repeatedly among ESBL bla(TEM-1) descendants. Using a single-nucleotide polymorphism-specific real-time quantitative PCR method, we analyzed the fitness of strains expressing bla(TEM-1), bla(TEM-10), and bla(TEM-12). Our results show that bacteria expressing the ancestral bla(TEM-1) allele have a fitness advantage over those expressing either bla(TEM-10) or bla(TEM-12) when exposed to ampicillin. This observation, combined with the fact that penicillins are the most prevalent antimicrobials prescribed worldwide, may explain why bla(TEM-1) has persisted as the most frequently encountered bla(TEM) allele in bacterial populations.
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Khan MKR, Thukral SS, Gaind R. EVALUATION OF A MODIFIED DOUBLE-DISC SYNERGY TEST FOR DETECTION OF EXTENDED SPECTRUM β-LACTAMASES IN AMPC β-LACTAMASE-PRODUCING PROTEUS MIRABILIS. Indian J Med Microbiol 2008. [DOI: 10.1016/s0255-0857(21)01994-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ercis S, Sancak B, Kocagöz T, Kocagöz S, Hasçelik G, Bolmström A. Rapid 4 to 6 hour detection of extended-spectrum beta-lactamases in a routine laboratory. ACTA ACUST UNITED AC 2007; 39:781-5. [PMID: 17701716 DOI: 10.1080/00365540701367751] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
With the growing frequency of extended-spectrum beta-lactamases (ESBL) among Enterobacteriaceae, treatment of Gram-negative nosocomial infections requires rapid and reliable detection of this enzyme. Quicolor agar (QC agar) (Salubris Inc., Massachusetts, USA) is a novel chromogenic agar medium changing colour within 4 to 6 h due to the metabolic activity of growing bacteria. This study investigated the use of QC agar compared to Mueller Hinton agar (MH) for the detection of ESBL using disk diffusion and E-test. 100 Enterobacteriaceae isolated at Hacettepe University Hospital, of which 50 were predetermined to be ESBL positive and 50 as negative using the CLSI disk diffusion ESBL (phenotypic confirmatory test) criteria. For disk diffusion and E-test, cefotaxime+/-clavulanate (CT/CTL) and ceftazidime+/-clavulanate (TZ/TZL) were used, and for E-test, cefepime+/-clavulanate (PM/PML) was also used. QC agar rapid ESBL results for all strains were in agreement with the standard overnight procedure. All 50 ESBL positives were detected by both methods. For the 50 ESBL negatives, QC agar rapid results from E-test and disk diffusion were in complete accordance with the overnight MH results. Moreover, E-test detected 8 additional ESBL positive strains that disk diffusion missed. For disk diffusion, CT/CTL alone detected all 50 ESBL positives while TZ/TZL alone missed 5 ESBL positives. E-test CT/CTL alone confirmed all 50 ESBL positives and identified 4 additional ESBL-positive strains. When used together, E-test CT/CTL, TZ/TZL and PM/PML identified a total of 58 ESBL positives among the 100 strains tested. QC agar can be used for rapid and reliable ESBL detection within 4 to 6 h, using disk diffusion and E-test ESBL reagents. This rapid method should be further validated using genotype characterized ESBL and other beta-lactamase positive strains.
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Affiliation(s)
- Serpil Ercis
- Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Wu JJ, Chen HM, Ko WC, Wu HM, Tsai SH, Yan JJ. Prevalence of extended-spectrum beta-lactamases in Proteus mirabilis in a Taiwanese university hospital, 1999 to 2005: identification of a novel CTX-M enzyme (CTX-M-66). Diagn Microbiol Infect Dis 2007; 60:169-75. [PMID: 17913434 DOI: 10.1016/j.diagmicrobio.2007.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 08/09/2007] [Accepted: 08/16/2007] [Indexed: 11/23/2022]
Abstract
A total of 1574 nonduplicate Proteus mirabilis isolates collected at a Taiwanese hospital during 1999 to 2005 were analyzed for production of extended-spectrum beta-lactamases (ESBLs). Forty-four ESBL-producing isolates including 22 CTX-M-14, 18 CTX-M-3, 2 CTX-M-24, and 2 CTX-M-66 producers were detected, and the proportion of ESBL producers increased from 0.7% in 1999 to approximately 6% after 2002. CTX-M-66 is a novel variant of CTX-M ESBLs that differs from CTX-M-3 by a Ser to Asn change at amino acid position 23. Coresistances to aminoglycosides and ciprofloxacin were very common in the CTX-M-3 producers. The presence of ArmA-type or RmtB-type 16S rRNA methylase that confers high-level aminoglycoside resistance was detected in 12 CTX-M-3 producers and 4 CTX-M-14 producers. Twenty-four clones including an endemic CTX-M-14-producing clone were observed among the 44 ESBL producers by pulsed-field gel electrophoresis, suggesting that both horizontal transfer and clonal spread contributed to the increased prevalence of bla(CTX-M) in P. mirabilis.
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Affiliation(s)
- Jiunn-Jong Wu
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
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You JHS, Lo LPY, Chung IYK, Marasinghe T, Lee N, Ip M. Effect of an antimicrobial stewardship programme on the use of carbapenems in a Hong Kong teaching hospital: a pilot study. J Hosp Infect 2007; 65:378-9. [PMID: 17316898 DOI: 10.1016/j.jhin.2006.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Accepted: 12/21/2006] [Indexed: 11/21/2022]
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Duan RS, Sit THC, Wong SSY, Wong RCW, Chow KH, Mak GC, Yam WC, Ng LT, Yuen KY, Ho PL. Escherichia coli Producing CTX-M β-Lactamases in Food Animals in Hong Kong. Microb Drug Resist 2006; 12:145-8. [PMID: 16922633 DOI: 10.1089/mdr.2006.12.145] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A study was conducted to evaluate the occurrence of extended-spectrum beta-lactamases (ESBLs)-producing Escherichia coli from fecal samples of healthy food animals in Hong Kong. Rectal or cloacal swabs were obtained from cattle, pigs, chicken, ducks, geese, and pigeons in slaughterhouses or wholesale markets over a 5- month period in 2002. Antibiotic-containing medium was used for selective isolation of potentially ESBL-producing E. coli. Of 734 samples analyzed, six (2%) from pigs, three (3.1%) from cattle, and one (3%) from pigeons had E. coli strains with the ESBL phenotype. The ESBL content for the 10 isolates include CTXM- 3 (n = 4), CTX-M-13 (n = 3), CTX-M-14 (n = 2), and CTX-M-24 (n = 1). In five isolates, the bla (CTX-M) gene was encoded on transferable plasmids (60 or 90 kb), and the gene was found to transfer to E. coli (J53 or JP995) with frequencies of 10(7) to 10(3) per donor cells. The ten isolates had five distinct pulsotypes with some clonal spread. However, the isolates from the different kinds of animals were not clonally related. These findings imply that bacteria of animal origins may serve as reservoirs of some ESBL genes.
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Affiliation(s)
- R S Duan
- Division of Infectious Diseases, Department of Microbiology and Centre of Infection, University of Hong Kong, Hong Kong Special Administrative Region, China
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Wu LT, Wu HJ, Chung JG, Chuang YC, Cheng KC, Yu WL. Dissemination of Proteus mirabilis isolates harboring CTX-M-14 and CTX-M-3 β-lactamases at 2 hospitals in Taiwan. Diagn Microbiol Infect Dis 2006; 54:89-94. [PMID: 16406185 DOI: 10.1016/j.diagmicrobio.2005.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Revised: 09/09/2005] [Accepted: 09/12/2005] [Indexed: 11/17/2022]
Abstract
From February to June 2003, 111 clinical isolates of Proteus mirabilis were mainly isolated from patients with respiratory or urinary tract infections hospitalized at 3 district hospitals (A, B, C) in central Taiwan. Among them, 34 (30.6%) strains, isolated within 2 hospitals (A and B), exhibited nonsusceptibility to cefotaxime with significant reduction of MIC (> or = 3 log2 dilution) by the effect of clavulanic acid, which confirmed the phenotype of extended-spectrum beta-lactamases (ESBLs). These ESBL producers were coresistant to gentamicin, isepamicin, and amikacin, but remained susceptible to ceftazidime (MIC, < or = 0.5 microg/mL) and meropenem (MIC, <0.5 microg/mL). By isoelectric focusing analysis, polymerase chain reaction, and nucleotide sequencing, we detected the presence of CTX-M-14 in 33 strains and CTX-M-3 in 6 strains (5 strains harboring both CTX-M-14 and CTX-M-3 enzymes). These beta-lactamase genes can be successfully transferred by the conjugative plasmid. Molecular epidemiology of the 34 ESBL-producing P. mirabilis strains by pulsed-field gel electrophoresis using SfiI restriction enzyme revealed 9 different genotypes, suggesting epidemic clones with intra- and interhospital spread. In conclusion, the broadly extended clonal spreading of CTX-M-type P. mirabilis was first discovered at the district hospitals in Taiwan.
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Affiliation(s)
- Lii-Tzu Wu
- The Institute of Medical Science and Department of Microbiology, China Medical University, Taichung 404, Taiwan
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