1
|
Saeli N, Jafari-Ramedani S, Ramazanzadeh R, Nazari M, Sahebkar A, Khademi F. Prevalence and mechanisms of aminoglycoside resistance among drug-resistant Pseudomonas aeruginosa clinical isolates in Iran. BMC Infect Dis 2024; 24:680. [PMID: 38982386 PMCID: PMC11232330 DOI: 10.1186/s12879-024-09585-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/02/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Aminoglycosides have been a cornerstone of the treatment of nosocomial infections caused by Pseudomonas aeruginosa for over 80 years. However, escalating emergence of resistance poses a significant challenge. Therefore, this study aimed to investigate the prevailing patterns of aminoglycoside resistance among clinical isolates of P. aeruginosa in Iran; as well as the underlying resistance mechanisms observed in patients referred to Ardabil hospitals. METHODS A total of 200 isolates from five hospitals were evaluated. The resistance profiles of P. aeruginosa isolates to tobramycin, amikacin, and netilmicin were determined using the disk diffusion method. The capacity of aminoglycoside-resistant isolates to form biofilms was assessed through a phenotypic assay, and the results were confirmed using the gene amplification technique. The presence of genes associated with aminoglycoside resistance was detected using polymerase chain reaction (PCR). Quantitative reverse transcription PCR (qRT-PCR) was performed to measure the expression levels of genes encoding the MexXY-OprM efflux pump and PhoPQ two-component system (TCS). RESULTS The prevalence of aminoglycoside-resistant P. aeruginosa isolates was 48%, with 94.7% demonstrating multidrug resistance (MDR). All aminoglycoside-resistant P. aeruginosa strains exhibited biofilm-forming capabilities and harbored all the genes associated with biofilm production. Among the nine genes encoding 16S rRNA methylase and aminoglycoside-modifying enzymes, three genes were detected in these isolates: aac(6')-Ib (85.4%), ant(2'')-Ia (18.7%), and aph(3')-VI (3.1%). Additionally, all aminoglycoside-resistant P. aeruginosa isolates carried mexY and phoP genes, although the expression levels of mexY and phoP were 75% and 87.5%, respectively. CONCLUSION Given the considerably high prevalence of aminoglycoside-resistant P. aeruginosa strains, urgent measures are warranted to transition towards the use of novel aminoglycosides and to uphold vigilant surveillance of resistance patterns.
Collapse
Affiliation(s)
- Nilofar Saeli
- Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Saghar Jafari-Ramedani
- Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Rashid Ramazanzadeh
- Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Maryam Nazari
- Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Amirhossein Sahebkar
- Center for Global Health Research, Saveetha Institute of Medical and Technical Sciences, Saveetha Medical College and Hospitals, Saveetha University, Chennai, India
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzad Khademi
- Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
- Arthropod-Borne Diseases Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
| |
Collapse
|
2
|
de Sousa T, Silva C, Alves O, Costa E, Igrejas G, Poeta P, Hébraud M. Determination of Antimicrobial Resistance and the Impact of Imipenem + Cilastatin Synergy with Tetracycline in Pseudomonas aeruginosa Isolates from Sepsis. Microorganisms 2023; 11:2687. [PMID: 38004699 PMCID: PMC10673103 DOI: 10.3390/microorganisms11112687] [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: 09/29/2023] [Revised: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
Pseudomonas aeruginosa is among the most ubiquitous bacteria in the natural world, exhibiting metabolic and physiological versatility, which makes it highly adaptable. Imipenem + cilastatin and tetracycline are antibiotic combinations commonly used to treat infections caused by P. aeruginosa, including serious infections such as sepsis. In the context of bacterial infections, biofilm, formed by bacterial cells surrounded by extracellular substances forming a matrix, plays a pivotal role in the resistance of P. aeruginosa to antibiotics. This study aimed to characterize a representative panel of P. aeruginosa isolates from septicemias, assessing their susceptibility to various antibiotics, specifically, imipenem + cilastatin and tetracycline, and the impact of these treatments on biofilm formation. Results from antibiotic susceptibility tests revealed sensitivity in most isolates to six antibiotics, with four showing near or equal to 100% sensitivity. However, resistance was observed in some antibiotics, albeit at minimal levels. Notably, tetracycline showed a 100% resistance phenotype, while imipenem + cilastatin predominantly displayed an intermediate phenotype (85.72%), with some resistance (38.1%). Microdilution susceptibility testing identified effective combinations against different isolates. Regarding biofilm formation, P. aeruginosa demonstrated the ability to produce biofilms. The staining of microtiter plates confirmed that specific concentrations of imipenem + cilastatin and tetracycline could inhibit biofilm production. A significant proportion of isolates exhibited resistance to aminoglycoside antibiotics because of the presence of modifying genes (aac(3)-II and aac(3)-III), reducing their effectiveness. This study also explored various resistance genes, unveiling diverse resistance mechanisms among P. aeruginosa isolates. Several virulence genes were detected, including the las quorum-sensing system genes (lasI and lasR) in a significant proportion of isolates, contributing to virulence factor activation. However, genes related to the type IV pili (T4P) system (pilB and pilA) were found in limited isolates. In conclusion, this comprehensive study sheds light on the intricate dynamics of P. aeruginosa, a remarkably adaptable bacterium with a widespread presence in the natural world. Our findings provide valuable insights into the ongoing battle against P. aeruginosa infections, highlighting the need for tailored antibiotic therapies and innovative approaches to combat biofilm-related resistance.
Collapse
Affiliation(s)
- Telma de Sousa
- MicroART-Antibiotic Resistance Team, Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal; (T.d.S.); (C.S.); (P.P.)
- Department of Genetics and Biotechnology, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal;
- Functional Genomics and Proteomics Unit, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
- Associated Laboratory for Green Chemistry, University NOVA of Lisbon, 1099-085 Caparica, Portugal
| | - Catarina Silva
- MicroART-Antibiotic Resistance Team, Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal; (T.d.S.); (C.S.); (P.P.)
| | - Olimpia Alves
- Hospital Centre of Trás-os-Montes and Alto Douro, Clinical Pathology Department, 5000-801 Vila Real, Portugal; (O.A.); (E.C.)
| | - Eliana Costa
- Hospital Centre of Trás-os-Montes and Alto Douro, Clinical Pathology Department, 5000-801 Vila Real, Portugal; (O.A.); (E.C.)
| | - Gilberto Igrejas
- Department of Genetics and Biotechnology, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal;
- Functional Genomics and Proteomics Unit, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
- Associated Laboratory for Green Chemistry, University NOVA of Lisbon, 1099-085 Caparica, Portugal
| | - Patricia Poeta
- MicroART-Antibiotic Resistance Team, Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal; (T.d.S.); (C.S.); (P.P.)
- Associated Laboratory for Green Chemistry, University NOVA of Lisbon, 1099-085 Caparica, Portugal
- CECAV—Veterinary and Animal Research Centre, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
- Veterinary and Animal Research Centre, Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 5000-801 Vila Real, Portugal
| | - Michel Hébraud
- INRAE, Université Clermont Auvergne, UMR Microbiologie Environnement Digestif Santé (MEDiS), 63122 Saint-Genès-Champanelle, France
| |
Collapse
|
3
|
Barbu IC, Gheorghe-Barbu I, Grigore GA, Vrancianu CO, Chifiriuc MC. Antimicrobial Resistance in Romania: Updates on Gram-Negative ESCAPE Pathogens in the Clinical, Veterinary, and Aquatic Sectors. Int J Mol Sci 2023; 24:7892. [PMID: 37175597 PMCID: PMC10178704 DOI: 10.3390/ijms24097892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Multidrug-resistant Gram-negative bacteria such as Acinetobacter baumannii, Pseudomonas aeruginosa, and members of the Enterobacterales order are a challenging multi-sectorial and global threat, being listed by the WHO in the priority list of pathogens requiring the urgent discovery and development of therapeutic strategies. We present here an overview of the antibiotic resistance profiles and epidemiology of Gram-negative pathogens listed in the ESCAPE group circulating in Romania. The review starts with a discussion of the mechanisms and clinical significance of Gram-negative bacteria, the most frequent genetic determinants of resistance, and then summarizes and discusses the epidemiological studies reported for A. baumannii, P. aeruginosa, and Enterobacterales-resistant strains circulating in Romania, both in hospital and veterinary settings and mirrored in the aquatic environment. The Romanian landscape of Gram-negative pathogens included in the ESCAPE list reveals that all significant, clinically relevant, globally spread antibiotic resistance genes and carrying platforms are well established in different geographical areas of Romania and have already been disseminated beyond clinical settings.
Collapse
Affiliation(s)
- Ilda Czobor Barbu
- Microbiology-Immunology Department, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania
- The Research Institute of the University of Bucharest, 050095 Bucharest, Romania
| | - Irina Gheorghe-Barbu
- Microbiology-Immunology Department, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania
- The Research Institute of the University of Bucharest, 050095 Bucharest, Romania
| | - Georgiana Alexandra Grigore
- Microbiology-Immunology Department, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania
- The Research Institute of the University of Bucharest, 050095 Bucharest, Romania
- National Institute of Research and Development for Biological Sciences, 060031 Bucharest, Romania
| | - Corneliu Ovidiu Vrancianu
- Microbiology-Immunology Department, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania
- The Research Institute of the University of Bucharest, 050095 Bucharest, Romania
| | - Mariana Carmen Chifiriuc
- Microbiology-Immunology Department, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania
- The Research Institute of the University of Bucharest, 050095 Bucharest, Romania
- Academy of Romanian Scientists, 050044 Bucharest, Romania
- Romanian Academy, 010071 Bucharest, Romania
| |
Collapse
|
4
|
Chen X, Tan Q, Lyu Q, Yu C, Jiang N, Li J, Luo L. Unmarked Gene Editing in Clavibacter michiganensis Using CRISPR/Cas9 and 5-Fluorocytosine Counterselection. MOLECULAR PLANT-MICROBE INTERACTIONS : MPMI 2022; 35:4-14. [PMID: 34543054 DOI: 10.1094/mpmi-07-21-0179-ta] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Plant-pathogenic bacteria in the genus Clavibacter are important quarantine species that cause considerable economic loss worldwide. The development of effective gene editing techniques and additional selectable markers is essential to expedite gene functional analysis in this important Gram-positive genus. The current study details a highly efficient unmarked CRISPR/Cas9-mediated gene editing system in Clavibacter michiganensis, which couples the expression of cas9 and single-guide RNA with homology-directed repair templates and the negative selectable marker codA::upp within a single plasmid. Initial experiments indicated that CRISPR/Cas9-mediated transformation could be utilized for both site-directed mutagenesis, in which an A to G point mutation was introduced at the 128th nucleotide of the C. michiganensis rpsL gene to generate a streptomycin-resistant mutant, and complete gene knockout, in which the deletion of the C. michiganensis celA or katA genes resulted in transformants that lacked cellulase and catalase activity, respectively. In subsequent experiments, the introduction of the codA::upp cassette into the transformation vector facilitated the counterselection of unmarked transformants by incubation in the absence of the selective antibiotic, followed by plating on M9 agar containing 5-fluorocytosine at 100 μg/ml, in which an unmarked katA mutant lacking the transformation vector was recovered. Compared with conventional homologous recombination, the unmarked CRISPR/Cas9-mediated system was more useful and convenient because it allowed the template plasmid to be reused repeatedly to facilitate the editing of multiple genes, which constitutes a major advancement that could revolutionize research into C. michiganensis and other Clavibacter spp.[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.
Collapse
Affiliation(s)
- Xing Chen
- Department of Plant Pathology and MOA Key Laboratory of Pest Monitoring and Green Management, College of Plant Protection, Beijing Key Laboratory of Seed Disease Testing and Control, China Agricultural University; Beijing, P. R. China
| | - Qing Tan
- Department of Plant Pathology and MOA Key Laboratory of Pest Monitoring and Green Management, College of Plant Protection, Beijing Key Laboratory of Seed Disease Testing and Control, China Agricultural University; Beijing, P. R. China
| | - Qingyang Lyu
- Department of Plant Pathology and MOA Key Laboratory of Pest Monitoring and Green Management, College of Plant Protection, Beijing Key Laboratory of Seed Disease Testing and Control, China Agricultural University; Beijing, P. R. China
- CAS Key Laboratory of Environmental and Applied Microbiology, Environmental Microbiology Key Laboratory of Sichuan Province, Chengdu Institute of Biology, Chinese Academy of Sciences, Chengdu, P. R. China
| | - Chengxuan Yu
- Department of Plant Pathology and MOA Key Laboratory of Pest Monitoring and Green Management, College of Plant Protection, Beijing Key Laboratory of Seed Disease Testing and Control, China Agricultural University; Beijing, P. R. China
| | - Na Jiang
- Department of Plant Pathology and MOA Key Laboratory of Pest Monitoring and Green Management, College of Plant Protection, Beijing Key Laboratory of Seed Disease Testing and Control, China Agricultural University; Beijing, P. R. China
| | - Jianqiang Li
- Department of Plant Pathology and MOA Key Laboratory of Pest Monitoring and Green Management, College of Plant Protection, Beijing Key Laboratory of Seed Disease Testing and Control, China Agricultural University; Beijing, P. R. China
| | - Laixin Luo
- Department of Plant Pathology and MOA Key Laboratory of Pest Monitoring and Green Management, College of Plant Protection, Beijing Key Laboratory of Seed Disease Testing and Control, China Agricultural University; Beijing, P. R. China
| |
Collapse
|
5
|
Role of Aminoglycoside-Modifying Enzymes (AMEs) in Resistance to Aminoglycosides among Clinical Isolates of Pseudomonas aeruginosa in the North of Iran. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7077344. [PMID: 34471641 PMCID: PMC8405309 DOI: 10.1155/2021/7077344] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/07/2021] [Indexed: 11/18/2022]
Abstract
In recent years, the prevalence of resistance to aminoglycosides among clinical isolates of Pseudomonas aeruginosa is increasing. The aim of this study was to investigate the role of aminoglycoside-modifying enzymes (AMEs) in resistance to aminoglycosides in clinical isolates of P. aeruginosa. The clinical isolates were collected from different hospitals. Disk agar diffusion test was used to determine the antimicrobial resistance pattern of the clinical isolates, and the minimum inhibitory concentration of aminoglycosides was detected by microbroth dilution method. The PCR was performed for discovery of aminoglycoside-modifying enzyme-encoding genes. Among 100 screened isolates, 43 (43%) isolates were resistant to at least one tested aminoglycosides. However, 13 (13%) isolates were resistant to all tested aminoglycosides and 37 isolates were detected as multidrug resistant (MDR). The resistance rates of P. aeruginosa isolates against tested antibiotics were as follows: ciprofloxacin (41%), piperacillin-tazobactam (12%), cefepime (32%), piperacillin (26%), and imipenem (31%). However, according to the MIC method, 13%, 32%, 33%, and 37% of the isolates were resistant to amikacin, gentamicin, tobramycin, and netilmicin, respectively. The PCR results showed that AAC(6')-Ib was the most commonly (26/43, 60.4%) identified AME-encoding gene followed by AAC(6')-IIa (41.86%), APH(3')-IIb (34.8%), ANT(3 ″ )-Ia (18.6), ANT(2 ″ )-Ia (13.95%), and APH(3 ″ )-Ib (2.32%). However, APH(3')-Ib was not found in any of the studied isolates. The high prevalence of AME-encoding genes among aminoglycoside-resistant P. aeruginosa isolates in this area indicated the important role of AMEs in resistance to these antibiotics similar to most studies worldwide. Due to the transmission possibility of these genes between the Gram-negative bacteria, we need to control the prescription of aminoglycosides in hospitals.
Collapse
|
6
|
Upstream region of OprD mutations in imipenem-resistant and imipenem-sensitive Pseudomonas isolates. AMB Express 2021; 11:82. [PMID: 34089411 PMCID: PMC8179858 DOI: 10.1186/s13568-021-01243-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/31/2021] [Indexed: 01/07/2023] Open
Abstract
The current study was aimed at investigating the prevalence of the mutations upstream of the oprD coding region and its promoters among imipenem-resistant and sensitive Pseudomonas aeruginosa isolated from educational hospitals in Yazd City, Iran. All isolates were identified by the conventional biochemical tests. Then, the antibiotic resistance of these isolates was determined using the disk diffusion method according to the CLSI guidelines. Also, the E.test was performed to determine the minimum inhibitory concentrations (MIC) of imipenem. The mutations of this gene were recognized by the amplification of this region and subsequently sequenced. Sequencing of the genomic region upstream of oprD these regions were done in the 29 clinical strains. Statistical analysis was done by the statistical software SPSS-18. Seventy (77.7%) of isolates had MIC ≥ 16 and were resistant to imipenem. Mutations of the upstream of the oprD gene and its promoters were seen in 25 (86.2%) isolates and 4 isolates had no mutation. One isolate had a base substitution A→Cat nt 25 in the coding region and this isolate had a point mutation leading to an amino acid change at positions 9 (I→L). Our study results indicated that none of the strains had mutation in Shine-Dalgarno and the point mutations were the most common mutations upstream of the oprD coding region among P. aeruginosa isolates. Mutations were observed in imipenem-resistant isolates and it seems this mechanism is effective in resistance of isolates to imipenem and this confirmed that the indiscriminate use of antibiotic should be controlled.
Collapse
|
7
|
Panahi T, Asadpour L, Ranji N. Distribution of aminoglycoside resistance genes in clinical isolates of Pseudomonas aeruginosa in north of Iran. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
8
|
Prevalence of Aminoglycoside Resistance Genes and Molecular Characterization of a Novel Gene, aac(3)-IIg, among Clinical Isolates of the Enterobacter cloacae Complex from a Chinese Teaching Hospital. Antimicrob Agents Chemother 2020; 64:AAC.00852-20. [PMID: 32571822 DOI: 10.1128/aac.00852-20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/16/2020] [Indexed: 12/19/2022] Open
Abstract
Members of the Enterobacter cloacae complex are important opportunistic human pathogens capable of causing a wide variety of infections. During recent decades, aminoglycoside-resistant E. cloacae complex isolates have increasingly been reported and have become a major concern. Here, we employed high-throughput sequencing in combination with specific PCR assays to investigate the prevalence of aminoglycoside resistance genes among 170 isolates of the E. cloacae complex collected from a teaching hospital in Wenzhou, China. A total of 12 known genes [aphA-1, strA, strB, aac(6')-IIc, aadA2, aac(3)-IId, aadB, aadA1, rmtB, armA, aadA5, and aac(6')-Ie-aph(2'')-Ia] and 1 novel gene [aac(3)-IIg] were identified, with aphA-1 (71.18%), strA (55.29%), and strB (52.35%) being the most prevalent, and aac(3)-IIg was detected with a positive rate of 21.76% (37/170). The aac(3)-IIg gene was 810 bp in length and encoded a protein that shared 72 to 78% identities with previously known AAC(3)-II aminoglycoside 3-N-acetyltransferases. The MICs of gentamicin and tobramycin were 512 μg/ml and 64 μg/ml, respectively, when aac(3)-IIg was cloned into Escherichia coli DH5α. All aac(3)-IIg-positive isolates exerted broad aminoglycoside resistance profiles, mediated by the coexistence of multiple resistance genes. Moreover, aminoglycoside resistance and resistance genes were found to be transferable in most strains (24/37). Nevertheless, pulsed-field gel electrophoresis (PFGE) and dendrogram analysis showed clonal diversity among these isolates. S1 nuclease PFGE, Southern hybridization, and whole-genome sequencing indicated that aac(3)-IIg was located on transferable as well as nontransferable plasmids of various sizes. The analysis of the genetic environment suggested that aac(3)-IIg is embedded within a class 1 integron, with IS26 playing an important role in its mobility.
Collapse
|
9
|
Lalitha Aishwarya KV, Venkataramana Geetha P, Eswaran S, Mariappan S, Sekar U. Spectrum of Aminoglycoside Modifying Enzymes in Gram-Negative Bacteria Causing Human Infections. J Lab Physicians 2020; 12:27-31. [PMID: 32792790 PMCID: PMC7419166 DOI: 10.1055/s-0040-1713687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction
Aminoglycosides are formidable broad-spectrum antibiotics used in clinical settings; woefully their usage has been reduced by the emergence and distribution of resistance mainly due to aminoglycoside modifying enzymes (AME).
Purpose
This study was performed to determine the diverse prevalence of AME and their pattern of occurrence in the clinical isolates of gram-negative bacteria. This study also aimed to detect the presence of AMEs that are prevalent in gram-positive bacteria, among gram negatives.
Materials and Methods
A total number of 386 clinical isolates were included in this study. Polymerase chain reaction revealed the prevalence rate of AMEs screened [aac(6′)-lb, aac(3′)-I, aac(3′)-II, aac(3′)-VI, ant(2′)-I, ant(4′)-IIb, aac(3′)-III, aac(3′)-IV, aph(2′)-Ib, aph(2′)-Ic, aph(2′)-Id, aac (6′)-Ie- aph(2′)-Ia, and aph(3′)-IIIa]. Conjugation experiment was performed for the clinical isolates which harbored any one of the AME which was prevalent in gram-positive bacteria [aph(3′)-IIIa, aac(6′)-Ie-aph(2′)-Ia].
Results
aac(6′)-lb is the most prevalent AME, followed by aac(3′)-I, aph(3′)-VI, aac(3′)-VI, and aac(3′)-II. The AMEs such as ant (2′)-I, ant(4′)-IIb, aac(3′)-III, aac(3′)-IV, aph(2′)-Ib, aph(2′)-Ic, and aph(2′)-Id were not established in our study isolates. The rate of prevalence of aph(3′)-IIIa, aac(6′)-Ie-aph(2′)-Ia—the AMEs encountered in gram-positive and their co-existence was 19.68% and the conjugation experiment revealed their transfer via plasmids.
Conclusion
This is the first report from India revealing the presence and prevalence of AMEs which are often encountered among gram-positive bacteria in gram negatives and their presence on conjugative plasmids.
Collapse
Affiliation(s)
| | - Pacha Venkataramana Geetha
- Department of Microbiology, Sri Ramachandra Institute for Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sudalai Eswaran
- Department of Microbiology, Sri Ramachandra Institute for Higher Education and Research, Chennai, Tamil Nadu, India
| | - Shanthi Mariappan
- Department of Microbiology, Sri Ramachandra Institute for Higher Education and Research, Chennai, Tamil Nadu, India
| | - Uma Sekar
- Department of Microbiology, Sri Ramachandra Institute for Higher Education and Research, Chennai, Tamil Nadu, India
| |
Collapse
|
10
|
Coste A, Deslandes G, Jalin L, Corvec S, Caillon J, Boutoille D, Grégoire M, Bretonnière C. PK/PD targets of amikacin and gentamicin in ICU patients. Med Mal Infect 2019; 50:709-714. [PMID: 31883736 DOI: 10.1016/j.medmal.2019.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 05/16/2019] [Accepted: 12/04/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We aimed to evaluate the probability to achieve PK-PD targets in patients with sepsis hospitalized in the intensive care unit (ICU) after a single dose of 30mg/kg of amikacin or 8mg/kg of gentamicin. PATIENTS AND METHODS This single-center prospective study included 138 ICU patients with severe sepsis or septic shock with an indication for intravenous amikacin (N=89) or gentamicin (N=49). Maximum concentration (Cmax) was measured 30 minutes after infusion completion. PK/PD objectives were respectively Cmax≥60mg/L and ≥30mg/L for amikacin and gentamicin for empirical therapy, and a Cmax/MIC ratio≥8, as per French guidelines. RESULTS The median Simplified Acute Physiology Score II was 43 and ICU case fatality rate was 34.8%. A causative bacterial agent was identified in 94 patients (68.1%). Three pathogens had acquired aminoglycoside resistance and 15 were naturally resistant. The targeted Cmax for the first dose was achieved in 53 patients (59.6%) receiving amikacin, and one (2.2%) patient receiving gentamicin. Cmax/MIC ratio≥8 was obtained in all patients infected with susceptible pathogens (N=72). Factors associated with Cmax≥60mg/L of amikacin in multivariate analysis were dose per kg of adapted body weight (OR=1.39, P<0.001) and renal clearance estimated with CKD-EPI formula (OR=0.98, P=0.003). CONCLUSIONS Despite high doses, amikacin and gentamicin first Cmax remain dramatically low in ICU patients. However, an adequate Cmax/MIC ratio was reached in all patients.
Collapse
Affiliation(s)
- A Coste
- EE 1701 MIHAR, université de Nantes, 44035 Nantes, France; Service de maladies infectieuses, CHU de Brest, 29609 Brest, France.
| | - G Deslandes
- Service de pharmacologie clinique, CHU de Nantes, 44093 Nantes, France
| | - L Jalin
- Unité de neuro-anesthésie-réanimation, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - S Corvec
- Service de bactériologie - Hygiène hospitalière, CHU de Nantes, 44093 Nantes, France; CRCINA, INSERM U1232, Université de Nantes, 44035, Nantes
| | - J Caillon
- Service de bactériologie - Hygiène hospitalière, CHU de Nantes, 44093 Nantes, France; Laboratoire UPRES EA3826 « thérapeutiques cliniques et expérimentales des infections » IRS2 - Nantes Biotech, Université de Nantes, Nantes, France
| | - D Boutoille
- Laboratoire UPRES EA3826 « thérapeutiques cliniques et expérimentales des infections » IRS2 - Nantes Biotech, Université de Nantes, Nantes, France; Service de maladies infectieuses et tropicales, CIC 1413, INSERM, CHU de Nantes, 44093 Nantes, France
| | - M Grégoire
- Service de pharmacologie clinique, CHU de Nantes, 44093 Nantes, France; UMR 1235 « The enteric Nervous System in Gut and Brain Disorders », université de Nantes, Nantes, France
| | - C Bretonnière
- Laboratoire UPRES EA3826 « thérapeutiques cliniques et expérimentales des infections » IRS2 - Nantes Biotech, Université de Nantes, Nantes, France; Service de Pneumologie, Institut du Thorax, CHU de Nantes, Université de Nantes, 44093 Nantes, France
| |
Collapse
|
11
|
Abo-State MAM, Saleh YES, Ghareeb HM. Prevalence and sequence of aminoglycosides modifying enzymes genes among E.coli and Klebsiella species isolated from Egyptian hospitals. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2019. [DOI: 10.1016/j.jrras.2018.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mervat Aly Mohamed Abo-State
- Department of Radiation Microbiology, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority(EAEA), Cairo, Egypt
| | | | - Hazem Mahmmoud Ghareeb
- National Center for Nuclear Safety and Radiation, Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
| |
Collapse
|
12
|
López-Lozano JM, Lawes T, Nebot C, Beyaert A, Bertrand X, Hocquet D, Aldeyab M, Scott M, Conlon-Bingham G, Farren D, Kardos G, Fésűs A, Rodríguez-Baño J, Retamar P, Gonzalo-Jiménez N, Gould IM. A nonlinear time-series analysis approach to identify thresholds in associations between population antibiotic use and rates of resistance. Nat Microbiol 2019; 4:1160-1172. [PMID: 30962570 DOI: 10.1038/s41564-019-0410-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/13/2019] [Indexed: 11/09/2022]
Abstract
Balancing access to antibiotics with the control of antibiotic resistance is a global public health priority. At present, antibiotic stewardship is informed by a 'use it and lose it' principle, in which antibiotic use by the population is linearly related to resistance rates. However, theoretical and mathematical models suggest that use-resistance relationships are nonlinear. One explanation for this is that resistance genes are commonly associated with 'fitness costs' that impair the replication or transmissibility of the pathogen. Therefore, resistant genes and pathogens may only gain a survival advantage where antibiotic selection pressures exceed critical thresholds. These thresholds may provide quantitative targets for stewardship-optimizing the control of resistance while avoiding over-restriction of antibiotics. Here, we evaluated the generalizability of a nonlinear time-series analysis approach for identifying thresholds using historical prescribing and microbiological data from five populations in Europe. We identified minimum thresholds in temporal relationships between the use of selected antibiotics and incidence rates of carbapenem-resistant Acinetobacter baumannii (Hungary), extended-spectrum β-lactamase-producing Escherichia coli (Spain), cefepime-resistant E. coli (Spain), gentamicin-resistant Pseudomonas aeruginosa (France) and methicillin-resistant Staphylococcus aureus (Northern Ireland) in different epidemiological phases. Using routinely generated data, our approach can identify context-specific quantitative targets for rationalizing population antibiotic use and controlling resistance. Prospective intervention studies that restrict antibiotic consumption are needed to validate these thresholds.
Collapse
Affiliation(s)
| | - Timothy Lawes
- The Wellcome Trust Liverpool-Glasgow Centre for Global Health Research, Liverpool, UK.
| | - César Nebot
- Centro Universitario de la Defensa de San Javier, Murcia, Spain
| | - Arielle Beyaert
- Departamento de Métodos Cuantitativos para la Economía y la Empresa, University of Murcia, Murcia, Spain
| | - Xavier Bertrand
- Laboratoire Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France.,Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Didier Hocquet
- Laboratoire Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France.,Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Mamoon Aldeyab
- School of Pharmacy and Pharmaceutical Science, Ulster University, Coleraine, UK
| | - Michael Scott
- Pharmacy Department, Northern Health and Social Care Trust and Regional Medicines Optimisation Innovation Centre, Antrim, UK
| | - Geraldine Conlon-Bingham
- Pharmacy Department, Northern Health and Social Care Trust and Regional Medicines Optimisation Innovation Centre, Antrim, UK
| | - David Farren
- Department of Medical Microbiology, Antrim Area Hospital, Antrim, UK
| | - Gábor Kardos
- Department of Medical Microbiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Adina Fésűs
- Clinical Pharmacy, University of Debrecen, Debrecen, Hungary
| | - Jesús Rodríguez-Baño
- Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario Virgen Macarena, Seville, Spain.,Department of Medicine, Instituto de Biomedicina de Sevilla, University of Sevilla, Seville, Spain
| | - Pilar Retamar
- Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario Virgen Macarena, Seville, Spain.,Department of Medicine, Instituto de Biomedicina de Sevilla, University of Sevilla, Seville, Spain
| | | | - Ian M Gould
- Medical Microbiology Department, Aberdeen Royal Infirmary, Aberdeen, UK
| | | |
Collapse
|
13
|
The Prevalence of Aminoglycoside-Modifying Enzyme Genes Among Pseudomonas aeruginosa Strains Isolated From Burn Patients. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2016. [DOI: 10.5812/archcid.40896] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
14
|
Allou N, Bouteau A, Allyn J, Snauwaert A, Valance D, Jabot J, Bouchet B, Galliot R, Corradi L, Montravers P, Augustin P. Impact of a high loading dose of amikacin in patients with severe sepsis or septic shock. Ann Intensive Care 2016; 6:106. [PMID: 27807818 PMCID: PMC5093100 DOI: 10.1186/s13613-016-0211-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 10/24/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The therapeutic effect of aminoglycosides is highest and optimal when the peak plasma concentration (C max)/minimal inhibitory concentration (MIC) ratio is between 8 and 10. The French guidelines recommend to use high doses of aminoglycosides for empiric antibiotic therapy in patients suffering from severe sepsis or septic shock. In clinical practice, the recommended target is an amikacin C max between 60 and 80 mg/L, which corresponds to approximately 8 times the MIC breakpoint, as defined by the European Committee on Antimicrobial Susceptibility Testing. The aim of this study was to assess the incidence and impact on mortality of an amikacin concentration between 60 and 80 mg/L in patients suffering from severe sepsis or septic shock. METHODS This was a prospective observational cohort study conducted in two intensive care units (ICU). Patients receiving amikacin at a loading dose of 30 mg/kg for severe sepsis or septic shock were enrolled in the cohort. The target C max for amikacin was between 60 and 80 mg/L, as recommended by French guidelines (i.e. C max/MIC breakpoint = 8-10). RESULTS Over the study period, the amikacin C max was <60 mg/L, between 60 and 80 mg/L, and >80 mg/L in 20 (18.2%), 46 (41.8%) and 44 (40%) of the 110 selected patients, respectively. Mortality rate was 40, 28.3 and 56.8% in the groups of patients with C max < 60 mg/L, 60 mg/L < C max < 80 mg/L and C max > 80 mg/L, respectively. Following multivariate analysis, mortality rate was significantly lower in the group of patients with amikacin C max between 60 and 80 mg/L than in the group of patients with amikacin C max > 80 mg/L (P = 0.004). The multivariate analysis also revealed that the factors independently associated with a higher in-ICU mortality rate were age (P = 0.02) and norepinephrine dose (P = 0.0001). CONCLUSIONS With a loading dose of 30 mg/kg of amikacin, concentration was potentially suboptimal (C max < 60 mg/L) in only 18.2% of patients. The pharmacodynamic target (60 mg/L < C max < 80 mg/L) recommended by French guidelines was reached in 41.8% of patients and was associated with reduced in-ICU mortality. But amikacin overexposure (i.e. C max > 80 mg/L) was frequent and potentially associated with increased mortality.
Collapse
Affiliation(s)
- Nicolas Allou
- Réanimation polyvalente, Hôpital Felix Guyon, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, Bellepierre, 97405 Saint Denis, France
| | - Astrid Bouteau
- Département d’Anesthésie Réanimation, AP-HP, Centre Hospitalier Universitaire Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - Jérôme Allyn
- Réanimation polyvalente, Hôpital Felix Guyon, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, Bellepierre, 97405 Saint Denis, France
| | - Aurélie Snauwaert
- Département d’Anesthésie Réanimation, AP-HP, Centre Hospitalier Universitaire Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - Dorothée Valance
- Réanimation polyvalente, Hôpital Felix Guyon, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, Bellepierre, 97405 Saint Denis, France
| | - Julien Jabot
- Réanimation polyvalente, Hôpital Felix Guyon, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, Bellepierre, 97405 Saint Denis, France
| | - Bruno Bouchet
- Réanimation polyvalente, Hôpital Felix Guyon, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, Bellepierre, 97405 Saint Denis, France
| | - Richard Galliot
- Réanimation polyvalente, Hôpital Felix Guyon, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, Bellepierre, 97405 Saint Denis, France
| | - Laure Corradi
- Réanimation polyvalente, Hôpital Felix Guyon, Centre Hospitalier Universitaire Felix Guyon, Allée des Topazes, Bellepierre, 97405 Saint Denis, France
| | - Philippe Montravers
- Département d’Anesthésie Réanimation, AP-HP, Centre Hospitalier Universitaire Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - Pascal Augustin
- Département d’Anesthésie Réanimation, AP-HP, Centre Hospitalier Universitaire Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| |
Collapse
|
15
|
Meradji S, Barguigua A, Bentakouk MC, Nayme K, Zerouali K, Mazouz D, Chettibi H, Timinouni M. Epidemiology and virulence of VIM-4 metallo-beta-lactamase-producing Pseudomonas aeruginosa isolated from burn patients in eastern Algeria. Burns 2016; 42:906-18. [PMID: 27156788 DOI: 10.1016/j.burns.2016.02.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 10/21/2022]
Abstract
In this study, we investigated the prevalence of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in burn patients from eastern Algeria, CRPA virulence factors and the molecular epidemiology of CRPA. The overall prevalence of CRPA was 48.38%. Seven (46.66%) isolates were metallo-β-lactamases (MBL) producers and contained the MBL genes blaVIM-4 (n=6) and blaVIM-2 (n=1). Risk factors for CRPA infection were urinary catheter use and intubation (p=0.008). A high percentage of virulence factors (86.6% of these isolates were able to produce protease; 73.3% of isolates has DNase; and 66.6% were haemolysin positive) was observed in CRPA isolates. Among the seven MBL-producing isolates, four had the same clonal profile. The class 1 integrons, which contained the aadA7 gene cassette, were detected in six isolates. The 16SrRNA methylase gene, rmtB, was detected in one strain. All CRPA isolates were biofilm formers. A study on the kinetics of biofilm production revealed that biofilm production increased when the concentration of imipenem or ciprofloxacin and the incubation time increased. This is the first study to report the presence of VIM-4-producing P. aeruginosa from North Africa and also of the high prevalence of CRPA isolates. Based on our study of burn unit patients, the high percentage of P. aeruginosa with virulence factors and multi-drug resistance is alarming.
Collapse
Affiliation(s)
- Samah Meradji
- Biochemistry and Applied Microbiology Laboratory, Badji Mokhtar Faculty of Sciences, Department of Biology, Annaba University, Box 12 Sidi Amar, 23000 Annaba, Algeria
| | - Abouddihaj Barguigua
- Molecular Bacteriology Laboratory, Institut Pasteur du Maroc, 1 Place Louis Pasteur, 20360 Casablanca, Morocco; Microbiology Laboratory, Faculty of Medicine and Pharmacy, 1 Street Hospital, 20360 Casablanca, Morocco
| | | | - Kaotar Nayme
- Molecular Bacteriology Laboratory, Institut Pasteur du Maroc, 1 Place Louis Pasteur, 20360 Casablanca, Morocco; Microbiology Laboratory, Faculty of Medicine and Pharmacy, 1 Street Hospital, 20360 Casablanca, Morocco
| | - Khalid Zerouali
- Microbiology Laboratory, Faculty of Medicine and Pharmacy, 1 Street Hospital, 20360 Casablanca, Morocco
| | - Dekhil Mazouz
- Microbiology Laboratory, University Hospital Dorban, 23000 Annaba, Algeria
| | - Houria Chettibi
- Biochemistry and Applied Microbiology Laboratory, Badji Mokhtar Faculty of Sciences, Department of Biology, Annaba University, Box 12 Sidi Amar, 23000 Annaba, Algeria
| | - Mohammed Timinouni
- Molecular Bacteriology Laboratory, Institut Pasteur du Maroc, 1 Place Louis Pasteur, 20360 Casablanca, Morocco.
| |
Collapse
|
16
|
Allou N, Allyn J, Levy Y, Bouteau A, Caujolle M, Delmas B, Valance D, Brulliard C, Martinet O, Vandroux D, Montravers P, Augustin P. Assessment of the National French recommendations regarding the dosing regimen of 8mg/kg of gentamicin in patients hospitalised in intensive care units. Anaesth Crit Care Pain Med 2016; 35:331-335. [PMID: 27133236 DOI: 10.1016/j.accpm.2015.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/27/2015] [Accepted: 12/01/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION To assess the French National Agency for Medicines and Health Products Safety (ANSM) guidelines concerning the peak plasma concentration (Cmax) of gentamicin when using a loading dose of 8mg/kg administered in patients hospitalised in the intensive care unit (ICU). PATIENTS AND METHODS A prospective observational cohort study conducted in one ICU. RESULTS During the study period, 34 patients with a median simplified acute physiology score 2 of 54 [44-70] received a median dose of 8 [7.9-8.1] mg/kg of gentamicin. The median Cmax was 17.5 [15.4-20.7] mg/L and no patient had a Cmax>30mg/L. Twenty-four of 34 patients (71%) had a Cmax>16mg/L. Following multivariate analysis, the only factor associated with Cmax<16mg/L was a positive fluid balance 24hours before gentamicin administration (per 1000mL increment) (OR: 0.37, 95% CI: 0.18-0.77, P=0.008). CONCLUSIONS These results suggest that a Cmax>30mg/L [which corresponds to approximately 8 times the minimal inhibiting concentrations (MIC) breakpoints for Pseudomonas aeruginosa and Enterobacteriaceae with intermediate sensitivity] of gentamicin as recommended by ANSM guidelines seems impossible to obtain with a loading dose of 8mg/kg in the ICU. A loading dose of 8mg/kg should probably not be used in the empiric antibiotic treatment of infection due to non-fermenting Gram-negative bacilli and Enterobacteriaceae with intermediate sensitivity whose MIC breakpoint is 4mg/L. A Cmax>16mg/L was not reached in almost 30% of patients, particularly in the group with a positive fluid balance who require higher doses than currently recommended.
Collapse
Affiliation(s)
- Nicolas Allou
- Réanimation polyvalente, CHU Felix-Guyon, allée des Topazes, 97405 Saint-Denis, France.
| | - Jérôme Allyn
- Réanimation polyvalente, CHU Felix-Guyon, allée des Topazes, 97405 Saint-Denis, France.
| | - Yaël Levy
- Réanimation polyvalente, CHU Felix-Guyon, allée des Topazes, 97405 Saint-Denis, France.
| | - Astrid Bouteau
- Département d'Anesthésie-Réanimation, AP-HP, CHU Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France.
| | - Marie Caujolle
- Réanimation polyvalente, CHU Felix-Guyon, allée des Topazes, 97405 Saint-Denis, France.
| | - Benjamin Delmas
- Réanimation polyvalente, CHU Felix-Guyon, allée des Topazes, 97405 Saint-Denis, France.
| | - Dorothée Valance
- Réanimation polyvalente, CHU Felix-Guyon, allée des Topazes, 97405 Saint-Denis, France.
| | - Caroline Brulliard
- Réanimation polyvalente, CHU Felix-Guyon, allée des Topazes, 97405 Saint-Denis, France.
| | - Olivier Martinet
- Réanimation polyvalente, CHU Felix-Guyon, allée des Topazes, 97405 Saint-Denis, France.
| | - David Vandroux
- Réanimation polyvalente, CHU Felix-Guyon, allée des Topazes, 97405 Saint-Denis, France.
| | - Philippe Montravers
- Département d'Anesthésie-Réanimation, AP-HP, CHU Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France.
| | - Pascal Augustin
- Département d'Anesthésie-Réanimation, AP-HP, CHU Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France.
| |
Collapse
|
17
|
Wright LL, Turton JF, Hopkins KL, Livermore DM, Woodford N. Genetic environment of metallo-β-lactamase genes in Pseudomonas aeruginosa isolates from the UK. J Antimicrob Chemother 2015; 70:3250-8. [PMID: 26318194 DOI: 10.1093/jac/dkv263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/29/2015] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES We sought to characterize the genetic environment of blaVIM and blaIMP genes in Pseudomonas aeruginosa isolates from the UK; these included members of six previously described prevalent complexes, A-F, which correspond to international 'high-risk clones', along with diverse strains. METHODS Metallo-β-lactamase (MBL)-encoding class 1 integrons were amplified by PCR from 218 P. aeruginosa isolates producing VIM-type (n = 196) or IMP-type (n = 22) enzymes, referred from UK hospital laboratories between 2003 and 2012. The variable regions of selected integrons were sequenced using a primer walking method. RESULTS One-hundred-and-nineteen isolates had an MBL-encoding integron with the 3' conserved sequence (3'CS), 65 had Tn5090-like 3' regions and 17 had the sul1 gene, but lacked the qacEΔ1 gene; the 3' region could not be amplified using any primer combinations for the remaining 17 isolates. Six integron profiles were each seen in more than five isolates. Predominant integron types were seen amongst isolates belonging to STs 111, 233, 654/964 and 773 (complexes A, C, D and F, respectively), whereas diverse integron profiles were seen in isolates belonging to ST235 (complex B) and ST357 (complex E). CONCLUSIONS In UK P. aeruginosa isolates, MBL genes occur in diverse class 1 integron structures, though commonly with 3' regions containing the classical 3'CS or Tn5090-like regions. Four of the six main clonal complexes, referred from multiple laboratories, carried a predominant integron type, whereas the remaining two had more diverse types.
Collapse
Affiliation(s)
- Laura L Wright
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK
| | - Jane F Turton
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Katie L Hopkins
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - David M Livermore
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK
| | - Neil Woodford
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| |
Collapse
|
18
|
Meradji S, Barguigua A, Zerouali K, Mazouz D, Chettibi H, Elmdaghri N, Timinouni M. Epidemiology of carbapenem non-susceptible Pseudomonas aeruginosa isolates in Eastern Algeria. Antimicrob Resist Infect Control 2015; 4:27. [PMID: 26075066 PMCID: PMC4465145 DOI: 10.1186/s13756-015-0067-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/04/2015] [Indexed: 01/19/2023] Open
Abstract
Background Carbapenem resistance among Pseudomonas aeruginosa has become a serious life-threatening problem due to the limited therapeutic options. In this study, we investigated the prevalence and the molecular epidemiology of carbapenem resistant Pseudomonas aeruginosa (CRPA) isolated from three hospitals in Annaba city, Algeria. Methods During the study period (January, 2012 to December, 2013), all patients infected by P. aeruginosa were considered as the potential study population. Antibiotic susceptibility testing was performed as recommended by the CLSI. Screening of carbapenemase producer isolates was performed by using imipenem-EDTA double-disk synergy test and modified Hodge test. CRPA isolates were tested for the presence of genes encoding β-lactamases, plasmid mediated quinolone resistance, aminoglycoside resistance and class 1 integrons were investigated by PCR and sequencing. The clonal relatedness among CRPA isolates was analyzed by pulsed-field gel electrophoresis method. The clinical data were collected to identify risk factors for CRPA carriage of P. aeruginosa infection. Results The overall prevalence of CRPA was 18.75 %. The risk factors for carrying CRPA were the length of hospital stay (p = 0.04), co-infections with Staphylococcus aureus (p = 0.01), and the use of urinary catheter (p = 0.03). The in-hospital mortality rate among case patients was 13.33 % compared with 1.53 % for control patients (p = 0.09). All CRPA isolates were multidrug resistance and the most effective antibiotic against CRPA isolates was amikacin and colistin. PFGE revealed an epidemic clonal dissemination of CRPA isolates. None of CRPA isolated were found to be carbapenemase-producers. The blaPSE-1 and aac(3)-II gene was detected in two and five strains respectively. The class1 integrons were detected in 2 isolates with the presence of aadA7 gene cassette in these integrons. Conclusion The endemic clonal dissemination and multi-drug resistance of CRPA isolates in our institution is highly alarming. Strict measure will be required to control the further spread of these pathogens in hospital setting.
Collapse
Affiliation(s)
- Samah Meradji
- Department of Biology, Biochemstry and Applied Microbiology Laboratory, Badji Mokhtar Faculty of sciences, Annaba University, Box 12, Sidi Amar, 23000 Annaba, Algeria
| | - Abouddihaj Barguigua
- Molecular Bacteriology Laboratory, Pasteur Institute of Morocco, 1, Place Louis Pasteur, 20360 Casablanca,, Morocco ; Microbiology Laboratory, Faculty of Medicine and Pharmacy, 1 Street Hospital, 20360 Casablanca, Morocco
| | - Khalid Zerouali
- Microbiology Laboratory, Faculty of Medicine and Pharmacy, 1 Street Hospital, 20360 Casablanca, Morocco
| | - Dekhil Mazouz
- Microbiology Laboratory, University Hospital Ibn Rochd, 23000 Annaba, Algeria
| | - Houria Chettibi
- Department of Biology, Biochemstry and Applied Microbiology Laboratory, Badji Mokhtar Faculty of sciences, Annaba University, Box 12, Sidi Amar, 23000 Annaba, Algeria
| | - Naima Elmdaghri
- Molecular Bacteriology Laboratory, Pasteur Institute of Morocco, 1, Place Louis Pasteur, 20360 Casablanca,, Morocco
| | - Mohammed Timinouni
- Molecular Bacteriology Laboratory, Pasteur Institute of Morocco, 1, Place Louis Pasteur, 20360 Casablanca,, Morocco
| |
Collapse
|
19
|
Isolation of VIM-2-producing Pseudomonas monteilii clinical strains disseminated in a tertiary hospital in northern Spain. Antimicrob Agents Chemother 2014; 59:1334-6. [PMID: 25421471 DOI: 10.1128/aac.04639-14] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe here the occurrence of blaVIM-2 in 10 carbapenem-resistant Pseudomonas monteilii strains isolated from different clinical samples from patients at the University Hospital Marqués de Valdecilla in northern Spain. All the blaVIM-2-harboring P. monteilii isolates possessed a class 1 integron, with the cassette array [intI1_blaVIM-2_aac(6')-Ib_qacEΔ1_sul1]. Our results show the emergence of VIM-2-producing multidrug-resistant species other than Pseudomonas aeruginosa or Pseudomonas putida in a Spanish hospital. P. monteilii, although sporadically isolated, should also be considered an important metallo-β-lactamase (MBL) reservoir.
Collapse
|
20
|
Botelho J, Grosso F, Sousa C, Peixe L. Characterization of a new genetic environment associated with GES-6 carbapenemase from a Pseudomonas aeruginosa isolate belonging to the high-risk clone ST235. J Antimicrob Chemother 2014; 70:615-7. [PMID: 25261420 DOI: 10.1093/jac/dku391] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- João Botelho
- REQUIMTE, Laboratório de Microbiologia, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Filipa Grosso
- REQUIMTE, Laboratório de Microbiologia, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Clara Sousa
- CEB, Centro de Engenharia Biológica, Universidade do Minho, Braga, Portugal
| | - Luísa Peixe
- REQUIMTE, Laboratório de Microbiologia, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| |
Collapse
|
21
|
Khatua B, Van Vleet J, Choudhury BP, Chaudhry R, Mandal C. Sialylation of outer membrane porin protein D: a mechanistic basis of antibiotic uptake in Pseudomonas aeruginosa. Mol Cell Proteomics 2014; 13:1412-28. [PMID: 24643970 DOI: 10.1074/mcp.m113.030999] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Pseudomonas aeruginosa (PA) is an environmentally ubiquitous, extracellular, opportunistic pathogen, associated with severe infections of immune-compromised host. We demonstrated earlier the presence of both α2,3- and α2,6-linked sialic acids (Sias) on PA (PA(+Sias)) and normal human serum is their source of Sias. PA(+Sias) showed decreased complement deposition and exhibited enhanced association with immune-cells through sialic acid binding immunoglobulin like lectins (Siglecs). Such Sias-siglec-9 interaction between PA(+Sias) and neutrophils helped to subvert host immunity. Additionally, PA(+Sias) showed more resistant to β-lactam antibiotics as reflected in their minimum inhibitory concentration required to inhibit the growth of 50% than PA(-Sias). Accordingly, we have affinity purified sialoglycoproteins of PA(+Sias). They were electrophoresed and identified by matrix-assisted laser desorption-ionization time-of-flight/time-of-flight mass spectrometry analysis. Sequence study indicated the presence of a few α2,6-linked, α2,3-linked, and both α2,3- and α2,6-linked sialylated proteins in PA. The outer membrane porin protein D (OprD), a specialized channel-forming protein, responsible for uptake of β-lactam antibiotics, is one such identified sialoglycoprotein. Accordingly, sialylated (OprD(+Sias)) and non-sialylated (OprD(-Sias)) porin proteins were separately purified by using anion exchange chromatography. Sialylation of purified OprD(+Sias) was confirmed by several analytical and biochemical procedures. Profiling of glycan structures revealed three sialylated N-glycans and two sialylated O-glycans in OprD(+Sias). In contrast, OprD(-Sias) exhibit only one sialylated N-glycans. OprD(-Sias) interacts with β-lactam antibiotics more than OprD(+Sias) as demonstrated by surface plasmon resonance study. Lyposome-swelling assay further exhibited that antibiotics have more capability to penetrate through OprD(-Sias) purified from four clinical isolates of PA. Taken together, it may be envisaged that sialic acids on OprD protein play important role toward the uptake of commonly used antibiotics in PA(+Sias). This might be one of the new mechanisms of PA for β-lactam antibiotic uptake.
Collapse
Affiliation(s)
- Biswajit Khatua
- From the ‡Cancer Biology and Inflammatory Disorder Division, Council of Scientific and Industrial Research (CSIR)-Indian Institute of Chemical Biology, 4, Raja S.C. Mullick Road, Kolkata-700 032, India
| | - Jeremy Van Vleet
- §Glycobiology Core Resources, Regents of the University of California, USCD, 9500 Gilman Drive (MC-0687), La Jolla, California, 92093-0687
| | - Biswa Pronab Choudhury
- §Glycobiology Core Resources, Regents of the University of California, USCD, 9500 Gilman Drive (MC-0687), La Jolla, California, 92093-0687
| | - Rama Chaudhry
- ¶Microbiology Department, All India Institute of Medical Sciences, Ansari Nagar East, Gautam Nagar, New Delhi, Delhi 110029
| | - Chitra Mandal
- From the ‡Cancer Biology and Inflammatory Disorder Division, Council of Scientific and Industrial Research (CSIR)-Indian Institute of Chemical Biology, 4, Raja S.C. Mullick Road, Kolkata-700 032, India;
| |
Collapse
|
22
|
Curcio D. Activity of a novel combination against multidrug-resistant nonfermenters: ceftazidime plus NXL104. Expert Rev Anti Infect Ther 2014; 9:173-6. [DOI: 10.1586/eri.10.173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
23
|
Woegerbauer M, Zeinzinger J, Springer B, Hufnagl P, Indra A, Korschineck I, Hofrichter J, Kopacka I, Fuchs R, Steinwider J, Fuchs K, Nielsen KM, Allerberger F. Prevalence of the aminoglycoside phosphotransferase genes aph(3')-IIIa and aph(3')-IIa in Escherichia coli, Enterococcus faecalis, Enterococcus faecium, Pseudomonas aeruginosa, Salmonella enterica subsp. enterica and Staphylococcus aureus isolates in Austria. J Med Microbiol 2013; 63:210-217. [PMID: 24194558 DOI: 10.1099/jmm.0.065789-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The aminoglycoside phosphotransferase aph(3')-IIa primarily inactivates kanamycin and neomycin, whilst aph(3')-IIIa also inactivates amikacin. The aim of this study was to determine the frequency of both resistance genes in major human pathogens to obtain their baseline prevalence in the gene pool of these bacterial populations in Austria. In total, 10 541 Escherichia coli, Enterococcus faecalis, Enterococcus faecium, Pseudomonas aeruginosa, Salmonella enterica subsp. enterica and Staphylococcus aureus isolates were collected representatively without selection bias between 2008 and 2011. Isolates were analysed by aph(3')-IIIa/nptIII- and aph(3')-IIa/nptII-specific TaqMan real-time PCR. For positive strains, MICs using Etests were performed and resistance gene sequences were determined. The overall prevalence of aph(3')-IIIa/nptIII was 1.62 % (95 % confidence interval: 1.38-1.88 %). In Escherichia coli, enterococci, Staphylococcus aureus, P. aeruginosa and Salmonella spp., the aph(3')-IIIa/nptIII prevalence was 0.47 % (0-1.47 %), 37.53 % (32.84-42.40 %), 2.90 % (1.51-5.02 %), 0 % (0-0.32 %) and 0 % (0-0.037 %), respectively. Eleven of a total of 169 carriers showed single-nucleotide polymorphisms in the resistance allele. The overall prevalence of aph(3')-IIa/nptII was 0.0096 % (0-0.046 %). Escherichia coli (0-0.70 %), enterococci (0-0.75 %), Staphylococcus aureus (0-0.73 %) and P. aeruginosa (0-0.32 %) did not carry aph(3')-IIa. A single Salmonella isolate was positive, resulting in an aph(3')-IIa prevalence of 0.013 % (0-0.058 %). aph(3')-IIIa/nptIII carriers were moderately prevalent in the strains tested except for in enterococci, which appeared to be an important reservoir for aph(3')-IIIa. aph(3')-IIa/nptII genes were detected at clinically irrelevant frequencies and played no significant role in the aminoglycoside resistance gene pool during the observation period.
Collapse
Affiliation(s)
- Markus Woegerbauer
- Division for Data, Statistics and Risk Assessment, Austrian Agency for Health and Food Safety (AGES - Österreichische Agentur für Gesundheit und Ernährungssicherheit), Vienna, Austria
| | - Josef Zeinzinger
- Division for Public Health, Institute for Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety (AGES - Österreichische Agentur für Gesundheit und Ernährungssicherheit), Vienna, Austria
| | - Burkhard Springer
- Division for Public Health, Institute for Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety (AGES - Österreichische Agentur für Gesundheit und Ernährungssicherheit), Vienna, Austria
| | - Peter Hufnagl
- Division for Public Health, Institute for Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety (AGES - Österreichische Agentur für Gesundheit und Ernährungssicherheit), Vienna, Austria
| | - Alexander Indra
- Division for Public Health, Institute for Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety (AGES - Österreichische Agentur für Gesundheit und Ernährungssicherheit), Vienna, Austria
| | | | - Johannes Hofrichter
- Division for Data, Statistics and Risk Assessment, Austrian Agency for Health and Food Safety (AGES - Österreichische Agentur für Gesundheit und Ernährungssicherheit), Vienna, Austria
| | - Ian Kopacka
- Division for Data, Statistics and Risk Assessment, Austrian Agency for Health and Food Safety (AGES - Österreichische Agentur für Gesundheit und Ernährungssicherheit), Vienna, Austria
| | - Reinhard Fuchs
- Division for Data, Statistics and Risk Assessment, Austrian Agency for Health and Food Safety (AGES - Österreichische Agentur für Gesundheit und Ernährungssicherheit), Vienna, Austria
| | - Johann Steinwider
- Division for Data, Statistics and Risk Assessment, Austrian Agency for Health and Food Safety (AGES - Österreichische Agentur für Gesundheit und Ernährungssicherheit), Vienna, Austria
| | - Klemens Fuchs
- Division for Data, Statistics and Risk Assessment, Austrian Agency for Health and Food Safety (AGES - Österreichische Agentur für Gesundheit und Ernährungssicherheit), Vienna, Austria
| | | | - Franz Allerberger
- Division for Public Health, Institute for Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety (AGES - Österreichische Agentur für Gesundheit und Ernährungssicherheit), Vienna, Austria
| |
Collapse
|
24
|
Clonal dissemination of Pseudomonas aeruginosa isolates producing extended-spectrum β-lactamase SHV-2a. J Clin Microbiol 2012; 51:673-5. [PMID: 23241379 DOI: 10.1128/jcm.02313-12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
From January to December 2011, 24 Pseudomonas aeruginosa strains producing the extended-spectrum β-lactamase SHV-2a were identified in 13 hospitals in France. With one exception, all the strains belonged to the same clone. Double-disk synergy tests with cefepime and clavulanate were able to detect all the SHV-2a-positive isolates.
Collapse
|
25
|
Determinants of intrinsic aminoglycoside resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother 2012; 56:5591-602. [PMID: 22908149 DOI: 10.1128/aac.01446-12] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Screening of a transposon insertion mutant library of Pseudomonas aeruginosa for increased susceptibility to paromomycin identified a number of genes whose disruption enhanced susceptibility of this organism to multiple aminoglycosides, including tobramycin, amikacin, and gentamicin. These included genes associated with lipid biosynthesis or metabolism (lptA, faoA), phosphate uptake (pstB), and two-component regulators (amgRS, PA2797-PA2798) and a gene of unknown function (PA0392). Deletion mutants lacking these showed enhanced panaminoglycoside susceptibility that was reversed by the cloned genes, confirming their contribution to intrinsic panaminoglycoside resistance. None of these mutants showed increased aminoglycoside permeation of the cell envelope, indicating that increased susceptibility was not related to enhanced aminoglycoside uptake owing to a reduced envelope barrier function. Several mutants (pstB, faoA, PA0392, amgR) did, however, show increased cytoplasmic membrane depolarization relative to wild type following gentamicin exposure, consistent with the membranes of these mutants being more prone to perturbation, likely by gentamicin-generated mistranslated polypeptides. Mutants lacking any two of these resistance genes in various combinations invariably showed increased aminoglycoside susceptibility relative to single-deletion mutants, confirming their independent contribution to resistance and highlighting the complexity of the intrinsic aminoglycoside resistome in P. aeruginosa. Deletion of these genes also compromised the high-level panaminoglycoside resistance of clinical isolates, emphasizing their important contribution to acquired resistance.
Collapse
|
26
|
Maravić A, Skočibušić M, Samanić I, Puizina J. Antibiotic susceptibility profiles and first report of TEM extended-spectrum β-lactamase in Pseudomonas fluorescens from coastal waters of the Kaštela Bay, Croatia. World J Microbiol Biotechnol 2012; 28:2039-45. [PMID: 22806025 DOI: 10.1007/s11274-012-1006-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 01/21/2012] [Indexed: 10/14/2022]
Abstract
The aim of this study was to investigate the antibiotic susceptibility profiles and the presence of extended-spectrum-β-lactamases (ESBLs) in Pseudomonas fluorescens isolates from coastal waters of the Kaštela Bay, Croatia. Twenty-two water samples were collected during 2009. Isolates were tested for susceptibilities to 13 antibiotics by Etest. ESBL production was confirmed by double-disk synergy test carried out on Mueller-Hinton agar plates containing efflux pump inhibitor Phe-Arg-β-naphthylamide dihydrochloride. PCR and DNA sequencing analysis were used to identify ESBL-encoding genes. The transferability of cephalosporin resistance was tested by conjugation experiments. Genetic relatedness of ESBL-producing isolates was determined by random amplified polymorphic DNA (RAPD) analysis. Out of 185 P. fluorescens isolates recovered, 70 (37.8%) demonstrated multiresistance phenotype with highest rates of resistance to tetracycline (61.6%), aztreonam (31.9%), meropenem (17.3%), ceftazidime (15.1%) and cefotaxime (12.4%). Ten (5.4%) isolates were identified as ESBL producers. All isolates carried chromosomally located bla (TEM-116) gene. RAPD analysis identified four different genotypes. Here, we demonstrated a baseline profiles of antimicrobial resistance of P. fluorescens from coastal waters of the Kaštela Bay, Croatia. To our knowledge, this is the first report of the presence of TEM-type ESBL in P. fluorescens, indicating this bacterium as a reservoir of antibiotic resistance genes with clinical relevance.
Collapse
Affiliation(s)
- Ana Maravić
- Department of Biology, Faculty of Science, University of Split, N. Tesle 12, 21000 Split, Croatia.
| | | | | | | |
Collapse
|
27
|
Mérens A, Delacour H, Plésiat P, Cavallo JD, Jeannot K. Pseudomonas aeruginosa et résistance aux antibiotiques. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1773-035x(11)71102-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
28
|
Abstract
Pseudomonas aeruginosa is intrinsically resistant to a variety of antimicrobials and can develop resistance during anti-pseudomonal chemotherapy both of which compromise treatment of infections caused by this organism. Resistance to multiple classes of antimicrobials (multidrug resistance) in particular is increasingly common in P. aeruginosa, with a number of reports of pan-resistant isolates treatable with a single agent, colistin. Acquired resistance in this organism is multifactorial and attributable to chromosomal mutations and the acquisition of resistance genes via horizontal gene transfer. Mutational changes impacting resistance include upregulation of multidrug efflux systems to promote antimicrobial expulsion, derepression of ampC, AmpC alterations that expand the enzyme's substrate specificity (i.e., extended-spectrum AmpC), alterations to outer membrane permeability to limit antimicrobial entry and alterations to antimicrobial targets. Acquired mechanisms contributing to resistance in P. aeruginosa include β-lactamases, notably the extended-spectrum β-lactamases and the carbapenemases that hydrolyze most β-lactams, aminoglycoside-modifying enzymes, and 16S rRNA methylases that provide high-level pan-aminoglycoside resistance. The organism's propensity to grow in vivo as antimicrobial-tolerant biofilms and the occurrence of hypermutator strains that yield antimicrobial resistant mutants at higher frequency also compromise anti-pseudomonal chemotherapy. With limited therapeutic options and increasing resistance will the untreatable P. aeruginosa infection soon be upon us?
Collapse
Affiliation(s)
- Keith Poole
- Department of Microbiology and Immunology, Queen's University Kingston, ON, Canada
| |
Collapse
|
29
|
Tanoue K, Nishi K, Kadowaki D, Hirata S. Removal of doripenem during hemodialysis and the optimum dosing regimen for patients undergoing hemodialysis. Ther Apher Dial 2011; 15:327-33. [PMID: 21624085 DOI: 10.1111/j.1744-9987.2011.00914.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The removal of doripenem by hemodialysis was studied in six hemodialysis patients. Following an intravenous drip infusion of 0.5 g of doripenem, plasma concentrations of the drug were measured. The decrease in drug concentrations in plasma was observed during various periods of non-hemodialysis, and hemodialysis accelerated the elimination of doripenem. For example, the calculated mean half-life during hemodialysis was significantly shorter than that during non-hemodialysis periods (P = 0.002). The calculated pharmacokinetic parameters indicated that the mean rate of decrease in plasma concentration due to hemodialysis alone was 56.12 ± 8.11%. Upon obtaining these results and several pharmacokinetic parameters, we attempted to optimize the dosing regimen of doripenem for hemodialysis patients. We recommend the use of 0.25 g of doripenem once a day in patients infected with viable bacteria, and in patients who are infected with Pseudomonas aeruginosa, 0.5 g twice a day on the first day of administration, followed by 0.5 g once a day.
Collapse
Affiliation(s)
- Kazutaka Tanoue
- Division of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Kumamoto University, Oe-honmachi Dialysis Center, Kumamoto University Hospital, Honjo, Japan.
| | | | | | | |
Collapse
|
30
|
Poole K. Pseudomonas aeruginosa: resistance to the max. Front Microbiol 2011; 2:65. [PMID: 21747788 PMCID: PMC3128976 DOI: 10.3389/fmicb.2011.00065] [Citation(s) in RCA: 561] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 03/24/2011] [Indexed: 01/04/2023] Open
Abstract
Pseudomonas aeruginosa is intrinsically resistant to a variety of antimicrobials and can develop resistance during anti-pseudomonal chemotherapy both of which compromise treatment of infections caused by this organism. Resistance to multiple classes of antimicrobials (multidrug resistance) in particular is increasingly common in P. aeruginosa, with a number of reports of pan-resistant isolates treatable with a single agent, colistin. Acquired resistance in this organism is multifactorial and attributable to chromosomal mutations and the acquisition of resistance genes via horizontal gene transfer. Mutational changes impacting resistance include upregulation of multidrug efflux systems to promote antimicrobial expulsion, derepression of ampC, AmpC alterations that expand the enzyme's substrate specificity (i.e., extended-spectrum AmpC), alterations to outer membrane permeability to limit antimicrobial entry and alterations to antimicrobial targets. Acquired mechanisms contributing to resistance in P. aeruginosa include β-lactamases, notably the extended-spectrum β-lactamases and the carbapenemases that hydrolyze most β-lactams, aminoglycoside-modifying enzymes, and 16S rRNA methylases that provide high-level pan-aminoglycoside resistance. The organism's propensity to grow in vivo as antimicrobial-tolerant biofilms and the occurrence of hypermutator strains that yield antimicrobial resistant mutants at higher frequency also compromise anti-pseudomonal chemotherapy. With limited therapeutic options and increasing resistance will the untreatable P. aeruginosa infection soon be upon us?
Collapse
Affiliation(s)
- Keith Poole
- Department of Microbiology and Immunology, Queen's University Kingston, ON, Canada
| |
Collapse
|
31
|
Mechanisms of ceftazidime and ciprofloxacin transport through porins in multidrug-resistance developed by extended-spectrum beta-lactamase E.coli strains. J Fluoresc 2011; 21:1421-9. [PMID: 21234661 DOI: 10.1007/s10895-010-0826-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 12/29/2010] [Indexed: 10/18/2022]
Abstract
Resistance towards antibiotics stands out today as a major issue in the clinical act of treatment of bacterial-generated infections. This process was characterized in proteoliposomes reconstituted from an E.coli strain isolated from invasive infections (blood culture) occurred in patients with a cardio-vascular device admitted for surgery. Fluorescence spectroscopy and patch-clamp technique have been used. Two types of antibiotics have been targeted: ceftazidime and ciprofloxacin. Antibiotics addition in proteoliposomes suspension undergoes a quenching in tryptophan residues from outer membrane porins structure, probably due to the formation of a transient non-fluorescent porin-antibiotic complex. Patch-clamp recordings revealed strong ion current blockages for both antibiotics, reflecting antibiotic-channel interactions but with varying strength of interaction. The present study puts forward the mechanism of multidrug-resistance in extended-spectrum beta-lactamase E.coli strains, as being caused by alterations of the antibiotics transport across the porins of the outer bacterial membrane.
Collapse
|
32
|
Vaziri F, Peerayeh SN, Nejad QB, Farhadian A. The prevalence of aminoglycoside-modifying enzyme genes (aac (6')-I, aac (6')-II, ant (2")-I, aph (3')-VI) in Pseudomonas aeruginosa. Clinics (Sao Paulo) 2011; 66:1519-22. [PMID: 22179152 PMCID: PMC3164397 DOI: 10.1590/s1807-59322011000900002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 05/16/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Pseudomonas aeruginosa (P. aeruginosa) is one of the primary opportunistic pathogens responsible for nosocomial infections. Aminoglycosides are an import ant component of antipseudomonal chemotherapy. The inactivation of drugs by modifying enzymes is the most common mechanism of aminoglycoside resistance. OBJECTIVES The inactivation of aminoglycosides by modifying enzymes is the primary resistance mechanism employed by P. aeruginosa. The aim of the present study was to investigate the occurrence of aminoglycoside resistance and the prevalence of four import ant modifying enzyme genes (aac (6')-I, aac (6')-II, ant (2")-I, aph (3')-VI) in P. aeruginosa in Iran. METHODS A total of 250 clinical isolates of P. aeruginosa were collected from several hospitals in seven cities in Iran. Antimicrobial susceptibility tests (using the disk diffusion method and E-tests) were performed for all 250 isolates. In addition, all isolates were screened for the presence of modifying enzyme genes by polymerase chain reaction. RESULTS The resistance rates, as determined by the disk diffusion method, were as follows: gentamicin 43%, tobramycin 38%, and amikacin 24%. Of the genes examined, aac (6')-II (36%) was the most frequently identified gene in phenotypic resist ant isolates, followed by ant (2")-I, aph (3')-VI, and aac (6')-I. CONCLUSIONS Aminoglycoside resistance in P. aeruginosa remains a significant problem in Iran. Therefore, there is considerable local surveillance of aminoglycoside resistance.
Collapse
Affiliation(s)
- Farzam Vaziri
- Department of Bacteriology, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | | | | | | |
Collapse
|
33
|
Abstract
Aminoglycosides have been an essential component of the armamentarium in the treatment of life-threatening infections. Unfortunately, their efficacy has been reduced by the surge and dissemination of resistance. In some cases the levels of resistance reached the point that rendered them virtually useless. Among many known mechanisms of resistance to aminoglycosides, enzymatic modification is the most prevalent in the clinical setting. Aminoglycoside modifying enzymes catalyze the modification at different -OH or -NH₂ groups of the 2-deoxystreptamine nucleus or the sugar moieties and can be nucleotidyltransferases, phosphotransferases, or acetyltransferases. The number of aminoglycoside modifying enzymes identified to date as well as the genetic environments where the coding genes are located is impressive and there is virtually no bacteria that is unable to support enzymatic resistance to aminoglycosides. Aside from the development of new aminoglycosides refractory to as many as possible modifying enzymes there are currently two main strategies being pursued to overcome the action of aminoglycoside modifying enzymes. Their successful development would extend the useful life of existing antibiotics that have proven effective in the treatment of infections. These strategies consist of the development of inhibitors of the enzymatic action or of the expression of the modifying enzymes.
Collapse
|
34
|
Acquisition of a transposon encoding extended-spectrum beta-lactamase SHV-12 by Pseudomonas aeruginosa isolates during the clinical course of a burn patient. Antimicrob Agents Chemother 2010; 54:3956-9. [PMID: 20566763 DOI: 10.1128/aac.00110-10] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Three of seven clonally related Pseudomonas aeruginosa strains isolated from a burn patient produced the extended-spectrum beta-lactamase (ESBL) SHV-12. Its gene was flanked by two IS26 elements with a large transposon (>24 kb). The transposon also contained at least five IS26 elements and a gene encoding the amikacin resistance determinant aminoglycoside 6'-N-acetyltransferase type Ib [aac(6')-Ib]. It was inserted into the gene PA5317 in the P. aeruginosa chromosome.
Collapse
|
35
|
Nationwide investigation of extended-spectrum beta-lactamases, metallo-beta-lactamases, and extended-spectrum oxacillinases produced by ceftazidime-resistant Pseudomonas aeruginosa strains in France. Antimicrob Agents Chemother 2010; 54:3512-5. [PMID: 20547814 DOI: 10.1128/aac.01646-09] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A nationwide study aimed to identify the extended-spectrum beta-lactamases (ESBLs), metallo-beta-lactamases (MBLs), and extended-spectrum oxacillinases (ES-OXAs) in a French collection of 140 clinical Pseudomonas aeruginosa isolates highly resistant to ceftazidime. Six ESBLs (PER-1, n=3; SHV-2a, n=2; VEB-1a, n=1), four MBLs (VIM-2, n=3; IMP-18, n=1), and five ES-OXAs (OXA-19, n=4; OXA-28, n=1) were identified in 13 isolates (9.3% of the collection). The prevalence of these enzymes is still low in French clinical P. aeruginosa isolates but deserves to be closely monitored.
Collapse
|
36
|
Haddadin RN, Saleh SA, Mahmoud RA, Shehabi AA. Multiple drug resistance and strength of attachment to surfaces in Pseudomonas aeruginosa isolates. Lett Appl Microbiol 2010; 51:48-53. [PMID: 20477963 DOI: 10.1111/j.1472-765x.2010.02857.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To investigate the presence of a relationship between the strength of attachment of Pseudomonas aeruginosa to stainless steel surfaces and their observed multiple drug resistance. METHODS AND RESULTS Multiple drug resistance of clinical and environmental isolates of Ps. aeruginosa was evaluated using disc diffusion method. The blot succession technique was used to quantify the strength of attachment of Ps. aeruginosa isolates. Different multiple drug-resistant Ps. aeruginosa isolates exhibited variable attachment strength. Although the highest multiple drug-resistant clinical isolate was shown to have the least attachment strength among clinical isolates, a weak correlation was found between attachment strength and multiple resistance among our investigated Ps. aeruginosa isolates. CONCLUSIONS There is a weak correlation between multiple drug resistance and strength of attachment to stainless steel surfaces. SIGNIFICANCE AND IMPACT OF THE STUDY Even low-resistant Ps. aeruginosa could have the potential of attaching firmly to surfaces and forming biofilm.
Collapse
Affiliation(s)
- R N Haddadin
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, University of Jordan, Amman, Jordan
| | | | | | | |
Collapse
|
37
|
Mima T, Kohira N, Li Y, Sekiya H, Ogawa W, Kuroda T, Tsuchiya T. Gene cloning and characteristics of the RND-type multidrug efflux pump MuxABC-OpmB possessing two RND components in Pseudomonas aeruginosa. Microbiology (Reading) 2009; 155:3509-3517. [DOI: 10.1099/mic.0.031260-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
muxA-muxB-muxC-opmB (formerly PA2528-PA2527-PA2526-opmB), encoding a putative resistance nodulation cell division (RND)-type multidrug efflux pump system, was cloned from Pseudomonas aeruginosa PAO1. Introduction of muxABC-opmB into P. aeruginosa YM64, a drug-hypersusceptible strain, led to elevated MICs of aztreonam, macrolides, novobiocin and tetracycline. Since muxB and muxC, both of which encode RND components, were essential for function, MuxABC-OpmB is thought to be a drug efflux pump with four components. One novobiocin-resistant mutant, PMX725, isolated from P. aeruginosa PMX7 showed elevated resistance not only to novobiocin but also to aztreonam, macrolides and tetracycline. Increased mRNA expression of muxABC-opmB was observed in the mutant PMX725 compared with the parental strain. Sequencing analysis revealed that a single-nucleotide insertion had occurred in the deduced promoter region for muxABC-opmB in PMX725. In this study, we have characterized the last RND-type multidrug efflux pump predicted from the genome sequence in P. aeruginosa.
Collapse
Affiliation(s)
- Takehiko Mima
- Department of Molecular Microbiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Tsushima, Kita-ku, Okayama 700-8530, Japan
| | - Naoki Kohira
- Department of Molecular Microbiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Tsushima, Kita-ku, Okayama 700-8530, Japan
| | - Yang Li
- Department of Molecular Microbiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Tsushima, Kita-ku, Okayama 700-8530, Japan
| | - Hiroshi Sekiya
- Department of Molecular Microbiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Tsushima, Kita-ku, Okayama 700-8530, Japan
| | - Wakano Ogawa
- Department of Molecular Microbiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Tsushima, Kita-ku, Okayama 700-8530, Japan
| | - Teruo Kuroda
- Department of Genome Applied Microbiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Tsushima, Kita-ku, Okayama 700-8530, Japan
- Department of Molecular Microbiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Tsushima, Kita-ku, Okayama 700-8530, Japan
| | - Tomofusa Tsuchiya
- Department of Molecular Microbiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Tsushima, Kita-ku, Okayama 700-8530, Japan
| |
Collapse
|
38
|
Fosfomycin for the treatment of infections caused by multidrug-resistant non-fermenting Gram-negative bacilli: a systematic review of microbiological, animal and clinical studies. Int J Antimicrob Agents 2009; 34:111-20. [DOI: 10.1016/j.ijantimicag.2009.03.009] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 03/10/2009] [Indexed: 11/24/2022]
|
39
|
Vidaillac C, Leonard SN, Sader HS, Jones RN, Rybak MJ. In vitro activity of ceftaroline alone and in combination against clinical isolates of resistant gram-negative pathogens, including beta-lactamase-producing Enterobacteriaceae and Pseudomonas aeruginosa. Antimicrob Agents Chemother 2009; 53:2360-6. [PMID: 19349512 PMCID: PMC2687221 DOI: 10.1128/aac.01452-08] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Revised: 12/10/2008] [Accepted: 03/27/2009] [Indexed: 01/07/2023] Open
Abstract
Ceftaroline is a novel broad-spectrum cephalosporin that exhibits bactericidal activity against many gram-positive and -negative pathogens. However, the activity of ceftaroline cannot be solely relied upon for eradication of multidrug-resistant gram-negative isolates, such as Pseudomonas aeruginosa and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, which represent a current clinical concern. As drug combinations might be beneficial by potential synergy, we evaluated the in vitro activity of ceftaroline combined with meropenem, aztreonam, cefepime, tazobactam, amikacin, levofloxacin, and tigecycline. Susceptibility testing was performed for 20 clinical P. aeruginosa isolates, 10 ESBL-producing Escherichia coli isolates, 10 ESBL-producing Klebsiella pneumoniae isolates, and 10 AmpC-derepressed Enterobacter cloacae isolates. Time-kill experiments were performed for 10 isolates using antimicrobials at one-fourth the MIC. Ceftaroline exhibited a MIC range of 0.125 to 1,024 microg/ml and was reduced 2- to 512-fold by combination with tazobactam (4 microg/ml) for ESBL-producing strains. In time-kill experiments, ceftaroline plus amikacin was synergistic against 90% of the isolates (and indifferent for one P. aeruginosa isolate). Ceftaroline plus tazobactam was indifferent for E. cloacae and P. aeruginosa strains but synergistic against 100% of E. coli and K. pneumoniae isolates. Combinations of ceftaroline plus meropenem or aztreonam were also synergistic for all E. coli and E. cloacae isolates, respectively, but indifferent against 90% of the other isolates. Finally, combinations of ceftaroline plus either tigecycline, levofloxacin, or cefepime were indifferent for 100% of the isolates. No antagonism was observed with any combination. Ceftaroline plus amikacin appeared as the most likely synergistic combination. This represents a promising therapeutic option, and further studies are warranted to elucidate the clinical value of ceftaroline combinations against resistant gram-negative pathogens.
Collapse
Affiliation(s)
- Céline Vidaillac
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Ave., Detroit, MI 48201, USA
| | | | | | | | | |
Collapse
|