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Chelaru EC, Muntean AA, Hogea MO, Muntean MM, Popa MI, Popa GL. The Importance of Carbapenemase-Producing Enterobacterales in African Countries: Evolution and Current Burden. Antibiotics (Basel) 2024; 13:295. [PMID: 38666971 PMCID: PMC11047529 DOI: 10.3390/antibiotics13040295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/29/2024] Open
Abstract
Antimicrobial resistance (AMR) is a worldwide healthcare problem. Multidrug-resistant organisms (MDROs) can spread quickly owing to their resistance mechanisms. Although colonized individuals are crucial for MDRO dissemination, colonizing microbes can lead to symptomatic infections in carriers. Carbapenemase-producing Enterobacterales (CPE) are among the most important MDROs involved in colonizations and infections with severe outcomes. This review aimed to track down the first reports of CPE in Africa, describe their dissemination throughout African countries and summarize the current status of CRE and CPE data, highlighting current knowledge and limitations of reported data. Two database queries were undertaken using Medical Subject Headings (MeSH), employing relevant keywords to identify articles that had as their topics beta-lactamases, carbapenemases and carbapenem resistance pertaining to Africa or African regions and countries. The first information on CPE could be traced back to the mid-2000s, but data for many African countries were established after 2015-2018. Information is presented chronologically for each country. Although no clear conclusions could be drawn for some countries, it was observed that CPE infections and colonizations are present in most African countries and that carbapenem-resistance levels are rising. The most common CPE involved are Klebsiella pneumoniae and Escherichia coli, and the most prevalent carbapenemases are NDM-type and OXA-48-type enzymes. Prophylactic measures, such as screening, are required to combat this phenomenon.
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Affiliation(s)
- Edgar-Costin Chelaru
- Department of Microbiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.-C.C.); (A.-A.M.); (M.-O.H.); (M.-M.M.)
| | - Andrei-Alexandru Muntean
- Department of Microbiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.-C.C.); (A.-A.M.); (M.-O.H.); (M.-M.M.)
- Department of Microbiology, Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania
| | - Mihai-Octav Hogea
- Department of Microbiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.-C.C.); (A.-A.M.); (M.-O.H.); (M.-M.M.)
| | - Mădălina-Maria Muntean
- Department of Microbiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.-C.C.); (A.-A.M.); (M.-O.H.); (M.-M.M.)
| | - Mircea-Ioan Popa
- Department of Microbiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.-C.C.); (A.-A.M.); (M.-O.H.); (M.-M.M.)
- Department of Microbiology, Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania
| | - Gabriela-Loredana Popa
- Department of Microbiology, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Parasitic Disease Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
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Venne DM, Hartley DM, Malchione MD, Koch M, Britto AY, Goodman JL. Review and analysis of the overlapping threats of carbapenem and polymyxin resistant E. coli and Klebsiella in Africa. Antimicrob Resist Infect Control 2023; 12:29. [PMID: 37013626 PMCID: PMC10071777 DOI: 10.1186/s13756-023-01220-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/18/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Carbapenem-resistant Enterobacterales are among the most serious antimicrobial resistance (AMR) threats. Emerging resistance to polymyxins raises the specter of untreatable infections. These resistant organisms have spread globally but, as indicated in WHO reports, the surveillance needed to identify and track them is insufficient, particularly in less resourced countries. This study employs comprehensive search strategies with data extraction, meta-analysis and mapping to help address gaps in the understanding of the risks of carbapenem and polymyxin resistance in the nations of Africa. METHODS Three comprehensive Boolean searches were constructed and utilized to query scientific and medical databases as well as grey literature sources through the end of 2019. Search results were screened to exclude irrelevant results and remaining studies were examined for relevant information regarding carbapenem and/or polymyxin(s) susceptibility and/or resistance amongst E. coli and Klebsiella isolates from humans. Such data and study characteristics were extracted and coded, and the resulting data was analyzed and geographically mapped. RESULTS Our analysis yielded 1341 reports documenting carbapenem resistance in 40 of 54 nations. Resistance among E. coli was estimated as high (> 5%) in 3, moderate (1-5%) in 8 and low (< 1%) in 14 nations with at least 100 representative isolates from 2010 to 2019, while present in 9 others with insufficient isolates to support estimates. Carbapenem resistance was generally higher among Klebsiella: high in 10 nations, moderate in 6, low in 6, and present in 11 with insufficient isolates for estimates. While much less information was available concerning polymyxins, we found 341 reports from 33 of 54 nations, documenting resistance in 23. Resistance among E. coli was high in 2 nations, moderate in 1 and low in 6, while present in 10 with insufficient isolates for estimates. Among Klebsiella, resistance was low in 8 nations and present in 8 with insufficient isolates for estimates. The most widespread associated genotypes were, for carbapenems, blaOXA-48, blaNDM-1 and blaOXA-181 and, for polymyxins, mcr-1, mgrB, and phoPQ/pmrAB. Overlapping carbapenem and polymyxin resistance was documented in 23 nations. CONCLUSIONS While numerous data gaps remain, these data show that significant carbapenem resistance is widespread in Africa and polymyxin resistance is also widely distributed, indicating the need to support robust AMR surveillance, antimicrobial stewardship and infection control in a manner that also addresses broader animal and environmental health dimensions.
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Affiliation(s)
- Danielle M Venne
- Center on Medical Product Access, Safety and Stewardship, Georgetown University, 3900 Reservoir Road, Washington, DC, 20057, USA
| | - David M Hartley
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, 45229, USA
| | - Marissa D Malchione
- Center on Medical Product Access, Safety and Stewardship, Georgetown University, 3900 Reservoir Road, Washington, DC, 20057, USA
- Sabin Vaccine Institute, Influenza Vaccine Innovation, 2175 K St NW, Washington, DC, 20037, USA
| | - Michala Koch
- Center on Medical Product Access, Safety and Stewardship, Georgetown University, 3900 Reservoir Road, Washington, DC, 20057, USA
| | - Anjali Y Britto
- Center on Medical Product Access, Safety and Stewardship, Georgetown University, 3900 Reservoir Road, Washington, DC, 20057, USA
| | - Jesse L Goodman
- Center on Medical Product Access, Safety and Stewardship, Georgetown University, 3900 Reservoir Road, Washington, DC, 20057, USA.
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Sallem N, Hammami A, Mnif B. Trends in human intestinal carriage of ESBL- and carbapenemase-producing Enterobacterales among food handlers in Tunisia: emergence of C1-M27-ST131 subclades, blaOXA-48 and blaNDM. J Antimicrob Chemother 2022; 77:2142-2152. [PMID: 35640660 DOI: 10.1093/jac/dkac167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/06/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To determine the prevalence of community intestinal carriage of ESBL-producing Enterobacterales (ESBL-E), acquired-AmpC-producing Enterobacterales (aAmpC-E) and carbapenemase-producing Enterobacterales (CPE) in Tunisia. METHODS From November 2012 to September 2017, stool samples from food handlers in Sfax, Tunisia, were screened for ESBL-E, AmpC-E and CPE using antibiotic-containing media. The genes encoding these β-lactamases were characterized by PCR, sequencing, and transfer assays. ST131 clonal groups were detected by PCR and characterized for antibiotic resistance, virulence genes and PFGE patterns. RESULTS Of 2135 participants, ESBL-E, aAmpC-E, and CPE carriage were detected in 419 (19.63%), 35 (1.63%) and 7 (0.33%) participants, respectively. CTX-M-15 (60%), CTX-M-1 (16.8%) and CTX-M-27 (12.8%) were the most common ESBL determinants. The ESBL-E carriage was significantly higher in summer (33%) and autumn (25.7%) than in winter (12.1%) and spring (11.4%). ST131 was detected in 50 (13.2%) of the 378 ESBL-producing Escherichia coli isolates; most of them (35; 70%) belonged to subclade C1 (cluster C1-M27: 23 isolates, 46%; cluster C1-non-M27: 12 isolates, 24%) followed by those belonging to subclade C2 (11; 22%). Although subclade C2 isolates, all harbouring blaCTX-M-15, had the highest resistance rates and virulence factor and addiction system scores, the subclade C1 isolates, mainly harbouring blaCTX-M-27 (94%), were predominant since 2015. The most frequently detected carbapenemase-encoding gene was blaOXA-48-like (85%) and acquired AmpC-encoding genes were blaDHA-1 (54%) and blaCMY-2 (46%). CONCLUSIONS This is the first large Tunisian study to reveal a high faecal ESBL carriage rate, a low CPE carriage rate, and the predominance of CTX-M-27-producing subclade C1 among faecal ESBL-ST131 isolates in the Tunisian community.
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Affiliation(s)
- Nesrine Sallem
- Habib Bourguiba University Hospital, Research Laboratory Microorganisms and Human Disease, University of Sfax, Route El Ain Km 0.5, 3029, Sfax, Tunisia
| | - Adnene Hammami
- Habib Bourguiba University Hospital, Research Laboratory Microorganisms and Human Disease, University of Sfax, Route El Ain Km 0.5, 3029, Sfax, Tunisia.,Faculty of Medicine Sfax, Laboratory of Microbiology, University of Sfax, Avenue Majida Boulila, 3027, Sfax, Tunisia
| | - Basma Mnif
- Habib Bourguiba University Hospital, Research Laboratory Microorganisms and Human Disease, University of Sfax, Route El Ain Km 0.5, 3029, Sfax, Tunisia.,Faculty of Medicine Sfax, Laboratory of Microbiology, University of Sfax, Avenue Majida Boulila, 3027, Sfax, Tunisia
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Healthcare-associated outbreaks of bacterial infections in Africa, 2009-2018: A review. Int J Infect Dis 2020; 103:469-477. [PMID: 33333248 DOI: 10.1016/j.ijid.2020.12.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are a major global public health problem, increasing the transmission of drug-resistant infections. In Africa, the prevalence of HAIs among all hospital inpatients is estimated to be between 3% and 15%, but outbreaks are infrequently reported. Failure to detect and/or report outbreaks can increase the risk of ongoing infections and recurrent outbreaks. METHODS A search of the PubMed, Web of Science, Cochrane Library, and other outbreak databases was performed to identify published literature on bacterial HAI outbreaks in Africa (January 2009 to December 2018). Details of the outbreak characteristics, hospital environment, and the control measures implemented were extracted. RESULTS Twenty-two studies published over the 10-year period were identified. These reported 31 distinct outbreaks and a total of 31 causative pathogens, including Klebsiella pneumoniae (six outbreaks, 19%), Staphylococcus aureus (six outbreaks, 19%), and Enterococcus (five outbreaks, 16%). Most outbreaks were reported from university (n = 8, 26%) and tertiary hospitals (n = 11, 55%), from South Africa (n = 9, 41%) and Tunisia (n = 4, 18%). Interventions to control the outbreaks were described in 27 (90%) outbreaks, and all instituted or recommended enhancing hand hygiene and education. CONCLUSIONS Few facilities in Africa reported HAI outbreaks over the 10-year period, suggesting substantial under-detection and under-reporting. The quality and timeliness of reporting require improvement to ensure changes in public health practice.
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Dziri O, Dziri R, Ali El Salabi A, Chouchani C. Carbapenemase Producing Gram-Negative Bacteria in Tunisia: History of Thirteen Years of Challenge. Infect Drug Resist 2020; 13:4177-4191. [PMID: 33262613 PMCID: PMC7699306 DOI: 10.2147/idr.s259562] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/11/2020] [Indexed: 11/23/2022] Open
Abstract
The wide spread of multidrug-resistant bacteria, particularly carbapenem-resistant Gram-negative bacteria (CR-GNB), constitutes a major public health threat worldwide, owing to the limited therapeutic options. This review will describe and uncover the Tunisian experience in the challenge against carbapenem resistance. Indeed, we illuminate on the dissemination of CR-GNB in different hospitals, animals, and other natural environments in this country. We resumed the different carbapenemase variants detected from various bacterial species and mapped their regional distribution, basing on Tunisian published data during a period extended from 2006, the date of its first description in Tunisia, to February 2019. We also resumed the different mobile genetic elements implicated in their dissemination. This review shows that the majority of the research reports focused in the north and the coastal cities in spite of the fact that KPC and IMP carbapenemases were uncommonly detected in our country. However, VIM, NDM-1, and OXA-48 enzymes were usually reported with the predominance of OXA-48 among Enterobacteriaceae. Furthermore, OXA-23, OXA-51, and OXA-58 carbapenemases constituted the main mechanism conferring carbapenem resistance among Acinetobacter baumannii in Tunisia. Collaborative efforts and raising awareness of the threat of antibiotic resistance are required in order to minimize the spread of multidrug-resistant bacteria.
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Affiliation(s)
- Olfa Dziri
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Laboratory of Research in Sciences and Technology of Environment, High Institute of Science and Technology of Environment, University of Carthage, Hammam-Lif, Tunisia
| | - Raoudha Dziri
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Allaaeddin Ali El Salabi
- Department of Environmental Health, Faculty of Public Health, University of Benghazi, Benghazi, Libya.,Infection Control and Patient Safety Office, New Marwa Hospital, Benghazi, Libya
| | - Chedly Chouchani
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Laboratory of Research in Sciences and Technology of Environment, High Institute of Science and Technology of Environment, University of Carthage, Hammam-Lif, Tunisia
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Molecular epidemiology and resistance patterns of bla OXA-48Klebsiella pneumoniae and Escherichia coli: A nationwide multicenter study in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 54:665-672. [PMID: 32362456 DOI: 10.1016/j.jmii.2020.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND We describe the molecular epidemiology and resistance patterns of blaOXA-48Klebsiella pneumoniae and Escherichia coli in Taiwan. METHODS In this multicenter surveillance study from January 2012 to August 2015, the identified blaOXA-48Enterobacteriaceae isolates were subjected to antibiotics susceptibility testing. PCR method was used for detecting concomitant other beta-lactamases. Outer membrane porins were analyzed. Genetic relatedness and molecular epidemiology of the isolates were determined through pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Plasmid incompatibility was determined using PCR-based replicon typing. RESULTS Forty-three blaOXA-48K. pneumoniae and two E. coli isolates were analyzed. The annual incidence of blaOXA-48K. pneumoniae isolates from 2012 to 2015 were 0%, 1.1%, 2.4%, and 7.6%, respectively. Forty-three (95.5%) of 45 isolates were non-susceptible to broad-spectrum beta-lactams (ceftriaxone, ceftazidime, cefepime, piperacillin/tazobactam), Forty-two (93.3%) of the 45 isolates showed resistance against all tested carbapenems (imipenem, meropenem, doripenem, and ertapenem). Molecular characterization revealed that they co-produced at least one extended-spectrum beta-lactamases or AmpC beta-lactamases, with at least one outer membrane porin loss. Thirty-eight (88.3%) of the 43 K. pneumoniae isolates belonged to ST11. PFGE analysis of 43 K. pneumoniae isolates revealed dissemination of multiple clones. Six of the 12 tested K. pneumoniae representatives of different pulso-types belonged to IncA/C. CONCLUSION Concomitant loss of porins and production of other beta-lactamases renders the blaOXA-48-producing isolates in Taiwan a high-level carbapenem resistance and broad resistance against many beta-lactam antibiotics. Following dissemination of multiple clones of blaOXA-48 K pneumoniae ST 11, a trend of increased blaOXA-48 prevalence was noted.
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Abstract
Surveillance studies have shown that OXA-48-like carbapenemases are the most common carbapenemases in Enterobacterales in certain regions of the world and are being introduced on a regular basis into regions of nonendemicity, where they are responsible for nosocomial outbreaks. OXA-48, OXA-181, OXA-232, OXA-204, OXA-162, and OXA-244, in that order, are the most common enzymes identified among the OXA-48-like carbapenemase group. OXA-48 is associated with different Tn1999 variants on IncL plasmids and is endemic in North Africa and the Middle East. OXA-162 and OXA-244 are derivatives of OXA-48 and are present in Europe. OXA-181 and OXA-232 are associated with ISEcp1, Tn2013 on ColE2, and IncX3 types of plasmids and are endemic in the Indian subcontinent (e.g., India, Bangladesh, Pakistan, and Sri Lanka) and certain sub-Saharan African countries. Overall, clonal dissemination plays a minor role in the spread of OXA-48-like carbapenemases, but certain high-risk clones (e.g., Klebsiella pneumoniae sequence type 147 [ST147], ST307, ST15, and ST14 and Escherichia coli ST38 and ST410) have been associated with the global dispersion of OXA-48, OXA-181, OXA-232, and OXA-204. Chromosomal integration of bla OXA-48 within Tn6237 occurred among E. coli ST38 isolates, especially in the United Kingdom. The detection of Enterobacterales with OXA-48-like enzymes using phenotypic methods has improved recently but remains challenging for clinical laboratories in regions of nonendemicity. Identification of the specific type of OXA-48-like enzyme requires sequencing of the corresponding genes. Bacteria (especially K. pneumoniae and E. coli) with bla OXA-48, bla OXA-181, and bla OXA-232 are emerging in different parts of the world and are most likely underreported due to problems with the laboratory detection of these enzymes. The medical community should be aware of the looming threat that is posed by bacteria with OXA-48-like carbapenemases.
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Emergence and treatment of community-acquired OXA-48 producing Enterobacteriaceae infections in Tunisia. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 53:360-362. [PMID: 31704244 DOI: 10.1016/j.jmii.2019.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/12/2019] [Accepted: 10/15/2019] [Indexed: 11/23/2022]
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Messaoudi A, Haenni M, Bouallègue O, Saras E, Chatre P, Chaouch C, Boujâafar N, Mansour W, Madec JY. Dynamics and molecular features of OXA-48-like-producing Klebsiella pneumoniae lineages in a Tunisian hospital. J Glob Antimicrob Resist 2019; 20:87-93. [PMID: 31306816 DOI: 10.1016/j.jgar.2019.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/18/2019] [Accepted: 07/03/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The aim of this study was to elucidate the molecular features of genes, plasmids and clones of OXA-48-like producingKlebsiella pneumoniae isolates recovered in Sahloul Hospital (Sousse, Tunisia) in the period 2012-2014. METHODS In vitro antimicrobial susceptibility testing, S1 nuclease pulsed-field gel electrophoresis (S1-PFGE), Southern blotting and PCR-based replicon typing (PBRT) were performed. Extended-spectrum β-lactamase (ESBL) and carbapenemases genes were detected by PCR and sequencing. The clonality of isolates was assessed by PFGE and multilocus sequence typing (MLST). RESULTS Klebsiella pneumoniae accounted for 26.8% (1095/4083) of clinical Enterobacterales isolates identified during 2012-2014, of which 21.9% (240/1095) were resistant to carbapenems, mostly harbouring blaOXA-48-like genes (196/240; 81.7%). Plasmid analysis showed that blaOXA-204 and blaOXA-48 were mostly carried by IncA/C and IncL plasmids, respectively. The current data highlight the dominance of two ST101 and ST147 lineages spreading OXA-48 and OXA-204, respectively, through successive clonal spreads at this hospital. In addition, a large diversity of other K. pneumoniae lineages was also identified, such as ST15, ST36 and ST525 spreading OXA-48 as well as ST340, ST2032, ST301, ST199 and ST1561 spreading OXA-48 or OXA-204, constituting a reservoir of possible dominant clones in the future. CONCLUSION This study reports the full molecular characterisation of carbapenem resistance in K. pneumoniae and the predominance of a few clones responsible for the dissemination of OXA-48 and OXA-204 enzymes in a Tunisian hospital.
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Affiliation(s)
- Aziza Messaoudi
- Research Unit: Emergent Bacterial Resistance and Safety of Care (UR12SP37), Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia
| | - Marisa Haenni
- Université de Lyon-French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
| | - Olfa Bouallègue
- Research Unit: Emergent Bacterial Resistance and Safety of Care (UR12SP37), Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia; Faculty of Medicine Ibn Al Jazzar Sousse, University of Sousse, Sousse, Tunisia
| | - Estelle Saras
- Université de Lyon-French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
| | - Pierre Chatre
- Université de Lyon-French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
| | - Cherifa Chaouch
- Research Unit: Emergent Bacterial Resistance and Safety of Care (UR12SP37), Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia; Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Noureddine Boujâafar
- Research Unit: Emergent Bacterial Resistance and Safety of Care (UR12SP37), Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia; Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Wejdene Mansour
- Research Unit: Emergent Bacterial Resistance and Safety of Care (UR12SP37), Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia; Faculty of Medicine Ibn Al Jazzar Sousse, University of Sousse, Sousse, Tunisia; Laboratory of Metabolic Biophysics and Applied Pharmacology (LR12ES02), Department of Biophysics, Faculty of Medicine Ibn El Jazzar Sousse, University of Sousse, Sousse, Tunisia.
| | - Jean-Yves Madec
- Université de Lyon-French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
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DZIRI O, ALONSO CA, DZIRI R, GHARSA H, MARAOUB A, TORRES C, CHOUCHANI C. Metallo-β-lactamases and class D carbapenemases in south-east Tunisia: Implication of mobile genetic elements in their dissemination. Int J Antimicrob Agents 2018; 52:871-877. [DOI: 10.1016/j.ijantimicag.2018.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 05/14/2018] [Accepted: 06/02/2018] [Indexed: 10/28/2022]
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Ben Tanfous F, Achour W, Raddaoui A, Ben Hassen A. Molecular characterisation and epidemiology of extended-spectrum β-lactamase-producing Klebsiella pneumoniae isolates from immunocompromised patients in Tunisia. J Glob Antimicrob Resist 2018; 13:154-160. [DOI: 10.1016/j.jgar.2017.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/19/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022] Open
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Ben Helal R, Dziri R, Chedly M, Klibi N, Barguellil F, El Asli MS, Ben Moussa M. Occurrence and Characterization of Carbapenemase-Producing Enterobacteriaceae in a Tunisian Hospital. Microb Drug Resist 2018; 24:1361-1367. [PMID: 29596032 DOI: 10.1089/mdr.2018.0013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Carbapenem-resistant Enterobacteriaceae have become of particular concern, since they were quickly disseminated in various areas in the world. The aim of the study was to investigate the prevalence of carbapenemase production among clinical isolates of Enterobacteriaceae recovered from the Military Hospital of Tunisia. Bacterial isolates (n = 125) were recovered from patients in diverse services from March 2014 to February 2016 and identified by Vitek II Compact®. The multiplex PCR for blaVIM, blaIMP, blaNDM, blaKPC, and blaOXA-48 with subsequent amplicon detection by reverse hybridization was performed with the Hyplex SuperBug ID test system (AmplexDiagnostics GmbH, Gars-Bahnhof, Germany). The 125 strains showed resistance to carbapenems of which 102 strains (81.6%) were carbapenemase-producing Enterobacteriaceae and were identified as Klebsiella pneumoniae (85.2%), Enterobacter cloacae (9.8%), Escherichia coli (2.9%), Providencia stuartii (0.9%) and Enterobacter aerogenes (0.9%). These strains were isolated mainly from blood, anal, and urine samples. Patients were mainly hospitalized in the intensive care units, surgery, and medical services. All strains were resistant to ertapenem (100%) and 55.8% showed resistance to imipenem. Carbapenemases genes detected in our study were as follows: blaOXA-48 (84 isolates), blaNDM-1 (8 isolates), blaOXA-48 + blaVIM (5 isolates), and blaOXA-48 + blaNDM-1 (5 isolates). Our research provides epidemiological data showing the quick spread of carbapenem-resistant bacteria in our region, which calls for new surveillance strategies and strict hygiene rules.
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Affiliation(s)
- Rania Ben Helal
- 1 Service of Microbiology, Military Hospital of Tunis HMPIT , Tunis, Tunisia
| | - Raoudha Dziri
- 2 Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar , Tunis, Tunisia
| | - Meriem Chedly
- 1 Service of Microbiology, Military Hospital of Tunis HMPIT , Tunis, Tunisia
| | - Naouel Klibi
- 2 Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar , Tunis, Tunisia
| | - Farouk Barguellil
- 1 Service of Microbiology, Military Hospital of Tunis HMPIT , Tunis, Tunisia
- 3 Department of Microbiology, Faculty of Pharmacy , University of Monastir, Monastir, Tunisia
| | - Mohamed Selim El Asli
- 1 Service of Microbiology, Military Hospital of Tunis HMPIT , Tunis, Tunisia
- 3 Department of Microbiology, Faculty of Pharmacy , University of Monastir, Monastir, Tunisia
| | - Mohamed Ben Moussa
- 1 Service of Microbiology, Military Hospital of Tunis HMPIT , Tunis, Tunisia
- 3 Department of Microbiology, Faculty of Pharmacy , University of Monastir, Monastir, Tunisia
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Mahalingam N, Manivannan B, Khamari B, Siddaramappa S, Adak S, Bulagonda EP. Detection of Antibiotic Resistance Determinants and Their Transmissibility among Clinically Isolated Carbapenem-Resistant Escherichia coli from South India. Med Princ Pract 2018; 27:428-435. [PMID: 29739004 PMCID: PMC6243900 DOI: 10.1159/000489885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/08/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to analyze the prevalence of the CTX-M, TEM, SHV, VIM, NDM, and OXA genes in carbapenemase-producing Escherichia coli and their transmissibility at a tertiary care hospital in south India. MATERIALS AND METHODS Twenty-one carbapenem-resistant E. coli (carbapenem-resistant Enterobacteriaceae; CRE) were collected from the Sri Sathya Sai Institute of Higher Medical Sciences (Puttaparthi India). Resistance to antibiotics was analyzed by Vitek-2, and the identity of the isolates was confirmed by 16S rDNA sequencing. RAPD and enterobacterial repetitive intergenic consensus (ERIC)-PCR were performed for molecular typing. Metallo-β-lactamase production was confirmed by a double disc synergy test. The presence of the extended-spectrum β-lactamases CTX-M, TEM, and SHV and of the carbapenemases NDM, VIM, and OXA was determined by PCR. Carbapenemase variants were further confirmed by sequencing. The transmissibility of the genes was tested by conjugation. RESULTS Twelve of the 21 (57%) carbapenem-resistant E. coli isolates were community acquired, indicating the spread of CRE in environmental samples. TEM and NDM-5 were found to be the major β-lactamases produced by the pathogens. OXA-181 was found in 5 of the isolates. All 21 isolates were found to harbor more than one of the tested β-lactamases, and all of the isolates were found to have the capacity to participate in conjugation; 15 of the transconjugants were found to have acquired the tested β-lactamases, substantiating their ability to be transferred to other strains of bacteria. CONCLUSION Monitoring of community-acquired carbapenem-resistant bacteria is very important as the association of resistance determinants with mobile genetic elements would present a serious clinical challenge.
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Affiliation(s)
- Niranjana Mahalingam
- Department of Microbiology, Sri Sathya Sai Institute of Higher Medical Sciences, Puttaparthi, India
- Department of Biosciences, Sri Sathya Sai Institute of Higher Learning, Puttaparthi, India
| | - Bhavani Manivannan
- Department of Microbiology, Sri Sathya Sai Institute of Higher Medical Sciences, Puttaparthi, India
- Department of Biosciences, Sri Sathya Sai Institute of Higher Learning, Puttaparthi, India
| | - Balaram Khamari
- Department of Biosciences, Sri Sathya Sai Institute of Higher Learning, Puttaparthi, India
| | | | - Sudeshna Adak
- OMIX Research and Diagnostics Laboratories Private Limited, Bengaluru, India
| | - Eswarappa Pradeep Bulagonda
- Department of Biosciences, Sri Sathya Sai Institute of Higher Learning, Puttaparthi, India
- *Bulagonda Eswarappa Pradeep, Department of Biosciences, Sri Sathya Sai Institute of Higher Learning, Vidyagiri, Prasanthi Nilayam, Puttaparthi, Andhra Pradesh 515134 (India), E-Mail
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14
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Mairi A, Pantel A, Sotto A, Lavigne JP, Touati A. OXA-48-like carbapenemases producing Enterobacteriaceae in different niches. Eur J Clin Microbiol Infect Dis 2017; 37:587-604. [PMID: 28990132 DOI: 10.1007/s10096-017-3112-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/15/2017] [Indexed: 12/26/2022]
Abstract
The emergence of carbapenem-resistant enterobacterial species poses a serious threat to public health worldwide. OXA-48-type carbapenem-hydrolyzing class D β-lactamases are widely distributed among Enterobacteriaceae, with significant geographical differences. To date, 11 OXA-48-like variants have been identified, with classical OXA-48 being the most widespread. These enzymes show high-level hydrolytic activity against penicillins and low-level hydrolysis towards carbapenems. Since the first description of the OXA-48 carbapenemase in Turkey, bacterial strains producing the enzyme have been extensively reported in nosocomial and community outbreaks in many parts of the word, particularly in the Mediterranean area and European countries. The rapid spread of Enterobacteriaceae producing OXA-48-like enzymes in different ecosystems has become a serious issue recently. The number of reservoirs for such organisms is increasing, not only in hospitals, but also in the community, among animals (e.g., livestock, companion animals, and wildlife) and in the environment. This review aims to summarize the main characteristics of the OXA-48-type carbapenemases, covering genetic and enzymatic traits, their epidemiology, clonality and associated genes, correlation with extended-spectrum β-lactamases (ESBLs) or plasmidic AmpC (pAmpC) in different bacterial species worldwide.
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Affiliation(s)
- Assia Mairi
- Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, 06000, Bejaia, Algeria.,Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, 186 Chemin du Carreau de Lanes, CS83021, 30908, Nîmes, France
| | - Alix Pantel
- Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, 186 Chemin du Carreau de Lanes, CS83021, 30908, Nîmes, France.,Department of Microbiology, University Hospital of Nîmes, Nîmes, France
| | - Albert Sotto
- Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, 186 Chemin du Carreau de Lanes, CS83021, 30908, Nîmes, France
| | - Jean-Philippe Lavigne
- Institut National de la Santé et de la Recherche Médicale, U1047, Université Montpellier, UFR de Médecine, 186 Chemin du Carreau de Lanes, CS83021, 30908, Nîmes, France. .,Department of Microbiology, University Hospital of Nîmes, Nîmes, France.
| | - Aziz Touati
- Laboratoire d'Ecologie Microbienne, FSNV, Université de Bejaia, 06000, Bejaia, Algeria
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15
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Nasri E, Subirats J, Sànchez-Melsió A, Mansour HB, Borrego CM, Balcázar JL. Abundance of carbapenemase genes (bla KPC, bla NDM and bla OXA-48) in wastewater effluents from Tunisian hospitals. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2017; 229:371-374. [PMID: 28614760 DOI: 10.1016/j.envpol.2017.05.095] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/19/2017] [Accepted: 05/26/2017] [Indexed: 05/29/2023]
Abstract
Carbapenems are β-lactam antibiotics with a broad spectrum of activity and are usually considered the last resort for the treatment of severe infections caused by multidrug-resistant pathogens. The clinically most significant carbapenemases are KPC, NDM, and OXA-48-like enzymes, whose genes have been increasingly reported worldwide in members of the family Enterobacteriaceae. In this study, we quantified the abundance of these genes in wastewater effluents from different Tunisian hospitals. The blaNDM and blaOXA-48-like genes were detected at similar concentrations in all hospital wastewater effluents. In contrast, the blaKPC gene was detected at lower concentration than other genes and it was only detected in three of the seven effluents analyzed. To the best of our knowledge, this study quantified for the first time the abundance of blaKPC, blaNDM, and blaOXA-48-like genes in wastewater effluents from Tunisian hospitals, highlighting the widespread distribution of these carbapenemase genes.
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Affiliation(s)
- Emna Nasri
- Research Unit of Analysis and Process Applied to the Environmental - APAE Higher Institute of Applied Sciences and Technology Mahdia, University of Monastir, Monastir, Tunisia; Faculty of Sciences, University of Tunis El Manar, University Campus, Tunis, Tunisia
| | - Jessica Subirats
- Catalan Institute for Water Research (ICRA), Scientific and Technological Park of The University of Girona, Girona, Spain
| | - Alexandre Sànchez-Melsió
- Catalan Institute for Water Research (ICRA), Scientific and Technological Park of The University of Girona, Girona, Spain
| | - Hedi Ben Mansour
- Research Unit of Analysis and Process Applied to the Environmental - APAE Higher Institute of Applied Sciences and Technology Mahdia, University of Monastir, Monastir, Tunisia
| | - Carles M Borrego
- Catalan Institute for Water Research (ICRA), Scientific and Technological Park of The University of Girona, Girona, Spain; Group of Molecular Microbial Ecology, Institute of Aquatic Ecology, University of Girona, Girona, Spain
| | - José Luis Balcázar
- Catalan Institute for Water Research (ICRA), Scientific and Technological Park of The University of Girona, Girona, Spain.
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16
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de Toro M, Fernández J, García V, Mora A, Blanco J, de la Cruz F, Rodicio MR. Whole genome sequencing, molecular typing and in vivo virulence of OXA-48-producing Escherichia coli isolates including ST131 H30-Rx, H22 and H41 subclones. Sci Rep 2017; 7:12103. [PMID: 28935873 PMCID: PMC5608912 DOI: 10.1038/s41598-017-12015-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/31/2017] [Indexed: 12/23/2022] Open
Abstract
Carbapenem-resistant Enterobacteriaceae, including the increasingly reported OXA-48 Escherichia coli producers, are an emerging public health threat worldwide. Due to their alarming detection in our healthcare setting and their possible presence in the community, seven OXA-48-producing, extraintestinal pathogenic E. coli were analysed by whole genome sequencing as well as conventional tools, and tested for in vivo virulence. As a result, five E. coli OXA-48-producing subclones were detected (O25:H4-ST131/PST43-fimH30-virotype E; O25:H4-ST131/PST9-fimH22-virotype D5, O16:H5-ST131/PST506-fimH41; O25:H5-ST83/PST207 and O9:H25-ST58/PST24). Four ST131 and one ST83 isolates satisfied the ExPEC status, and all except the O16:H5 ST131 isolate were UPEC. All isolates exhibited local inflammatory response with extensive subcutaneous necrosis but low lethality when tested in a mouse sepsis model. The blaOXA-48 gene was located in MOBP131/IncL plasmids (four isolates) or within the chromosome (three ST131 H30-Rx isolates), carried by Tn1999-like elements. All, except the ST83 isolate, were multidrug-resistant, with additional plasmids acting as vehicles for the spread of various resistance genes. This is the first study to analyse the whole genome sequences of blaOXA-48-positive ST131, ST58 and ST83 E. coli isolates in conjunction with experimental data, and to evaluate the in vivo virulence of blaOXA-48 isolates, which pose an important challenge to patient management.
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Affiliation(s)
- María de Toro
- Plataforma de Genómica y Bioinformática, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Javier Fernández
- Departamento de Biología Funcional, Área de Microbiología, Universidad de Oviedo (UO), Oviedo, Spain.,Servicio de Microbiología, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Vanesa García
- Departamento de Biología Funcional, Área de Microbiología, Universidad de Oviedo (UO), Oviedo, Spain.,Laboratorio de Referencia de Escherichia coli (LREC), Departamento de Microbioloxía e Parasitoloxía, Facultade de Veterinaria, Universidade de Santiago de Compostela (USC), Lugo, Spain
| | - Azucena Mora
- Laboratorio de Referencia de Escherichia coli (LREC), Departamento de Microbioloxía e Parasitoloxía, Facultade de Veterinaria, Universidade de Santiago de Compostela (USC), Lugo, Spain
| | - Jorge Blanco
- Laboratorio de Referencia de Escherichia coli (LREC), Departamento de Microbioloxía e Parasitoloxía, Facultade de Veterinaria, Universidade de Santiago de Compostela (USC), Lugo, Spain
| | - Fernando de la Cruz
- Departamento de Biología Molecular and Instituto de Biomedicina y Biotecnología de Cantabria (IBBTEC), Universidad de Cantabria-CSIC, Santander, Spain
| | - M Rosario Rodicio
- Departamento de Biología Funcional, Área de Microbiología, Universidad de Oviedo (UO), Oviedo, Spain.
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17
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Ben Tanfous F, Alonso CA, Achour W, Ruiz-Ripa L, Torres C, Ben Hassen A. First Description of KPC-2-ProducingEscherichia coliand ST15 OXA-48-PositiveKlebsiella pneumoniaein Tunisia. Microb Drug Resist 2017; 23:365-375. [DOI: 10.1089/mdr.2016.0090] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Farah Ben Tanfous
- Université de Carthage, Faculté des Sciences de Bizerte, 7021, Tunis, Tunisie
- Service des Laboratoires, Centre National de Greffe de Moelle Osseuse, Tunis, Tunisie
- Faculté de Médecine de Tunis, Université de Tunis El Manar, UR 12ES02, Tunis, Tunisie
| | - Carla Andrea Alonso
- Área de Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
| | - Wafa Achour
- Service des Laboratoires, Centre National de Greffe de Moelle Osseuse, Tunis, Tunisie
- Faculté de Médecine de Tunis, Université de Tunis El Manar, UR 12ES02, Tunis, Tunisie
| | - Laura Ruiz-Ripa
- Área de Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
| | - Carmen Torres
- Área de Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
| | - Assia Ben Hassen
- Service des Laboratoires, Centre National de Greffe de Moelle Osseuse, Tunis, Tunisie
- Faculté de Médecine de Tunis, Université de Tunis El Manar, UR 12ES02, Tunis, Tunisie
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18
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Messaoudi A, Haenni M, Mansour W, Saras E, Bel Haj Khalifa A, Chaouch C, Naija W, Boujâafar N, Bouallègue O, Madec JY. ST147 NDM-1-producing Klebsiella pneumoniae spread in two Tunisian hospitals. J Antimicrob Chemother 2016; 72:315-316. [PMID: 27659734 DOI: 10.1093/jac/dkw401] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Aziza Messaoudi
- Unité de Recherche: Résistances Bactériennes Émergentes et Sécurité des Soins 'UR12SP37', Laboratoire de Microbiologie, Hôpital Universitaire Sahloul, Sousse, Tunisia
| | - Marisa Haenni
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
| | - Wejdene Mansour
- Unité de Recherche: Résistances Bactériennes Émergentes et Sécurité des Soins 'UR12SP37', Laboratoire de Microbiologie, Hôpital Universitaire Sahloul, Sousse, Tunisia
- Institut Supérieur des Sciences Appliquées et de Technologie de Mahdia, Université de Monastir, Monastir, Tunisia
| | - Estelle Saras
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
| | - Anis Bel Haj Khalifa
- Laboratoire de Microbiologie, Hopital Tahar Sfar, Mahdia, Tunisia
- Faculté de Pharmacie de Monastir, Université de Monastir, Monastir, Tunisia
| | - Cherifa Chaouch
- Unité de Recherche: Résistances Bactériennes Émergentes et Sécurité des Soins 'UR12SP37', Laboratoire de Microbiologie, Hôpital Universitaire Sahloul, Sousse, Tunisia
- Laboratoire de Microbiologie, Hopital Tahar Sfar, Mahdia, Tunisia
| | - Walid Naija
- Unité de Recherche: Résistances Bactériennes Émergentes et Sécurité des Soins 'UR12SP37', Laboratoire de Microbiologie, Hôpital Universitaire Sahloul, Sousse, Tunisia
- Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisia
| | - Noureddine Boujâafar
- Unité de Recherche: Résistances Bactériennes Émergentes et Sécurité des Soins 'UR12SP37', Laboratoire de Microbiologie, Hôpital Universitaire Sahloul, Sousse, Tunisia
- Faculté de Pharmacie de Monastir, Université de Monastir, Monastir, Tunisia
| | - Olfa Bouallègue
- Unité de Recherche: Résistances Bactériennes Émergentes et Sécurité des Soins 'UR12SP37', Laboratoire de Microbiologie, Hôpital Universitaire Sahloul, Sousse, Tunisia
- Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisia
| | - Jean-Yves Madec
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
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19
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Potter RF, D'Souza AW, Dantas G. The rapid spread of carbapenem-resistant Enterobacteriaceae. Drug Resist Updat 2016; 29:30-46. [PMID: 27912842 DOI: 10.1016/j.drup.2016.09.002] [Citation(s) in RCA: 252] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/23/2016] [Accepted: 09/07/2016] [Indexed: 02/07/2023]
Abstract
Carbapenems, our one-time silver bullet for multidrug resistant bacterial infections, are now threatened by widespread dissemination of carbapenem-resistant Enterobacteriaceae (CRE). Successful expansion of Enterobacteriaceae clonal groups and frequent horizontal gene transfer of carbapenemase expressing plasmids are causing increasing carbapenem resistance. Recent advances in genetic and phenotypic detection facilitate global surveillance of CRE diversity and prevalence. In particular, whole genome sequencing enabled efficient tracking, annotation, and study of genetic elements colocalized with carbapenemase genes on chromosomes and on plasmids. Improved characterization helps detail the co-occurrence of other antibiotic resistance genes in CRE isolates and helps identify pan-drug resistance mechanisms. The novel β-lactamase inhibitor, avibactam, combined with ceftazidime or aztreonam, is a promising CRE treatment compared to current colistin or tigecycline regimens. To halt increasing CRE-associated morbidity and mortality, we must continue quality, cooperative monitoring and urgently investigate novel treatments.
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Affiliation(s)
- Robert F Potter
- Center for Genome Sciences and System Biology, Washington University School of Medicine, 4515 McKinley Avenue, Campus Box 8510, St. Louis, MO 63110, USA
| | - Alaric W D'Souza
- Center for Genome Sciences and System Biology, Washington University School of Medicine, 4515 McKinley Avenue, Campus Box 8510, St. Louis, MO 63110, USA
| | - Gautam Dantas
- Center for Genome Sciences and System Biology, Washington University School of Medicine, 4515 McKinley Avenue, Campus Box 8510, St. Louis, MO 63110, USA; Department of Pathology & Immunology, Washington University School of Medicine, 660 South Euclid Ave, St. Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University in Saint Louis, 1 Brookings Drive, St. Louis, MO 63130, USA; Department of Molecular Microbiology, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, USA.
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20
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Mathlouthi N, Al-Bayssari C, Bakour S, Rolain JM, Chouchani C. RETRACTED ARTICLE: Prevalence and emergence of carbapenemases-producing Gram-negative bacteria in Mediterranean basin. Crit Rev Microbiol 2016; 43:43-61. [DOI: 10.3109/1040841x.2016.1160867] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Najla Mathlouthi
- Université Tunis El-Manar, Faculté des Sciences de Tunis, Laboratoire des Microorganismes et Biomolécules Actives, Campus Universitaire, El-Manar II, Tunisia
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), UM 63, CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France
- Université de Carthage, Institut Supérieur des Sciences et Technologies de l’Environnement de Borj-Cedria, Technopôle de Borj-Cedria, BP-1003, Hammam-Lif, Tunisia
| | - Charbel Al-Bayssari
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), UM 63, CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France
| | - Sofiane Bakour
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), UM 63, CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France
| | - Jean Marc Rolain
- Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), UM 63, CNRS 7278, IRD 198, INSERM 1095, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France
| | - Chedly Chouchani
- Université Tunis El-Manar, Faculté des Sciences de Tunis, Laboratoire des Microorganismes et Biomolécules Actives, Campus Universitaire, El-Manar II, Tunisia
- Université de Carthage, Institut Supérieur des Sciences et Technologies de l’Environnement de Borj-Cedria, Technopôle de Borj-Cedria, BP-1003, Hammam-Lif, Tunisia
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21
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Epidemiology of Carbapenem Resistant Klebsiella pneumoniae Infections in Mediterranean Countries. Mediterr J Hematol Infect Dis 2016; 8:e2016032. [PMID: 27441063 PMCID: PMC4943068 DOI: 10.4084/mjhid.2016.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 05/25/2016] [Indexed: 01/27/2023] Open
Abstract
Infections by Carbapenem-Resistant Enterobacteriaceae (CRE), in particular, carbapenem-resistant Klebsiella pneumoniae (CRKp), are a significant public health challenge worldwide. Resistance to carbapenems in enterobacteriaceae is linked to different mechanisms, including the production of the various types of enzymes like KPC, VIM, IMP, NDM, and OXA-48. Despite several attempts to control the spread of these infections at the local and national level, the epidemiological situation for CRKp had worsened in the last years in the Mediterranean area. The rate and types of CRKp isolates greatly differ in the various Mediterranean countries. KPC-producing K. pneumoniae is diffused particularly in the European countries bordering the Mediterranean Sea and is endemic in Greece and Italy. On the contrary, OXA-48-producing K. pneumoniae is endemic in Turkey and Malta and diffused at inter-regional level particularly in some North African and Middle East countries. The spread of these multiresistant pathogens in the world and the Mediterranean countries has been related to various epidemiological factors including the international transfer of patients coming from endemic areas.
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22
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Glupczynski Y, Evrard S, Ote I, Mertens P, Huang TD, Leclipteux T, Bogaerts P. Evaluation of two new commercial immunochromatographic assays for the rapid detection of OXA-48 and KPC carbapenemases from cultured bacteria. J Antimicrob Chemother 2016; 71:1217-22. [DOI: 10.1093/jac/dkv472] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/09/2015] [Indexed: 01/09/2023] Open
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23
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Grami R, Mansour W, Ben Haj Khalifa A, Dahmen S, Chatre P, Haenni M, Aouni M, Madec JY. Emergence of ST147 Klebsiella pneumoniae Producing OXA-204 Carbapenemase in a University Hospital, Tunisia. Microb Drug Resist 2015; 22:137-40. [PMID: 26447939 DOI: 10.1089/mdr.2014.0278] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Molecular features of the first carbapenem-resistant Klebsiella pneumoniae isolates (KP1 and KP2) from the University Hospital Tahar Sfar, Tunisia, were investigated. Antimicrobial susceptibility testing, multilocus sequence typing, S1 nuclease pulsed-field gel electrophoresis, Southern blot, and polymerase chain reaction (PCR)-based replicon typing were performed. Extended-spectrum β-lactamases and carbapenemase genes were detected by PCR and sequencing. Both isolates were multidrug resistant. KP1 was of sequence type (ST) ST101 and exhibited blaCTX-M-15 and blaTEM-1 on an untypeable plasmid and blaOXA-48 on an IncL/M plasmid. KP2 was genetically unrelated to KP1 (ST147) and harbored an IncA/C plasmid carrying blaCMY-4 and the blaOXA-48 derivative gene: blaOXA-204. This study reports the second case worldwide of an OXA-204-producing K. pneumoniae isolate from the same country, however, in a different genetic background.
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Affiliation(s)
- Raoudha Grami
- 1 Unité Antibiorésistance et Virulence Bactériennes , ANSES Site de Lyon, Lyon, France .,2 Laboratoire des Maladies Transmissibles et Substances Biologiquement Actives , Faculté de Pharmacie, Monastir, Tunisie
| | - Wejdene Mansour
- 2 Laboratoire des Maladies Transmissibles et Substances Biologiquement Actives , Faculté de Pharmacie, Monastir, Tunisie.,3 Unité de Recherche: Résistances Bactériennes Émergentes et Sécurité des Soins "UR12SP37," Laboratoire de Microbiologie, Hôpital Universitaire Sahloul , Sousse, Tunisie
| | | | - Safia Dahmen
- 3 Unité de Recherche: Résistances Bactériennes Émergentes et Sécurité des Soins "UR12SP37," Laboratoire de Microbiologie, Hôpital Universitaire Sahloul , Sousse, Tunisie
| | - Pierre Chatre
- 1 Unité Antibiorésistance et Virulence Bactériennes , ANSES Site de Lyon, Lyon, France
| | - Marisa Haenni
- 1 Unité Antibiorésistance et Virulence Bactériennes , ANSES Site de Lyon, Lyon, France
| | - Mahjoub Aouni
- 2 Laboratoire des Maladies Transmissibles et Substances Biologiquement Actives , Faculté de Pharmacie, Monastir, Tunisie
| | - Jean-Yves Madec
- 1 Unité Antibiorésistance et Virulence Bactériennes , ANSES Site de Lyon, Lyon, France
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24
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Ma L, Wang JT, Wu TL, Siu LK, Chuang YC, Lin JC, Lu MC, Lu PL. Emergence of OXA-48-Producing Klebsiella pneumoniae in Taiwan. PLoS One 2015; 10:e0139152. [PMID: 26414183 PMCID: PMC4587373 DOI: 10.1371/journal.pone.0139152] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 09/08/2015] [Indexed: 12/24/2022] Open
Abstract
The isolation of OXA-48-producing Enterobacteriaceae has increased dramatically in Mediterranean countries in the past 10 years, and has recently emerged in Asia. Between January 2012 and May 2014, a total of 760 carbapenem non-susceptible Klebsiella pneumoniae (CnSKP) isolates were collected during a Taiwan national surveillance. Carbapenemases were detected in 210 CnSKP isolates (27.6%), including 162 KPC-2 (n = 1), KPC-3, KPC-17, and NDM-1 (n = 1 each), OXA-48 (n = 4), IMP-8 (n = 18), and VIM-1 (n = 24). The four blaOXA-48 CnSKP isolates were detected in late 2013. Herein we report the emergence OXA-48-producing K. pneumoniae isolates in Taiwan. PFGE analysis revealed that the four isolates belonged to three different pulsotypes. Three isolates harboured blaCTX-M genes and belonged to MLST type ST11. In addition, the plasmids belonged to the incompatibility group, IncA/C. One isolate belonged to ST116 and the plasmid incompatibility group was non-typeable. The sequence upstream of the blaOXA-48 gene in all four isolates was identical to pKPOXA-48N1, a blaOXA-48-carrying plasmid. This is the first report of OXA-48-producing Enterobacteriaceae in Taiwan and the second report to identify blaOXA-48 on an IncA/C plasmid in K. pneumoniae. Given that three isolates belong to the same pandemic clone (ST11) and possess the IncA/C plasmid and similar plasmid digestion profile that indicated the role of clonal spread or plasmid for dissemination of blaOXA-48 gene, the emergence of OXA-48-producing K. pneumoniae in Taiwan is of great concern.
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Affiliation(s)
- Ling Ma
- National Institutes of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsu-Lan Wu
- Department of Clinical Pathology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - L. Kristopher Siu
- National Institutes of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
| | - Yin-Ching Chuang
- Department of Internal Medicine and Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Jung-Chung Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Min-Chi Lu
- Section of Infectious Diseases, Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- * E-mail: (MCL); (PLL)
| | - Po-Liang Lu
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail: (MCL); (PLL)
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Nordmann P, Poirel L. The difficult-to-control spread of carbapenemase producers among Enterobacteriaceae worldwide. Clin Microbiol Infect 2015; 20:821-30. [PMID: 24930781 DOI: 10.1111/1469-0691.12719] [Citation(s) in RCA: 487] [Impact Index Per Article: 54.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The spread of carbapenemase producers in Enterobacteriaceae has now been identified worldwide. Three main carbapenemases have been reported; they belong to three classes of β-lactamases, which are KPC, NDM, and OXA-48. The main reservoirs of KPC are Klebsiella pneumoniae in the USA, Israel, Greece, and Italy, those of NDM are K. pneumoniae and Escherichia coli in the Indian subcontinent, and those of OXA-48 are K. pneumoniae and Escherichia coli in North Africa and Turkey. KPC producers have been mostly identified among nosocomial isolates, whereas NDM and OXA-48 producers are both nosocomial and community-acquired pathogens. Control of their spread is still possible in hospital settings, and relies on the use of rapid diagnostic techniques and the strict implemention of hygiene measures.
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Affiliation(s)
- P Nordmann
- Medical and Molecular Microbiology Unit, Department of Medicine, Faculty of Science, University of Fribourg, Fribourg, Switzerland; Hôpital Fribourgeois - Hôpital Cantonal de Fribourg, Fribourg, Switzerland; INSERM U914, South-Paris Medical School, K.-Bicêtre, France
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Charfi K, Mansour W, Khalifa ABH, Mastouri M, Aouni M, Mammeri H. Emergence of OXA-204 β-lactamase in Tunisia. Diagn Microbiol Infect Dis 2015; 82:314-7. [PMID: 26001616 DOI: 10.1016/j.diagmicrobio.2015.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/06/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
Abstract
A retrospective epidemiological survey was carried out to determine the prevalence of carbapenemase producers among enterobacterial clinical isolates recovered in the center of maternity and neonatology of Monastir (Tunisia). PCR screening identified 1 OXA-48 and 2 OXA-204 producers, which coexpressed the CTX-M-15 or the CMY-4 β-lactamases. PCR mapping showed that the bla(OXA-48) gene was carried by a Tn1999.2 transposon, whereas the bla(OXA-204) gene was part of the Tn2016 transposon-like structure. The OXA-48- or OXA-204-producing Klebsiella pneumoniae clinical isolates and the OXA-204-expressing Escherichia coli clinical isolate belonged to the widespread sequence types ST11, ST101, and ST617, respectively. The OXA-204 enzyme, which is a point derivative of the OXA-48 carbapenemase, had hitherto been reported in 2013 from K. pneumoniae isolate. Our study shows for the first time the dissemination of this resistance marker in E. coli strain. The coproduction of OXA-204 with CTX-M-15 and CMY-4 enzymes may potentiate the risk of multiresistance and may enhance the risk of dissemination.
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Affiliation(s)
- Karama Charfi
- Laboratoire des Maladies Transmissibles et Substances Biologiquement Actives (LR99-ES27), Faculté de Pharmacie avenue Avicenne, 5000 Monastir, Tunisia
| | - Wejdène Mansour
- Laboratoire des Maladies Transmissibles et Substances Biologiquement Actives (LR99-ES27), Faculté de Pharmacie avenue Avicenne, 5000 Monastir, Tunisia.
| | - Anis Ben Haj Khalifa
- Laboratoire de Microbiologie, Centre Hospitalo-Universitaire Taher Sfar, 5100 Mahdia, Tunisia
| | - Maha Mastouri
- Laboratoire des Maladies Transmissibles et Substances Biologiquement Actives (LR99-ES27), Faculté de Pharmacie avenue Avicenne, 5000 Monastir, Tunisia
| | - Mahjoub Aouni
- Laboratoire des Maladies Transmissibles et Substances Biologiquement Actives (LR99-ES27), Faculté de Pharmacie avenue Avicenne, 5000 Monastir, Tunisia
| | - Hedi Mammeri
- Service de Bactériologie, Centre Hospitalo-Universitaire d'Amiens, Hôpital Sud, 80054 Amiens, France; INSERM, IAME, UMR 1137, F-75018 Paris, France
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First report of an OXA-48-producing multidrug-resistant Proteus mirabilis strain from Gaza, Palestine. Antimicrob Agents Chemother 2015; 59:4305-7. [PMID: 25896692 DOI: 10.1128/aac.00565-15] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 04/11/2015] [Indexed: 01/11/2023] Open
Abstract
We report the first multidrug-resistant Proteus mirabilis strain producing the carbapenemase OXA-48 (Pm-OXA-48) isolated at Al-Shifa hospital in Gaza, Palestine. Draft genome sequencing of Pm-OXA-48 identified 16 antimicrobial resistance genes, encoding resistance to β-lactams, aminoglycosides, fluoroquinolones, phenicols, streptothricin, tetracycline, and trimethoprim-sulfamethoxazole. Complete sequencing of the bla(OXA-48)-harboring plasmid revealed that it is a 72 kb long IncL/M plasmid, harboring carbapenemase gene bla(OXA-48), extended spectrum β-lactamase gene bla(CTX-M-14), and aminoglycoside resistance genes strA, strB, and aph(3')-VIb.
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Evaluation of a new phenotypic OXA-48 disk test for differentiation of OXA-48 carbapenemase-producing Enterobacteriaceae clinical isolates. J Clin Microbiol 2015; 53:1245-51. [PMID: 25653401 DOI: 10.1128/jcm.03318-14] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The current phenotypic methods for detecting carbapenemase-producing Enterobacteriaceae (CPE) allow differentiation between class A and B carbapenemases, but they cannot confirm in a single test class D OXA-48 carbapenemase producers. In this study, we evaluated a new phenotypic test, the OXA-48 disk test, which is based on an imipenem disk and two blank disks adjacent to the imipenem disk, loaded with the tested strain and impregnated with EDTA and EDTA plus phenyl boronic acid (PBA), respectively. The evaluation of the OXA-48 disk test was performed with 81 genotypically confirmed OXA-48-type-producing Enterobacteriaceae isolates (41 extended-spectrum β-lactamase [ESBL] producers, 3 AmpC producers, and 37 non-ESBL, non-AmpC producers). To measure the specificity of the test, 173 genotypically confirmed OXA-48-negative Enterobacteriaceae isolates (57 Klebsiella pneumoniae carbapenemase [KPC] producers, 34 VIM producers, 23 KPC/VIM producers, 22 NDM producers, and 37 AmpC or ESBL producers and porin deficient) that were nonsusceptible to at least one carbapenem were chosen for testing. Using the imipenem disk and the distortion of the inhibition halo around both blank disks containing EDTA and EDTA/PBA, the test differentiated all but 3 of the 81 OXA-48 producers (sensitivity of 96.3%). The test was negative for OXA-48 production in all but 4 of the 173 carbapenem-nonsusceptible isolates producing other carbapenemases, AmpCs, or ESBLs (specificity of 97.7%). This evaluation shows that the OXA-48 disk test is an accurate phenotypic method for the direct differentiation of OXA-48-producing Enterobacteriaceae. Its use along with combined disk tests employing inhibitor-supplemented carbapenem disks might allow the differentiation of the currently known carbapenemase types in Enterobacteriaceae species and provide important infection control information.
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Hammoudi D, Ayoub Moubareck C, Aires J, Adaime A, Barakat A, Fayad N, Hakime N, Houmani M, Itani T, Najjar Z, Suleiman M, Sarraf R, Karam Sarkis D. Countrywide spread of OXA-48 carbapenemase in Lebanon: surveillance and genetic characterization of carbapenem-non-susceptible Enterobacteriaceae in 10 hospitals over a one-year period. Int J Infect Dis 2014; 29:139-44. [PMID: 25449248 DOI: 10.1016/j.ijid.2014.07.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 05/26/2014] [Accepted: 07/24/2014] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To detect, characterize, and assess the genetic clonality of carbapenem-non-susceptible Enterobacteriaceae in 10 Lebanese hospitals in 2012. METHODS Selected Enterobacteriaceae isolates with reduced susceptibility to carbapenems were subject to phenotypic study including antibiotic susceptibility, cloxacillin effect, modified Hodge test, and activity of efflux pump inhibitor. Carbapenemase genes were detected using PCR; clonal relatedness was studied by pulsed field gel electrophoresis. RESULTS Out of 8717 Enterobacteriaceae isolated in 2012, 102 (1.2%) showed reduced susceptibility to carbapenems. Thirty-one (70%) of the 44 studied clinical isolates harbored blaOXA-48, including 15 Klebsiella pneumoniae, eight Escherichia coli, four Serratia marcescens, three Enterobacter cloacae, and one Morganella morganii. The majority of OXA-48 producers co-secreted an extended-spectrum beta-lactamase, while one had an acquired AmpC of the ACC type. In the non-OXA-48 producers, carbapenem resistance was attributed to the production of acquired AmpC cephalosporinases of MOX or CIT type, outer membrane impermeability, and/or efflux pump overproduction. DNA fingerprints revealed that OXA-48 producers were different, except for clonal relatedness among four K. pneumoniae, two E. coli, two E. cloacae, and three S. marcescens. CONCLUSIONS Nosocomial carbapenem-non-susceptible Enterobacteriaceae are moderately spread in Lebanon and the predominant mechanism is OXA-48 production.
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Affiliation(s)
- D Hammoudi
- Microbiology Laboratory, School of Pharmacy, Saint-Joseph University, Beirut, Lebanon; Rodolphe Mérieux Laboratory, Beirut, Lebanon.
| | - C Ayoub Moubareck
- Microbiology Laboratory, School of Pharmacy, Saint-Joseph University, Beirut, Lebanon; Rodolphe Mérieux Laboratory, Beirut, Lebanon; Department of Natural Science and Public Health, College of Sustainability Sciences and Humanities, Zayed University, Dubai, United Arab Emirates
| | - J Aires
- EA4065, Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - A Adaime
- Microbiology Laboratory, School of Pharmacy, Saint-Joseph University, Beirut, Lebanon; Rodolphe Mérieux Laboratory, Beirut, Lebanon; Clinique du Levant, Beirut, Lebanon
| | - A Barakat
- Bellevue Medical Center, Beirut, Lebanon
| | - N Fayad
- Secours Populaire Libanais, Nabatieh, South Lebanon
| | - N Hakime
- Saint George Hospital and University of Balamand, Beirut, Lebanon
| | - M Houmani
- Labib Medical Center, Saida, South Lebanon
| | - T Itani
- Microbiology Laboratory, School of Pharmacy, Saint-Joseph University, Beirut, Lebanon; Rodolphe Mérieux Laboratory, Beirut, Lebanon; Arz Hospital, Beirut, Lebanon
| | - Z Najjar
- Chtoura Hospital, Bekaa, Lebanon
| | | | - R Sarraf
- Monla Hospital, Tripoli, North Lebanon
| | - D Karam Sarkis
- Microbiology Laboratory, School of Pharmacy, Saint-Joseph University, Beirut, Lebanon; Rodolphe Mérieux Laboratory, Beirut, Lebanon
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30
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Manenzhe RI, Zar HJ, Nicol MP, Kaba M. The spread of carbapenemase-producing bacteria in Africa: a systematic review. J Antimicrob Chemother 2014; 70:23-40. [PMID: 25261423 DOI: 10.1093/jac/dku356] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Carbapenems are the last line of defence against ever more prevalent MDR Gram-negative bacteria, but their efficacy is threatened worldwide by bacteria that produce carbapenemase enzymes. The epidemiology of bacteria producing carbapenemases has been described in considerable detail in Europe, North America and Asia; however, little is known about their spread and clinical relevance in Africa. METHODS We systematically searched in PubMed, EBSCOhost, Web of Science, Scopus, Elsevier Masson Consulte and African Journals Online, international conference proceedings, published theses and dissertations for studies reporting on carbapenemase-producing bacteria in Africa. We included articles published in English or French up to 28 February 2014. We calculated the prevalence of carbapenemase producers only including studies where the total number of isolates tested was at least 30. RESULTS Eighty-three studies were included and analysed. Most studies were conducted in North Africa (74%, 61/83), followed by Southern Africa (12%, 10/83), especially South Africa (90%, 9/10), West Africa (8%, 7/83) and East Africa (6%, 6/83). Carbapenemase-producing bacteria were isolated from humans, the hospital environment and community environmental water samples, but not from animals. The prevalence of carbapenemase-producing isolates in hospital settings ranged from 2.3% to 67.7% in North Africa and from 9% to 60% in sub-Saharan Africa. CONCLUSIONS Carbapenemase-producing bacteria have been described in many African countries; however, their prevalence is poorly defined and has not been systematically studied. Antibiotic stewardship and surveillance systems, including molecular detection and genotyping of resistant isolates, should be implemented to monitor and reduce the spread of carbapenemase-producing bacteria.
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Affiliation(s)
- Rendani I Manenzhe
- Division of Medical Microbiology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Mark P Nicol
- Division of Medical Microbiology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Institute for Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Mamadou Kaba
- Division of Medical Microbiology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Institute for Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Epidemiology of carbapenemase-producing Enterobacteriaceae and Acinetobacter baumannii in Mediterranean countries. BIOMED RESEARCH INTERNATIONAL 2014; 2014:305784. [PMID: 24955354 PMCID: PMC4052623 DOI: 10.1155/2014/305784] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 04/22/2014] [Indexed: 01/17/2023]
Abstract
The emergence and global spread of carbapenemase-producing Enterobacteriaceae and Acinetobacter baumannii are of great concern to health services worldwide. These β-lactamases hydrolyse almost all β-lactams, are plasmid-encoded, and are easily transferable among bacterial species. They are mostly of the KPC, VIM, IMP, NDM, and OXA-48 types. Their current extensive spread worldwide in Enterobacteriaceae is an important source of concern. Infections caused by these bacteria have limited treatment options and have been associated with high mortality rates. Carbapenemase producers are mainly identified among Klebsiella pneumoniae, Escherichia coli, and A. baumannii and still mostly in hospital settings and rarely in the community. The Mediterranean region is of interest due to a great diversity and population mixing. The prevalence of carbapenemases is particularly high, with this area constituting one of the most important reservoirs. The types of carbapenemase vary among countries, partially depending on the population exchange relationship between the regions and the possible reservoirs of each carbapenemase. This review described the epidemiology of carbapenemases produced by enterobacteria and A. baumannii in this part of the world highlighting the worrisome situation and the need to screen and detect these enzymes to prevent and control their dissemination.
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Dautzenberg MJ, Ossewaarde JM, de Kraker ME, van der Zee A, van Burgh S, de Greeff SC, Bijlmer HA, Grundmann H, Cohen Stuart JW, Fluit AC, Troelstra A, Bonten M. Successful control of a hospital-wide outbreak of OXA-48 producing Enterobacteriaceae in the Netherlands, 2009 to 2011. Euro Surveill 2014; 19. [DOI: 10.2807/1560-7917.es2014.19.9.20723] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- M J Dautzenberg
- Department of Medical Microbiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J M Ossewaarde
- Department of Medical Microbiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - M E de Kraker
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - A van der Zee
- Department of Medical Microbiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - S van Burgh
- Department of Medical Microbiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - S C de Greeff
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - H A Bijlmer
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - H Grundmann
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- University Medical Center Groningen, University of Groningen, the Netherlands
| | - J W Cohen Stuart
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A C Fluit
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A Troelstra
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M Bonten
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Espedido BA, Steen JA, Ziochos H, Grimmond SM, Cooper MA, Gosbell IB, van Hal SJ, Jensen SO. Whole genome sequence analysis of the first Australian OXA-48-producing outbreak-associated Klebsiella pneumoniae isolates: the resistome and in vivo evolution. PLoS One 2013; 8:e59920. [PMID: 23555831 PMCID: PMC3612081 DOI: 10.1371/journal.pone.0059920] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 02/20/2013] [Indexed: 11/19/2022] Open
Abstract
Whole genome sequencing was used to characterize the resistome of intensive care unit (ICU) outbreak-associated carbapenem-resistant K. pneumoniae isolates. Importantly, and of particular concern, the carbapenem-hydrolyzing β-lactamase gene blaOXA-48 and the extended-spectrum β-lactamase gene blaCTX-M-14, were identified on a single broad host-range conjugative plasmid. This represents the first report of blaOXA-48 in Australia and highlights the importance of resistance gene surveillance, as such plasmids can silently spread amongst enterobacterial populations and have the potential to drastically limit treatment options. Furthermore, the in vivo evolution of these isolates was also examined after 18 months of intra-abdominal carriage in a patient that transited through the ICU during the outbreak period. Reflecting the clonality of K. pneumoniae, only 11 single nucleotide polymorphisms (SNPs) were accumulated during this time-period and many of these were associated with genes involved in tolerance/resistance to antibiotics, metals or organic solvents, and transcriptional regulation. Collectively, these SNPs are likely to be associated with changes in virulence (at least to some extent) that have refined the in vivo colonization capacity of the original outbreak isolate.
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Affiliation(s)
- Björn A. Espedido
- Antibiotic Resistance and Mobile Elements Group, School of Medicine, University of Western Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, New South Wales, Australia
| | - Jason A. Steen
- Queensland Centre for Medical Genomics, University of Queensland, Queensland, Australia
- Institute for Molecular Bioscience, University of Queensland, Queensland, Australia
| | - Helen Ziochos
- Sydney South Western Pathology Service, NSW Pathology, New South Wales, Australia
| | - Sean M. Grimmond
- Queensland Centre for Medical Genomics, University of Queensland, Queensland, Australia
- Institute for Molecular Bioscience, University of Queensland, Queensland, Australia
| | - Matthew A. Cooper
- Institute for Molecular Bioscience, University of Queensland, Queensland, Australia
| | - Iain B. Gosbell
- Antibiotic Resistance and Mobile Elements Group, School of Medicine, University of Western Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, New South Wales, Australia
- Sydney South Western Pathology Service, NSW Pathology, New South Wales, Australia
| | - Sebastiaan J. van Hal
- Antibiotic Resistance and Mobile Elements Group, School of Medicine, University of Western Sydney, New South Wales, Australia
- Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital, New South Wales, Australia
- * E-mail: (SJvH); (SOJ)
| | - Slade O. Jensen
- Antibiotic Resistance and Mobile Elements Group, School of Medicine, University of Western Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, New South Wales, Australia
- * E-mail: (SJvH); (SOJ)
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Saïdani M, Hammami S, Kammoun A, Slim A, Boutiba-Ben Boubaker I. Emergence of carbapenem-resistant OXA-48 carbapenemase-producing Enterobacteriaceae in Tunisia. J Med Microbiol 2012; 61:1746-1749. [DOI: 10.1099/jmm.0.045229-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- M. Saïdani
- Laboratoire de Bactériologie Virologie, Hôpital Charles Nicolle, Boulevard 9 Avril, 1006, Tunis, Tunisia
| | - S. Hammami
- Laboratoire de Bactériologie Virologie, Hôpital Charles Nicolle, Boulevard 9 Avril, 1006, Tunis, Tunisia
| | - A. Kammoun
- Laboratoire de Bactériologie Virologie, Hôpital Charles Nicolle, Boulevard 9 Avril, 1006, Tunis, Tunisia
| | - A. Slim
- Laboratoire de Bactériologie Virologie, Hôpital Charles Nicolle, Boulevard 9 Avril, 1006, Tunis, Tunisia
| | - I. Boutiba-Ben Boubaker
- Laboratoire de Bactériologie Virologie, Hôpital Charles Nicolle, Boulevard 9 Avril, 1006, Tunis, Tunisia
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Dahmen S, Mansour W, Charfi K, Boujaafar N, Arlet G, Bouallègue O. Imipenem Resistance inKlebsiella pneumoniaeIs Associated to the Combination of Plasmid-Mediated CMY-4 AmpC β-Lactamase and Loss of an Outer Membrane Protein. Microb Drug Resist 2012; 18:479-83. [DOI: 10.1089/mdr.2011.0214] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Safia Dahmen
- Infections with Multiresistant Bacteria to Antibiotics (UR/29/04), Department of Microbiology, University Hospital of Sahloul, Sousse, Tunisia
- Department of Bacteriology, University of Medicine Pierre and Marie Curie, Paris VI, Paris, France
| | - Wejdène Mansour
- Infections with Multiresistant Bacteria to Antibiotics (UR/29/04), Department of Microbiology, University Hospital of Sahloul, Sousse, Tunisia
| | - Karama Charfi
- Infections with Multiresistant Bacteria to Antibiotics (UR/29/04), Department of Microbiology, University Hospital of Sahloul, Sousse, Tunisia
| | - Noureddine Boujaafar
- Infections with Multiresistant Bacteria to Antibiotics (UR/29/04), Department of Microbiology, University Hospital of Sahloul, Sousse, Tunisia
| | - Guillaume Arlet
- Department of Bacteriology, University of Medicine Pierre and Marie Curie, Paris VI, Paris, France
| | - Olfa Bouallègue
- Infections with Multiresistant Bacteria to Antibiotics (UR/29/04), Department of Microbiology, University Hospital of Sahloul, Sousse, Tunisia
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36
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Mnif B, Ktari S, Chaari A, Medhioub F, Rhimi F, Bouaziz M, Hammami A. Nosocomial dissemination of Providencia stuartii isolates carrying bla OXA-48, bla PER-1, bla CMY-4 and qnrA6 in a Tunisian hospital. J Antimicrob Chemother 2012; 68:329-32. [PMID: 23014719 DOI: 10.1093/jac/dks386] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To report an outbreak due to Providencia stuartii isolates carrying bla(OXA-48), bla(PER-1), bla(CMY-4) and qnrA6 in a Tunisian hospital in 2011. METHODS Eight intensive care unit (ICU) patients infected/colonized by extended-spectrum β-lactamase (ESBL)-producing P. stuartii between March and May 2011 were included. Molecular epidemiology was studied by PFGE. Antibiotic resistance genes were analysed by PCR and sequencing and the plasmid incompatibility group by a PCR-based replicon typing scheme. RESULTS Eight patients were colonized with ESBL-producing P. stuartii isolates. All these isolates were clonally related and found to carry bla(OXA-48), bla(PER-1), bla(CMY-4), qnrA6 and aac-6'-Ib genes on the same self-conjugative IncA/C plasmid. The same strain was also cultured from environmental samples in the ICU. All these isolates were susceptible to carbapenems. Only one colonized patient developed P. stuartii pleurisy and was effectively treated with imipenem alone. CONCLUSIONS This is the first report of an outbreak due to P. stuartii isolates carrying bla(OXA-48) in Tunisia. The simultaneous expression of various resistance genes (bla(OXA-48), bla(CMY-4), bla(PER-1), qnrA and aac-6'-Ib) by P. stuartii isolates is alarming.
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Affiliation(s)
- Basma Mnif
- Laboratory of Microbiology, University Hospital Center of Habib Bourguiba, Sfax, Tunisia.
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Poirel L, Potron A, Nordmann P. OXA-48-like carbapenemases: the phantom menace. J Antimicrob Chemother 2012; 67:1597-606. [PMID: 22499996 DOI: 10.1093/jac/dks121] [Citation(s) in RCA: 659] [Impact Index Per Article: 54.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OXA-48-type carbapenem-hydrolysing class D β-lactamases are increasingly reported in enterobacterial species. To date, six OXA-48-like variants have been identified, with OXA-48 being the most widespread. They differ by a few amino acid substitutions or deletions (one to five amino acids). The enzymes hydrolyse penicillins at a high level and carbapenems at a low level, sparing broad-spectrum cephalosporins, and are not susceptible to β-lactamase inhibitors. When combining permeability defects, OXA-48-like producers may exhibit a high level of resistance to carbapenems. OXA-163 is an exception, hydrolysing broad-spectrum cephalosporins but carbapenems at a very low level, and being susceptible to β-lactamase inhibitors. The bla(OXA-48)-type genes are always plasmid-borne and have been identified in association with insertion sequences involved in their acquisition and expression. The current spread of the bla(OXA-48) gene is mostly linked to the dissemination of a single IncL/M-type self-transferable plasmid of 62 kb that does not carry any additional resistance gene. OXA-48-type carbapenemases have been identified mainly from North African countries, the Middle East, Turkey and India, those areas constituting the most important reservoirs; however, occurrence of OXA-48 producers in European countries is now well documented, with some reported hospital outbreaks. Since many OXA-48-like producers do not exhibit resistance to broad-spectrum cephalosporins, or only decreased susceptibility to carbapenems, their recognition and detection can be challenging. Adequate screening and detection methods are therefore required to prevent and control their dissemination.
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Affiliation(s)
- Laurent Poirel
- Service de Bactériologie-Virologie, INSERM U914 Emerging Resistance to Antibiotics, Hôpital de Bicêtre, Faculté de Médecine et Université Paris-Sud, 94275 K.-Bicêtre, France.
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OXA-163-producing Klebsiella pneumoniae in Cairo, Egypt, in 2009 and 2010. J Clin Microbiol 2012; 50:2489-91. [PMID: 22518851 DOI: 10.1128/jcm.06710-11] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Two genetically unrelated OXA-163-carrying Klebsiella pneumoniae strains were identified from two infection cases in June 2009 and May 2010 in Cairo, Egypt. OXA-163-producing Enterobacteriaceae had been previously reported in Argentina only. Both patients had no history of travel abroad. The emergence of this newly recognized OXA-48-related β-lactamase able to hydrolyze cephalosporins and carbapenems is especially worrying in a geographic area where OXA-48 is endemic and effective surveillance for antibiotic resistance is largely unaffordable.
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Emergence of OXA-48-type carbapenemase-producing Enterobacteriaceae in German hospitals. Antimicrob Agents Chemother 2012; 56:2125-8. [PMID: 22290940 DOI: 10.1128/aac.05315-11] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nine carbapenem-resistant Enterobacteriaceae isolates collected from eight patients in five German hospitals were investigated. Six isolates produced the OXA-48 carbapenemase, and three isolates produced OXA-162, which is a point mutant form of OXA-48. Both carbapenemase genes were located on IncL/M-type conjugative plasmids. Insertion sequence IS1999 (truncated or not by IS1R) was located upstream of the bla(OXA-48) and bla(OXA-162) genes in all of the isolates. Pulsed-field gel electrophoresis typing indicated the clonal transmission of an OXA-48-producing Klebsiella pneumoniae strain in two hospitals.
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Rapid emergence and spread of OXA-48-producing carbapenem-resistant Enterobacteriaceae isolates in Belgian hospitals. Int J Antimicrob Agents 2011; 39:168-72. [PMID: 22115539 DOI: 10.1016/j.ijantimicag.2011.10.005] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 10/07/2011] [Accepted: 10/10/2011] [Indexed: 11/22/2022]
Abstract
During a polymerase chain reaction (PCR)-based surveillance study of β-lactam resistance, 19 OXA-48-positive enterobacterial isolates were detected at nine Belgian hospitals from January 2010 to April 2011. Most cases were presumed to have been locally acquired and were detected in patients who had not travelled abroad. Clonally related outbreaks occurred in two different cities. The majority of isolates co-produced several β-lactamases as well as non-β-lactam resistance genes. This report highlights the rapid emergence and spread of OXA-48-producing Enterobacteriaceae in Belgium.
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Potron A, Kalpoe J, Poirel L, Nordmann P. European dissemination of a single OXA-48-producing Klebsiella pneumoniae clone. Clin Microbiol Infect 2011; 17:E24-6. [PMID: 21973185 DOI: 10.1111/j.1469-0691.2011.03669.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A Klebsiella pneumoniae isolate with decreased susceptibility to carbapenems was isolated in April 2011 in a hospital in Amsterdam (the Netherlands) and later found to be the source of an important outbreak in a Rotterdam hospital. The strain, belonging to sequence type (ST) 395, carried the bla(OXA-48) gene located onto a c 62-kb conjugative plasmid, together with the extended-spectrum β-lactamase gene bla(CTX-M-15) . It was closely related or identical to other OXA-48-positive Klebsiella pneumoniae isolates belonging to the same ST type and identified in France and Morocco. This study sheds light on the European dissemination of a single OXA-48 K. pneumoniae clone.
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Affiliation(s)
- A Potron
- Service de Bactériologie-Virologie, INSERM U914 Emerging Resistance to Antibiotics, Hôpital de Bicêtre, Assistance Publique/Hôpitaux de Paris, Faculté de Médecine et Université Paris-Sud, K. Bicêtre, France
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Introduction of OXA-48-producing Enterobacteriaceae to Israeli hospitals by medical tourism. J Antimicrob Chemother 2011; 66:2763-6. [DOI: 10.1093/jac/dkr382] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lahlaoui H, Poirel L, Barguellil F, Moussa MB, Nordmann P. Carbapenem-hydrolyzing class D β-lactamase OXA-48 in Klebsiella pneumoniae isolates from Tunisia. Eur J Clin Microbiol Infect Dis 2011; 31:937-9. [PMID: 21915739 DOI: 10.1007/s10096-011-1389-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 08/11/2011] [Indexed: 10/17/2022]
Abstract
Two carbapenem-resistant Klebsiella pneumoniae isolates producing the plasmid-encoded carbapenem-hydrolyzing OXA-48 were identified. These isolates, recovered from two patients hospitalized in two different hospitals in Tunisia in December 2010, were not clonally related. Molecular investigations showed that both isolates co-produced the narrow-spectrum β-lactamases TEM-1 and SHV-1, together with the extended-spectrum β-lactamase CTX--15.
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Affiliation(s)
- H Lahlaoui
- Service de Bactériologie-Virologie, INSERM U914, Hôpital de Bicêtre, Assistance Publique/Hôpitaux de Paris, Faculté de Médecine et Université Paris Sud, K.-Bicêtre, France
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Occurrence of the carbapenem-hydrolyzing beta-lactamase gene blaOXA-48 in the environment in Morocco. Antimicrob Agents Chemother 2011; 55:5413-4. [PMID: 21876064 DOI: 10.1128/aac.05120-11] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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