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Ncir S, Haenni M, Châtre P, Drapeau A, François P, Chaouch C, Souguir M, Azaiez S, Madec JY, Mansour W. Occurrence and persistence of multidrug-resistant Enterobacterales isolated from urban, industrial and surface water in Monastir, Tunisia. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 926:171562. [PMID: 38460700 DOI: 10.1016/j.scitotenv.2024.171562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/02/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
The One Health approach of antimicrobial resistance highlighted the role of the aquatic environment as a reservoir and dissemination source of resistance genes and resistant bacteria, especially due to anthropogenic activities. Resistance to extended-spectrum cephalosporins (ESC) conferred by extended-spectrum beta-lactamases (ESBLs) in E. coli has been proposed as the major marker of the AMR burden in cross-sectoral approaches. In this study, we investigated wastewater, surface water and seawater that are subjected to official water quality monitoring in Monastir, Tunisia. While all but one sample were declared compliant according to the official tests, ESC-resistant bacteria were detected in 31 (19.1 %) samples. Thirty-nine isolates, coming from urban, industrial and surface water in Monastir, were collected and characterized using antibiograms and whole-genome sequencing. These isolates were identified as 27 Escherichia coli (69.3 %) belonging to 13 STs, 10 Klebsiella pneumoniae (25.6 %) belonging to six STs, and two Citrobacter freundii (5.1 %). We observed the persistence and dissemination of clones over time and in different sampling sites, and no typically human-associated pathogens could be identified apart from one ST131. All isolates presented a blaCTX-M gene - blaCTX-M-15 (n = 22) and blaCTX-M-55 (n = 8) being the most frequent variants - which were identified on plasmids (n = 20) or on the chromosome (n = 19). In conclusion, we observed ESC resistance in rather ubiquitous bacteria that are capable of surviving in the water environment. This suggests that including the total coliform count and the ESBL count as determined by bacterial growth on selective plates in the official monitoring would greatly improve water quality control in Tunisia.
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Affiliation(s)
- Sana Ncir
- Université de Sousse, Faculté de Médecine Ibn Al Jazzar Sousse, Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée, LR12ES02, Tunisie; ANSES - Université de Lyon, Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
| | - Marisa Haenni
- ANSES - Université de Lyon, Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
| | - Pierre Châtre
- ANSES - Université de Lyon, Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
| | - Antoine Drapeau
- ANSES - Université de Lyon, Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
| | - Pauline François
- ANSES - Université de Lyon, Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
| | - Cherifa Chaouch
- Laboratory of Transmissible Diseases and Biologically Active Substances LR99ES27, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Meriem Souguir
- Université de Sousse, Faculté de Médecine Ibn Al Jazzar Sousse, Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée, LR12ES02, Tunisie; ANSES - Université de Lyon, Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
| | - Sana Azaiez
- Université de Sousse, Faculté de Médecine Ibn Al Jazzar Sousse, Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée, LR12ES02, Tunisie
| | - Jean-Yves Madec
- ANSES - Université de Lyon, Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
| | - Wejdene Mansour
- Université de Sousse, Faculté de Médecine Ibn Al Jazzar Sousse, Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée, LR12ES02, Tunisie.
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Ofosu-Appiah F, Acquah EE, Mohammed J, Sakyi Addo C, Agbodzi B, Ofosu DAS, Myers CJ, Mohktar Q, Ampomah OW, Ablordey A, Amissah NA. Klebsiella pneumoniae ST147 harboring blaNDM-1, multidrug resistance and hypervirulence plasmids. Microbiol Spectr 2024; 12:e0301723. [PMID: 38315028 PMCID: PMC10913492 DOI: 10.1128/spectrum.03017-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/17/2023] [Indexed: 02/07/2024] Open
Abstract
The spread of hypervirulent (hv) and carbapenem-/multidrug-resistant Klebsiella pneumoniae is an emerging problem in healthcare settings. The New Delhi metallo-β-lactamase-1 (blaNDM-1) is found in Enterobacteriaceae including K. pneumoniae. The blaNDM-1 is capable of hydrolyzing β-lactam antibiotics which are used for treatment of severe infections caused by multidrug-resistant Gram-negative bacteria. This is associated with the unacceptably high mortality rate in immunocompromised burn injury patients. This study reports on the characterization of blaNDM-1 gene and virulence factors in hv carbapenem-/multidrug-resistant K. pneumoniae ST147 in the burns unit of a tertiary teaching hospital during routine surveillance. Two K. pneumoniae strains were obtained from wounds of burn-infected patients from May 2020 to July 2021. The hypervirulence genes and genetic context of the blaNDM-1 gene and mobile genetic elements potentially involved in the transposition of the gene were analyzed. We identified a conserved genetic background and an IS26 and open reading frame flanking the blaNDM-1 gene that could suggest its involvement in the mobilization of the gene. The plasmid harbored additional antibiotic resistance predicted regions that were responsible for resistance to almost all the routinely used antibiotics. To ensure the identification of potential outbreak strains during routine surveillance, investigations on resistance genes and their environment in relation to evolution are necessary for molecular epidemiology.IMPORTANCEData obtained from this study will aid in the prompt identification of disease outbreaks including evolving resistance and virulence of the outbreak bacteria. This will help establish and implement antimicrobial stewardship programs and infection prevention protocols in fragile health systems in countries with limited resources. Integration of molecular surveillance and translation of whole-genome sequencing in routine diagnosis will provide valuable data for control of infection. This study reports for the first time a high-risk clone K. pneumoniae ST147 with hypervirulence and multidrug-resistance features in Ghana.
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Affiliation(s)
- Frederick Ofosu-Appiah
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ezra E. Acquah
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Jibril Mohammed
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Comfort Sakyi Addo
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Bright Agbodzi
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Dorcas A. S. Ofosu
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Charles J. Myers
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Quaneeta Mohktar
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Opoku-Ware Ampomah
- The Burns Unit, Reconstructive Plastic Surgery and Burns Unit, Korle Bu Teaching Hospital, Accra, Ghana
| | - Anthony Ablordey
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Nana Ama Amissah
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Ben Dhaou K, Ghariani A, Essalah L, Bouzouita I, Mahdhi S, Ben Nsir H, Frikha M, El Marzouk N, Zghal Mhiri E, Slim-Saidi NL. Evaluation of Phenotypic Tests for Carbapenemase Detection in Enterobacteriaceae in Tunisia. Microb Drug Resist 2024. [PMID: 38315778 DOI: 10.1089/mdr.2023.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
Introduction: Resistance to carbapenems in Enterobacteriaceae is a challenge for public health. Carbapenemase production is the leading mechanism. This work aims to evaluate four phenotypic methods for carbapenemase detection in comparison with a molecular method. Materials and Methods: Thirty-seven nonrepeating Enterobacteriaceae strains with decreased susceptibility to ertapenem were included. Imipenem MIC, Modified Hodge Test (MHT), Neo-Rapid Carb Kit® and KPC, MBL, and OXA-48 Confirm Kit® were performed. Isolates were tested for blaOXA-48, blaNDM, and blaVIM genes by end-point polymerase chain reaction. The results of the molecular study were used as a reference test to determine the performances of the phenotypic tests. Results: Imipenem resistance does not seem to be a good marker for carbapenemase production with a sensitivity of 54% (95% CI: 38-71). MHT showed 82% sensitivity (95% CI: 65-91). Overall, the enzymatic test showed the best performances for carbapenemase detection with 100% sensitivity (95% CI: 89-100) and the best turnaround time. The characterization of carbapenemases classes by the combined discs test demonstrated 88% overall sensitivity (95% CI: 72-95). Conclusion: The results of this study support the combination of the enzymatic and the combined disc tests for carbapenemase detection in Enterobacteria.
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Affiliation(s)
- Khouloud Ben Dhaou
- Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
- Microbiology Laboratory, Abderrahmen Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | - Asma Ghariani
- Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
- Microbiology Laboratory, Abderrahmen Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | - Leila Essalah
- Microbiology Laboratory, Abderrahmen Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | - Imen Bouzouita
- Microbiology Laboratory, Abderrahmen Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
- Faculty of Science, University of Tunis El Manar, Tunis, Tunisia
| | - Samia Mahdhi
- Microbiology Laboratory, Abderrahmen Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | - Hamida Ben Nsir
- Microbiology Laboratory, Abderrahmen Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | - Marwa Frikha
- Microbiology Laboratory, Abderrahmen Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | - Naceur El Marzouk
- Microbiology Laboratory, Abderrahmen Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | - Emna Zghal Mhiri
- Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
- Microbiology Laboratory, Abderrahmen Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | - Noura Leila Slim-Saidi
- Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
- Microbiology Laboratory, Abderrahmen Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
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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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Sola M, Mani Y, Saras E, Drapeau A, Grami R, Aouni M, Madec JY, Haenni M, Mansour W. Prevalence and Characterization of Extended-Spectrum β-Lactamase- and Carbapenemase-Producing Enterobacterales from Tunisian Seafood. Microorganisms 2022; 10:microorganisms10071364. [PMID: 35889085 PMCID: PMC9323973 DOI: 10.3390/microorganisms10071364] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/01/2022] [Accepted: 07/02/2022] [Indexed: 02/01/2023] Open
Abstract
Aquaculture is a rapidly expanding sector in which it is important to monitor the occurrence of multi-drug resistant (MDR) bacteria. The presence of extended-spectrum β-lactamase (ESBL-) or carbapenemase-producing Enterobacterales is a commonly used indicator of the resistance burden in a given sector. In this study, 641 pieces of farmed fish (sea bream and sea bass), as well as 1075 Mediterranean clams, were analyzed. All ESBL- and carbapenemase-producing Enterobacterales collected were whole-genome sequenced. The proportion of ESBL-producing Enterobacterales was 1.4% in fish and 1.6% in clams, carried by Escherichia coli (n = 23) and Klebsiella pneumoniae (n = 4). The ESBL phenotype was exclusively due to the presence of blaCTX-M genes, the most frequent one being blaCTX-M-15. The blaCTX-M-1 gene was also identified in six E. coli, among which four were carried by IncI1/pST3 plasmids, possibly betraying an animal origin. Carbapenemases were absent in fish but identified in two K. pneumoniae isolates from clams (blaNDM-1 and blaOXA-48). Several sequence types (STs) identified were associated with human MDR clones such as E. coli ST131 and ST617, or K. pneumoniae ST307 and ST147. Our results might indicate that bacteria from hospital or farm effluents can reach the open sea and contaminate seafood and fish that are living or raised nearby. Therefore, monitoring the quality of water discharged to the sea and the presence of MDR bacteria in seafood is mandatory to ensure the quality of fishery products.
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Affiliation(s)
- Mehdi Sola
- Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée (LR12ES02), Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia; (M.S.); (Y.M.); (R.G.); (W.M.)
| | - Yosra Mani
- Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée (LR12ES02), Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia; (M.S.); (Y.M.); (R.G.); (W.M.)
| | - Estelle Saras
- Unité Antibiorésistance et Virulence Bactériennes, ANSES Laboratoire de Lyon, Université de Lyon, 69007 Lyon, France; (E.S.); (A.D.); (J.-Y.M.)
| | - Antoine Drapeau
- Unité Antibiorésistance et Virulence Bactériennes, ANSES Laboratoire de Lyon, Université de Lyon, 69007 Lyon, France; (E.S.); (A.D.); (J.-Y.M.)
| | - Raoudha Grami
- Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée (LR12ES02), Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia; (M.S.); (Y.M.); (R.G.); (W.M.)
| | - Mahjoub Aouni
- Laboratoire des Maladies Transmissibles et Substances Biologiquement Actives, Faculté de Pharmacie de Monastir, Université de Monastir, Monastir 5000, Tunisia;
| | - Jean-Yves Madec
- Unité Antibiorésistance et Virulence Bactériennes, ANSES Laboratoire de Lyon, Université de Lyon, 69007 Lyon, France; (E.S.); (A.D.); (J.-Y.M.)
| | - Marisa Haenni
- Unité Antibiorésistance et Virulence Bactériennes, ANSES Laboratoire de Lyon, Université de Lyon, 69007 Lyon, France; (E.S.); (A.D.); (J.-Y.M.)
- Correspondence:
| | - Wejdene Mansour
- Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée (LR12ES02), Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia; (M.S.); (Y.M.); (R.G.); (W.M.)
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Ben Sallem R, Laribi B, Arfaoui A, Ben Khelifa Melki S, Ouzari I, Ben Slama K, Naas T, Klibi N. Co-occurrence of genes encoding carbapenemase, ESBL, pAmpC, and Non-β-Lactam resistance among Klebsiella pneumonia and E. coli clinical isolates in Tunisia. Lett Appl Microbiol 2022; 74:729-740. [PMID: 35076956 DOI: 10.1111/lam.13658] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 01/06/2022] [Accepted: 01/18/2022] [Indexed: 11/27/2022]
Abstract
This study aimed to investigate the molecular mechanisms of carbapenem and colistin resistance in K. pneumoniae and E. coli isolates obtained from hospitalized patients in Carthagene International Hospital of Tunis. A total of 25 K. pneumoniae and 2 E. coli clinical isolates with reduced susceptibility to carbapenems were recovered. Susceptibility testing and phenotypic screening tests were carried out. ESBL, AmpC, carbapenemase, and other antibiotic resistance genes were sought by PCR-sequencing. The presence of plasmid-mediated colistin resistance genes (mcr-1-8) was examined by PCR and the nucleotide sequence of the mgrB gene was determined. The analysis of plasmid content was performed by PCR-Based Replicon Typing (PBRT). The clonality of isolates was assessed by PFGE and multilocus sequence typing (MLST). All of the isolates produced carbapenemase activity. They showed a great variation in the distribution of ESBL, AmpC, carbapenemase, and other plasmid-mediated resistance determinants. K. pneumoniae isolates carried blaNDM-1 (n=11), blaOXA-48 (n=11), blaNDM-1 + blaOXA-48 (n=1), blaNDM-1 + blaVIM-1 (n=1), blaOXA-204 (n=1), along with blaCTX-M , blaOXA , blaTEM , blaCMY , blaDHA and blaSHV genes variants on conjugative plasmid of IncL/M, IncR, IncFIIK , IncFIB, and IncHI1 types. Three sequence types ST101, ST307, and ST15 were identified. The mgrB alteration g109a (G37S) was detected in a single colistin-resistant, NDM-1 and OXA-48-coproducing K. pneumoniae isolate. The two E. coli isolates belonged to ST95, co-produced NDM-1 and CTX-M-15, and harbored plasmid of IncFII and IncFIB types. To our knowledge, this is the first report in Tunisia of NDM-1, OXA-48, and CTX-M-15 coexistence in colistin-resistant K. pneumoniae ST15.
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Affiliation(s)
- Rym Ben Sallem
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, 2092, Tunis, Tunisia
| | - Bochra Laribi
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, 2092, Tunis, Tunisia
| | - Ameni Arfaoui
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, 2092, Tunis, Tunisia
| | | | - Imen Ouzari
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, 2092, Tunis, Tunisia
| | - Karim Ben Slama
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, 2092, Tunis, Tunisia
| | - Thierry Naas
- Bacteriology-Hygiene unit, Bicêtre Hospital, Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-producing Enterobacteriaceae, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Naouel Klibi
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, 2092, Tunis, Tunisia
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Ragheb SM, Govinden U, Osei Sekyere J. Genetic support of carbapenemases: a One Health systematic review and meta-analysis of current trends in Africa. Ann N Y Acad Sci 2021; 1509:50-73. [PMID: 34753206 DOI: 10.1111/nyas.14703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/06/2021] [Accepted: 09/26/2021] [Indexed: 11/28/2022]
Abstract
Antimicrobial resistance (AMR) is a public health threat globally. Carbapenems are β-lactam antibiotics used as last-resort agents for treating antibiotic-resistant infections. Mobile genetic elements (MGEs) play an important role in the dissemination and expression of antimicrobial resistance genes (ARGs), including the mobilization of ARGs within and between species. The presence of MGEs around carbapenem-hydrolyzing enzymes, called carbapenemases, in bacterial isolates in Africa is concerning. The association between MGEs and carbapenemases is described herein. Specific plasmid replicons, integrons, transposons, and insertion sequences were found flanking specific and different carbapenemases across the same and different clones and species isolated from humans, animals, and the environment. Notably, similar genetic contexts have been reported in non-African countries, supporting the importance of MGEs in driving the intra- and interclonal and species transmission of carbapenemases in Africa and globally. Technical and budgetary limitations remain challenges for epidemiological analysis of carbapenemases in Africa, as studies undertaken with whole-genome sequencing remained relatively few. Characterization of MGEs in antibiotic-resistant infections can deepen our understanding of carbapenemase epidemiology and facilitate the control of AMR in Africa. Investment in genomic epidemiology will facilitate faster clinical interventions and containment of outbreaks.
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Affiliation(s)
- Suzan Mohammed Ragheb
- Department of Microbiology and Immunology, Faculty of Pharmacy, Modern University for Technology and Information (MTI), Cairo, Egypt
| | - Usha Govinden
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - John Osei Sekyere
- Department of Microbiology & Immunology, Indiana University School of Medicine-Northwest, Gary, Indiana.,Department of Dermatology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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8
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Spaziante M, Venditti C, Butera O, Messina F, Di Caro A, Tonziello G, Lanini S, Cataldo MA, Puro V. Importance of Surveillance of New Delhi Metallo-Beta-Lactamase Klebsiella pneumoniae: Molecular Characterization and Clonality of Strains Isolated in the Lazio Region, Italy. Infect Drug Resist 2021; 14:3659-3665. [PMID: 34526785 PMCID: PMC8435879 DOI: 10.2147/idr.s318717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/25/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction New Delhi metallo-β-lactamase producing Klebsiella pneumoniae (NDM-Kpn) strains have been causing healthcare-associated infections worldwide. The aim of this study was to describe the molecular mechanisms of antimicrobial resistance and to analyze the clonality of NDM-Kpn isolates collected between January 2019 and June 2020 from patients admitted to hospitals from the Lazio region, Italy. Methods We performed a retrospective cohort study. Whole-genome sequencing (WGS) was performed on all NDM-Kpn strains; clonality and genetic relationships were further investigated. Results During the surveillance period, 17 NDM-Kpn isolates were obtained from 17 patients admitted to seven different hospitals. Eight different sequence types (STs) were detected: ST147 (n = 4), ST383 (n = 4), ST15 (n = 3), ST11 (n = 2), ST17 (n = 1), ST29 (n = 1), ST307 (n = 1) and the newly identified ST4853 (n = 1). Genetic relationships were further investigated by the WGS-based core genome MLST (cgMLST) scheme, and 5 cluster types (CTs) were identified. Whereas a substantial overall heterogeneity among isolates was detected (8 different STs were identified out of 17 isolates), the strains within each cluster showed a very high level of genome similarity. Discussion Our study highlights the key role of surveillance, which allowed taking a picture of a part of the NDM-Kpn strains circulating in Italy, adding further insight into their molecular features.
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Affiliation(s)
- Martina Spaziante
- Emerging Infection Unit and Regional Service for Surveillance and Control of Infectious Diseases (SeRESMI), National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Carolina Venditti
- Laboratory of Microbiology, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Ornella Butera
- Laboratory of Microbiology, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Francesco Messina
- Laboratory of Microbiology, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Antonino Di Caro
- Laboratory of Microbiology, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Gilda Tonziello
- Emerging Infection Unit and Regional Service for Surveillance and Control of Infectious Diseases (SeRESMI), National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Simone Lanini
- Emerging Infection Unit and Regional Service for Surveillance and Control of Infectious Diseases (SeRESMI), National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Maria Adriana Cataldo
- Emerging Infection Unit and Regional Service for Surveillance and Control of Infectious Diseases (SeRESMI), National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Vincenzo Puro
- Emerging Infection Unit and Regional Service for Surveillance and Control of Infectious Diseases (SeRESMI), National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
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9
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Biedrzycka M, Urbanowicz P, Guzek A, Brisse S, Gniadkowski M, Izdebski R. Dissemination of Klebsiella pneumoniae ST147 NDM-1 in Poland, 2015-19. J Antimicrob Chemother 2021; 76:2538-2545. [PMID: 34164678 DOI: 10.1093/jac/dkab207] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/29/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the spread of New Delhi metallo-β-lactamase-1 (NDM-1)-producing Klebsiella pneumoniae ST147 organisms in Poland since an introduction from Tunisia in March 2015, including their phylogenetic position in the global population of the high-risk clone. METHODS Out of 8925 unique NDM-positive K. pneumoniae isolates identified in Poland from April 2015 till December 2019, 126 isolates, including the Tunisian imports, were related by PFGE and blaNDM gene-carrying Tn125 transposon derivatives. Forty-seven representative isolates were sequenced by Illumina MiSeq. The phylogeny, resistome, virulome and plasmid replicons were analysed and compared with the international ST147 strains. Plasmids of six isolates were studied by the MinION sequencing. RESULTS A high homogeneity of the 47 isolates was observed, with minor variations in their resistomes and plasmid replicon profiles. However, the detailed SNP comparison discerned a strict outbreak cluster of 40 isolates. All of the organisms were grouped within the ST147 phylogenetic international lineage, and four NDM-1 producers from Tunisia, Egypt and France were the closest relatives of the Polish isolates. Yersiniabactin genes (YbST280 type) were located within the ICEKpn12-like element in most of the outbreak isolates, characterized by O2v1 and KL64 antigen loci. The blaNDM-1 genes were located in double-replicon IncFIIK2+IncFIBK plasmids. CONCLUSIONS The continuous spread of K. pneumoniae ST147 NDM-1 in Poland since 2015, largely in the Warsaw area, is demonstrated by this genomic analysis. The isolates showed a high degree of homogeneity, and close relatedness to organisms spreading in the Mediterranean region.
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Affiliation(s)
- M Biedrzycka
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - P Urbanowicz
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - A Guzek
- Department of Laboratory Diagnostics, Section of Microbiology, Military Institute of Medicine, Warsaw, Poland
| | - S Brisse
- Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Paris, France
| | - M Gniadkowski
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - R Izdebski
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
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10
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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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11
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Solgi H, Nematzadeh S, Giske CG, Badmasti F, Westerlund F, Lin YL, Goyal G, Nikbin VS, Nemati AH, Shahcheraghi F. Molecular Epidemiology of OXA-48 and NDM-1 Producing Enterobacterales Species at a University Hospital in Tehran, Iran, Between 2015 and 2016. Front Microbiol 2020; 11:936. [PMID: 32547503 PMCID: PMC7270168 DOI: 10.3389/fmicb.2020.00936] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/20/2020] [Indexed: 01/09/2023] Open
Abstract
Carbapenem-resistant Enterobacterales (CRE) is an increasing problem worldwide. Here, we examined the clonal relatedness of 71 non-repetitive CRE isolates collected in a university hospital in Tehran, Iran, between February 2015 and March 2016. Pulsed-field gel electrophoresis (PFGE) and MLST were used for epidemiological analysis. Screening for antibiotic resistance genes, PCR-based replicon typing, conjugation experiments, and optical DNA mapping were also performed. Among all 71 isolates, 47 isolates of Klebsiella pneumoniae (66.2%), eight Escherichia coli (11.2%), five Serratia marcescens (7%), and two Enterobacter cloacae (2.8%) harbored blaNDM–1 and blaOXA–48 genes together or alone. PFGE analysis revealed that most of the OXA-48- and NDM-1-producing K. pneumoniae and all of OXA-48-producing S. marcescens were clonally related, while all eight E. coli and two E. cloacae isolates were clonally unrelated. The predominant clones of carbapenemase-producing K. pneumoniae associated with outbreaks within the hospital were ST147 (n = 13) and ST893 (n = 10). Plasmids carrying blaNDM–1 and blaOXA–48 were successfully transferred to an E. coli K12-recipient strain. The blaOXA–48 gene was located on an IncL/M conjugative plasmid, while the blaNDM–1 gene was located on both IncFII ∼86-kb to ∼140-kb and IncA/C conjugative plasmids. Our findings provide novel epidemiologic data on carbapenemase-producing Enterobacterales (CPE) in Iran and highlight the importance of horizontal gene transfer in the dissemination of blaNDM–1 and blaOXA–48 genes. The occurrence and transmission of distinct K. pneumoniae clones call for improved infection control to prevent further spread of these pathogens in Iran.
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Affiliation(s)
- Hamid Solgi
- Division of Clinical Microbiology, Department of Laboratory Medicine, Amin Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shoeib Nematzadeh
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Christian G Giske
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Farzad Badmasti
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | - Fredrik Westerlund
- Division of Chemical Biology, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Yii-Lih Lin
- Division of Chemical Biology, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Gaurav Goyal
- Division of Chemical Biology, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
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12
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Benulič K, Pirš M, Couto N, Chlebowicz M, Rossen JWA, Zorec TM, Seme K, Poljak M, Lejko Zupanc T, Ružić-Sabljić E, Cerar T. Whole genome sequencing characterization of Slovenian carbapenem-resistant Klebsiella pneumoniae, including OXA-48 and NDM-1 producing outbreak isolates. PLoS One 2020; 15:e0231503. [PMID: 32282829 PMCID: PMC7153892 DOI: 10.1371/journal.pone.0231503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/24/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives The first hospital outbreak of carbapenemase-producing Enterobacteriaceae in Slovenia occurred in 2014–2016. Whole genome sequencing was used to analyse the population of carbapenem-resistant Klebsiella pneumoniae collected in Slovenia in 2014–2017, including OXA-48 and/or NDM-1 producing strains from the outbreak. Methods A total of 32 K. pneumoniae isolates were analysed using short-read sequencing. Multi-locus sequence typing and core genome multi-locus sequence typing were used to infer genetic relatedness. Antimicrobial resistance markers, virulence factors, plasmid content and wzi types were determined. Long-read sequencing was used for six isolates for detailed analysis of plasmids and their possible transmission. Results Overall, we detected 10 different sequence types (STs), the most common being ST437 (40.6%). Isolates from the initial outbreak belonged to ST437 (12/16) and ST147 (4/16). A second outbreak of four ST15 isolates was discovered. A new ST (ST3390) and two new wzi types (wzi-556, wzi-559) were identified. blaOXA-48 was found in 17 (53.1%) isolates, blaNDM-1 in five (15.6%), and a combination of blaOXA-48/NDM-1 in seven (21.9%) isolates. Identical plasmids carrying blaOXA-48 were found in outbreak isolates sequenced with long-read sequencing technology. Conclusions Whole genome sequencing of Slovenian carbapenem-resistant K. pneumoniae isolates revealed multiple clusters of STs, two of which were involved in the first hospital outbreak of carbapenem producing K. pneumoniae in Slovenia. Transmission of the plasmid carrying blaOXA-48 between two STs was likely to have occurred. A previously unidentified second outbreak was also discovered, highlighting the importance of whole genome sequencing in detection and/or characterization of hospital outbreaks and surveillance of drug-resistant bacterial clones.
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Affiliation(s)
- Katarina Benulič
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
- * E-mail:
| | - Mateja Pirš
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Natacha Couto
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Monika Chlebowicz
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - John W. A. Rossen
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Tomaž Mark Zorec
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Katja Seme
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Mario Poljak
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Tatjana Lejko Zupanc
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Eva Ružić-Sabljić
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Tjaša Cerar
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
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13
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Mhaya A, Trabelsi R, M'Zali F, Bégu D, Tounsi S, Gdoura R, Arpin C. First description of NDM-1-positive Klebsiella pneumoniae in the Tunisian community. J Glob Antimicrob Resist 2020; 21:49-50. [PMID: 32169682 DOI: 10.1016/j.jgar.2020.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/19/2020] [Accepted: 02/22/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Amel Mhaya
- University of Bordeaux, UMR CNRS 5234, 146 rue Léo Saignat, Bordeaux Cedex, 33076, France; Biotechnology Center of Sfax, Laboratory of Biopesticides, BP 1177 Sfax, 3018, Tunisia
| | - Rahma Trabelsi
- Department of Life Sciences, Research Laboratory of Environmental Toxicology-Microbiology and Health (LR17ES06), Faculty of Sciences, University of Sfax, Sfax, Tunisia
| | - Fatima M'Zali
- University of Bordeaux, Aquitaine Microbiologie, Bordeaux, France
| | - Dominique Bégu
- University of Bordeaux, UMR CNRS 5234, 146 rue Léo Saignat, Bordeaux Cedex, 33076, France
| | - Slim Tounsi
- Biotechnology Center of Sfax, Laboratory of Biopesticides, BP 1177 Sfax, 3018, Tunisia
| | - Radhouane Gdoura
- Department of Life Sciences, Research Laboratory of Environmental Toxicology-Microbiology and Health (LR17ES06), Faculty of Sciences, University of Sfax, Sfax, Tunisia
| | - Corinne Arpin
- University of Bordeaux, UMR CNRS 5234, 146 rue Léo Saignat, Bordeaux Cedex, 33076, France
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Jalalvand K, Shayanfar N, Shahcheraghi F, Amini E, Mohammadpour M, Babaheidarian P. Evaluation of Phenotypic and Genotypic Characteristics of Carbapnemases-producing Enterobacteriaceae and Its Prevalence in a Referral Hospital in Tehran City. IRANIAN JOURNAL OF PATHOLOGY 2020; 15:86-95. [PMID: 32215024 PMCID: PMC7081758 DOI: 10.30699/ijp.2020.111181.2188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 02/23/2020] [Indexed: 11/06/2022]
Abstract
Background & Objective Carbapenem-resistant Enterobacteriaceae is a growing concern worldwide including Iran. The emergence of this pathogen is worrying as carbapenem is one of the 'last-line' antibiotics for treatment of infections caused by multi drug resistant gram- negative bacteria. The main objective of this study was to determine the prevalence of carbapenem-resistant Enterobacteriaceae in a referral hospital in Tehran, Iran. Methods In this study, all positive isolates of Enterobacteriaceae recorded in blood, urine, and other body fluids were studied during April 2017 to April 2018 in a referral hospital in Tehran. All cases of resistance to carbapenems were first tested by modified Hodge test. All cases with positive or negative test, after gene extraction, were examined genotypically based on the primers designed for the three Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-β-lactamase (NDM), and OXA-48 genes by conventional PCR method. Results 108 isolates (13.6%) were resistant to all cephalosporins as well as to imipenem and meropenem. In a genotypic study, including 45 isolates, 13 isolates were positive for OXA-48 gene, 11 isolates for OXA-48 and NDM genes, 11 isolates for OXA-48, NDM and KPC genes, 4 isolates for OXA-48 genes and KPC, 3 isolates for NDM, one isolate for KPC. On the other hand, two isolates were negative for all three genes examined. Conclusion OXA-48 gene was one of the most common genes resistant to carbapenems in Iran. According to studies, the prevalence of antibiotic resistance in Iran is rising dramatically, which reduces the choice of antibiotics to treat severe infections in the future.
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Affiliation(s)
- Kosar Jalalvand
- Department of Pathology, Hazret-e-Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nasrin Shayanfar
- Department of Pathology, Hazret-e-Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Elahe Amini
- Skull Base Research Center, Hazret-e-Rasoul Hospital, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | | | - Pegah Babaheidarian
- Department of Pathology, Hazret-e-Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran
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15
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Naha S, Sands K, Mukherjee S, Roy C, Rameez MJ, Saha B, Dutta S, Walsh TR, Basu S. KPC-2-producing Klebsiella pneumoniae ST147 in a neonatal unit: Clonal isolates with differences in colistin susceptibility attributed to AcrAB-TolC pump. Int J Antimicrob Agents 2020; 55:105903. [PMID: 31954832 DOI: 10.1016/j.ijantimicag.2020.105903] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/08/2020] [Accepted: 01/11/2020] [Indexed: 01/21/2023]
Abstract
This study characterizes four KPC-2-producing Klebsiella pneumoniae isolates from neonates belonging to a single sequence type 147 (ST147) in relation to carbapenem resistance and explores probable mechanisms of differential colistin resistance among the clonal cluster. Whole genome sequencing (WGS) revealed that the isolates were nearly 100% identical and harbored resistance genes (blaKPC-2,OXA-9,CTX-M-15,SHV-11,OXA-1,TEM-1B, oqxA, oqxB, qnrB1, fosA, arr-2, sul1, aacA4, aac(6')Ib-cr, aac(6')Ib), and several virulence genes. blaKPC-2 was the only carbapenem-resistant gene found, bracketed between ISKpn7 and ISKpn6 of Tn4401b on a non-conjugative IncFII plasmid. Remarkably, one of the clonal isolates was resistant to colistin, the mechanistic basis of which was not apparent from comparative genomics. The transmissible colistin resistance gene, mcr, was absent. Efflux pump inhibitor, carbonyl cyanide 3-chlorophenylhydrazone (CCCP) rendered a 32-fold decrease in the minimum inhibitory concentration (MIC) of colistin in the resistant isolate only. acrB, tolC, ramA, and soxS genes of the AcrAB-TolC pump system overexpressed exclusively in the colistin-resistant isolate, although the corresponding homologs of the AcrAB-TolC pump, regulators and promoters were mutually identical. No change was observed in the expression of other efflux genes (kpnE/F and kpnG/H) or two-component system (TCS) genes (phoP/phoQ, pmrA/pmrB). Colistin resistance in one of the clonal KPC-2-producing isolates is postulated to be due to overexpression of the AcrAB-TolC pump. This study is probably the first to report clinical clonal K. pneumoniae isolates with differences in colistin susceptibility. The presence of carbapenem-resistant isolates with differential behavior in the expression of a genomically identical pump system indicates the nuances of the resistance mechanisms and the difficulty of treatment thereof.
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Affiliation(s)
- Sharmi Naha
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, P33, CIT Road, Scheme XM, Beliaghata, Kolkata-700010, West Bengal, India
| | - Kirsty Sands
- Department of Medical Microbiology and Infectious Disease, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, CF14 4XN, UK
| | - Subhankar Mukherjee
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, P33, CIT Road, Scheme XM, Beliaghata, Kolkata-700010, West Bengal, India
| | - Chayan Roy
- Department of Microbiology, Bose Institute, P-1/12 CIT Road, Scheme VIIM, Kolkata-700054, West Bengal, India
| | - Moidu Jameela Rameez
- Department of Microbiology, Bose Institute, P-1/12 CIT Road, Scheme VIIM, Kolkata-700054, West Bengal, India
| | - Bijan Saha
- Department of Neonatology, Institute of Post-Graduate Medical Education & Research and SSKM Hospital, Kolkata-700020, West Bengal, India
| | - Shanta Dutta
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, P33, CIT Road, Scheme XM, Beliaghata, Kolkata-700010, West Bengal, India
| | - Timothy R Walsh
- Department of Medical Microbiology and Infectious Disease, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, CF14 4XN, UK
| | - Sulagna Basu
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, P33, CIT Road, Scheme XM, Beliaghata, Kolkata-700010, West Bengal, India.
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Dziri R, Ayari I, Barguellil F, Ouzari HI, El Asli MS, Klibi N. First Report of NDM and VIM Coproducing Klebsiella pneumoniae in Tunisia and Emergence of Novel Clones. Microb Drug Resist 2019; 25:1282-1286. [DOI: 10.1089/mdr.2019.0115] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Raoudha Dziri
- Laboratory of Microorganisms and Active Biomolecules, Department of Biology, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Imen Ayari
- Laboratory of Microorganisms and Active Biomolecules, Department of Biology, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Farouk Barguellil
- Service of Microbiology, Military Hospital of Tunis HMPIT, Tunis, Tunisia
- Department of Microbiology, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Hadda-Imen Ouzari
- Laboratory of Microorganisms and Active Biomolecules, Department of Biology, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Selim El Asli
- Service of Microbiology, Military Hospital of Tunis HMPIT, Tunis, Tunisia
- Department of Microbiology, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Naouel Klibi
- Laboratory of Microorganisms and Active Biomolecules, Department of Biology, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
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17
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Emergence of OXA-204 carbapenemase in Enterobacter cloacae. Int J Antimicrob Agents 2019; 54:829-830. [PMID: 31521810 DOI: 10.1016/j.ijantimicag.2019.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 09/07/2019] [Indexed: 11/20/2022]
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18
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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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Messaoudi A, Mansour W, Jaidane N, Chaouch C, Boujaâfar N, Bouallègue O. Epidemiology of resistance and phenotypic characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae isolates at Sahloul University Hospital-Sousse, Tunisia. Afr Health Sci 2019; 19:2008-2020. [PMID: 31656484 PMCID: PMC6794520 DOI: 10.4314/ahs.v19i2.24] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objective To assess the prevalence of ESBL producing and carbapenem resistant Klebsiella pneumoniae isolated from in-come and out-come patients at Sahloul-university hospital. Methods A retrospective study over a 3 years period (January 2012 and December 2014) focused on 2160 strains of Klebsiella pneumoniae. Statistical analysis was carried out using SPSS program. ESBL detection was performed using a double disc diffusion method and carbapenemase detection was realized by Rosco-Disk kit. Results A total of 2160 Klebsiella pneumoniae strains were isolated during the period of the study, 26.2% (n=566) were ESBL-producers and 15.8% (n=342) showed resistance to carbapenem. The wards most affected by these strains were basically urology and intensive care units. Eighty four percent of studied strains (203/241) were resistant to temocillin, which correlate with the production of a class D (OXA-48-like) carbapenemase and 7% (17/241) showed sensitivity to EDTA and dipicolinic acid, which indicate the production of metallo-enzyme. The rate of resistance to colistin remains low. Conclusion Resistance of Enterobacteriaceae, including K. pneumoniae, to third generation cephalosporins (3rd GC) and carbapenem through the mechanism of ESBL and carbapenemases production is becoming increasingly worrying. This suggests a more rational use of antibiotics, as well as the rigorous application of hygiene measurement.
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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
| | - Wejdène Mansour
- Laboratory of Metabolic Biophysics and Applied Pharmacology (LR12ES02), Department of Biophysics, Faculty of Medicine Ibn El Jazzar of Sousse, University of Sousse, Sousse, Tunisia
- Faculty of Medicine Ibn Al Jazzar, Sousse, University of Sousse, Tunisia
| | - Nedia Jaidane
- Research Unit: Emergent Bacterial Resistance and Safety of Care (UR12SP37), Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia
| | - Chrifa Chaouch
- Research Unit: Emergent Bacterial Resistance and Safety of Care (UR12SP37), Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia
- Faculty of Pharmacy, Monastir, University of Monastir, Monastir, Tunisia
| | | | - Olfa Bouallègue
- Faculty of Medicine Ibn Al Jazzar, Sousse, University of Sousse, Tunisia
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20
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Bouattour H, Ghariani A, Essalah L, Mehiri E, Slim-Saidi L. Détection phénotypique et moléculaire des souches de Klebsiella pneumoniae productrices de carbapénémase. Med Mal Infect 2019; 49:225-226. [DOI: 10.1016/j.medmal.2018.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 09/01/2018] [Accepted: 10/18/2018] [Indexed: 11/16/2022]
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21
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Mansour W, Grami R, Jaidane N, Messaoudi A, Charfi K, Ben Romdhane L, Bel Haj Khalifa A, Khedher M, Boujaafar N, Bouallègue O, Mammeri H. Epidemiology and Whole-Genome Analysis of NDM-1-Producing Klebsiella pneumoniae KP3771 from Tunisia. Microb Drug Resist 2019; 25:644-651. [PMID: 30614778 DOI: 10.1089/mdr.2018.0204] [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] [Indexed: 11/13/2022] Open
Abstract
Objectives: The whole-genome sequence (WGS) of Klebsiella pneumoniae KP3771 isolate was characterized. This strain was recovered from the urine sample of an 80-year-old man hospitalized in an intensive care unit of the University Hospital Tahar Sfar in Tunisia. Materials and Methods: WGS using a MiSeq platform was used. The assembled genome was subjected to several software analyses. Results: K. pneumoniae KP3771 was resistant to all antibiotics but colistin and tigecycline. WGS analysis found 18 transmissible genes encoding resistance markers, including blaNDM-1 and blaCTX-M-15 genes, which were carried by four plasmids belonging to the Inc Ib, IIk, and R groups. Three families of genes encoding virulence factors were detected, including adhesins (fimH, fimA, fimB, fimC, mrkD, Kpn, and ycfM), siderophores (enterobactin, aerobactin, and yersiniabactin siderophores), and protectin/invasin (traT). The strain was assigned to the sequence type 147. Conclusions: This study describes the genome of a carbapenemase-producing K. pneumoniae clinical isolate recovered in Tunisia. Bacteria WGS has become the reference technology to address epidemiological issues; this high level of information is particularly well suited to enrich epidemiological workflows' output.
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Affiliation(s)
- Wejdene Mansour
- 1 Research Unit Emergent Bacterial Resistance and Safety of Care UR12SP37, Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia.,2 Faculty of Medicine Ibn Al Jazzar, Sousse, University of Sousse, Tunisia
| | - Raoudha Grami
- 1 Research Unit Emergent Bacterial Resistance and Safety of Care UR12SP37, Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia
| | - Nadia Jaidane
- 1 Research Unit Emergent Bacterial Resistance and Safety of Care UR12SP37, Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia
| | - Aziza Messaoudi
- 1 Research Unit Emergent Bacterial Resistance and Safety of Care UR12SP37, Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia
| | - Karama Charfi
- 1 Research Unit Emergent Bacterial Resistance and Safety of Care UR12SP37, Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia
| | - Lotfi Ben Romdhane
- 3 Research Unit MARS (Modeling of Automated Reasoning Systems) University of Sousse, Sousse, Tunisia
| | - Anis Bel Haj Khalifa
- 4 Laboratory of Microbiology, University Hospital Tahar Sfar, Mahdia, Tunisia.,5 Faculty of Pharmacy, Monastir, University of Monastir, Monastir, Tunisia
| | - Mohamed Khedher
- 4 Laboratory of Microbiology, University Hospital Tahar Sfar, Mahdia, Tunisia.,5 Faculty of Pharmacy, Monastir, University of Monastir, Monastir, Tunisia
| | - Noureddine Boujaafar
- 1 Research Unit Emergent Bacterial Resistance and Safety of Care UR12SP37, Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia.,5 Faculty of Pharmacy, Monastir, University of Monastir, Monastir, Tunisia
| | - Olfa Bouallègue
- 1 Research Unit Emergent Bacterial Resistance and Safety of Care UR12SP37, Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia.,2 Faculty of Medicine Ibn Al Jazzar, Sousse, University of Sousse, Tunisia
| | - Hedi Mammeri
- 6 INSERM, IAME, UMR 1137, Paris, France.,7 University Paris Diderot, IAME, UMR 1137, Sorbonne, Paris, France.,8 Service of Bacteriology, University Hospital Bichat, Paris, France
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22
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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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23
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Hamzaoui Z, Ocampo-Sosa A, Maamar E, Fernandez Martinez M, Ferjani S, Hammami S, Harbaoui S, Genel N, Arlet G, Saidani M, Slim A, Boutiba-Ben Boubaker I, Martinez-Martinez L. An Outbreak of NDM-1-ProducingKlebsiella pneumoniae, Associated with OmpK35 and OmpK36 Porin Loss in Tunisia. Microb Drug Resist 2018; 24:1137-1147. [DOI: 10.1089/mdr.2017.0165] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Zaineb Hamzaoui
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
- Faculty of Sciences of Bizerte, University of Carthage, Tunis, Tunisia
| | - Alain Ocampo-Sosa
- Service of Microbiology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Elaa Maamar
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
| | | | - Sana Ferjani
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
- Faculty of Sciences of Bizerte, University of Carthage, Tunis, Tunisia
| | - Samia Hammami
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
- Faculty of Sciences of Bizerte, University of Carthage, Tunis, Tunisia
| | - Sarra Harbaoui
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
| | - Nathalie Genel
- Department of Bacteriology, Medical School, University Pierre et Marie Curie, Paris, France
| | - Guillaume Arlet
- Department of Bacteriology, Medical School, University Pierre et Marie Curie, Paris, France
| | - Mabrouka Saidani
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Amine Slim
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ilhem Boutiba-Ben Boubaker
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Luis Martinez-Martinez
- Service of Microbiology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Department of Molecular Biology, School of Medicine, University of Cantabria, Santander, Spain
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24
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Cheikh HB, Domingues S, Silveira E, Kadri Y, Rosário N, Mastouri M, Da Silva GJ. Molecular characterization of carbapenemases of clinical Acinetobacter baumannii- calcoaceticus complex isolates from a University Hospital in Tunisia. 3 Biotech 2018; 8:297. [PMID: 29963357 DOI: 10.1007/s13205-018-1310-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/15/2018] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to identify the carbapenemases from clinical carbapenem-resistant Acinetobacter baumannii-calcoaceticus complex (CRABC) isolates and to assess their potential dissemination by conjugation and natural transformation. CRABC (n = 101) were collected consecutively from inpatients of the University Hospital of Monastir, Tunisia, from 2013 to 2016. Antimicrobial susceptibility was determined by the disk diffusion method and E-test. Carbapenemase-encoding genes were screened by PCR. Genotyping was performed by Pasteur MLST scheme. Isolates were resistant to all beta-lactams, fluoroquinolones and aminoglycosides while 80 and 90% were susceptible to tigecycline and colistin, respectively. Resistance and intermediate resistance to imipenem were 87 and 13%, respectively. The genes blaOXA-24-like, blaOXA-58-like, blaOXA-143-like, blaOXA-48-like, blaVIM, blaIMP, and blaKPC were not found. The blaOXA-51-like and blaOXA-23-like genes were present in 100 and 82.17% isolates, respectively. One isolate (< 1%) carried blaNDM-1 and blaOXA-51-like and belonged to Sequence Type 85 (ST85). Absence of transconjugants suggests a chromosomal location of NDM-1 determinant. The blaNDM-1 gene was inserted in a truncated form of Tn125, which may explain the absence of blaNDM-1 carrier-transformants. To our knowledge, this is the first report of the finding of NDM-positive A. baumannii in Tunisian territory. The study shows that despite the low prevalence and potential spread of NDM-1 enzyme among CRABC, continuous regional antimicrobial resistance surveillance and improved infection control measures are required in Tunisia to prevent further dissemination.
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Affiliation(s)
- Hadhemi Ben Cheikh
- 1Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
- 2Faculty of Science, Bizerta Carthage University, Bizerta, Tunisia
- Laboratory of Contagious Disease and Biologically Active Substances LR99-ES27, Monastir's Pharmacy Faculty, Monastir, Tunisia
| | - Sara Domingues
- 1Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
- 4Laboratory of Microbiology, Center for Neuroscience and Cell Biology (CNC), Faculty of Pharmacy, Health Sciences Campus, University of Coimbra, Azinhaga de Sta Comba, 3000-548 Coimbra, Portugal
| | | | - Yosr Kadri
- Laboratory of Contagious Disease and Biologically Active Substances LR99-ES27, Monastir's Pharmacy Faculty, Monastir, Tunisia
- 5Laboratory of Microbiology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Natasha Rosário
- 1Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Maha Mastouri
- Laboratory of Contagious Disease and Biologically Active Substances LR99-ES27, Monastir's Pharmacy Faculty, Monastir, Tunisia
- 5Laboratory of Microbiology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Gabriela Jorge Da Silva
- 1Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
- 4Laboratory of Microbiology, Center for Neuroscience and Cell Biology (CNC), Faculty of Pharmacy, Health Sciences Campus, University of Coimbra, Azinhaga de Sta Comba, 3000-548 Coimbra, Portugal
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25
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Müller H, Sib E, Gajdiss M, Klanke U, Lenz-Plet F, Barabasch V, Albert C, Schallenberg A, Timm C, Zacharias N, Schmithausen RM, Engelhart S, Exner M, Parcina M, Schreiber C, Bierbaum G. Dissemination of multi-resistant Gram-negative bacteria into German wastewater and surface waters. FEMS Microbiol Ecol 2018; 94:4963742. [DOI: 10.1093/femsec/fiy057] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/05/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Heike Müller
- University of Bonn, University Hospital, Institute for Hygiene and Public Health, 53105 Bonn, Sigmund-Freud-Str. 25, Germany
| | - Esther Sib
- University of Bonn, University Hospital, Institute of Medical Microbiology, Immunology and Parasitology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Mike Gajdiss
- University of Bonn, University Hospital, Institute of Medical Microbiology, Immunology and Parasitology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Ursula Klanke
- University of Bonn, University Hospital, Institute of Medical Microbiology, Immunology and Parasitology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Franziska Lenz-Plet
- University of Bonn, University Hospital, Institute of Medical Microbiology, Immunology and Parasitology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Vanessa Barabasch
- University of Bonn, University Hospital, Institute of Medical Microbiology, Immunology and Parasitology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Cathrin Albert
- University of Bonn, University Hospital, Institute of Medical Microbiology, Immunology and Parasitology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Anna Schallenberg
- University of Bonn, University Hospital, Institute of Medical Microbiology, Immunology and Parasitology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Christian Timm
- University of Bonn, University Hospital, Institute for Hygiene and Public Health, 53105 Bonn, Sigmund-Freud-Str. 25, Germany
| | - Nicole Zacharias
- University of Bonn, University Hospital, Institute for Hygiene and Public Health, 53105 Bonn, Sigmund-Freud-Str. 25, Germany
| | - Ricarda Maria Schmithausen
- University of Bonn, University Hospital, Institute for Hygiene and Public Health, 53105 Bonn, Sigmund-Freud-Str. 25, Germany
| | - Steffen Engelhart
- University of Bonn, University Hospital, Institute for Hygiene and Public Health, 53105 Bonn, Sigmund-Freud-Str. 25, Germany
| | - Martin Exner
- University of Bonn, University Hospital, Institute for Hygiene and Public Health, 53105 Bonn, Sigmund-Freud-Str. 25, Germany
| | - Marijo Parcina
- University of Bonn, University Hospital, Institute of Medical Microbiology, Immunology and Parasitology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Christiane Schreiber
- University of Bonn, University Hospital, Institute for Hygiene and Public Health, 53105 Bonn, Sigmund-Freud-Str. 25, Germany
| | - Gabriele Bierbaum
- University of Bonn, University Hospital, Institute of Medical Microbiology, Immunology and Parasitology, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
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26
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Hamzaoui Z, Ocampo-Sosa A, Fernandez Martinez M, Landolsi S, Ferjani S, Maamar E, Saidani M, Slim A, Martinez-Martinez L, Boutiba-Ben Boubaker I. Role of association of OmpK35 and OmpK36 alteration and bla ESBL and/or bla AmpC genes in conferring carbapenem resistance among non-carbapenemase-producing Klebsiella pneumoniae. Int J Antimicrob Agents 2018; 52:898-905. [PMID: 29621592 DOI: 10.1016/j.ijantimicag.2018.03.020] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/01/2018] [Accepted: 03/28/2018] [Indexed: 12/16/2022]
Abstract
In Klebsiella pneumoniae, loss of the two major outer membrane porins (OMPs) OmpK35 and OmpK36 confers resistance to carbapenems in strains producing extended-spectrum β-lactamases (ESBLs) or plasmid-mediated AmpC-type β-lactamases. This study investigated mechanisms responsible for carbapenem resistance in non-carbapenemase-producing K. pneumoniae (NCPK). All carbapenem-resistant Enterobacteriaceae (CRE) at Charles Nicolle Hospital (Tunis, Tunisia) were collected over a 6-year period (2010-2015). Among the 334 CRE strains collected, 44 (13.2%) were NCPK. MIC ranges for ertapenem, imipenem and meropenem were 1 to >32 mg/L, 0.125-8 mg/L and 0.125-32 mg/L, respectively. All strains showed a multidrug-resistant (MDR) phenotype and were negative for carbapenemase activity. None of the carbapenemase genes searched for were found. ESBL production was confirmed in all isolates except one [CTX-M-15 (n = 39) and SHV-5 (n = 4)]. Three isolates produce DHA-1 (associated with CTX-M-15 in two strains). Molecular fingerprints grouped the 44 NCPK isolates into seven clusters. In seven representative strains of these clusters, SDS-PAGE results showed that four isolates lacked the OmpK35 porin, one isolate lacked OmpK36 and two isolates lacked both OmpK35 and OmpK36. Sequencing of the corresponding porin genes showed amino acid insertions and deletions leading to early termination of translation, point mutations in the promoter region, or insertion sequences disrupting the gene coding sequence. Loss or deficiency of OMPs, coupled with ESBL and/or AmpC production, plays an important role in conferring carbapenem resistance in K. pneumoniae. Dissemination of these MDR bacteria in our hospital may create serious therapeutic problems in the future.
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Affiliation(s)
- Zaineb Hamzaoui
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory 'Antimicrobial resistance', 1007 Tunis, Tunisia; University of Carthage, Faculty of Sciences of Bizerte, Tunis, Tunisia.
| | - Alain Ocampo-Sosa
- Service of Microbiology, University Hospital Marqués de Valdecilla-IDIVAL, Santander 39008, Spain
| | - Marta Fernandez Martinez
- Service of Microbiology, University Hospital Marqués de Valdecilla-IDIVAL, Santander 39008, Spain
| | - Sarrah Landolsi
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory 'Antimicrobial resistance', 1007 Tunis, Tunisia
| | - Sana Ferjani
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory 'Antimicrobial resistance', 1007 Tunis, Tunisia; University of Carthage, Faculty of Sciences of Bizerte, Tunis, Tunisia
| | - Elaa Maamar
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory 'Antimicrobial resistance', 1007 Tunis, Tunisia
| | - Mabrouka Saidani
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory 'Antimicrobial resistance', 1007 Tunis, Tunisia; Charles Nicolle Hospital, Laboratory of Microbiology, 1006 Tunis, Tunisia
| | - Amine Slim
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory 'Antimicrobial resistance', 1007 Tunis, Tunisia; Charles Nicolle Hospital, Laboratory of Microbiology, 1006 Tunis, Tunisia
| | - Luis Martinez-Martinez
- Clinical Unit of Microbiology, University Hospital Reina Sofía, Córdoba, Spain; Department of Microbiology, University of Córdoba, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Ilhem Boutiba-Ben Boubaker
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES09 Research Laboratory 'Antimicrobial resistance', 1007 Tunis, Tunisia; Charles Nicolle Hospital, Laboratory of Microbiology, 1006 Tunis, Tunisia
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27
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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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28
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High Rate of Association of 16S rRNA Methylases and Carbapenemases in Enterobacteriaceae Recovered from Hospitalized Children in Angola. Antimicrob Agents Chemother 2018; 62:AAC.00021-18. [PMID: 29439957 DOI: 10.1128/aac.00021-18] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/02/2018] [Indexed: 11/20/2022] Open
Abstract
Acquired 16S rRNA methylases (RMTases) conferring pan-drug resistance to aminoglycosides were searched among enterobacterial isolates recovered in Angola. A total of 36 hospitalized children were screened for rectal colonization using the Superaminoglycoside selective medium. Twenty-two pan-aminoglycoside-resistant enterobacterial isolates were recovered, all of which produced RMTases, i.e., RmtB, ArmA, and RmtC. Highly diverse genetic backgrounds were identified for Escherichia coli and Klebsiella pneumoniae isolates, most of which coproduced carbapenemases NDM-1 or NDM-5, respectively.
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29
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Solgi H, Badmasti F, Giske CG, Aghamohammad S, Shahcheraghi F. Molecular epidemiology of NDM-1- and OXA-48-producing Klebsiella pneumoniae in an Iranian hospital: clonal dissemination of ST11 and ST893. J Antimicrob Chemother 2018. [DOI: 10.1093/jac/dky081] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hamid Solgi
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | - Farzad Badmasti
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
| | - Christian G Giske
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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Genomic Insights into Colistin-Resistant Klebsiella pneumoniae from a Tunisian Teaching Hospital. Antimicrob Agents Chemother 2018; 62:AAC.01601-17. [PMID: 29229634 DOI: 10.1128/aac.01601-17] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/27/2017] [Indexed: 11/20/2022] Open
Abstract
The emergence of colistin-resistant Klebsiella pneumoniae (CoRKp) is a public health concern, since this antibiotic has become the last line of treatment for infections caused by multidrug-resistant (MDR) Gram negatives. In this study, we have investigated the molecular basis of colistin resistance in 13 MDR K. pneumoniae strains isolated from 12 patients in a teaching hospital in Sousse, Tunisia. Whole-genome sequencing (WGS) was used to decipher the molecular mechanism of colistin resistance and to identify the resistome of these CoRKp isolates. It revealed a genome of ca. 5.5 Mbp in size with a G+C content of 57%, corresponding to that commonly observed for K. pneumoniae These isolates belonged to the 5 different sequence types (ST11, ST15, ST101, ST147, and ST392), and their resistome was composed of acquired β-lactamases, including extended-spectrum beta-lactamase and carbapenemase genes (blaCTX-M-15, blaOXA-204, blaOXA-48, and blaNDM-1 genes), aminoglycoside resistance genes [aac(6')Ib-cr, aph(3″)-Ib, aph(6)-Id, and aac(3)-IIa], and fosfomycin (fosA), fluoroquinolone (qnr-like), chloramphenicol, trimethoprim, and tetracycline resistance genes. All of the isolates were identified as having a mutated mgrB gene. Mapping reads with reference sequences of the most common genes involved in colistin resistance revealed several modifications in mgrB, pmr, and pho operons (deletions, insertions, and substitutions) likely affecting the function of these proteins. It is worth noting that among the 12 patients, 10 were treated with colistin before the isolation of CoRKp No plasmid encoding mcr-1 to mcr-5 genes was found in these isolates. This study corresponds to the first molecular characterization of a collection of CoRKp strains in Tunisia and highlights that the small-transmembrane protein MgrB is a main mechanism for colistin resistance in K. pneumoniae.
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Genome Sequences of Two NDM-1 Metallo-β-Lactamase-Producing Multidrug-Resistant Strains of Klebsiella pneumoniae with a High Degree of Similarity, One of Which Contains Prophage. GENOME ANNOUNCEMENTS 2017; 5:5/42/e01173-17. [PMID: 29051261 PMCID: PMC5646414 DOI: 10.1128/genomea.01173-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We report genome sequences of two NDM-1 metallo-β-lactamase-producing multidrug-resistant Klebsiella pneumoniae isolates of sequence type 147 (ST147) from one hospital. The genomes are highly similar and differ in prophage located in the chromosome of K. pneumoniae KPB-1470/16 and in the additional plasmid-carrying blaOXA-48 gene in K. pneumoniae KPB-417/16.
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Abderrahim A, Djahmi N, Pujol C, Nedjai S, Bentakouk MC, Kirane-Gacemi D, Dekhil M, Sotto A, Lavigne JP, Pantel A. First Case of NDM-1-ProducingKlebsiella pneumoniaein Annaba University Hospital, Algeria. Microb Drug Resist 2017; 23:895-900. [DOI: 10.1089/mdr.2016.0213] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Amel Abderrahim
- Institut National de la Santé et de la Recherche Médicale, U1047, Université de Montpellier, UFR de Médecine, Nîmes, France
- Laboratoire d'Amélioration Génétique des Plantes, Equipe Microorganismes et Environnement, Université Badji Mokhtar, Annaba, Algérie
| | - Nassima Djahmi
- Laboratoire de Microbiologie, CHU Ibn Rochd, Annaba, Algérie
| | | | - Sabina Nedjai
- Laboratoire de Microbiologie, CHU Ibn Rochd, Annaba, Algérie
| | - Mohamed Cherif Bentakouk
- Centre de Réanimation et de Traitement des Brûlés, Hôpital Ibn-Sina, CHU Annaba, Annaba, Algérie
| | - Djamila Kirane-Gacemi
- Laboratoire d'Amélioration Génétique des Plantes, Equipe Microorganismes et Environnement, Université Badji Mokhtar, Annaba, Algérie
| | - Mazouz Dekhil
- Laboratoire de Microbiologie, CHU Ibn Rochd, Annaba, Algérie
| | - Albert Sotto
- Institut National de la Santé et de la Recherche Médicale, U1047, Université de Montpellier, UFR de Médecine, Nîmes, France
- Service des Maladies Infectieuses et Tropicales, CHU Carémeau, Nîmes, France
| | - Jean-Philippe Lavigne
- Institut National de la Santé et de la Recherche Médicale, U1047, Université de Montpellier, UFR de Médecine, Nîmes, France
- Service de Microbiologie, CHU Carémeau, Nîmes, France
| | - Alix Pantel
- Institut National de la Santé et de la Recherche Médicale, U1047, Université de Montpellier, UFR de Médecine, Nîmes, France
- Service de Microbiologie, CHU Carémeau, Nîmes, France
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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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Outbreak of colistin-resistant carbapenemase-producing Klebsiella pneumoniae in Tunisia. J Glob Antimicrob Resist 2017; 10:88-94. [DOI: 10.1016/j.jgar.2017.03.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/21/2017] [Accepted: 03/27/2017] [Indexed: 12/11/2022] Open
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Multihospital Occurrence of Pan-Resistant Klebsiella pneumoniae Sequence Type 147 with an IS Ecp1-Directed blaOXA-181 Insertion in the mgrB Gene in the United Arab Emirates. Antimicrob Agents Chemother 2017; 61:AAC.00418-17. [PMID: 28438945 DOI: 10.1128/aac.00418-17] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 04/19/2017] [Indexed: 11/20/2022] Open
Abstract
The emergence of pan-resistant Klebsiella pneumoniae strains is an increasing concern. In the present study, we describe a cluster of 9 pan-resistant K. pneumoniae sequence type 147 (ST147) isolates encountered in 4 patients over nearly 1 year in 3 hospitals of the United Arab Emirates (UAE). The isolates exhibited highly similar genotypes. All produced chromosomally encoded OXA-181, and the majority also produced the NDM-5 carbapenemase. As with the previously described single isolate from the UAE, MS6671, the mgrB was disrupted by a functional, ISEcp1-driven blaOXA-181 insertion causing resistance to carbapenems. The mutation was successfully complemented with an intact mgrB gene, indicating that it was responsible for colistin resistance. blaNDM-5 was located within a resistance island of an approximately 100-kb IncFII plasmid carrying ermB, mph(A), blaTEM-1B, rmtB, blaNDM-5, sul1, aadA2, and dfrA12 resistance genes. Sequencing this plasmid (pABC143-NDM) revealed that its backbone was nearly identical to that of plasmid pMS6671E from which several resistance genes, including blaNDM-5, had been deleted. More extensive similarities of the backbone and the resistance island were found between pABC143C-NDM and the blaNDM-5-carrying IncFII plasmids of two K. pneumoniae ST147 isolates from South Korea, one of which was colistin resistant, and both also produced OXA-181. Notably, one of these strains was isolated from a patient transferred from the UAE. Our data show that this pan-resistant clone has an alarming capacity to maintain itself over an extended period of time and is even likely to be transmitted internationally.
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