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Hansen GT. Continuous Evolution: Perspective on the Epidemiology of Carbapenemase Resistance Among Enterobacterales and Other Gram-Negative Bacteria. Infect Dis Ther 2021; 10:75-92. [PMID: 33492641 PMCID: PMC7954928 DOI: 10.1007/s40121-020-00395-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/22/2020] [Indexed: 12/20/2022] Open
Abstract
The global emergence of carbapenemase-producing bacteria capable of hydrolyzing the once effective carbapenem antibiotics is considered a contemporary public health concern. Carbapenemase enzymes, once constrained to isolates of Klebsiella pneumoniae, are now routinely reported in different bacteria within the Enterobacterales order of bacteria, creating the acronym CRE which now defines Carbapenem-Resistant Enterobacterales. CRE harboring different types of enzymes, including the most prevalent types KPC, VIM, IMP, NDM, and OXA-48, are now routinely reported and more importantly, are now frequently present in many infections world-wide. Defining and updating the contemporary epidemiology of both the US and global burden of carbapenem-resistant infections is now more important than ever. This review describes the global distribution and continued evolution of carbapenemases which continue to spread at alarming rates. Informed understanding of the current epidemiology of CRE, coupled with advances in antibiotic options, and the use rapid diagnostics offers the potential for rapid identification and management of carbapenem-resistant infections.
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Affiliation(s)
- Glen T Hansen
- Department of Pathology and Laboratory Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
- Department of Pathology and Laboratory Medicine, University of Minnesota, School of Medicine, Minneapolis, MN, USA.
- Department of Medicine, Infectious Disease, University of Minnesota, School of Medicine, Minneapolis, MN, USA.
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Lentz SAM, Adam FC, Rivas PM, Souza SN, Cupertino VML, Boff RT, da Motta ADS, Wink PL, Barth AL, Martins AF. High Levels of Resistance to Cephalosporins Associated with the Presence of Extended-Spectrum and AmpC β-Lactamases in Escherichia coli from Broilers in Southern Brazil. Microb Drug Resist 2019; 26:531-535. [PMID: 31718408 DOI: 10.1089/mdr.2019.0050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The clinical importance of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli has increased steadily over the years. The presence of the blaTEM, blaSHV, and blaCTX-M genes in the environment has been recently recognized as an important issue in the dissemination of resistance to cephalosporins. Food animals are considered important vectors for transfer of ESBL genes from the environment to humans. The objective of this study was to characterize the ESBL genes (blaTEM, blaSHV, and blaCTX-M types) that were most prevalent among 343 ceftazidime-resistant E. coli isolates (17 batches from 12 different farms) obtained from cloacal swabs of broiler chicken in southern Brazil. The blaSHV, blaCTX-M, blaTEM, blaIMP-type, blaVIM-type, blaNDM-1, blaKPC-type, blaGES-type, blaOXA-48, and mcr-1 genes were evaluated by polymerase chain reaction. A total of 27 (7.9%) E. coli isolates were positive for ESBL genes as follows: 24 for blaCTX-M (23 blaCTX-M-2 Group and 1 blaCTX-M-8) and 3 for blaSHV (2 blaSHV-2a and 1 blaSHV-18). A random sample of 32 ceftazidime/cefotaxime-resistant isolates that were negative for ESBL genes were evaluated for the presence of blaCMY-2 and 24 (75%) tested positive. We detected the blaCMY-2 gene in isolates from all farms. All isolates positive for ESBL or blaCMY-2 are considered multidrug resistant (resistant to at least three antibiotic classes). Our results suggest that broiler chickens are an important reservoir of blaCMY-2 and ESBL genes, including blaSHV-2a, described for the first time in animals originating from Brazil in this study, and blaSHV-18, which has never been described in Brazil before. This fact highlights the importance of controlling the use of antibiotics in animal production to reduce environmental sources of resistance genes.
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Affiliation(s)
- Silvia Adriana Mayer Lentz
- Programa de Pós-graduação em Microbiologia Agrícola e do Ambiente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Microbiologia Aplicada, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Franciele Caroline Adam
- Programa de Pós-graduação em Microbiologia Agrícola e do Ambiente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Microbiologia Aplicada, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Paula Marques Rivas
- Coordenadoria Geral de Vigilância em Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Sara Neves Souza
- Coordenadoria Geral de Vigilância em Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Victória Martins Lima Cupertino
- Programa de Pós-graduação em Microbiologia Agrícola e do Ambiente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Microbiologia Aplicada, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Roberta Taufer Boff
- Programa de Pós-graduação em Microbiologia Agrícola e do Ambiente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Microbiologia Aplicada, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Amanda de Souza da Motta
- Programa de Pós-graduação em Microbiologia Agrícola e do Ambiente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Priscila Lamb Wink
- LABRESIS-Laboratório de Pesquisa em Resistência Bacteriana, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Afonso Luís Barth
- LABRESIS-Laboratório de Pesquisa em Resistência Bacteriana, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Andreza Francisco Martins
- Programa de Pós-graduação em Microbiologia Agrícola e do Ambiente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Microbiologia Aplicada, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Koga VL, Maluta RP, da Silveira WD, Ribeiro RA, Hungria M, Vespero EC, Nakazato G, Kobayashi RKT. Characterization of CMY-2-type beta-lactamase-producing Escherichia coli isolated from chicken carcasses and human infection in a city of South Brazil. BMC Microbiol 2019; 19:174. [PMID: 31362706 PMCID: PMC6664532 DOI: 10.1186/s12866-019-1550-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 07/19/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Food-producing animals, mainly poultry, have been associated with the maintenance and dissemination of antibiotic-resistant bacteria, such as plasmid-mediated AmpC (pAmpC)-producing Enterobacteriaceae, to humans, thus impacting food safety. Many studies have shown that Escherichia coli strains isolated from poultry and humans infections share identical cephalosporin resistance, suggesting that transmission of resistance from poultry meat to humans may occur. The aim of this study was to characterize pAmpC-producing E. coli strains isolated from chicken carcasses and human infection in a restrict area and to determine their antimicrobial resistance profiles, and molecular type by multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). RESULTS A total of 14 pAmpC-producing E. coli strains were isolated, including eight strains from chicken carcasses and six strains from human infections (from urine, tissue and secretion). The blaCMY-2 gene was identified in all pAmpC-producing E. coli strains by polymerase chain reaction (PCR) and DNA sequencing. High percentages of strains resistant to tetracycline, nalidixic acid and sulfamethoxazole-trimethoprim (78-92%) were detected, all of which were considered multidrug-resistant. Among the non-beta-lactam resistance genes, the majority of the strains showed tetA, tetB, sulI and sulII. No strain was considered an extended-spectrum beta-lactamases (ESBL) producer, and the blaTEM-1 gene was found in 2 strains isolated from human infection. Six strains from chicken carcasses and four strains from humans infections were linked to an ISEcp1-like element. Through MLST, 11 sequence types were found. Three strains isolated from human infection and one strain isolated from chicken carcasses belonged to the same sequence type (ST354). However, considerable heterogeneity between the strains from chicken carcasses and humans was confirmed by PFGE analysis. CONCLUSION This study showed the prevalence of E. coli strains producing blaCMY-2 linked to ISEcp1 that were present in both chickens and humans in a restricted area. Our results also suggest the presence of a highly diverse strains that harbor pAmpC, indicating no clonal dissemination. Therefore, continuous monitoring and comparative analyses of resistant bacteria from humans and food-producing animals are needed.
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Affiliation(s)
- Vanessa L Koga
- Basic and Applied Bacteriology Laboratory, Department of Microbiology, State University of Londrina (UEL), Londrina, PR, Brazil
| | - Renato P Maluta
- Bacterial Molecular Biology Laboratory, Department of Genetics, Evolution and Bioagents, Institute of Biology, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Wanderley D da Silveira
- Bacterial Molecular Biology Laboratory, Department of Genetics, Evolution and Bioagents, Institute of Biology, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Renan A Ribeiro
- Soil Biotechnology Laboratory, Brazilian Agricultural Research Corporation (Embrapa), Londrina, PR, Brazil
| | - Mariangela Hungria
- Soil Biotechnology Laboratory, Brazilian Agricultural Research Corporation (Embrapa), Londrina, PR, Brazil
| | - Eliana C Vespero
- Department of Pathology and Clinical and Toxicological Analysis, State University of Londrina (UEL), Londrina, PR, Brazil
| | - Gerson Nakazato
- Basic and Applied Bacteriology Laboratory, Department of Microbiology, State University of Londrina (UEL), Londrina, PR, Brazil
| | - Renata K T Kobayashi
- Basic and Applied Bacteriology Laboratory, Department of Microbiology, State University of Londrina (UEL), Londrina, PR, Brazil.
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Li Q, Wang H, Xu Y, Bai X, Wang J, Zhang Z, Liu X, Miao Y, Zhang L, Li X, Zou N, Yan G, Chen X, Zhang J, Fu S, Fan R, Xu J, Li J, Xiong Y. Multidrug-Resistant Escherichia albertii: Co-occurrence of β-Lactamase and MCR-1 Encoding Genes. Front Microbiol 2018; 9:258. [PMID: 29503643 PMCID: PMC5820351 DOI: 10.3389/fmicb.2018.00258] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 02/01/2018] [Indexed: 01/21/2023] Open
Abstract
Escherichia albertii is an emerging member of the Enterobacteriaceae causing human and animal enteric infections. Antimicrobial resistance among enteropathogens has been reported to be increasing in the past years. The purpose of this study was to investigate antibiotic resistance and resistance genes in E. albertii isolated from Zigong city, Sichuan province, China. The susceptibility to 21 antimicrobial agents was determined by Kirby-Bauer disk diffusion method. The highest prevalence was tetracycline resistance with a rate of 62.7%, followed by resistance to nalidixic acid and streptomycin with a rate of 56.9 and 51.0%, respectively. All isolates were sensitive or intermediate susceptible to imipenem, meropenem, amoxicillin-clavulanic acid, and levofloxacin. Among 51 E. albertii isolates, 15 were extended-spectrum β-lactamase-producing as confirmed by the double disk test. The main β-lactamase gene groups, i.e., blaTEM, blaSHV, and blaCTX-M, were detected in17, 20, and 22 isolates, respectively. Furthermore, four colistin-resistant isolates with minimum inhibitory concentrations of 8 mg/L were identified. The colistin-resistant isolates all harbored mcr-1 and blaCTX-M-55. Genome sequencing showed that E. albertii strain SP140150 carried mcr-1 and blaCTX-M-55 in two different plasmids. This study provided significant information regarding antibiotic resistance profiles and identified the co-occurrence of β-lactamase and MCR-1 encoding genes in E. albertii isolates.
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Affiliation(s)
- Qun Li
- Zigong Center for Disease Control and Prevention, Zigong, China
| | - Hong Wang
- Zigong Center for Disease Control and Prevention, Zigong, China
| | - Yanmei Xu
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiangning Bai
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianping Wang
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhengdong Zhang
- Zigong Center for Disease Control and Prevention, Zigong, China
| | - Xiang Liu
- Zigong Center for Disease Control and Prevention, Zigong, China
| | - Yimao Miao
- Zigong Center for Disease Control and Prevention, Zigong, China
| | - Ling Zhang
- Zigong Center for Disease Control and Prevention, Zigong, China
| | - Xinqiong Li
- Zigong Center for Disease Control and Prevention, Zigong, China
| | - Nianli Zou
- Zigong Center for Disease Control and Prevention, Zigong, China
| | - Guodong Yan
- Zigong Center for Disease Control and Prevention, Zigong, China
| | - Xi Chen
- Zigong Center for Disease Control and Prevention, Zigong, China
| | - Jie Zhang
- Zigong Center for Disease Control and Prevention, Zigong, China
| | - Shanshan Fu
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ruyue Fan
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianguo Xu
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Juan Li
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yanwen Xiong
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Ingti B, Paul D, Maurya AP, Bora D, Chanda DD, Chakravarty A, Bhattacharjee A. Occurrence of bla DHA-1 mediated cephalosporin resistance in Escherichia coli and their transcriptional response against cephalosporin stress: a report from India. Ann Clin Microbiol Antimicrob 2017; 16:13. [PMID: 28320396 PMCID: PMC5359928 DOI: 10.1186/s12941-017-0189-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/10/2017] [Indexed: 01/21/2023] Open
Abstract
Background Treatment alternatives for DHA-1 harboring strains are challenging as it confers resistance to broad spectrum cephalosporins and may further limit treatment option when expressed at higher levels. Therefore, this study was designed to know the prevalence of DHA genes and analyse the transcription level of DHA-1 against different β-lactam stress. Methods Screening of AmpC β-lactamase phenotypically by modified three dimensional extract method followed by Antimicrobial Susceptibility and MIC determination. Genotyping screening of β-lactamase genes was performed by PCR assay followed by their sequencing. The blaDHA-1 transcriptional response was evaluated under different cephalosporin stress by RT PCR. Transferability of blaDHA gene was performed by transformation and conjugation and plasmid incompatibility typing, DNA fingerprinting by enterobacterial repetitive intergenic consensus sequences PCR. Results 16 DHA-1 genes were screened positive from 176 Escherichia coli isolates and primer extension analysis showed a significant increase in DHA-1 mRNA transcription in response to cefotaxime at 8 µg/ml (6.99 × 102 fold), ceftriaxone at 2 µg/ml (2.63 × 103 fold), ceftazidime at 8 µg/ml (7.06 × 103 fold) and cefoxitin at 4 µg/ml (3.60 × 104 fold) when compared with untreated strain. These transcription data were found significant when analyzed statistically using one way ANOVA. Four different ESBL genes were detected in 10 isolates which include CTX-M (n = 6), SHV (n = 4), TEM (n = 3) and OXA-10 (n = 1), whereas, carbapenemase gene (NDM) was detected only in one isolate. Other plasmid mediated AmpC β-lactamases CIT (n = 9), EBC (n = 2) were detected in nine isolates. All DHA-1 genes detected were encoded in plasmid and incompatibility typing from the transformants indicated that the plasmid encoding blaDHA-1 was carried mostly by the FIA and L/M Inc group. Conclusion This study demonstrates the prevalence of DHA-1 gene in this region and highlights high transcription of DHA-1 when induced with different β-lactam antibiotics. Therefore, cephalosporin treatment must be restricted for the patients infected with pathogen expressing this resistance determinant.
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Affiliation(s)
- Birson Ingti
- Department of Microbiology, Assam University, Silchar, 788011, India
| | - Deepjyoti Paul
- Department of Microbiology, Assam University, Silchar, 788011, India
| | | | - Debajyoti Bora
- Department of Statistics, Dibrugarh University, Dibrugarh, India
| | - Debadatta Dhar Chanda
- Department of Microbiology, Silchar Medical College and Hospital, Silchar, 788014, India
| | - Atanu Chakravarty
- Department of Microbiology, Silchar Medical College and Hospital, Silchar, 788014, India
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Fróes AM, da Mota FF, Cuadrat RRC, Dávila AMR. Distribution and Classification of Serine β-Lactamases in Brazilian Hospital Sewage and Other Environmental Metagenomes Deposited in Public Databases. Front Microbiol 2016; 7:1790. [PMID: 27895627 PMCID: PMC5108929 DOI: 10.3389/fmicb.2016.01790] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/25/2016] [Indexed: 01/09/2023] Open
Abstract
β-lactam is the most used antibiotic class in the clinical area and it acts on blocking the bacteria cell wall synthesis, causing cell death. However, some bacteria have evolved resistance to these antibiotics mainly due the production of enzymes known as β-lactamases. Hospital sewage is an important source of dispersion of multidrug-resistant bacteria in rivers and oceans. In this work, we used next-generation DNA sequencing to explore the diversity and dissemination of serine β-lactamases in two hospital sewage from Rio de Janeiro, Brazil (South Zone, SZ and North Zone, NZ), presenting different profiles, and to compare them with public environmental data available. Also, we propose a Hidden-Markov-Model approach to screen potential serine β-lactamases genes (in public environments samples and generated hospital sewage data), exploring its evolutionary relationships. Due to the high variability in β-lactamases, we used a position-specific scoring matrix search method (RPS-BLAST) against conserved domain database profiles (CDD, Pfam, and COG) followed by visual inspection to detect conserved motifs, to increase the reliability of the results and remove possible false positives. We were able to identify novel β-lactamases from Brazilian hospital sewage and to estimate relative abundance of its types. The highest relative abundance found in SZ was the Class A (50%), while Class D is predominant in NZ (55%). CfxA (65%) and ACC (47%) types were the most abundant genes detected in SZ, while in NZ the most frequent were OXA-10 (32%), CfxA (28%), ACC (21%), CEPA (20%), and FOX (19%). Phylogenetic analysis revealed β-lactamases from Brazilian hospital sewage grouped in the same clade and close to sequences belonging to Firmicutes and Bacteroidetes groups, but distant from potential β-lactamases screened from public environmental data, that grouped closer to β-lactamases of Proteobacteria. Our results demonstrated that HMM-based approach identified homologs of serine β-lactamases, indicating the specificity and high sensitivity of this approach in large datasets, contributing for the identification and classification of a large number of homologous genes, comprising possible new ones. Phylogenetic analysis revealed the potential reservoir of β-lactam resistance genes in the environment, contributing to understanding the evolution and dissemination of these genes.
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Affiliation(s)
- Adriana M Fróes
- Laboratório de Biologia Computacional e Sistemas, Instituto Oswaldo Cruz, FIOCRUZ Rio de Janeiro, Brazil
| | - Fábio F da Mota
- Laboratório de Biologia Computacional e Sistemas, Instituto Oswaldo Cruz, FIOCRUZ Rio de Janeiro, Brazil
| | - Rafael R C Cuadrat
- Laboratório de Biologia Computacional e Sistemas, Instituto Oswaldo Cruz, FIOCRUZ Rio de Janeiro, Brazil
| | - Alberto M R Dávila
- Laboratório de Biologia Computacional e Sistemas, Instituto Oswaldo Cruz, FIOCRUZ Rio de Janeiro, Brazil
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Sampaio JLM, Gales AC. Antimicrobial resistance in Enterobacteriaceae in Brazil: focus on β-lactams and polymyxins. Braz J Microbiol 2016; 47 Suppl 1:31-37. [PMID: 27825605 PMCID: PMC5156504 DOI: 10.1016/j.bjm.2016.10.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 12/22/2022] Open
Abstract
During the last 30 years there has been a dissemination of plasmid-mediated β-lactamases in Enterobacteriaceae in Brazil. Extended spectrum β-lactamases (ESBL) are widely disseminated in the hospital setting and are detected in a lower frequency in the community setting. Cefotaximases are the most frequently detected ESBL type and Klebsiella pneumoniae is the predominant species among ESBL producers. Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae became widely disseminated in Brazil during the last decade and KPC production is currently the most frequent resistance mechanism (96.2%) in carbapenem resistant K. pneumoniae. To date KPC-2 is the only variant reported in Brazil. Polymyxin B resistance in KPC-2-producing K. pneumoniae has come to an alarming rate of 27.1% in 2015 in São Paulo, the largest city in Brazil. New Delhi metallo-β-lactamase was detected in Brazil in 2013, has been reported in different Brazilian states but are not widely disseminated. Antimicrobial resistance in Enterobacteriaceae in Brazil is a very serious problem that needs urgent actions which includes both more strict adherence to infection control measures and more judicious use of antimicrobials.
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Affiliation(s)
- Jorge Luiz Mello Sampaio
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas, Departamento de Análises Clínicas e Toxicológicas, São Paulo, SP, Brazil; Fleury Medicina e Saúde, Seção de Microbiologia, São Paulo, SP, Brazil.
| | - Ana Cristina Gales
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina Interna, São Paulo, Brazil.
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da Silva KC, Cunha MPV, Cerdeira L, de Oliveira MGX, de Oliveira MCV, Gomes CR, Lincopan N, Knöbl T, Moreno AM. High-virulence CMY-2- and CTX-M-2-producing avian pathogenic Escherichia coli strains isolated from commercial turkeys. Diagn Microbiol Infect Dis 2016; 87:64-67. [PMID: 27773543 DOI: 10.1016/j.diagmicrobio.2016.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/21/2016] [Accepted: 10/05/2016] [Indexed: 11/25/2022]
Abstract
This study reports the high-virulence phylogenetic backgrounds of CMY-2- and CTX-M-2-producing avian pathogenic Escherichia coli strains isolated from turkeys sent to slaughter and condemned by airsacculitis in Brazil. Among 300 air sac samples, seven E. coli strains produced plasmid-mediated CMY-2-type AmpC, of which three carried also the blaCTX-M-2 Extended Spectrum Beta-Lactamase encoding gene. Interestingly, the transfer of the blaCMY-2 gene was positive for three E. coli strains, being associated with the presence of IncI1 plasmids. The complete sequence of the representative pJB10 plasmid revealed that the blaCMY-2 gene was within a transposon-like element in the classical genetic environment consisting of tnpA-blaCMY-2-blc-sugE structure. This plasmid with 94-kb belonged to the sequence type (ST) 12 among IncI1 plasmids, which has been associated with the worldwide spread of blaCMY-2 among Salmonella enterica and E. coli. Furthermore, to the best of our knowledge, this is the first complete sequence of a CMY-2-encoding plasmid derived from an Escherichia coli isolated from food-producing animals in Latin America.
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Affiliation(s)
- Ketrin Cristina da Silva
- Department of Preventive Veterinary Medicine and Animal Health, University of São Paulo, College of Veterinary Medicine and Zootechny, São Paulo, Brazil
| | - Marcos Paulo Vieira Cunha
- Department of Pathology, University of São Paulo, College of Veterinary Medicine and Zootechnics, São Paulo, Brazil
| | - Louise Cerdeira
- Department of Clinical Analysis, School of Pharmacy, University of São Paulo, São Paulo, Brazil
| | | | | | - Cleise Ribeiro Gomes
- Department of Preventive Veterinary Medicine and Animal Health, University of São Paulo, College of Veterinary Medicine and Zootechny, São Paulo, Brazil
| | - Nilton Lincopan
- Department of Clinical Analysis, School of Pharmacy, University of São Paulo, São Paulo, Brazil; Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Terezinha Knöbl
- Department of Pathology, University of São Paulo, College of Veterinary Medicine and Zootechnics, São Paulo, Brazil
| | - Andrea Micke Moreno
- Department of Preventive Veterinary Medicine and Animal Health, University of São Paulo, College of Veterinary Medicine and Zootechny, São Paulo, Brazil.
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Pavez M, Vieira C, de Araujo MR, Cerda A, de Almeida LM, Lincopan N, Mamizuka EM. Molecular mechanisms of membrane impermeability in clinical isolates of Enterobacteriaceae exposed to imipenem selective pressure. Int J Antimicrob Agents 2016; 48:78-85. [DOI: 10.1016/j.ijantimicag.2016.04.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 04/08/2016] [Accepted: 04/16/2016] [Indexed: 01/08/2023]
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Martirosov DM, Lodise TP. Emerging trends in epidemiology and management of infections caused by carbapenem-resistant Enterobacteriaceae. Diagn Microbiol Infect Dis 2016; 85:266-75. [DOI: 10.1016/j.diagmicrobio.2015.10.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 10/02/2015] [Accepted: 10/09/2015] [Indexed: 11/16/2022]
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Rocha DAC, Campos JC, Passadore LF, Sampaio SCF, Nicodemo AC, Sampaio JLM. Frequency of Plasmid-Mediated AmpC β-Lactamases in Escherichia coli Isolates from Urine Samples in São Paulo, Brazil. Microb Drug Resist 2015; 22:321-7. [PMID: 26670152 DOI: 10.1089/mdr.2015.0190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Plasmid-mediated AmpC β-lactamases (PMACBLs) in Enterobacteriaceae encode resistance to third-generation cephalosporins, and these can mediate carbapenem resistance when associated with porin loss. However, no standardized phenotypic method is available for detecting these enzymes in the clinical microbiology laboratory. Limited data are available concerning the frequency of PMACBLs in Enterobacteriaceae in Brazil. This study was conducted in response to an increased cefoxitin (CFO) resistance rate of 3.7% in Escherichia coli isolates from urine samples from patients with suspected urinary tract infections during 2010. We collected 2,266 E. coli isolates prospectively during January 2012. A total of 109 (4.8%) isolates were nonsusceptible to CFO. These strains were further examined using multiplex PCR for the presence of genes encoding PMACBLs and using inhibitor assays with CFO and ceftazidime (CAZ) disks with and without phenylboronic acid. Pulsed-field gel electrophoresis was used to evaluate clonal dissemination. Genes encoding PMACBLs were detected in 1.8% of the isolates from inpatients and 0.46% of isolates from outpatients. The most prevalent gene was blaCMY-2 and blaCMY-4 was also detected. The phenotypic analysis showed 100% sensitivity and specificity for CMY-2 and CMY-4 when CFO-resistant isolates with a minimum zone diameter difference of 5 mm for CAZ or CAZ and CFO were considered positive. Although most of the isolates were nonclonal, one clonal group with two isolates was observed. Thus, the most frequent PMACBL in E. coli from São Paulo, Brazil is CMY-2, and both clonal and plasmid-mediated dissemination occur.
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Affiliation(s)
- Darlan Augusto Costa Rocha
- 1 Clinical Analysis and Toxicology Department, School of Pharmacy, University of São Paulo , São Paulo, Brazil
| | - Juliana Coutinho Campos
- 1 Clinical Analysis and Toxicology Department, School of Pharmacy, University of São Paulo , São Paulo, Brazil
| | | | | | - Antonio Carlos Nicodemo
- 4 Department of Infectious and Parasitic Diseases, University of São Paulo , Medical School, São Paulo, Brazil
| | - Jorge Luiz Mello Sampaio
- 1 Clinical Analysis and Toxicology Department, School of Pharmacy, University of São Paulo , São Paulo, Brazil .,5 Fleury Diagnostic Medicine-Microbiology Section , São Paulo, Brazil
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Koga VL, Scandorieiro S, Vespero EC, Oba A, de Brito BG, de Brito KCT, Nakazato G, Kobayashi RKT. Comparison of Antibiotic Resistance and Virulence Factors among Escherichia coli Isolated from Conventional and Free-Range Poultry. BIOMED RESEARCH INTERNATIONAL 2015; 2015:618752. [PMID: 26579536 PMCID: PMC4633531 DOI: 10.1155/2015/618752] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/17/2022]
Abstract
Microbiological contamination in commercial poultry production has caused concerns for human health because of both the presence of pathogenic microorganisms and the increase in antimicrobial resistance in bacterial strains that can cause treatment failure of human infections. The aim of our study was to analyze the profile of antimicrobial resistance and virulence factors of E. coli isolates from chicken carcasses obtained from different farming systems (conventional and free-range poultry). A total of 156 E. coli strains were isolated and characterized for genes encoding virulence factors described in extraintestinal pathogenic E. coli (ExPEC). Antimicrobial susceptibility testing was performed for 15 antimicrobials, and strains were confirmed as extended spectrum of β-lactamases- (ESBLs-) producing E. coli by phenotypic and genotypic tests. The results indicated that strains from free-range poultry have fewer virulence factors than strains from conventional poultry. Strains from conventionally raised chickens had a higher frequency of antimicrobial resistance for all antibiotics tested and also exhibited genes encoding ESBL and AmpC, unlike free-range poultry isolates, which did not. Group 2 CTX-M and CIT were the most prevalent ESBL and AmpC genes, respectively. The farming systems of poultries can be related with the frequency of virulence factors and resistance to antimicrobials in bacteria.
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Affiliation(s)
- Vanessa L. Koga
- Department of Microbiology, Laboratory of Basic and Applied Bacteriology, State University of Londrina (UEL), Rodovia Celso Garcia Cid, Caixa Postal 6001, 86051-980 Londrina, PR, Brazil
| | - Sara Scandorieiro
- Department of Microbiology, Laboratory of Basic and Applied Bacteriology, State University of Londrina (UEL), Rodovia Celso Garcia Cid, Caixa Postal 6001, 86051-980 Londrina, PR, Brazil
| | - Eliana C. Vespero
- Department of Pathology and Clinical and Toxicological Analysis, State University of Londrina (UEL), Avenida Robert Koch, No. 60, Vila Operária, 86038-350 Londrina, PR, Brazil
| | - Alexandre Oba
- Department of Zootechnia, State University of Londrina (UEL), Rodovia Celso Garcia Cid, Caixa Postal 6001, 86051-980 Londrina, PR, Brazil
| | - Benito G. de Brito
- Laboratory of Bird Health, Fepagro Animal Health, Veterinary Research Institute Desidério Finamor (IPVDF), Estrada do Conde, No. 6000, 92990-000 Eldorado do Sul, RS, Brazil
| | - Kelly C. T. de Brito
- Laboratory of Bird Health, Fepagro Animal Health, Veterinary Research Institute Desidério Finamor (IPVDF), Estrada do Conde, No. 6000, 92990-000 Eldorado do Sul, RS, Brazil
| | - Gerson Nakazato
- Department of Microbiology, Laboratory of Basic and Applied Bacteriology, State University of Londrina (UEL), Rodovia Celso Garcia Cid, Caixa Postal 6001, 86051-980 Londrina, PR, Brazil
| | - Renata K. T. Kobayashi
- Department of Microbiology, Laboratory of Basic and Applied Bacteriology, State University of Londrina (UEL), Rodovia Celso Garcia Cid, Caixa Postal 6001, 86051-980 Londrina, PR, Brazil
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Bonelli RR, Moreira BM, Picão RC. Antimicrobial resistance among Enterobacteriaceae in South America: history, current dissemination status and associated socioeconomic factors. Drug Resist Updat 2014; 17:24-36. [PMID: 24618111 DOI: 10.1016/j.drup.2014.02.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
South America exhibits some of the higher rates of antimicrobial resistance in Enterobactericeae worldwide. This continent includes 12 independent countries with huge socioeconomic differences, where the ample access to antimicrobials, including counterfeit ones, coexists with ineffective health systems and sanitation problems, favoring the emergence and dissemination of resistant strains. This work presents a literature review concerning the evolution and current status of antimicrobial resistance threats found among Enterobacteriaceae in South America. Resistance to β-lactams, fluoroquinolones and aminoglycosides was emphasized along with description of key epidemiological studies that highlight the success of specific resistance determinants in different parts of the continent. In addition, a discussion regarding political and socioeconomic factors possibly related to the dissemination of antimicrobial resistant strains in clinical settings and at the community is presented. Finally, in order to assess the possible sources of resistant bacteria, we compile the current knowledge about the occurrence of antimicrobial resistance in isolates in South American' food, food-producing animals and off-hospitals environments. By addressing that intensive intercontinental commerce and tourism neutralizes the protective effect of geographic barriers, we provide arguments reinforcing that globally integrated efforts are needed to decelerate the emergence and dissemination of antimicrobial resistant strains.
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Affiliation(s)
- Raquel Regina Bonelli
- LIM Laboratório Integrado de Microbiologia, Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Beatriz Meurer Moreira
- LIM Laboratório Integrado de Microbiologia, Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renata Cristina Picão
- LIM Laboratório Integrado de Microbiologia, Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Campana EH, Barbosa PP, Fehlberg LCC, Gales AC. Frequency of plasmid-mediated AmpC in Enterobacteriaceae isolated in a Brazilian Teaching Hospital. Braz J Microbiol 2013; 44:477-80. [PMID: 24294242 PMCID: PMC3833148 DOI: 10.1590/s1517-83822013000200023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 06/05/2012] [Indexed: 11/22/2022] Open
Abstract
In Brazil, the presence of plasmid-mediated AmpC (pAmpC)-producing isolates has been sporadically reported. We evaluated the frequency of pAmpC among 133 Enterobacteriaceae clinical isolates. The blaCMY-2-like gene was detected in a single Klebsiella pneumoniae isolate. In our study, the pAmpC frequency was very low as previously reported.
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Affiliation(s)
- Eloiza H Campana
- Laboratório ALERTA, Disciplina de Infectologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Chia J, Siu L, Su L, Lin H, Kuo A, Lee M, Wu T. Emergence of Carbapenem-ResistantEscherichia Coliin Taiwan: Resistance Due to Combined CMY-2 Production and Porin Deficiency. J Chemother 2013; 21:621-6. [DOI: 10.1179/joc.2009.21.6.621] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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16
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Hofer B, Dantier C, Gebhardt K, Desarbre E, Schmitt-Hoffmann A, Page MGP. Combined effects of the siderophore monosulfactam BAL30072 and carbapenems on multidrug-resistant Gram-negative bacilli. J Antimicrob Chemother 2013; 68:1120-9. [DOI: 10.1093/jac/dks527] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Hawser SP, Bouchillon SK, Hoban DJ, Badal RE, Hackel MA, Lascols CA, Villegas MV, Rossi F. Low frequency of ertapenem-resistant intra-abdominal isolates of Escherichia coli from Latin America: susceptibility, ESBL-occurrence, and molecular characterisation (SMART 2008-2009). J Chemother 2012; 24:6-11. [PMID: 22546718 DOI: 10.1179/1120009x12z.0000000003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The Study for Monitoring Antimicrobial Resistance Trends is an ongoing multi-year surveillance study that tracks worldwide antimicrobial resistance trends among aerobic and facultatively anaerobic Gram-negative bacilli isolated from intra-abdominal infections. During 2008-2009, 1366 isolates of Escherichia coli were collected from 19 investigator sites in 11 Latin American countries. Of the 1366 isolates, 323 (23.6%) were extended spectrum beta-lactamase (ESBL)-positive. Overall, the most effective agents tested were imipenem, ertapenem, and amikacin with susceptibilities of ≥96%. Against ESBL-positive isolates, only imipenem and ertapenem exhibited susceptibility ≥90%. Based on the use of the new Clinical and Laboratory Standards Institute clinical breakpoints for ertapenem (resistance ≥1 μg/ml), resistance to ertapenem among all E. coli isolates was only 0.3% (4/1366) throughout the region, ranging from 0% in several countries up to 1.2% in Ecuador. Against ESBL-positive isolates only, resistance to ertapenem in Latin America overall was 0.9% (3/323), with a maximum of 9.1% (1/11) observed in Argentina.
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18
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Beirão EM, Furtado JJD, Girardello R, Ferreira Filho H, Gales AC. Clinical and microbiological characterization of KPC-producing Klebsiella pneumoniae infections in Brazil. Braz J Infect Dis 2011; 15:69-73. [PMID: 21412593 DOI: 10.1016/s1413-8670(11)70143-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Accepted: 06/18/2010] [Indexed: 11/17/2022] Open
Abstract
In 2008 isolates of KPC-producing Klebsiella pneumoniae (KPC-KPN) were detected for the first time at Hospital Heliópolis, São Paulo, Brazil. The aim of this study was to characterize the clinical and microbiological outcomes of infections caused by KPC-KPN. A historical cohort of patients from whom KPC-KPN strains were isolated was performed. Isolates were identified as resistant to ertapenem by automated broth microdilution system and screened as carbapenemase producers by the modified Hodge test. The beta-lactamase resistance gene blaKPC was detected by PCR. The genetic relatedness of isolates was determined by PFGE. The study provides early clinical experience in treating KPC-KPN infections in a Brazilian tertiary center.
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Affiliation(s)
- Elisa Maria Beirão
- Departamento de Infectologia, Hospital Heliópolis, Rua Conego Xavier 276, Sao Paulo, SP, Brazil.
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When carbapenem-hydrolyzing beta-lactamase Kpc meets Escherichia coli ST131 in France. Antimicrob Agents Chemother 2011; 55:4933-4. [PMID: 21768511 DOI: 10.1128/aac.00719-11] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Chang HJ, Hsu PC, Yang CC, Kuo AJ, Chia JH, Wu TL, Lee MH. Risk factors and outcomes of carbapenem-nonsusceptible Escherichia coli bacteremia: A matched case–control study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2011; 44:125-30. [DOI: 10.1016/j.jmii.2010.06.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 04/21/2010] [Accepted: 06/22/2010] [Indexed: 02/04/2023]
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21
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Cergole-Novella MC, Guth BE, Castanheira M, Carmo MS, Pignatari AC. First Description ofblaCTX-M-14- andblaCTX-M-15-ProducingEscherichia coliIsolates in Brazil. Microb Drug Resist 2010; 16:177-84. [DOI: 10.1089/mdr.2010.0008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maria Cecilia Cergole-Novella
- Infectious Disease Division, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Microbiology, Immunology and Parasitology, Universidade Federal de São Paulo, Brazil
| | - Beatriz E.C. Guth
- Department of Microbiology, Immunology and Parasitology, Universidade Federal de São Paulo, Brazil
| | | | - Mirian S. Carmo
- Infectious Disease Division, Universidade Federal de São Paulo, São Paulo, Brazil
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