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Mitsuwan W, Intongead S, Saengsawang P, Romyasamit C, Narinthorn R, Nissapatorn V, Pereira MDL, Paul AK, Wongtawan T, Boripun R. Occurrence of multidrug resistance associated with extended-spectrum β‑lactamase and the biofilm forming ability of Escherichia coli in environmental swine husbandry. Comp Immunol Microbiol Infect Dis 2023; 103:102093. [PMID: 37976973 DOI: 10.1016/j.cimid.2023.102093] [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: 07/30/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
Extended-spectrum beta-lactamase (ESBL) production and biofilm formation are mechanisms employed by Escherichia coli to resist beta-lactam antibiotics. Thus, we aimed to examine antibiotic resistance associated with ESBL production and biofilm formation in E. coli isolates from swine farms in Southern Thailand. In total, 159 E. coli isolates were obtained, with 44 isolates identified as ESBL producers, originating from feces (18.87 %) and wastewater (8.80 %) samples. All ESBL-producing strains exhibited resistance to ampicillin (100 %), followed by the cephalosporin group (97.73 %) and tetracycline (84.09 %). Multidrug resistance was observed in 17 isolates (38.63 %). Among the isolates from feces samples, the blaGES gene was the most prevalent, detected in 90 % of the samples, followed by blaCTX-M9 (86.67 %) and blaCTX-M1 (66.67 %), respectively. In the bacteria isolated from wastewater, both blaGES and blaCTX-M9 genes were the predominant resistance genes, detected in 100 % of the isolates, followed by blaCTX-M1 (64.29 %) and blaTEM (50 %), respectively. Strong biofilm formation was observed in 11 isolates (36.67 %) from feces and 4 isolates (25.57 %) from wastewater samples. Notably, nearly 100 % of ESBL-producing strains isolated from feces tested positive for both pgaA and pgaC genes, which play a role in intracellular adhesion and biofilm production. These findings contribute to the understanding and potential control of ESBL-producing E. coli, and the dissemination of antibiotic resistance and biofilm-related genes in swine farms.
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Affiliation(s)
- Watcharapong Mitsuwan
- Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80160, Thailand; One Health Research Center, Walailak University, Nakhon Si Thammarat 80160, Thailand; Center of Excellence in Innovation of Essential Oil and Bio-active compound, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Sutsiree Intongead
- Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Phirabhat Saengsawang
- Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80160, Thailand; One Health Research Center, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Chonticha Romyasamit
- School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
| | - Ruethai Narinthorn
- Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Veeranoot Nissapatorn
- School of Allied Health Sciences, Southeast Asia Water Team (SEA Water Team), World Union for Herbal Drug Discovery (WUHeDD), and Research Excellence Center for Innovation and Health Products (RECIHP), Walailak University, Nakhon Si Thammarat, Thailand
| | - Maria de Lourdes Pereira
- CICECO-Aveiro Institute of Materials and Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Alok K Paul
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart TAS 7001, Australia
| | - Tuempong Wongtawan
- Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80160, Thailand; One Health Research Center, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Ratchadaporn Boripun
- Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80160, Thailand; One Health Research Center, Walailak University, Nakhon Si Thammarat 80160, Thailand.
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Tran HH, Nguyen HAT, Tran HB, Vu BNT, Nguyen TCT, Tacoli C, Tran TP, Trinh TS, Cai THN, Nadjm B, Tran KHT, Pham QD, Nguyen THT, Nguyen TT, Pham TD, Kesteman T, Dang DA, Tran TD, van Doorn HR, Lewycka S. Feasibility, acceptability, and bacterial recovery for community-based sample collection to estimate antibiotic resistance in commensal gut and upper respiratory tract bacteria. Sci Rep 2022; 12:22512. [PMID: 36581706 PMCID: PMC9797900 DOI: 10.1038/s41598-022-27084-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022] Open
Abstract
Vietnam has high rates of antibiotic use and resistance. Measuring resistance in commensal bacteria could provide an objective indicator for evaluating the impact of interventions to reduce antibiotic use and resistance. This study aimed to evaluate the feasibility, acceptability, and bacterial recovery for different sampling strategies. We conducted a cross-sectional mixed methods study in a rural community in Ha Nam Province, northern Vietnam, and collected structured interviews, samples, and in-depth interviews from households. Out of 389 households invited, 324 participated (83%), representing 1502 individuals. Samples were collected from these individuals (1498 stool, 1002 self-administered nasal swabs, and 496 HW-administered nasopharyngeal swabs). Pneumococci were recovered from 11.1% (128/1149) of the total population and 26.2% (48/183) of those under 5-years. Recovery was higher for health-worker (HW)-administered swabs (13.7%, 48/350) than self-administered swabs (10.0%, 80/799) (OR 2.06, 95% CI 1.07-3.96). Cost per swab was cheaper for self-administered ($7.26) than HW-administered ($8.63) swabs, but the overall cost for 100 positive samples was higher ($7260 and $6300 respectively). Qualitative interviews revealed that HW-administered nasopharyngeal swabs took longer to collect, caused more discomfort, and were more difficult to take from children. Factors affecting participation included sense of contribution, perceived trade-offs between benefits and effort, and peer influence. Reluctance was related to stool sampling and negative perceptions of research. This study provides important evidence for planning community-based carriage studies, including cost, logistics, and acceptability. Self-administered swabs had lower recovery, and though cheaper and quicker, this would translate to higher costs for large population-based studies. Recovery might be improved by swab-type, transport medium, and better cold-chain to lab.
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Affiliation(s)
- Hoang Huy Tran
- National Institute for Hygiene and Epidemiology, Hanoi, Vietnam
| | | | | | | | | | | | | | - Tung Son Trinh
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | | | - Behzad Nadjm
- Oxford University Clinical Research Unit, Hanoi, Vietnam.,Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Serekunda, The Gambia
| | | | | | | | | | - Thai Duy Pham
- National Institute for Hygiene and Epidemiology, Hanoi, Vietnam
| | - Thomas Kesteman
- Oxford University Clinical Research Unit, Hanoi, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Duc Anh Dang
- National Institute for Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tien Dac Tran
- Centre for Disease Control, Phu Ly, Ha Nam Province, Vietnam
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sonia Lewycka
- Oxford University Clinical Research Unit, Hanoi, Vietnam. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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El-Mohandes SS, Eid RH, Allam AM, Abou-Zeina HAA, Elbayoumy MK. Phenotyping and genotyping studies on extended-spectrum β-lactamase-producing Escherichia coli isolates from mastitic cows on dairy farms in Egypt. Vet World 2022; 15:890-897. [PMID: 35698499 PMCID: PMC9178576 DOI: 10.14202/vetworld.2022.890-897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Aim: Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae have become a serious public health hazard worldwide. This importance is derived from the increase of new variants, particularly blaTEM, blaSHV, and blaCTX-M genes. This study aimed to examine ESBL-producing Escherichia coli isolated from different governorates in Egypt from dairy cows infected with subclinical and clinical mastitis.
Materials and Methods: This study examined 207 milk samples for the resistance of isolates against 14 different antibiotics and ran serological identification of ESBL-producing E. coli isolates with complete antibiotic resistance. Genotypic and sequencing analyses of several resistance genes were conducted using a polymerase chain reaction.
Results: E. coli was identified in cases with subclinical mastitis (80.5%) and clinical mastitis (85.7%). ESBL-producing E. coli was isolated from 38.2% of subclinical mastitic milk compared to 39.3% in clinical cases, where O26:k60, O125:k70, and O25:k11 were the serotypes with complete resistance to antibiotics. ESBL-producing E. coli isolates were resistant to cefotaxime, amoxicillin, cloxacillin, oxacillin, rifampicin, and penicillin in 100% but susceptible to amoxicillin and clavulanic acid in 82.5% of the cases. Results also revealed that 51.25%, 52.5%, 66.25%, 77.5% and 60% of ESBL-producing E. coli isolates were responsive to ciprofloxacin, ofloxacin, norfloxacin, levofloxacin, and gentamycin, respectively. The detected genes were registered in GenBank as MW345819.1 and MW345820.1 for the E. coli blaTEM gene and MW295407 for the E. coli blaSHV gene.
Conclusion: This study found ESBL-producing E. coli in mastitic milk samples from Egyptian dairy farms and confirmed the occurrence and circulation of the main antibiotic genes (blaTEM and blaSHV) in the samples. Regular and thorough surveillance of ESBL-producing E. coli and subsequent preventive actions are essential for preventing the spread of these resistance genes in the future, which could pose serious and catastrophic health risks. Authorities should cling to the concept of One Health to minimize the risk of new varieties.
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Affiliation(s)
- Shereen S. El-Mohandes
- Department of Mastitis and Neonatal Diseases, Animal Reproduction Research Institute, Agriculture Research Center, Giza 12622, Egypt
| | - Rasha H. Eid
- Department of Mastitis and Neonatal Diseases, Animal Reproduction Research Institute, Agriculture Research Center, Giza 12622, Egypt
| | - Ahmad M. Allam
- Department of Parasitology and Animal Diseases, Veterinary Research Institute, National Research Centre, Giza 12556, Egypt
| | - Hala A. A. Abou-Zeina
- Department of Parasitology and Animal Diseases, Veterinary Research Institute, National Research Centre, Giza 12556, Egypt
| | - Mohamed K. Elbayoumy
- Department of Parasitology and Animal Diseases, Veterinary Research Institute, National Research Centre, Giza 12556, Egypt
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Korichi W, Ibrahimi M, Loqman S, Ouhdouch Y, Younes K, Lemée L. Assessment of actinobacteria use in the elimination of multidrug-resistant bacteria of Ibn Tofail hospital wastewater (Marrakesh, Morocco): a chemometric data analysis approach. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:26840-26848. [PMID: 33501577 DOI: 10.1007/s11356-021-12445-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/08/2021] [Indexed: 06/12/2023]
Abstract
The efficiency of the treatment of hospital wastewater by actinobacteria was investigated using two chemometric data analysis methods. Six strains of multi-resistant bacteria isolated from Marrakesh hospital wastewater and four strains of antagonistic actinobacteria isolated from Moroccan marine environment were characterized by fatty acids released as methyl esters by thermochemolysis-GC/MS. The hierarchical cluster analysis (HCA) and the principal component analysis (PCA) were used to correlate fatty acids (FA) distributions within strains. HCA allowed to discriminate between bacteria and actinobacteria. A lower Euclidean distance is noted for bacteria. With PCA, linear and branched-chained FAs correlated with bacteria whereas mono unsaturated FAs correlated more specifically with Gram (-) bacteria. Terminally branched-chained FAs correlated most likely with actinobacteria. A co-culture of actinobacteria and bacteria monitored during 15 days demonstrated the efficiency of the biological treatment for 2 of the 4 studied actinobacteria. The effect is more important on Gram-negative bacteria. Antagonistic actinobacteria seem to be poorly efficient against Gram-positive bacteria.
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Affiliation(s)
- Wassila Korichi
- Laboratory of Microbial Biotechnologies, Agrosciences and Environment (BioMAgE), Faculty of Sciences Semlalia, Cadi Ayyad University, PO Box 2390, Marrakesh, Morocco
- Laboratory of Microbiology and Virology, Faculty of Medicine and Pharmacy, Cadi Ayyad University, PO Box 7010, Marrakesh, Morocco
- Institut de Chimie des Milieux et Matériaux de Poitiers (IC2MP - CNRS UMR 7285), Université de Poitiers, 4 rue Michel Brunet - TSA 51106, 86073, Poitiers Cedex 9, France
| | - Manar Ibrahimi
- Laboratoire de Chimie Organique et Analytique, FST, Université Sultan Moulay Slimane, Beni Mellal, Morocco
| | - Souad Loqman
- Laboratory of Microbiology and Virology, Faculty of Medicine and Pharmacy, Cadi Ayyad University, PO Box 7010, Marrakesh, Morocco
| | - Yedir Ouhdouch
- Laboratory of Microbial Biotechnologies, Agrosciences and Environment (BioMAgE), Faculty of Sciences Semlalia, Cadi Ayyad University, PO Box 2390, Marrakesh, Morocco
- Agro Bio Sciences Program, Mohammed VI Polytechnic University (UM6P), 43150, Benguerir, Morocco
| | - Khaled Younes
- Institut de Chimie des Milieux et Matériaux de Poitiers (IC2MP - CNRS UMR 7285), Université de Poitiers, 4 rue Michel Brunet - TSA 51106, 86073, Poitiers Cedex 9, France.
- College of Engineering and Technology, American University of the Middle East (AUM), Kuwait, Kuwait.
| | - Laurent Lemée
- Institut de Chimie des Milieux et Matériaux de Poitiers (IC2MP - CNRS UMR 7285), Université de Poitiers, 4 rue Michel Brunet - TSA 51106, 86073, Poitiers Cedex 9, France.
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Lee YQ, Ahmad Kamar A, Velayuthan RD, Chong CW, Teh CSJ. Clonal relatedness in the acquisition of intestinal carriage and transmission of multidrug resistant (MDR) Klebsiella pneumoniae and Escherichia coli and its risk factors among preterm infants admitted to the neonatal intensive care unit (NICU). Pediatr Neonatol 2021; 62:129-137. [PMID: 33218933 DOI: 10.1016/j.pedneo.2020.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 09/10/2020] [Accepted: 10/12/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Gastrointestinal carriage of multidrug resistant (MDR) Gram-negative bacilli, especially Klebsiella pneumoniae and Escherichia coli, was highly associated with severe nosocomial infections. The main objectives of this study were to determine the clonal relatedness of intestinal carriage and transmission risk factors of MDR E. coli and K. pneumoniae amongst preterm infants admitted to the neonatal intensive care unit (NICU). METHODS A prospective cohort study of preterm infants with gestational age < 37 weeks was conducted in the NICU of the University of Malaya Medical Centre (UMMC). Infants' stool specimens were collected on day 1 (meconium), week 1, week 2, week 8 and week 10 during their admission (from 1st June to 31st August 2017) until discharge. The presence and antibiotic resistance pattern of MDR E. coli and K. pneumoniae were determined. Strain clonality and relatedness were explored via pulsed-field gel electrophoresis (PFGE) fingerprints. The risk factors for MDR strains acquisition were evaluated using the Cox proportional-hazards model and Firth logistic regression. RESULTS A total of 139 stool specimens were obtained from 50 subjects. Twenty-six (52%) infants were colonized with MDR K. pneumoniae and/or E. coli. High clonal dissemination between two clusters of ESBL-producing K. pneumoniae strains was seen from PFGE profile. We detected a persistent, dominant, aminoglycosides-resistant strains cluster (cluster B), which harbored blaTEM, blaSHV, blaOXA-1, blaCTX-M-1, ompK35 and ompK36 genes. Infants born to women who were anemic in pregnancy [OR = 0.01 (CI = 0.00-0.39), P-value = 0.042] and infants exposed to penicillin/β-lactams group antibiotics during the first week of life [OR = 0.02 (CI = 0.02-0.32), P-value = 0.013] were found to have a lower risk of MDR K. pneumoniae and E. coli colonization. CONCLUSIONS The prevalence of dominant aminoglycosides-resistant strains cluster in the NICU is alarming. Awareness of and vigilance for the dominant cluster found will enable the reduction of cross-transmission amongst high-risk infants.
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Affiliation(s)
- Yee Qing Lee
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Azanna Ahmad Kamar
- Department of Paediatrics, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Rukumani Devi Velayuthan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chun Wie Chong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor, Malaysia
| | - Cindy Shuan Ju Teh
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Kibwana UO, Majigo M, Kamori D, Manyahi J. High fecal carriage of extended Beta Lactamase producing Enterobacteriaceae among adult patients admitted in referral hospitals in Dar es Salaam, Tanzania. BMC Infect Dis 2020; 20:557. [PMID: 32736605 PMCID: PMC7393831 DOI: 10.1186/s12879-020-05272-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 07/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multi-drug resistance pathogens such as Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae (ESBL-PE) are of great global health concern, since they are associated with increased morbidity and mortality. Even in the absence of infections caused by these pathogens, colonization is a great threat and can lead to cross transfer among hospitalized patients. To date data on carriage of these pathogens is still limited in Tanzania. Therefore, this study aimed to determine ESBL-PE fecal carriage rate and associated factors among hospitalized patients at Referral hospitals in Dar es Salaam. METHODS This was a cross sectional study conducted from May to July 2017 among patients admitted in three referral hospitals in Dar es Salaam, Tanzania. Rectal swabs were collected and screened for ESBL production using MacConkey agar supplemented with Ceftazidime 2 μg/ml. Phenotypic confirmation of ESBL-PE was done by double disk diffusion method. Statistical analysis was performed using Statistical Package for Social Sciences (SPPS) software version 20. RESULTS Of the 196 enrolled participants, 59.7% (117/196) were confirmed to carry ESBL-PE. Diarrheic patients (57/79) had statistically significant high prevalence of ESBL colonization compared to those without diarrhea (60/117) (p = 0.01). A total of 131 ESBL-PE were isolated from 117 patients, whereby, Escherichia coli accounted for 68.7%, Klebsiella pneumoniae 28.2% and Citrobacter species 0.8%. ESBL-PE carriage was significantly higher in patients with diarrhea compared to those without diarrhea (72% vs 53.1%, p = 0.01). Recent antibiotic use was independently associated with carriage of ESBL-PE (aOR 14.65, 95%CI 3.07-69.88, p = 0.01). CONCLUSIONS High prevalence of fecal carriage of ESBL-PE was observed in patients admitted in tertiary hospitals in Dar es Salaam, Tanzania. The use of antibiotics was associated with carriage of ESBL producers among the study population.
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Affiliation(s)
- Upendo O Kibwana
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences Dar es Salaam, P.O. Box 65001, Dar es Salaam, Tanzania.
| | - Mtebe Majigo
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences Dar es Salaam, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Doreen Kamori
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences Dar es Salaam, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Joel Manyahi
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences Dar es Salaam, P.O. Box 65001, Dar es Salaam, Tanzania
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Baothman OA, Alshamrani YA, Al-Talhi HA. Prevalence of Extended-Spectrum β-lactamases in Enterobacteriaceae Isolated from Polluted Wild Fish. Open Biochem J 2020. [DOI: 10.2174/1874091x02014010019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background:
Antibiotic resistance is becoming a major public health concern worldwide. In marine animals, pollution is associated with the emergence of extended-spectrum β-lactamase (ESBL)-expressing bacteria, resulting in antibiotic resistance. However, the prevalence of these bacteria in wild fish has not been reported.
Objective:
Accordingly, in this study, we explored the influence of pollution oxidative stress on the incidence of ESBL-expressing Enterobacteriaceae in the gut of wild fish species from the Red Sea coastal region of Jeddah City, Saudi Arabia. Additionally, we evaluated the incidence of varied ESBL genes contributing to the ESBL+ phenotype.
Methods:
Antibiotic susceptibility tests were performed using cephalosporins and carbapenems against ESBL- and carbapenem-resistant Enterobacteriaceae (CRE)-producing bacteria. Frequent genes contributing to the ESBL+ phenotype were analyzed. Primers targeting ESBLs (e.g., blaCTX, blaSHV, blaTEM, and blaOXA) were used in polymerase chain reaction assays to detect the ESBL+ phenotype.
Results:
Screening results from the polluted site revealed ESBL-resistant Klebsiella pneumoniae B8 and CRE-resistant Morganella morganii A4. The evolution of the blaCTX-M gene in M. morganii was a consequence of aquatic pollution. The other isolates Acinetobacter pittii and Providencia rettgeri were found in the clean reference site. The isolate M. morganii showed resistance to most mutual antibiotics and expressed some β-lactamase genes.
Conclusion:
Our findings provide useful data for selecting marine molecular genomic biomarkers caused by aquatic pollution.
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Valsdottir F, Elfarsdottir Jelle A, Gudlaugsson O, Hilmarsdottir I. Long-lasting outbreak due to CTX-M-15-producing Klebsiella pneumoniae ST336 in a rehabilitation ward: report and literature review. J Hosp Infect 2017; 97:42-51. [PMID: 28454769 DOI: 10.1016/j.jhin.2017.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 04/04/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Whereas Klebsiella species are the most frequently occurring agents in nosocomial outbreaks due to multidrug-resistant Gram-negative organisms, very few outbreaks have been reported from rehabilitation wards. AIM To describe a long-lasting outbreak due to extended-spectrum β-lactamase-producing (ESBL) Klebsiella pneumoniae in a rehabilitation ward. METHODS ESBL K. pneumoniae from all in- and outpatients whose specimens were tested at a tertiary care university hospital between 2007 and 2012 were typed by pulsed-field gel electrophoresis and selected isolates were submitted to multi-locus sequence typing and ESBL genotyping. Outbreak characteristics and infection control interventions were summarized. The literature was searched for K. pneumoniae-related outbreaks in rehabilitation wards. FINDINGS ESBL K. pneumoniae was detected in 69 out of 2478 K. pneumoniae-positive patients (2.8%) during the study period. Eight related outbreak clones from 35 patients, 25 of whom were in the rehabilitation ward, produced CTX-M-15 and belonged to ST336. The outbreak lasted for more than three years and was controlled by sequentially increasing measures culminating in review of all patient-related care, compulsory educational meetings for personnel, profession-specific guidelines and educational flyers for patients. CONCLUSION Half of ESBL K. pneumoniae-positive patients identified over six years at a tertiary care university hospital harboured related clones, and more than a third were hospitalized in a rehabilitation ward. Rehabilitation wards pose particular challenges for infection control because of patient dependency and an environment that encourages socializing. They are, however, rarely involved in K. pneumoniae-related outbreaks.
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Affiliation(s)
- F Valsdottir
- Department of Microbiology, Landspítali - The University Hospital of Iceland, Reykjavík, Iceland
| | - A Elfarsdottir Jelle
- Department of Infection Control, Landspítali - The University Hospital of Iceland, Reykjavík, Iceland
| | - O Gudlaugsson
- Department of Infection Control, Landspítali - The University Hospital of Iceland, Reykjavík, Iceland
| | - I Hilmarsdottir
- Department of Microbiology, Landspítali - The University Hospital of Iceland, Reykjavík, Iceland; Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
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