1
|
Antibiotic Resistance of Legionella pneumophila in Clinical and Water Isolates-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165809. [PMID: 32796666 PMCID: PMC7459901 DOI: 10.3390/ijerph17165809] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 12/21/2022]
Abstract
The current systematic review investigates the antibiotic susceptibility pattern of Legionella pneumophila isolates from the 1980s to the present day, deriving data from clinical and/or water samples from studies carried out all over the world. Eighty-nine papers meeting the inclusion criteria, i.e., “Legionella pneumophila” and “resistance to antibiotics”, were evaluated according to pre-defined validity criteria. Sixty articles referred to clinical isolates, and 18 articles reported water-related L. pneumophila isolates, while 11 articles included both clinical and water isolates. Several methods have been proposed as suitable for the determination of MICs, such as the E-test, broth and agar dilution, and disk diffusion methods, in vivo and in vitro, using various media. The E-test method proposed by the European Society of Clinical Microbiology and Infectious Diseases (EUCAST) seems to be the second most frequently used method overall, but it is the preferred method in the most recent publications (2000–2019) for the interpretation criteria. Erythromycin has been proved to be the preference for resistance testing over the years. However, in the last 19 years, the antibiotics ciprofloxacin (CIP), erythromycin (ERM), levofloxacin (LEV) and azithromycin (AZM) were the ones that saw an increase in their use. A decrease in the sensitivity to antibiotics was identified in approximately half of the reviewed articles.
Collapse
|
2
|
Assaidi A, Ellouali M, Latrache H, Timinouni M, Zahir H, Karoumi A, Barguigua A, Mliji EM. Antimicrobial Susceptibility Patterns of Legionella spp. Strains Isolated from Water Systems in Morocco. Microb Drug Resist 2020; 26:991-996. [PMID: 32125920 DOI: 10.1089/mdr.2019.0218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Legionella is a waterborne pathogen that causes a severe form of pneumonia called Legionnaires' diseases, which is normally acquired by inhalation of aerosols containing Legionella originating from natural and man-made water systems. The aim of this study was to describe the level of antimicrobial susceptibility of environmental Legionella spp. strains to preferred and recommended therapeutic agents to treat Legionella disease. Methods: The minimum inhibitory concentrations (MICs) of 60 environmental Legionella spp. strains were tested using the broth dilution method. Susceptibility testing was performed for 12 antimicrobial agents: macrolides (erythromycin, azithromycin [AZI], and clarithromycin [CLA]), fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin, and gemifloxacin), a ketolide (telithromycin), cefotaxime (CEF), tigecycline (TIG), doxycycline (DOX), and rifampicin (RIF). Results: All tested strains of Legionella spp. were inhibited by low concentrations of fluoroquinolones and macrolides. Regarding the macrolides, CLA was the most active antibiotic, and AZI was the least active. RIF was the most effective antibiotic against the isolates in vitro. All isolates were inhibited by the following antibiotics (in decreasing order of their MICs): DOX>CEF>TIG. Conclusions: No resistance against these drugs was detected, and all isolates were inhibited by low concentrations of the tested antibiotics. Susceptibility testing of environmental Legionella spp. isolates must be monitored often to detect and evaluate the possible development of antibiotic resistance.
Collapse
Affiliation(s)
- Abdelwahid Assaidi
- Laboratory of Bioprocess and Biointerfaces, Life Sciences Department, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco.,Laboratory of Water Microbiology and Environmental Hygiene, Food Safety & Environment Department, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Mostafa Ellouali
- Laboratory of Bioprocess and Biointerfaces, Life Sciences Department, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco
| | - Hassan Latrache
- Laboratory of Bioprocess and Biointerfaces, Life Sciences Department, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco
| | - Mohammed Timinouni
- Laboratory of Water Microbiology and Environmental Hygiene, Food Safety & Environment Department, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Hafida Zahir
- Laboratory of Bioprocess and Biointerfaces, Life Sciences Department, Faculty of Sciences and Techniques, Sultan Moulay Slimane University, Beni Mellal, Morocco
| | - Abdelaziz Karoumi
- Laboratory of Water Microbiology and Environmental Hygiene, Food Safety & Environment Department, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Abouddihaj Barguigua
- Laboratory of Biotechnology and Sustainable Development of Natural Ressources, Life Sciences Department, Polydisciplinary Faculty, Sultan Moulay Slimane University, Beni Mellal, Morocco
| | - El Mostafa Mliji
- Laboratory of Water Microbiology and Environmental Hygiene, Food Safety & Environment Department, Institut Pasteur du Maroc, Casablanca, Morocco
| |
Collapse
|
3
|
Antimicrobial agent susceptibilities of Legionella pneumophila MLVA-8 genotypes. Sci Rep 2019; 9:6138. [PMID: 30992549 PMCID: PMC6468011 DOI: 10.1038/s41598-019-42425-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 04/01/2019] [Indexed: 11/08/2022] Open
Abstract
Legionella pneumophila causes human lung infections resulting in severe pneumonia. High-resolution genotyping of L. pneumophila isolates can be achieved by multiple-locus variable-number tandem-repeat analysis (MLVA-8). Legionella infections in humans occur as a result of inhalation of bacteria-containing aerosols, thus, our aim was to study the antimicrobial susceptibilities of different MLVA-8 genotypes to ten commonly used antimicrobial agents in legionellosis therapy. Epidemiological cut-off values were determined for all antibiotics. Significant differences were found between the antimicrobial agents' susceptibilities of the three studied environmental genotypes (Gt4, Gt6, and Gt15). Each genotype exhibited a significantly different susceptibility profile, with Gt4 strains (Sequence Type 1) significantly more resistant towards most studied antimicrobial agents. In contrast, Gt6 strains (also Sequence Type 1) were more susceptible to six of the ten studied antimicrobial agents compared to the other genotypes. Our findings show that environmental strains isolated from adjacent points of the same water system, exhibit distinct antimicrobial resistance profiles. These differences highlight the importance of susceptibility testing of Legionella strains. In Israel, the most extensively used macrolide for pneumonia is azithromycin. Our results point at the fact that clarithromycin (another macrolide) and trimethoprim with sulfamethoxazole (SXT) were the most effective antimicrobial agents towards L. pneumophila strains. Moreover, legionellosis can be caused by multiple L. pneumophila genotypes, thus, the treatment approach should be the use of combined antibiotic therapy. Further studies are needed to evaluate specific antimicrobial combinations for legionellosis therapy.
Collapse
|
4
|
Torre I, Alfano R, Borriello T, De Giglio O, Iervolino C, Montagna MT, Scamardo MS, Pennino F. Environmental surveillance and in vitro activity of antimicrobial agents against Legionella pneumophila isolated from hospital water systems in Campania, South Italy: a 5-year study. ENVIRONMENTAL RESEARCH 2018; 164:574-579. [PMID: 29625340 DOI: 10.1016/j.envres.2018.02.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/26/2018] [Accepted: 02/21/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Legionellosis' treatment failures have been recently reported showing the possibility of resistance development to traditional therapy, especially in healthcare related disease cases. Environmental impact of antibiotic residues, especially in hospital waters, may act on the resistome of Legionella resulting in developing resistance mechanisms. OBJECTIVES In this study we investigate the antibiotic susceptibility of environmental Legionella pneumophila (Lpn) strains isolated from hospital water systems in Campania, a region located in Southwest Italy. METHODS 5321 hospital water samples were investigated for the presence of Lpn. Among positive samples, antibiotic susceptibility was tested for a random subset of 125 Lpn strains (25 Lpn isolates from each of the following serogroups: 1, 3, 5, 6, 8). Susceptibility testing was performed, using the E-test on buffered charcoal yeast extract agar supplemented with α-ketoglutarate, for 10 antimicrobial drugs: azithromycin, cefotaxime, clarithromycin, doxycycline, erythromycin, rifampicin, tigecycline, ciprofloxacin, levofloxacin and moxifloxacin. Non parametric tests were used to determine and assess the significant differences in susceptibility to the different antimicrobics between the serogroups. RESULTS Among the isolated strains, none showed resistance to the antibiotics tested. Rifampicin was the most active antibiotic against overall Legionella strains, followed by levofloxacin. Between the macrolides the clarithromycin was overall the most active drug, instead the azithromycin was the less active. Analyzing the different serogroups a significant difference was found between serogroup 1 and non-1 serogroup isolates for doxycycline and tigecycline. CONCLUSIONS Antibiotic susceptibility of environmental isolates of Legionella spp. might be useful for the early detection of resistance to antibiotics that directly impacts on mortality and length of hospital stay.
Collapse
Affiliation(s)
- Ida Torre
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy.
| | - Rossella Alfano
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Tonia Borriello
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Italy
| | - Carmela Iervolino
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Italy
| | - Marina Silvia Scamardo
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| | - Francesca Pennino
- Department of Public Health, University of Napoli "Federico II", Via S. Pansini 5, 80131 Naples, Italy
| |
Collapse
|
5
|
Community-acquired pneumonia related to intracellular pathogens. Intensive Care Med 2016; 42:1374-86. [PMID: 27276986 DOI: 10.1007/s00134-016-4394-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/14/2016] [Indexed: 01/22/2023]
Abstract
Community-acquired pneumonia (CAP) is associated with high rates of morbidity and mortality worldwide; the annual incidence of CAP among adults in Europe has ranged from 1.5 to 1.7 per 1000 population. Intracellular bacteria are common causes of CAP. However, there is considerable variation in the reported incidence between countries and change over time. The intracellular pathogens that are well established as causes of pneumonia are Legionella pneumophila, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Chlamydophila psittaci, and Coxiella burnetii. Since it is known that antibiotic treatment for severe CAP is empiric and includes coverage of typical and atypical pathogens, microbiological diagnosis bears an important relationship to prognosis of pneumonia. Factors such as adequacy of initial antibiotic or early de-escalation of therapy are important variables associated with outcomes, especially in severe cases. Intracellular pathogens sometimes appear to cause more severe disease with respiratory failure and multisystem dysfunction associated with fatal outcomes. The clinical relevance of intracellular pathogens in severe CAP has not been specifically investigated. We review the prevalence, general characteristics, and outcomes of severe CAP cases caused by intracellular pathogens.
Collapse
|
6
|
De Giglio O, Napoli C, Lovero G, Diella G, Rutigliano S, Caggiano G, Montagna MT. Antibiotic susceptibility of Legionella pneumophila strains isolated from hospital water systems in Southern Italy. ENVIRONMENTAL RESEARCH 2015; 142:586-90. [PMID: 26298602 DOI: 10.1016/j.envres.2015.08.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 05/04/2023]
Abstract
OBJECTIVES The purpose of this study was to describe the susceptibility of environmental strains of Legionella spp. to 10 antimicrobials commonly used for legionellosis therapy. A study of environmental strains could be useful to timely predict the onset of antibiotic resistance in the environment before it is evidenced in clinical specimens. METHODS The minimum inhibitory concentrations (MICs) of 100 environmental Legionella pneumophila (Lpn) strains belonging to serogroups (sgs) 1, 6, 8, and 10 were tested using the E-test methodology on buffered charcoal yeast extract agar supplemented with α-ketoglutarate. The most frequent sgs were selected from those obtained during microbiological surveillance conducted in 2014 in a hospital in Southern Italy. The MICs were read after 2 days of incubation at 35 °C in a humidified atmosphere without CO2. RESULTS All isolates were inhibited by low concentrations of fluoroquinolones and macrolides. Rifampicin was the most active drug against the isolates in vitro. All Lpn isolates were inhibited by the following drugs (in decreasing order of their MICs): doxycycline>tigecycline>cefotaxime. The MICs of azithromycin, ciprofloxacin, levofloxacin, moxifloxacin, and tigecycline were significantly lower for Lpn non-sg 1 than Lpn sg 1 isolates. CONCLUSIONS Susceptibility testing of Legionella strains to appropriate antibiotics should be performed often to evaluate the possible emergence of resistance, to improve the outcomes of patients, and to reduce the direct costs associated with hospitalization.
Collapse
Affiliation(s)
- Osvalda De Giglio
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Christian Napoli
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Grazia Lovero
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giusy Diella
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Serafina Rutigliano
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giuseppina Caggiano
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Maria Teresa Montagna
- Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy.
| |
Collapse
|
7
|
Erdogan H, Can F, Demirbilek M, Timurkaynak F, Arslan H. In vitro activity of antimicrobial agents against Legionella isolated from environmental water systems: first results from Turkey. ENVIRONMENTAL MONITORING AND ASSESSMENT 2010; 171:487-91. [PMID: 20049525 DOI: 10.1007/s10661-009-1293-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2008] [Accepted: 12/16/2009] [Indexed: 05/25/2023]
Abstract
We evaluated the in vitro activity of antimicrobial agents against Legionella obtained from hotel and hospital water systems in three different regions of Turkey. Sixty-five Legionella strains (Legionella pneumophila serogroup 6 [n=32], L. pneumophila serogroup 1 [n=27], L. pneumophila serogroup 3 [n=2], and Legionella spp. [n=4]) were tested against levofloxacin, ciprofloxacin, clarithromycin, azithromycin, and rifampicin. The minimum inhibitory concentration (MIC) values of each antimicrobial agent for these strains was determined by the microdilution method using buffered yeast extract medium supplemented with 0.1% ketoglutarate broth. L. pneumophila ATCC 33152, Staphylococcus aureus ATCC 29213, and Escherichia coli ATCC 25922 were used as controls. Minimum inhibitory concentration values were in the following ranges: clarithromycin 0.001-0.5 mg/L, azithromycin 0.001-0.5 mg/L, levofloxacin 0.001-0.5 mg/L, ciprofloxacin 0.001-0.125 mg/L, and rifampicin 0.001- 0.5 mg/L. The MIC(90) for rifampicin, levofloxacin, ciprofloxacin, azithromycin, and clarithromycin were 0.015, 0.125, 0.06, 0.125, and 0.06 mg/L, respectively. To the best of our knowledge, this is the first study to determine in vitro activities of antimicrobial agents against Legionella species in Turkey. Rifampicin had the lowest MIC(90) value. It would seem that azithromycin and clarithromycin exhibit good activity as well as levofloxacin and ciprofloxacin against Legionella isolated from environmental water systems in Turkey.
Collapse
Affiliation(s)
- Haluk Erdogan
- Department of Infectious Diseases and Clinical Microbiology, Baskent University Faculty of Medicine, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
8
|
In vitro activities of the Rx-01 oxazolidinones against hospital and community pathogens. Antimicrob Agents Chemother 2008; 52:1653-62. [PMID: 18316525 DOI: 10.1128/aac.01383-07] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rx-01_423 and Rx-01_667 are two members of the family of oxazolidinones that were designed using a combination of computational and medicinal chemistry and conventional biological techniques. The compounds have a two- to eightfold-improved potency over linezolid against serious gram-positive pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant streptococci, and vancomycin-resistant enterococci. This enhanced potency extends to the coverage of linezolid-resistant gram-positive microbes, especially multidrug-resistant enterococci and pneumococci. Compounds from this series expand the spectrum compared with linezolid to include fastidious gram-negative organisms like Haemophilus influenzae and Moraxella catarrhalis. Like linezolid, the Rx-01 compounds are bacteriostatic against MRSA and enterococci but are generally bactericidal against S. pneumoniae and H. influenzae.
Collapse
|