1
|
Ijaz S, Ansari F, Nawaz M, Ejaz H, Anjum AA, Saeed A, Ali T, Rehman OU, Fatima E, Ijaz T. Genomic Insights into and In Vitro Evaluation of Antimicrobial Combination Therapies for Carbapenem-Resistant Acinetobacter baumannii. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1086. [PMID: 39064515 PMCID: PMC11278937 DOI: 10.3390/medicina60071086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/25/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Acinetobacter baumannii (A. baumannii), particularly carbapenem-resistant A. baumannii (CRAB), represents a grave concern in healthcare settings and is associated with high mortality. This study aimed to conduct molecular, mutational, and phylogenetic analyses of specific genes in CRAB and evaluate the synergistic effects of selected antimicrobial combinations. Materials and Methods: Phenotypic characterization was performed on six CRAB strains by using the Modified Hodge Test (MHT) and IMP-EDTA Double-Disc Synergy Test (IMP-EDTA DDST). Carbapenemase- and metallo-beta-lactamase-encoding genes were amplified by using Polymerase Chain Reaction. Phylogenetic analysis using the MEGA 11 tool was used to determine the evolutionary relatedness of these genes. Mutational analysis was performed by using I-Mutant, MUPro, and PHD-SNP bioinformatics tools to predict mutations in the carbapenemase-encoding genes. Microdilution checkerboard titration assessed the synergistic effects of antimicrobial combinations (azithromycin-meropenem, rifampicin-meropenem, meropenem-colistin, and azithromycin-colistin) on these CRAB isolates. Results: The phenotypic characterization of six CRAB isolates revealed positive results for MHT and IMP-EDTA DDST. The molecular characterization revealed that carbapenemase- and MBL-encoding genes were present in all isolates with varying frequencies, including blaOXA-51 (100%) and blaIMP (0%). The sequence analysis revealed high evolutionary relatedness to sequences in the NCBI database. The mutational analysis identified 16 mutations, of which 1 mutation (P116L) in the blaOXA-58 gene predicted a change in the protein product, potentially contributing to carbapenem resistance. The checkerboard titration method did not reveal any synergism among the tested antimicrobial combinations against CRAB. Conclusion: This study's findings underscore the significant challenges posed by CRAB isolates harboring multiple resistant genes in treatment. This highlights the urgent need for novel antimicrobial agents, a crucial step towards reducing mortality rates not only in Pakistan but also globally.
Collapse
Affiliation(s)
- Saadia Ijaz
- Institute of Molecular Biology & Biotechnology (IMBB), University of Lahore, Lahore 54590, Pakistan
| | - Farheen Ansari
- Institute of Molecular Biology & Biotechnology (IMBB), University of Lahore, Lahore 54590, Pakistan
| | - Muhammad Nawaz
- Institute of Microbiology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - Hasan Ejaz
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka 72388, Saudi Arabia
| | - Aftab Ahmad Anjum
- Institute of Microbiology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - Aqib Saeed
- Institute of Microbiology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - Tehreem Ali
- Institute of Microbiology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - Obaid Ur Rehman
- Department of Medicine, Services Institute of Medical Sciences, Lahore 54000, Pakistan
| | - Eeshal Fatima
- Department of Medicine, Services Institute of Medical Sciences, Lahore 54000, Pakistan
| | - Tayyaba Ijaz
- Mayo Hospital, Health Department, Lahore 54000, Pakistan
| |
Collapse
|
2
|
Walklett AJ, Flack EKP, Chidwick HS, Hatton NE, Keenan T, Budhadev D, Walton J, Thomas GH, Fascione MA. The Retaining Pse5Ac7Ac Pseudaminyltransferase KpsS1 Defines a Previously Unreported glycosyltransferase family (GT118). Angew Chem Int Ed Engl 2024; 63:e202318523. [PMID: 38224120 DOI: 10.1002/anie.202318523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/16/2024]
Abstract
Cell surface sugar 5,7-diacetyl pseudaminic acid (Pse5Ac7Ac) is a bacterial analogue of the ubiquitous sialic acid, Neu5Ac, and contributes to the virulence of a number of multidrug resistant bacteria, including ESKAPE pathogens Pseudomonas aeruginosa, and Acinetobacter baumannii. Despite its discovery in the surface glycans of bacteria over thirty years ago, to date no glycosyltransferase enzymes (GTs) dedicated to the synthesis of a pseudaminic acid glycosidic linkage have been unequivocally characterised in vitro. Herein we demonstrate that A. baumannii KpsS1 is a dedicated pseudaminyltransferase enzyme (PseT) which constructs a Pse5Ac7Ac-α(2,6)-Glcp linkage, and proceeds with retention of anomeric configuration. We utilise this PseT activity in tandem with the biosynthetic enzymes required for CMP-Pse5Ac7Ac assembly, in a two-pot, seven enzyme synthesis of an α-linked Pse5Ac7Ac glycoside. Due to its unique activity and protein sequence, we also assign KpsS1 as the prototypical member of a previously unreported GT family (GT118).
Collapse
Affiliation(s)
| | - Emily K P Flack
- Department of Chemistry, University of York, York, YO10 5DD, UK
- Department of Biology, University of York, York, YO10 5DD, UK
| | | | | | - Tessa Keenan
- Department of Chemistry, University of York, York, YO10 5DD, UK
| | | | - Julia Walton
- Department of Chemistry, University of York, York, YO10 5DD, UK
| | - Gavin H Thomas
- Department of Biology, University of York, York, YO10 5DD, UK
| | | |
Collapse
|
3
|
Bouza E, Muñoz P, Burillo A. How to treat severe Acinetobacter baumannii infections. Curr Opin Infect Dis 2023; 36:596-608. [PMID: 37930071 DOI: 10.1097/qco.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
PURPOSE OF REVIEW To update the management of severe Acinetobacter baumannii infections (ABI), particularly those caused by multi-resistant isolates. RECENT FINDINGS The in vitro activity of the various antimicrobial agents potentially helpful in treating ABI is highly variable and has progressively decreased for many of them, limiting current therapeutic options. The combination of more than one drug is still advisable in most circumstances. Ideally, two active first-line drugs should be used. Alternatively, a first-line and a second-line drug and, if this is not possible, two or more second-line drugs in combination. The emergence of new agents such as Cefiderocol, the combination of Sulbactam and Durlobactam, and the new Tetracyclines offer therapeutic options that need to be supported by clinical evidence. SUMMARY The apparent limitations in treating infections caused by this bacterium, the rapid development of resistance, and the serious underlying situation in most cases invite the search for alternatives to antibiotic treatment, the most promising of which seems to be bacteriophage therapy.
Collapse
Affiliation(s)
- Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Medicine Department, School of Medicine, Universidad Complutense de Madrid
- Gregorio Marañón Health Research Institute
- CIBER of Respiratory Diseases (CIBERES CB06/06/0058), Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Medicine Department, School of Medicine, Universidad Complutense de Madrid
- Gregorio Marañón Health Research Institute
- CIBER of Respiratory Diseases (CIBERES CB06/06/0058), Madrid, Spain
| | - Almudena Burillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Medicine Department, School of Medicine, Universidad Complutense de Madrid
- Gregorio Marañón Health Research Institute
| |
Collapse
|
4
|
Kilbas EPK, Kilbas I, Ciftci IH. Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii isolates in Turkiye: Systematic review. North Clin Istanb 2023; 10:531-539. [PMID: 37719251 PMCID: PMC10500232 DOI: 10.14744/nci.2022.17003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/21/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
The World Health Organization has designated carbapenem-resistant Acinetobacter baumannii (CRAB) as a "critical" pathogen on the global priority list of antibiotic-resistant bacteria. This study aims to discuss the molecular epidemiology of CRAB isolates in Turkiye in the last 12 years and the prevalence of gene regions associated with resistance or pathogenesis using a systematic review method. Our study consists of a literature search, determination of eligibility and exclusion criteria, qualitative analysis of studies, data extraction, and statistical analysis. All studies were analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines. The incidence rates of blaOXA-23, blaOXA-23-like, blaOXA-24/40, blaOXA-24/40-like, blaOXA-51, blaOXA-51-like, blaOXA-58, and blaOXA-58-like genes in CRAB strains were 76.4%, 68.6%, 1.2%, 3.4%, 97.0%, 98.6%, 8.4%, and 17.1%, respectively. It was determined that the prevalence of the blaOXA-23 and blaOXA-58 gene regions showed a statistically significant change over the years. Due to the high prevalence of A. baumannii strains carrying the blaOXA-23 variant, it is necessary to follow its geographical distribution and transposon and plasmid movements. Based on available data, molecular surveillance of CRAB strains should be standardized. In addition, sterilization and disinfection processes applied within the scope of an effective struggle against CRAB strains that can remain live on surfaces for a long time should be reviewed frequently.
Collapse
Affiliation(s)
- Elmas Pinar Kahraman Kilbas
- Department of Medical Laboratory Techniques, Fenerbahce University, Health Services Vocational School, Istanbul, Turkiye
| | - Imdat Kilbas
- Medical Microbiology Doctorate Program, Istanbul University, Institute of Health Sciences, Istanbul, Turkiye
| | - Ihsan Hakki Ciftci
- Department of Microbiology, Sakarya University Faculty of Medicine, Sakarya, Turkiye
| |
Collapse
|
5
|
Kaur R, Mandal D, Kumar A. Phage therapy for Acinetobacter baumannii infection. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2023; 200:303-324. [PMID: 37739559 DOI: 10.1016/bs.pmbts.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
Acinetobacter is a gram-negative nosocomial pathogenic bacteria. The contributing factor for the pathogenicity of Acinetobacter is severe due to its property of antibacterial drug resistance. Often antibiotic treatment is used to treat bacterial infection, however due to the resistance of a broad range of antibiotics by Acinetobacter the treatment viability of this bacterial species seems to be reduced. To combat this diverse treatment options are being incorporated with phage therapy being an effective choice due to its intrinsic property to infect bacteria. In this chapter the various phage therapy used in recent times has been elaborated on. The phage therapy is considered to be in response to Carbapenem resistance. The various mode of phage propagation has been mentioned in this chapter along with the type of resistance conferred to the administered therapy. The chapter deals with the advances observed due to therapy of Acibel004, Acibel007, vB-GEC_Ab-M-G7, ZZ1 and Bacteriophage p54 containing Endolysin LysAB54 bacteriophages have been elucidated.
Collapse
Affiliation(s)
- Ramneet Kaur
- Department of Basic and Applied Sciences, RIMT University, Punjab, India
| | - Dibita Mandal
- Department of Biosciences, SBST, Vellore Institute of Technology, Vellore, India
| | - Ajay Kumar
- Department of Biotechnology, Faculty of Engineering and Technology, Rama University, Kanpur, Uttar Pradesh, India.
| |
Collapse
|
6
|
Michaeli J, Mandel S, Maximov S, Zazoun J, Savoia P, Kothari N, Valmont T, Ferrari L, Duncan LR, Hawser S, Cohen-Kutner M, Bachnoff N. In Vitro and In Vivo Antimicrobial Activity of the Novel Peptide OMN6 against Multidrug-Resistant Acinetobacter baumannii. Antibiotics (Basel) 2022; 11:antibiotics11091201. [PMID: 36139979 PMCID: PMC9494975 DOI: 10.3390/antibiotics11091201] [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: 08/17/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
The rapid worldwide spread of antimicrobial resistance highlights the significant need for the development of innovative treatments to fight multidrug-resistant bacteria. This study describes the potent antimicrobial activity of the novel peptide OMN6 against a wide array of drug-resistant Acinetobacter baumannii clinical isolates. OMN6 prevented the growth of all tested isolates, regardless of any pre-existing resistance mechanisms. Moreover, in vitro serial-passaging studies demonstrated that no resistance developed against OMN6. Importantly, OMN6 was highly efficacious in treating animal models of lung and blood infections caused by multidrug-resistant A. baumannii. Taken together, these results point to OMN6 as a novel antimicrobial agent with the potential to treat life-threatening infections caused by multidrug-resistant A. baumannii avoiding resistance.
Collapse
Affiliation(s)
- Janna Michaeli
- Omnix Medical Ltd., High-Tech Village, Givat-Ram Campus, Jerusalem 9270401, Israel
| | - Shira Mandel
- Omnix Medical Ltd., High-Tech Village, Givat-Ram Campus, Jerusalem 9270401, Israel
| | - Shelly Maximov
- Omnix Medical Ltd., High-Tech Village, Givat-Ram Campus, Jerusalem 9270401, Israel
| | - Jonathan Zazoun
- Omnix Medical Ltd., High-Tech Village, Givat-Ram Campus, Jerusalem 9270401, Israel
| | - Paola Savoia
- Evotec Anti-Infective, Department of Microbiology Discovery, Aptuit (Verona) Srl, an Evotec Company, Via A. Fleming 4, 37135 Verona, Italy
| | - Nimmi Kothari
- IHMA Europe Sàrl, Route de l’Ile-au-Bois 1A, 1870 Monthey, Switzerland
| | - Thomas Valmont
- IHMA Europe Sàrl, Route de l’Ile-au-Bois 1A, 1870 Monthey, Switzerland
| | - Livia Ferrari
- Evotec Anti-Infective, Department of Microbiology Discovery, Aptuit (Verona) Srl, an Evotec Company, Via A. Fleming 4, 37135 Verona, Italy
| | - Leonard R. Duncan
- JMI Laboratories, 345 Beaver Kreek Centre, Suite A, North Liberty, IA 52317, USA
| | - Stephen Hawser
- IHMA Europe Sàrl, Route de l’Ile-au-Bois 1A, 1870 Monthey, Switzerland
| | - Moshe Cohen-Kutner
- Omnix Medical Ltd., High-Tech Village, Givat-Ram Campus, Jerusalem 9270401, Israel
| | - Niv Bachnoff
- Omnix Medical Ltd., High-Tech Village, Givat-Ram Campus, Jerusalem 9270401, Israel
- Correspondence:
| |
Collapse
|
7
|
Clinical and Antimicrobial profile of Acinetobacter Species at a Tertiary Care Teaching Hospital. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.3.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Acinetobacter infection with multidrug resistant strains is an emerging infection of global concern as it leads to serious disease. They are also important pathogens causing hospital acquired infections. Information on the prevalence, spectrum of illness and antibiotic sensitivity pattern of Acinetobacter is important for appropriate management of patients. We aimed to determine the prevalence of Acinetobacter species and evaluate the clinical profile and antibiotic sensitivity pattern of Acinetobacter species from various clinical samples. From October 2018 to September 2019, various clinical samples received in the microbiology laboratory were studied from the electronic records and the data on the isolation of Acinetobacter from these samples and its antibiotic sensitivity pattern was collected and analysed. The clinical data was also collected to determine the clinical spectrum. The prevalence of Acinetobacter species from various clinical samples was found to be 8.9%. Isolates were more common in general wards than in ICUs. The Acinetobacter infections occurred significantly in male patients (65.7%) than in female patients (34.3%), with male: female ratio of 1.9:1. The most common infection caused by Acinetobacter species was Wound infection (54.36%) followed by Respiratory tract infection (34.27%). Multidrug resistance was seen in 75 % of the isolates. Significant prevalence of multidrug resistant Acinetobacter infections was noted in our study. The findings emphasize the need for strict hospital infection control practices and the restricted use of antibiotics to prevent the occurrence of these infections.
Collapse
|
8
|
Kim SE, Choi SM, Yu Y, Shin SU, Oh TH, Kang SJ, Park KH, Shin JH, Kim UJ, Jung SI. Replacement of the Dominant ST191 Clone by ST369 Among Carbapenem-Resistant Acinetobacter baumannii Bloodstream Isolates at a Tertiary Care Hospital in South Korea. Front Microbiol 2022; 13:949060. [PMID: 35910596 PMCID: PMC9335038 DOI: 10.3389/fmicb.2022.949060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
The clonal dissemination of carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia is a serious clinical problem worldwide. However, the factors related to the emergence and replacement of predominant CRAB clones in nosocomial settings are unclear. By multilocus sequence typing (MLST), we evaluated the genetic relatedness of CRAB bloodstream isolates at a tertiary care hospital over a 3.5-year period and investigated the clinical and microbiologic characteristics of the predominant sequence types (STs). One hundred and seventy-nine CRAB bloodstream isolates were collected from June 2016 to December 2019, and their MLSTs according to Oxford scheme and clinical data were obtained. The predominant STs were assessed for in vitro growth, competitive growth, and virulence in a mouse model of intraperitoneal infection. Two dominant clones—ST369 (n = 98) and ST191 (n = 48)—belonging to international clone 2 (IC2) were recovered from patients admitted to intensive care units (ICUs) or wards. ST191 predominated (61%, 27/43) from June 2016 to July 2017, whereas ST369 (72%, 98/136), which was first isolated from a patient admitted to the emergency room, replaced ST191 (15%, 21/136) after August 2017. In a multivariate analysis, leukopenia (OR = 3.62, 95% CI 1.04–12.6, p = 0.04) and ST191 or 369 (OR = 5.32, 95% CI 1.25–22.65, p = 0.02) were independent risk factors for 7-day mortality. Compared with non-ST369, ST369 was associated with a shorter time to bacteremia from ICU admission (7 vs. 11 days, p = 0.01), pneumonia as an origin of bacteremia (67 vs. 52%, p = 0.04), leukopenia (28 vs. 11%, p < 0.01), and a lower 7-day survival rate (41 vs. 70%, p < 0.01). In vitro, ST 369 isolates had significantly higher growth rates and enhanced competitive growth compared to ST191. Finally, ST369 had greater virulence and a higher mortality rate than other STs in a mouse infection model. We report almost-complete replacement of the predominant ST191 clone by ST369 within an 8-month period at our hospital. ST369 had a high incidence density rate of CRAB bacteremia, a short time to bacteremia after ICU admission, and a high early mortality rate, which may be in part explained by its faster competitive growth rate and higher virulence than ST191.
Collapse
Affiliation(s)
- Seong Eun Kim
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, South Korea
| | - Su-Mi Choi
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, South Korea
| | - Yohan Yu
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, South Korea
| | - Sung Un Shin
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, South Korea
| | - Tae Hoon Oh
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, South Korea
| | - Seung-Ji Kang
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, South Korea
| | - Kyung-Hwa Park
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, South Korea
| | - Jong Hee Shin
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Uh Jin Kim
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, South Korea
- Uh Jin Kim,
| | - Sook In Jung
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, South Korea
- *Correspondence: Sook In Jung,
| |
Collapse
|
9
|
Huo W, Busch LM, Hernandez-Bird J, Hamami E, Marshall CW, Geisinger E, Cooper VS, van Opijnen T, Rosch JW, Isberg RR. Immunosuppression broadens evolutionary pathways to drug resistance and treatment failure during Acinetobacter baumannii pneumonia in mice. Nat Microbiol 2022; 7:796-809. [PMID: 35618774 PMCID: PMC9159950 DOI: 10.1038/s41564-022-01126-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/20/2022] [Indexed: 01/02/2023]
Abstract
Acinetobacter baumannii is increasingly refractory to antibiotic treatment in healthcare settings. As is true of most human pathogens, the genetic path to antimicrobial resistance (AMR) and the role that the immune system plays in modulating AMR during disease are poorly understood. Here we reproduced several routes to fluoroquinolone resistance, performing evolution experiments using sequential lung infections in mice that are replete with or depleted of neutrophils, providing two key insights into the evolution of drug resistance. First, neutropenic hosts acted as reservoirs for the accumulation of drug resistance during drug treatment. Selection for variants with altered drug sensitivity profiles arose readily in the absence of neutrophils, while immunocompetent animals restricted the appearance of these variants. Secondly, antibiotic treatment failure in the immunocompromised host was shown to occur without clinically defined resistance, an unexpected result that provides a model for how antibiotic failure occurs clinically in the absence of AMR. The genetic mechanism underlying both these results is initiated by mutations activating the drug egress pump regulator AdeL, which drives persistence in the presence of antibiotic. Therefore, antibiotic persistence mutations present a two-pronged risk during disease, causing drug treatment failure in the immunocompromised host while simultaneously increasing the emergence of high-level AMR.
Collapse
Affiliation(s)
- Wenwen Huo
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA, USA
| | - Lindsay M Busch
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA, USA
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Juan Hernandez-Bird
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA, USA
| | - Efrat Hamami
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA, USA
| | - Christopher W Marshall
- Department of Microbiology and Molecular Genetics and Center for Evolutionary Biology and Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Biological Sciences, Marquette University, Milwaukee, WI, USA
| | | | - Vaughn S Cooper
- Department of Microbiology and Molecular Genetics and Center for Evolutionary Biology and Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Jason W Rosch
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Ralph R Isberg
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA, USA.
| |
Collapse
|
10
|
Novikova IE, Sadeeva ZZ, Shakirzyanova RA, Alyabieva NM, Lazareva AV, Karaseva OV, Vershinina MG, Fisenko AP. The using of the polymerase chain reaction for the detection of resistance genes in gram-negative bacteria in routine practice in a pediatric hospital. Klin Lab Diagn 2022; 67:180-185. [PMID: 35320635 DOI: 10.51620/0869-2084-2022-67-3-180-185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective - assessment of RT-PCR for the detection of carbapenem-resistance genes in gram-negative bacteria. A total, 499 strains of gram-negative microorganisms isolated in two pediatric hospitals in 2019-2020 were studied. Species identification was performed using MALDI-ToF mass-spectrometry (Bruker Daltonics, Germany). Meropenem and imipenem minimal inhibitory concentration (MIC) was determined by E-test method (BioMerieux, France). The presence of acquired carbapenemase genes of IMP, NDM, VIM, KPC, OXA-48, OXA-23, OXA-40, OXA-58-groups was determined by RT-PCR. Klebsiella pneumoniae (34%), Escherichia coli (4%), Serratia marcescens (6%) and other members of Enterobacterales (6%), also gram-negative non-glucose-fermenting bacteria Acinetobacter baumannii (14%), Pseudomonas aeruginosa (36%) were found among selected strains. Carbapenemase production was found in 385 isolates (77%). The main mechanism determining carbapenem resistance in P. aeruginosa was the production of blaVIM (100%). A. baumanii strains harbored OXA-23 (55%) and OXA-40 (45%) carbapenemases. The major determinant of carbapenem resistance in K. pneumoniae isolates was OXA-48 carbapenemase, detected in 63% strains, 13% of the strains possessed blaNDM-group, 16% isolates had a combination of blaNDM-group and blaOXA-48-like. Carbapenemase of KPC-group was found in 8% K. pneumoniae strains. OXA-48 carbapenemase prevailed (95%) among S. marcescens strains. Most of E. coli isolates harbored metallo-beta-lactamase NDM (89%). Other members of Enterobacterales most often had OXA-48 carbapenemase (57%), 39% of the isolates carried blaNDM-group. In one strain, a combination of blaNDM-group and blaOXA-48-like was discovered. RT-PCR is a fast and reliable method for the detection of acquired carbapenemases and can be recommended for routine use in bacteriological laboratories.
Collapse
Affiliation(s)
- I E Novikova
- Federal State Autonomous Institution «National Medical Research Center of Children's Health» of the Ministry of Health
| | - Z Z Sadeeva
- Federal State Autonomous Institution «National Medical Research Center of Children's Health» of the Ministry of Health
| | - R A Shakirzyanova
- Federal State Autonomous Institution «National Medical Research Center of Children's Health» of the Ministry of Health
| | - N M Alyabieva
- Federal State Autonomous Institution «National Medical Research Center of Children's Health» of the Ministry of Health
| | - A V Lazareva
- Federal State Autonomous Institution «National Medical Research Center of Children's Health» of the Ministry of Health
| | - O V Karaseva
- Clinical and Research Institute of Emergency Pediatric Surgery and Trauma/CRIEPST (Publicity funded health facility of Moscow City Health Department)
| | - M G Vershinina
- Federal State Autonomous Institution «National Medical Research Center of Children's Health» of the Ministry of Health
| | - A P Fisenko
- Federal State Autonomous Institution «National Medical Research Center of Children's Health» of the Ministry of Health
| |
Collapse
|
11
|
Çalışkan E, İnce N, Akar N, Öztürk CE. INVESTIGATION OF TIGECYCLINE SUSCEPTIBILITY OF MULTIDRUG-RESISTANT ACINETOBACTER BAUMANNII ISOLATES BY DISC DIFFUSION, AGAR GRADIENT AND BROTH MICRODILUTION TESTS. Acta Clin Croat 2022; 61:46-51. [PMID: 36398087 PMCID: PMC9616034 DOI: 10.20471/acc.2022.61.01.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 07/14/2020] [Indexed: 09/01/2023] Open
Abstract
The use of tigecycline is becoming increasingly important because of the high levels of antibiotic resistance in Acinetobacter baumannii (A. baumannii) isolates. In this prospective study, multidrug-resistant A. baumannii isolates were obtained from various tissue and fluid samples of patients admitted to or treated at various departments and tested in Laboratory of Microbiology, Duzce University Medical Faculty between January 2013 and December 2015. Tigecycline resistance in multidrug-resistant A. baumannii isolates were analyzed using the disc diffusion test (DDT), agar gradient test (AGT), and gold standard test [broth microdilution test (BMT)]. A. baumannii isolates resistant to multiple drugs were included in the study (N=94). Using the BMT method, 89 (95%), 4 (4%) and 1 (1%) A. baumannii isolates were determined as tigecycline susceptible, intermediate and resistant isolates, respectively. Using the Food and Drug Administration criteria, the rates of major error (ME), minor error (mE) and categorical agreement (CA) for DDT were 26%, 67% and 9%, respectively. In contrast, for AGT, the rates of ME, mE and CA were 0%, 4%, 95%, respectively. Tigecycline resistance as assessed by BMT showed no increase between 2013 and 2015. Accordingly, isolates found to be resistant or intermediate by DDT should be confirmed by BMT. Due to the ease of application, AGT is a safe method of detecting susceptibility.
Collapse
Affiliation(s)
- Emel Çalışkan
- Duzce University Faculty of Medicine, Department of Medical Microbiology, Duzce, Turkey
| | - Nevin İnce
- Duzce University Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Duzce, Turkey
| | - Nida Akar
- Hacettepe University Faculty of Medicine, Department of Medical Mycology, Ankara, Turkey
| | - Cihadiye Elif Öztürk
- Duzce University Faculty of Medicine, Department of Medical Microbiology, Duzce, Turkey
| |
Collapse
|
12
|
Ling W, Furuya-Kanamori L, Ezure Y, Harris PNA, Paterson DL. Adverse clinical outcomes associated with carbapenem-resistant Acinetobacter (CRA) infections: a systematic review and meta-analysis. JAC Antimicrob Resist 2021; 3:dlab157. [PMID: 34755112 PMCID: PMC8568848 DOI: 10.1093/jacamr/dlab157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background Carbapenem-resistant Acinetobacter (CRA) infections have been associated with increased morbidity and mortality in hospitalized patients. This systematic review and meta-analysis aimed to quantify the association between CRA infections and adverse clinical outcomes. Methods Three databases (i.e. PubMed, EMBASE and Scopus) were searched for epidemiological studies that compared mortality, severe sepsis or shock, or bacteraemia among adult inpatients with CRA infections and those with carbapenem-susceptible Acinetobacter (CSA) infections. The pooled ORs for the three outcomes were estimated using the inverse variance heterogeneity model. Results Thirty-four studies were included. Patients with CRA infections had higher odds of mortality (31 studies, OR = 2.10, 95% CI: 1.58–2.79, I2=60.6%) and severe sepsis or septic shock (7 studies, OR = 1.51, 95% CI: 1.09–2.09, I2=0%) compared with CSA-infected patients. There was no difference in the odds of bacteraemia (four studies, OR = 1.39, 95% CI: 0.79–2.46, I2=38.1%). CRA-infected patients presented with worse comorbidity at admission (e.g. APACHE score) (eight studies, standardized mean difference = 0.25, 95% CI: −0.01 to 0.52) and had lower frequency of appropriate antibiotic therapy. Results were consistent when pooling 16 study-adjusted risk estimates for mortality. There was no difference in risk of mortality from CRA infection when compared across geographical regions, country income, median year of enrolment and day of mortality from infection onset. Conclusions CRA-infected patients had worse clinical outcomes. This might be due to delay in appropriate antibiotic therapy, patients being sicker at admission and CRA strains potentially being more virulent than CSA strains. Improving appropriateness of antibiotic therapy in CRA-infected patients could reduce adverse clinical outcomes.
Collapse
Affiliation(s)
- Weiping Ling
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Herston, Brisbane, Australia
| | - Luis Furuya-Kanamori
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Herston, Brisbane, Australia
| | - Yukiko Ezure
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Herston, Brisbane, Australia
| | - Patrick N A Harris
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Herston, Brisbane, Australia.,Central Microbiology, Pathology Queensland, Royal Brisbane & Women's Hospital, Herston, Brisbane, Australia
| | - David L Paterson
- University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Herston, Brisbane, Australia
| |
Collapse
|
13
|
Complete Genome Sequence of Acinetobacter pittii BHS4, Isolated from Air-Conditioning Condensate in Hong Kong. Microbiol Resour Announc 2021; 10:e0088021. [PMID: 34672711 PMCID: PMC8530085 DOI: 10.1128/mra.00880-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Acinetobacter pittii is widespread in the environment, and the Acinetobacter calcoaceticus-baumannii complex, to which it belongs, is a major cause of hospital-acquired pneumonia and bacteremia. A. pitti BHS4 was isolated from an air-conditioning unit in Hong Kong and its complete genome sequence (3,901,980 bp; GC content, 38.79%) established through hybrid assembly.
Collapse
|
14
|
Medkour H, Amona I, Akiana J, Laidoudi Y, Davoust B, Bitam I, Lafri I, Levasseur A, Diatta G, Sokhna C, Hernandez-Aguilar RA, Barciela A, Gorsane S, Banga-Mboko H, Raoult D, Fenollar F, Mediannikov O. Bacterial Infections in Humans and Nonhuman Primates from Africa: Expanding the Knowledge. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2021; 94:227-248. [PMID: 34211344 PMCID: PMC8223552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The close phylogenetic relationship between humans and other primates creates exceptionally high potential for pathogen exchange. The surveillance of pathogens in primates plays an important role in anticipating possible outbreaks. In this study, we conducted a molecular investigation of pathogenic bacteria in feces from African nonhuman primates (NHPs). We also investigated the pathogens shared by the human population and gorillas living in the same territory in the Republic of Congo. In total, 93% of NHPs (n=176) and 95% (n=38) of humans were found to carry at least one bacterium. Non-pallidum Treponema spp. (including T. succinifaciens, T. berlinense, and several potential new species) were recovered from stools of 70% of great apes, 88% of monkeys, and 79% of humans. Non-tuberculosis Mycobacterium spp. were also common in almost all NHP species as well as in humans. In addition, Acinetobacter spp., members of the primate gut microbiota, were mainly prevalent in human and gorilla. Pathogenic Leptospira spp. were highly present in humans (82%) and gorillas (66%) stool samples in Congo, but were absent in the other NHPs, therefore suggesting a possible gorillas-humans exchange. Particular attention will be necessary for enteropathogenic bacteria detected in humans such as Helicobacter pylori, Salmonella spp. (including S. typhi/paratyphi), Staphyloccocus aureus, and Tropheryma whipplei, some of which were also present in gorillas in the same territory (S. aureus and T. whipplei). This study enhances our knowledge of pathogenic bacteria that threaten African NHPs and humans by using a non-invasive sampling technique. Contact between humans and NHPs results in an exchange of pathogens. Ongoing surveillance, prevention, and treatment strategies alone will limit the spread of these infectious agents.
Collapse
Affiliation(s)
- Hacène Medkour
- IHU Méditerranée Infection, Marseille, France,Aix Marseille Université, IRD, AP-HM, Microbes, MEPHI,
Marseille, France,PADESCA Laboratory, Veterinary Science Institute,
University Constantine, El Khroub, Algeria,To whom all correspondence should be addressed:
DVM Hacène Medkour, IHU Méditerranée Infection, 19-21, Bd Jean Moulin, 13385
Marseille Cedex 05, France; , ORCID
iD: 0000-0002-5208-2576; Dr. Oleg Mediannikov, IHU Méditerranée Infection,
19-21, Bd Jean Moulin, 13385 Marseille Cedex 05, France;
, ORCID iD: https://orcid.org/0000-0001-6039-2008
| | - Inestin Amona
- IHU Méditerranée Infection, Marseille, France,Aix-Marseille Université, IRD, AP-HM, SSA, VITROME,
Marseille, France,Faculté des Sciences et Techniques, Université Marien
NGOUABI, Brazzaville, Republic of the Congo
| | - Jean Akiana
- Laboratoire National de Santé Publique, Brazzaville,
Republic of the Congo
| | - Younes Laidoudi
- IHU Méditerranée Infection, Marseille, France,Aix Marseille Université, IRD, AP-HM, Microbes, MEPHI,
Marseille, France,PADESCA Laboratory, Veterinary Science Institute,
University Constantine, El Khroub, Algeria
| | - Bernard Davoust
- IHU Méditerranée Infection, Marseille, France,Aix Marseille Université, IRD, AP-HM, Microbes, MEPHI,
Marseille, France
| | - Idir Bitam
- Aix-Marseille Université, IRD, AP-HM, SSA, VITROME,
Marseille, France,Superior School of Food Sciences and Food Industries,
Algiers, Algeria
| | - Ismail Lafri
- Aix-Marseille Université, IRD, AP-HM, SSA, VITROME,
Marseille, France,Institute of Veterinary Sciences, University of Blida
1, Blida, Algeria,Laboratory of Biotechnology related to Animal
Reproduction (LBRA), University of Blida 1, Blida, Algeria
| | - Anthony Levasseur
- IHU Méditerranée Infection, Marseille, France,Aix Marseille Université, IRD, AP-HM, Microbes, MEPHI,
Marseille, France
| | - Georges Diatta
- Aix-Marseille Université, IRD, AP-HM, SSA, VITROME,
Marseille, France,IRD VITROME, Dakar, Senegal
| | - Cheikh Sokhna
- IHU Méditerranée Infection, Marseille, France,Aix-Marseille Université, IRD, AP-HM, SSA, VITROME,
Marseille, France,IRD VITROME, Dakar, Senegal
| | - R. Adriana Hernandez-Aguilar
- IRD VITROME, Dakar, Senegal,Department of Social Psychology and Quantitative
Psychology, Faculty of Psychology, University of Barcelona, Barcelona,
Spain
| | - Amanda Barciela
- Jane Goodall Institute Spain and Senegal, Dindefelo
Biological Station, Dindefelo, Kedougou, Senegal
| | - Slim Gorsane
- Direction interarmées du Service de santé des armées
des Forces Françaises stationnées à Djibouti
| | - Henri Banga-Mboko
- Ecole Nationale d’Agronomie et de Foresterie,
Université Marien Ngouabi, Brazzaville, Republic of the Congo
| | - Didier Raoult
- IHU Méditerranée Infection, Marseille, France,Aix Marseille Université, IRD, AP-HM, Microbes, MEPHI,
Marseille, France
| | - Florence Fenollar
- IHU Méditerranée Infection, Marseille, France,Aix-Marseille Université, IRD, AP-HM, SSA, VITROME,
Marseille, France
| | - Oleg Mediannikov
- IHU Méditerranée Infection, Marseille, France,Aix Marseille Université, IRD, AP-HM, Microbes, MEPHI,
Marseille, France,To whom all correspondence should be addressed:
DVM Hacène Medkour, IHU Méditerranée Infection, 19-21, Bd Jean Moulin, 13385
Marseille Cedex 05, France; , ORCID
iD: 0000-0002-5208-2576; Dr. Oleg Mediannikov, IHU Méditerranée Infection,
19-21, Bd Jean Moulin, 13385 Marseille Cedex 05, France;
, ORCID iD: https://orcid.org/0000-0001-6039-2008
| |
Collapse
|
15
|
Ibekwe AM, Ors S, Ferreira JFS, Liu X, Suarez DL. Influence of seasonal changes and salinity on spinach phyllosphere bacterial functional assemblage. PLoS One 2021; 16:e0252242. [PMID: 34061881 PMCID: PMC8168849 DOI: 10.1371/journal.pone.0252242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/11/2021] [Indexed: 11/18/2022] Open
Abstract
The phyllosphere is the aerial part of plants that is exposed to different environmental conditions and is also known to harbor a wide variety of bacteria including both plant and human pathogens. However, studies on phyllosphere bacterial communities have focused on bacterial composition at different stages of plant growth without correlating their functional capabilities to bacterial communities. In this study, we examined the seasonal effects and temporal variabilities driving bacterial community composition and function in spinach phyllosphere due to increasing salinity and season and estimated the functional capacity of bacterial community16S V4 rRNA gene profiles by indirectly inferring the abundance of functional genes based on metagenomics inference tool Piphillin. The experimental design involved three sets of spinach (Spinacia oleracea L., cv. Racoon) grown with saline water during different seasons. Total bacteria DNA from leaf surfaces were sequenced using MiSeq® Illumina platform. About 66.35% of bacteria detected in the phyllosphere were dominated by four phyla- Proteobacteria, Firmicutes, Bacteroidetes, and Actinobacteria. Permutational analysis of variance (PERMANOVA) showed that phyllosphere microbiomes were significantly (P < 0.003) affected by season, but not salinity (P = 0.501). The most abundant inferred functional pathways in leaf samples were the amino acids biosynthesis, ABC transporters, ribosome, aminoacyl-tRNA biosynthesis, two-component system, carbon metabolism, purine metabolism, and pyrimidine metabolism. The photosynthesis antenna proteins pathway was significantly enriched in June leaf samples, when compared to March and May. Several genes related to toxin co-regulated pilus biosynthesis proteins were also significantly enriched in June leaf samples, when compared to March and May leaf samples. Therefore, planting and harvesting times must be considered during leafy green production due to the influence of seasons in growth and proliferation of phyllosphere microbial communities.
Collapse
Affiliation(s)
| | - Selda Ors
- Ataturk University, Department of Agricultural Structures and Irrigation, Erzurum, Turkey
| | | | - Xuan Liu
- US Salinity Laboratory, USDA-ARS, Riverside, CA, United States of America
| | - Donald L. Suarez
- US Salinity Laboratory, USDA-ARS, Riverside, CA, United States of America
| |
Collapse
|
16
|
The Role of Uniform Meropenem Usage in Acinetobacter baumannii Clone Replacement. Antibiotics (Basel) 2021; 10:antibiotics10020127. [PMID: 33572723 PMCID: PMC7911629 DOI: 10.3390/antibiotics10020127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 01/01/2023] Open
Abstract
The dominant carbapenem resistant Acinetobacter baumannii harboring blaOXA-23-like carbapenemase was replaced by blaOXA-40-like carriers in a Hungarian tertiary-care center with high meropenem but relatively low imipenem use. We hypothesized that alterations in antibiotic consumption may have contributed to this switch. Our workgroup previous study examined the relation between resistance spiral and the antibiotic consumption, and the results suggest that the antibiotic usage provoked the increasing resistance in case of A. baumannii. We aimed at measuring the activity of imipenem and meropenem to compare the selection pressure exerted by the different carbapenems in time-kill assays. Strain replacement was confirmed by whole genome sequencing, core-genome multilocus sequence typing (cgMLST), and resistome analysis. Based on results of the time-kill assays, we found a significant difference between two different sequence-types (STs) in case of meropenem, but not in case of imipenem susceptibility. The newly emerged ST636 and ST492 had increased resistance level against meropenem compared to the previously dominant ST2 and ST49. On the other hand, the imipenem and colistin resistance profiles were similar. These results suggest, that the uniform meropenem usage may have contributed to A. baumannii strain replacement in our setting.
Collapse
|
17
|
Antimicrobial Resistance Pattern of Bacterial Isolates among Nosocomial Infections (Urinary Tract Infection and Blood Stream Infection) from the Intensive Care Unit of a Tertiary Care Government Hospital in India. ACTA ACUST UNITED AC 2020. [DOI: 10.14260/jemds/2020/495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
18
|
Jakovac S, Goić-Barišić I, Pirija M, Kovačić A, Hrenović J, Petrović T, Tutiš B, Tonkić M. Molecular Characterization and Survival of Carbapenem-Resistant Acinetobacter baumannii Isolated from Hospitalized Patients in Mostar, Bosnia and Herzegovina. Microb Drug Resist 2020; 27:383-390. [PMID: 32721271 DOI: 10.1089/mdr.2020.0163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Increasingly difficult treatment of multidrug-resistant (MDR) bacteria has become a global problem of the 21st century. Within a group of multiresistant bacteria, the Acinetobacter baumannii convincingly occupies the position at the top of the group designated as ESKAPE pathogens. In this study, 61 isolates of A. baumannii were recovered from different samples originating from various departments of the University Clinical Hospital Mostar during 2018. All of the isolates were identified using conventional phenotypic methods and the VITEK® 2 Compact System, and were confirmed by MALDI-TOF mass spectrometry. The minimum inhibitory concentrations (MICs) were determined by the microbroth dilution method using MICRONAUT-S MDR MRGN-Screening and VITEK 2 Compact System. All strains were resistant to carbapenems and classified in eight different resistotypes according to their antibiotic resistance and macrorestriction pulsed-field gel electrophoresis profiles, with all belonging to IC II. One isolate displayed resistance to colistin (MIC ≥16 mg/L). The presence of blaOXA genes encoding OXA-type carbapenemases was investigated by multiplex PCR and the Eazyplex® SuperBugAcineto system and showed 100% compatibility with the detection of acquired oxacillinases. Molecular characterization of the isolates tested in this study revealed the OXA-23- and OXA-40-like groups of acquired oxacillinases. Sequencing of two PCR products of the OXA-40-like group confirmed the presence of OXA-72. Survival assays with two selected isolates of A. baumannii encoding different mechanisms of carbapenem resistance revealed that one isolate was able to survive on a fragment of white laboratory coat during 90 days of monitoring. To the best of our knowledge, this is the first article to present the results of a comprehensive phenotypic, genotypic, and molecular analysis of A. baumannii isolates from the leading clinical hospital center in the southwestern part of Bosnia and Herzegovina, including data for the survival of this pathogen on the white laboratory coats used as compulsory medical clothing.
Collapse
Affiliation(s)
- Sanja Jakovac
- Institute for Microbiological Diagnostics, University Clinical Hospital Mostar and School of Medicine University of Mostar, Mostar, Bosnia and Herzegovina
| | - Ivana Goić-Barišić
- University Hospital of Split and University of Split School of Medicine, Split, Croatia
| | - Mario Pirija
- Department of Clinical Microbiology, University Hospital of Split, Split, Croatia
| | - Ana Kovačić
- Institute of Public Health of Split and Dalmatia Country, Split, Croatia
| | - Jasna Hrenović
- Department of Biology, Faculty of Science, University of Zagreb, Zagreb, Croatia
| | - Tanja Petrović
- Institute for Microbiological Diagnostics, University Clinical Hospital Mostar and School of Medicine University of Mostar, Mostar, Bosnia and Herzegovina
| | - Borka Tutiš
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Marija Tonkić
- University Hospital of Split and University of Split School of Medicine, Split, Croatia
| |
Collapse
|
19
|
Antibiotic Resistance Profiles, Molecular Mechanisms and Innovative Treatment Strategies of Acinetobacter baumannii. Microorganisms 2020; 8:microorganisms8060935. [PMID: 32575913 PMCID: PMC7355832 DOI: 10.3390/microorganisms8060935] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 12/18/2022] Open
Abstract
Antibiotic resistance is one of the biggest challenges for the clinical sector and industry, environment and societal development. One of the most important pathogens responsible for severe nosocomial infections is Acinetobacter baumannii, a Gram-negative bacterium from the Moraxellaceae family, due to its various resistance mechanisms, such as the β-lactamases production, efflux pumps, decreased membrane permeability and altered target site of the antibiotic. The enormous adaptive capacity of A. baumannii and the acquisition and transfer of antibiotic resistance determinants contribute to the ineffectiveness of most current therapeutic strategies, including last-line or combined antibiotic therapy. In this review, we will present an update of the antibiotic resistance profiles and underlying mechanisms in A. baumannii and the current progress in developing innovative strategies for combating multidrug-resistant A. baumannii (MDRAB) infections.
Collapse
|
20
|
Hamidian M, Nigro SJ. Emergence, molecular mechanisms and global spread of carbapenem-resistant Acinetobacter baumannii. Microb Genom 2020; 5. [PMID: 31599224 PMCID: PMC6861865 DOI: 10.1099/mgen.0.000306] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Acinetobacter baumannii is a nosocomial pathogen that has emerged as a global threat because of high levels of resistance to many antibiotics, particularly those considered to be last-resort antibiotics, such as carbapenems. Although alterations in the efflux pump and outer membrane proteins can cause carbapenem resistance, the main mechanism is the acquisition of carbapenem-hydrolyzing oxacillinase-encoding genes. Of these, oxa23 is by far the most widespread in most countries, while oxa24 and oxa58 appear to be dominant in specific regions. Historically, much of the global spread of carbapenem resistance has been due to the dissemination of two major clones, known as global clones 1 and 2, although new lineages are now common in some parts of the world. The analysis of all publicly available genome sequences performed here indicates that ST2, ST1, ST79 and ST25 account for over 71 % of all genomes sequenced to date, with ST2 by far the most dominant type and oxa23 the most widespread carbapenem resistance determinant globally, regardless of clonal type. Whilst this highlights the global spread of ST1 and ST2, and the dominance of oxa23 in both clones, it could also be a result of preferential selection of carbapenem-resistant strains, which mainly belong to the two major clones. Furthermore, ~70 % of the sequenced strains have been isolated from five countries, namely the USA, PR China, Australia, Thailand and Pakistan, with only a limited number from other countries. These genomes are a vital resource, but it is currently difficult to draw an accurate global picture of this important superbug, highlighting the need for more comprehensive genome sequence data and genomic analysis.
Collapse
Affiliation(s)
- Mohammad Hamidian
- The ithree institute, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Steven J Nigro
- Communicable Diseases Branch, Health Protection NSW, St Leonards, NSW 2065, Australia
| |
Collapse
|
21
|
M Campos JC, Antunes LCM, Ferreira RBR. Global priority pathogens: virulence, antimicrobial resistance and prospective treatment options. Future Microbiol 2020; 15:649-677. [DOI: 10.2217/fmb-2019-0333] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp. and Salmonella spp. are part of a group of pathogens that pose a major threat to human health due to the emergence of multidrug-resistant strains. Moreover, these bacteria have several virulence factors that allow them to successfully colonize their hosts, such as toxins and the ability to produce biofilms, resulting in an urgent need to develop new strategies to fight these pathogens. In this review, we compile the most up-to-date information on the epidemiology, virulence and resistance of these clinically important microorganisms. Additionally, we address new therapeutic alternatives, with a focus on molecules with antivirulence activity, which are considered promising to combat multidrug-resistant bacteria.
Collapse
Affiliation(s)
- Juliana C de M Campos
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luis CM Antunes
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Instituto Nacional de Ciência e Tecnologia de Inovação em Doenças de Populações Negligenciadas, Centro de Desenvolvimento Tecnológico em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Rosana BR Ferreira
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
22
|
Abstract
Acinetobacter baumannii is an important Gram-negative opportunistic pathogen commonly infecting critically ill patients. It possesses a remarkable ability to survive in the hospital environment and acquires resistance determinants corresponding to a wide range of antibacterial agents. Given that the current treatment options for multidrug resistant A. baumannii are extremely limited, colistin administration has become the treatment of last resort. However, colistin-resistant A. baumannii strains have recently been reported. The mechanism of resistance to colistin in A. baumannii has rarely been reported. Here, we found two novel mutations in pmrA (I13M) and pmrB (Q270P) that caused colistin resistance. It is also first reported here that the presence of miaA with a I221V mutation enhanced the colistin resistance of pmrAP102R. Colistin is used as the “last resort” to treat infections caused by multidrug-resistant Acinetobacter baumannii, which is at the top of the World Health Organization’s list of the most dangerous bacterial species that threaten human health. Unfortunately, colistin resistance has emerged in A. baumannii. To broaden the study of the resistance mechanism of colistin in A. baumannii, we obtained colistin-resistant mutants via two methods: (i) screening and isolation from a mariner-based A. baumannii ATCC 19606 transposon mutant library; (ii) selection from challenge of ATCC 19606 with successively increasing concentrations of colistin. A total of 41 mutants with colistin MIC of 4 μg/ml to 64 μg/ml were obtained by transposon mutant library screening. Five highly resistant mutants with colistin MICs ranging from 256 μg/ml to 512 μg/ml were selected from successive colistin challenges. Genotypic complementation and remodeling of the transposon mutants revealed that the genes inactivated by the transposon insertion were not responsible for resistance. Whole-genome sequence analysis of the colistin-resistant strains revealed that the main causes of the resistance to colistin were mutations in the pmrA-pmrB genes, including pmrAP102R, pmrBP233S, and pmrBT235N and the novel alleles pmrAI13M and pmrBQ270P. Interestingly, we found that miaAI221V mutation of A. baumannii strain ATCC 19606 (pmrAP102R) resulted in 4-fold increases in the colistin MIC, which rose from 32 μg/ml to 128 μg/ml. But miaAI221V itself had little effect on the colistin susceptibility of ATCC 19606. These data broaden knowledge of the scope of chromosomally encoded mechanisms of resistance to colistin. IMPORTANCEAcinetobacter baumannii is an important Gram-negative opportunistic pathogen commonly infecting critically ill patients. It possesses a remarkable ability to survive in the hospital environment and acquires resistance determinants corresponding to a wide range of antibacterial agents. Given that the current treatment options for multidrug resistant A. baumannii are extremely limited, colistin administration has become the treatment of last resort. However, colistin-resistant A. baumannii strains have recently been reported. The mechanism of resistance to colistin in A. baumannii has rarely been reported. Here, we found two novel mutations in pmrA (I13M) and pmrB (Q270P) that caused colistin resistance. It is also first reported here that the presence of miaA with a I221V mutation enhanced the colistin resistance of pmrAP102R.
Collapse
|
23
|
Mlynarcik P, Chalachanova A, Vagnerovă I, Holy O, Zatloukalova S, Kolar M. PCR Detection of Oxacillinases in Bacteria. Microb Drug Resist 2020; 26:1023-1037. [PMID: 32212994 DOI: 10.1089/mdr.2019.0330] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Oxacillinases (OXA) have been mostly described in Enterobacteriaceae, Acinetobacter, and Pseudomonas species. Recent years have witnessed an increased prevalence of intrinsic and/or acquired β-lactamase-producing Acinetobacter in food-producing animals. This study was conducted to assess the prevalence of OXA among selected bacterial species and to characterize these enzymes by in silico analysis. Screening of OXA was performed by PCR amplification using specific pairs of oligonucleotides. Overall, 40 pairs of primers were designed, of which 6 were experimentally tested in vitro. Among 49 bacterial isolates examined, the presence of blaOXA-1-like genes was confirmed in 20 cases (41%; 19 times in Klebsiella pneumoniae and once in Enterobacter cloacae). No OXA were found in animal isolates. The study results confirmed the specificity of the designed oligonucleotide pairs. Furthermore, the designed primers were found to possess the ability to specifically detect 90.2% of all OXA. These facts suggest that the in silico and in vitro tested primers could be used for single or multiplex PCR to screen for the presence of OXA in various bacteria, as well as to monitor their spread. At the same time, the presence of conserved characteristic amino acids and motifs was confirmed by in silico analysis of sequences of representative members of OXA.
Collapse
Affiliation(s)
- Patrik Mlynarcik
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Andrea Chalachanova
- Department of Cell Biology and Genetics, Faculty of Science, Palacky University Olomouc, Olomouc, Czech Republic
| | - Iva Vagnerovă
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Ondrej Holy
- Department of Public Health, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Simona Zatloukalova
- Department of Public Health, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Milan Kolar
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic.,Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| |
Collapse
|
24
|
Koirala J, Tyagi I, Guntupalli L, Koirala S, Chapagain U, Quarshie C, Akram S, Sundareshan V, Koirala S, Lawhorn J, Doi Y, Olson M. OXA-23 and OXA-40 producing carbapenem-resistant Acinetobacter baumannii in Central Illinois. Diagn Microbiol Infect Dis 2020; 97:114999. [PMID: 32059871 DOI: 10.1016/j.diagmicrobio.2020.114999] [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] [Received: 10/24/2019] [Revised: 12/31/2019] [Accepted: 01/23/2020] [Indexed: 01/23/2023]
Abstract
We reviewed susceptibility of 840 A. baumannii complex isolates at two academic medical centers and explored their mechanism of carbapenem resistance. Carbapenem resistance rates among A. baumannii increased from <5% before 2005 to 55% in 2011 and declined thereafter. We subjected 86 isolates for further antibiotic susceptibility testing using E-test, screened for MBL and carbapenemase production, and performed PCR for blaOXA genes. Statistical analyses included correlation of resistance genes with susceptibility. Sixty-one isolates were non-susceptible to carbapenems (MIC >2 μg/mL). Phenotypic screening showed carbapenemase production in 50 isolates, but none was positive for MBL. Among carbapenem non-susceptible isolates, the CHDL (group D carbapenemase) encoding genes blaOXA-23 (52%) and blaOXA-40 (28%) were the most frequent genes. In conclusion, carbapenem resistance rates in A. baumannii peaked in 2011 and have since declined in our region. Carbapenem resistance among A. baumannii was primarily associated with production of acquired CHDLs including OXA-23 and OXA-40.
Collapse
Affiliation(s)
- Janak Koirala
- Division of Infectious Diseases, Southern Illinois University School of Medicine, Springfield, IL, USA.
| | - Isha Tyagi
- Division of Infectious Diseases, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Lohitha Guntupalli
- Division of Infectious Diseases, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Sameena Koirala
- Division of Infectious Diseases, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Udita Chapagain
- Division of Infectious Diseases, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Christopher Quarshie
- Division of Infectious Diseases, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Sami Akram
- Division of Infectious Diseases, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Vidya Sundareshan
- Division of Infectious Diseases, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Sajan Koirala
- Tulane University, School of Public Health, New Orleans, Louisiana, USA
| | - Jerry Lawhorn
- Department of Microbiology, Memorial Medical Center, Springfield, IL, USA
| | - Yohei Doi
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Olson
- Department of Medical Microbiology, Immunology and Cell Biology, Southern Illinois University School of Medicine, Springfield, IL, USA
| |
Collapse
|
25
|
Lukić-Grlić A, Kos M, Žižek M, Luxner J, Grisold A, Zarfel G, Bedenić B. Emergence of Carbapenem-Hydrolyzing Oxacillinases in Acinetobacter baumannii in Children from Croatia. Chemotherapy 2019; 64:167-172. [PMID: 31707391 DOI: 10.1159/000503746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/26/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Carbapenem resistance in Acinetobacter baumannii can be mediated by carbapenemases of class A, class B metallo-β-lactamases (MBLs), and class D carbapenem-hydrolyzing oxacillinases (CHDL). The aim of the study was to investigate the antimicrobial susceptibility and β-lactamase production of carbapenem-resistant A. baumannii isolates (CRAB) from the Children's Hospital Zagreb, Croatia. METHODS A total of 12 A. baumannii isolates collected between August 2016 and March 2018 were analyzed. Antibiotic susceptibility was determined by the broth microdilution method. The presence of MBLs was explored by combined disk test with EDTA. The presence of carbapenemases of class A, B, and D was explored by PCR. The occurrence of the ISAba1 upstream of the blaOXA-51-like or blaOXA-23-like was determined by PCR mapping. Epidemiological typing was performed by determination of sequence groups (SG). Genotyping was performed by SG determination, rep-PCR, and MLST. RESULTS All CRAB were resistant to piperacillin/tazobactam, ceftazidime, cefotaxime, ceftriaxone, cefepime, imipenem, meropenem, gentamicin, and ciprofloxacin. Moderate resistance rates were observed for ampicillin/sulbactam (67%) and tigecycline (42%). The isolates were uniformly susceptible to colistin. PCR revealed the presence of genes encoding OXA-24-like CHDL in nine and OXA-23-like CHDL in three isolates. blaOXA-51 genes were preceded by ISAba1. PCR for the common MBLs in Acinetobacter was negative. All isolates belonged to SG 1 corresponding to ICL (International Clonal Lineage) II. Rep-PCR identified four major clones. CONCLUSIONS The study found OXA-24-like β-lactamase to be the dominant CHDL among children'sCRAB. The predominant spread of OXA-24-like is in contrast with the recent global dissemination of OXA-23 reported all over the world. In contrast to the previous studies in which emergency of OXA-24-like positive isolates was monoclonal, we found considerable genetic diversity of the isolates.
Collapse
Affiliation(s)
- Amarela Lukić-Grlić
- School of Medicine, University of Zagreb, Zagreb, Croatia, .,Children's Hospital Zagreb, Zagreb, Croatia,
| | - Matea Kos
- Children's Hospital Zagreb, Zagreb, Croatia
| | - Marta Žižek
- Faculty of Health Sciences, University of Zagreb, Zagreb, Croatia
| | - Josefa Luxner
- Institute of Microbiology, Hygiene and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Andrea Grisold
- Institute of Microbiology, Hygiene and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Gernot Zarfel
- Institute of Microbiology, Hygiene and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Branka Bedenić
- School of Medicine, University of Zagreb, Zagreb, Croatia.,University Hospital Center, Zagreb, Croatia
| |
Collapse
|
26
|
Oh DH, Kim YC, Kim EJ, Jung IY, Jeong SJ, Kim SY, Park MS, Kim A, Lee JG, Paik HC. Multidrug-resistant Acinetobacter baumannii infection in lung transplant recipients: risk factors and prognosis. Infect Dis (Lond) 2019; 51:493-501. [PMID: 31081415 DOI: 10.1080/23744235.2018.1556400] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Backgrounds: Infectious complication is an important cause of poor outcome of lung transplantation (LT). Infections with Acinetobacter baumannii (A. baumannii) are problematic, because of limited therapeutic option due to increasing resistance to antibiotics. However, there are few studies on A. baumannii infection in lung transplant recipients. Thus, we aimed to investigate epidemiology and risk factors for infection with A. baumannii in lung transplant recipients. Methods: Lung transplant recipients ≥18 years of age in a university hospital were enrolled in this retrospective cohort study. Risk factors for infection with multidrug resistant A. baumannii and 90-day mortality were analysed. Results: Fifty-one of 96 lung transplant recipients experienced A. baumannii infection. Infected patients had a significantly higher 90-day mortality rate than uninfected (19.6% vs. 2.2%, p = .009). High blood urea nitrogen (BUN) before transplantation (odds ratio [OR] 1.16; p = .008), long duration of surgery (OR 1.16; p = .029) and hypoalbuminemia before transplantation (OR 4.01; p = .037) were independent risk factors for infection with multidrug resistant A. baumannii. On multivariate analysis, severe thrombocytopenia (OR 28.69; p = .005), high serum creatinine (OR 1.48; p = .042) and infection with multidrug resistant A. baumannii (OR 22.58; p = .031) were independent risk factors for 90-day mortality. Conclusions: Prolonged surgery, high BUN and hypoalbuminemia before LT were significant risk factors for infection with multidrug resistant A. baumannii. Severe thrombocytopenia, high serum creatinine and infection with multidrug resistant A. baumannii infection were independent risk factors for 90-day mortality.
Collapse
Affiliation(s)
- Dong Hyun Oh
- a Department of Internal Medicine, Division of Infectious Disease , Seoul Medical Center , Seoul , South Korea
| | - Yong Chan Kim
- b Department of Internal Medicine, Division of Infectious Disease , Yonsei University College of Medicine , Seoul , South Korea
| | - Eun Jin Kim
- b Department of Internal Medicine, Division of Infectious Disease , Yonsei University College of Medicine , Seoul , South Korea
| | - In Young Jung
- b Department of Internal Medicine, Division of Infectious Disease , Yonsei University College of Medicine , Seoul , South Korea
| | - Su Jin Jeong
- b Department of Internal Medicine, Division of Infectious Disease , Yonsei University College of Medicine , Seoul , South Korea
| | - Song Yee Kim
- c Department of Internal Medicine, Division of Pulmonology , Institute of Chest Diseases, Yonsei University College of Medicine , Seoul , South Korea
| | - Moo Suk Park
- c Department of Internal Medicine, Division of Pulmonology , Institute of Chest Diseases, Yonsei University College of Medicine , Seoul , South Korea
| | - Anes Kim
- d Department of Thoracic and Cardiovascular Surgery , Yonsei University College of Medicine , Seoul , South Korea
| | - Jin Gu Lee
- d Department of Thoracic and Cardiovascular Surgery , Yonsei University College of Medicine , Seoul , South Korea
| | - Hyo Chae Paik
- d Department of Thoracic and Cardiovascular Surgery , Yonsei University College of Medicine , Seoul , South Korea
| |
Collapse
|
27
|
Wannigama DL, Hurst C, Pearson L, Saethang T, Singkham-In U, Luk-In S, Storer RJ, Chatsuwan T. Simple fluorometric-based assay of antibiotic effectiveness for Acinetobacter baumannii biofilms. Sci Rep 2019; 9:6300. [PMID: 31004100 PMCID: PMC6474882 DOI: 10.1038/s41598-019-42353-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/27/2019] [Indexed: 02/07/2023] Open
Abstract
Despite strengthened antimicrobial therapy, biofilm infections of Acinetobacter baumannii are associated with poor prognosis and limited therapeutic options. Assessing antibiotics on planktonic bacteria can result in failure against biofilm infections. Currently, antibiotics to treat biofilm infections are administered empirically, usually without considering the susceptibility of the biofilm objectively before beginning treatment. For effective therapy to resolve biofilm infections it is essential to assess the efficacy of commonly used antibiotics against biofilms. Here, we offer a robust and simple assay to assess the efficacy of antibiotics against biofilms. In the present work, we carefully optimized the incubation time, detection range, and fluorescence reading mode for resazurin-based viability staining of biofilms in 96-well-plates and determined minimal biofilm eradication concentrations (MBECs) for A. baumannii isolates from patients with chronic infection. By applying this assay, we demonstrated that antibiotic response patterns varied uniquely within the biofilm formation of various clinical samples. MBEC-50 and 75 have significant discriminatory power over minimum inhibitory concentrations for planktonic suspensions to differentiate the overall efficiency of an antibiotic to eradicate a biofilm. The present assay is an ideal platform on which to assess the efficacy of antibiotics against biofilms in vitro to pave the way for more effective therapy.
Collapse
Affiliation(s)
- Dhammika Leshan Wannigama
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Nedlands, Western Australia, Australia
- Antimicrobial Resistance and Stewardship Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Cameron Hurst
- Center of Excellence in Biostatistics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Statistics, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Lachlan Pearson
- Systems Biology Center, Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Snowy River Vet Clinic and Veterinary Hospital, Orbost, Victoria, Australia
| | - Thammakorn Saethang
- Systems Biology Center, Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Computer Science, Faculty of Science, Kasetsart University, Bangkok, Thailand
| | - Uthaibhorn Singkham-In
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Antimicrobial Resistance and Stewardship Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sirirat Luk-In
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Interdisciplinary Program of Medical Microbiology, Graduate School, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - Robin James Storer
- Office of Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tanittha Chatsuwan
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
- Antimicrobial Resistance and Stewardship Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| |
Collapse
|
28
|
Eichenberger EM, Thaden JT. Epidemiology and Mechanisms of Resistance of Extensively Drug Resistant Gram-Negative Bacteria. Antibiotics (Basel) 2019; 8:antibiotics8020037. [PMID: 30959901 PMCID: PMC6628318 DOI: 10.3390/antibiotics8020037] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/22/2019] [Accepted: 03/31/2019] [Indexed: 12/13/2022] Open
Abstract
Antibiotic resistance has increased markedly in gram-negative bacteria over the last two decades, and in many cases has been associated with increased mortality and healthcare costs. The adoption of genotyping and next generation whole genome sequencing of large sets of clinical bacterial isolates has greatly expanded our understanding of how antibiotic resistance develops and transmits among bacteria and between patients. Diverse mechanisms of resistance, including antibiotic degradation, antibiotic target modification, and modulation of permeability through the bacterial membrane have been demonstrated. These fundamental insights into the mechanisms of gram-negative antibiotic resistance have influenced the development of novel antibiotics and treatment practices in highly resistant infections. Here, we review the mechanisms and global epidemiology of antibiotic resistance in some of the most clinically important resistance phenotypes, including carbapenem resistant Enterobacteriaceae, extensively drug resistant (XDR) Pseudomonas aeruginosa, and XDR Acinetobacter baumannii. Understanding the resistance mechanisms and epidemiology of these pathogens is critical for the development of novel antibacterials and for individual treatment decisions, which often involve alternatives to β-lactam antibiotics.
Collapse
Affiliation(s)
- Emily M Eichenberger
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Joshua T Thaden
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, NC 27710, USA.
| |
Collapse
|
29
|
Jeon J, Park JH, Yong D. Efficacy of bacteriophage treatment against carbapenem-resistant Acinetobacter baumannii in Galleria mellonella larvae and a mouse model of acute pneumonia. BMC Microbiol 2019; 19:70. [PMID: 30940074 PMCID: PMC6444642 DOI: 10.1186/s12866-019-1443-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 03/25/2019] [Indexed: 01/21/2023] Open
Abstract
Background Acinetobacter baumannii is an opportunistic pathogen that causes serious nosocomial infection in intensive care units. In particular, carbapenem-resistant A. baumannii (CRAB) strains have been increasing in the past decade, and they have caused major medical problems worldwide. In this study, a novel A. baumannii lytic phage, the YMC 13/03/R2096 ABA BP (phage Βϕ-R2096), which specifically causes the lysis of CRAB strains, was characterized in detail in vitro and in silico, and the in vivo effectiveness of phage therapy was evaluated using Galleria mellonella and a mouse model of acute pneumonia. Results The A. baumannii phage Βϕ-R2096 was isolated from sewage water using CRAB clinical strains selected from patients at a university hospital in South Korea. The complete genome of the phage Βϕ-R2096, which belongs to the Myoviridae family, was analyzed. Phage Βϕ-R2096 inhibited bacterial growth in a dose-dependent manner and exhibited high bacteriolytic activity at MOI = 10. In the evaluation of its therapeutic potential against CRAB clinical isolates using two in vivo models, phage Βϕ-R2096 increased the survival rates of both G. mellonella larvae (from 0 to 50% at 24 h) and mice (from 30% with MOI = 0.1 to 100% with MOI = 10 for 12 days) in post-infection of CRAB. In particular, phage Βϕ-R2096 strongly ameliorated histologic damage to infected lungs, with bacterial clearance in the lungs observed on day 3 postinfection in the mouse acute pneumonia model. Moreover, in vivo studies revealed no mortality or serious side effects in phage-treated groups. Conclusion The results of this study strongly suggest that phage Βϕ-R2096, a novel A. baumannii lytic phage, could be an alternative antibacterial agent to control CRAB infections. This study is the first report to compare in vivo evaluations (G. mellonella larvae and a mouse acute pneumonia model) of the therapeutic efficacy of a phage against CRAB infections. Electronic supplementary material The online version of this article (10.1186/s12866-019-1443-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jongsoo Jeon
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Y, Seoul, Republic of Korea.
| | - Jong-Hwan Park
- Laboratory Animal Medicine, College of Veterinary Medicine, Chonnam National University, Gwang-ju, 61186, Republic of Korea
| | - Dongeun Yong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Y, Seoul, Republic of Korea. .,Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 50-1Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
| |
Collapse
|
30
|
Naimi-Shamel N, Pourali P, Dolatabadi S. Green synthesis of gold nanoparticles using Fusarium oxysporum and antibacterial activity of its tetracycline conjugant. J Mycol Med 2019; 29:7-13. [PMID: 30709721 DOI: 10.1016/j.mycmed.2019.01.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/12/2019] [Accepted: 01/14/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The emerging microbial drug resistance has limited the choices of treatments for infectious diseases. Application of drugs conjugated with nanoparticles is among the strategies to subside the chance of acquiring resistance and increase the potency of current antibiotics. This study was conducted to produce gold nanoparticles (GNPs) by Fusarium oxysporum to evaluate the antibacterial activity of GNPs conjugated with tetracycline under different conditions. MATERIAL AND METHODS GNPs were synthesized using the culture supernatants of F. oxysporum treated with a chloroauric acid solution. Production of GNPs and their conjugation with tetracycline was confirmed by noticing the change in color, spectrophotometry, X-ray diffraction analysis, transmission electron microscopy, and Fourier transform infrared spectroscopy spectra. The antibacterial activity of the conjugated GNPs was then assessed. RESULTS The formation of GNPs was confirmed by appearance of purple color and an absorption peak at 530nm The produced GNPs were found to be spherical and hexagonal. FTIR confirmed the binding of functional groups of tetracycline to the GNPs surface. The minimum inhibitory concentration of conjugated GNPs demonstrated a much greater antibacterial activity against Gram-positive and Gram -negative bacteria as compared to tetracycline and free GNPs. CONCLUSIONS Biosynthesis of GNPs by F. oxysporum has advantages including fast growth rate, inexpensive biomass handling, safety and easy processing. Conjugation of tetracycline with GNPs enhances antibacterial activity, which may have significant therapeutic applications.
Collapse
Affiliation(s)
- N Naimi-Shamel
- Department of Microbiology, Faculty of Sciences, Neyshabur Branch, Islamic Azad University, Neyshabur, Iran
| | - P Pourali
- Department of Medical Sciences, Shahrood Branch, Islamic Azad University, Shahrood, Iran
| | - S Dolatabadi
- Department of Microbiology, Faculty of Sciences, Neyshabur Branch, Islamic Azad University, Neyshabur, Iran.
| |
Collapse
|
31
|
Roy MA, Arnaud JM, Jasmin PM, Hamner S, Hasan NA, Colwell RR, Ford TE. A Metagenomic Approach to Evaluating Surface Water Quality in Haiti. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102211. [PMID: 30309013 PMCID: PMC6209974 DOI: 10.3390/ijerph15102211] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/10/2018] [Accepted: 10/04/2018] [Indexed: 12/31/2022]
Abstract
The cholera epidemic that occurred in Haiti post-earthquake in 2010 has resulted in over 9000 deaths during the past eight years. Currently, morbidity and mortality rates for cholera have declined, but cholera cases still occur on a daily basis. One continuing issue is an inability to accurately predict and identify when cholera outbreaks might occur. To explore this surveillance gap, a metagenomic approach employing environmental samples was taken. In this study, surface water samples were collected at two time points from several sites near the original epicenter of the cholera outbreak in the Central Plateau of Haiti. These samples underwent whole genome sequencing and subsequent metagenomic analysis to characterize the microbial community of bacteria, fungi, protists, and viruses, and to identify antibiotic resistance and virulence associated genes. Replicates from sites were analyzed by principle components analysis, and distinct genomic profiles were obtained for each site. Cholera toxin converting phage was detected at one site, and Shiga toxin converting phages at several sites. Members of the Acinetobacter family were frequently detected in samples, including members implicated in waterborne diseases. These results indicate a metagenomic approach to evaluating water samples can be useful for source tracking and the surveillance of pathogens such as Vibrio cholerae over time, as well as for monitoring virulence factors such as cholera toxin.
Collapse
Affiliation(s)
- Monika A Roy
- Department of Environmental Health Sciences, School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA.
- Biotechnology Training Program, University of Massachusetts Amherst, Amherst, MA 01003, USA.
| | - Jean M Arnaud
- Department of Environmental Health Sciences, School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA.
| | - Paul M Jasmin
- Equipes mobiles d'intervention rapide (EMIRA) du Ministère de la Santé Publique et de la Population (MSPP), Hinche HT 5111, Haiti.
| | - Steve Hamner
- Department of Environmental Health Sciences, School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA.
| | - Nur A Hasan
- CosmosID Inc., 1600 East Gude Drive, Rockville, MD 20850, USA.
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, MD 20742, USA.
| | - Rita R Colwell
- CosmosID Inc., 1600 East Gude Drive, Rockville, MD 20850, USA.
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, MD 20742, USA.
| | - Timothy E Ford
- Department of Environmental Health Sciences, School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA.
| |
Collapse
|
32
|
Chen Y, Yang Y, Liu L, Qiu G, Han X, Tian S, Zhao J, Chen F, Grundmann H, Li H, Sun J, Han L. High prevalence and clonal dissemination of OXA-72-producing Acinetobacter baumannii in a Chinese hospital: a cross sectional study. BMC Infect Dis 2018; 18:491. [PMID: 30268099 PMCID: PMC6162926 DOI: 10.1186/s12879-018-3359-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 08/23/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Carbapenem resistance in Acinetobacter baumannii in China was mainly mediated by OXA-23-like carbapenemases, while OXA-24/40-like carbapenemases were rarely identified. OXA-72 is one variant of OXA-24/40-like carbapenemases. This study aimed to demonstrate the epidemiology and characterizations of OXA-72-producing A. baumannii in a Chinese hospital. METHODS A total of 107 clinical A. calcoaceticus-A. baumannii (Acb) complex isolates were collected in a Chinese hospital during between 2014 and 2016. These isolates were identified using Vitek 2 system and gyrB multiplex PCR. Vitek 2 system was used for antibiotic susceptibility testing. Genes encoding for major classes of carbapenemases were investigated by PCR. Rep-PCR was used for genotyping of all the A. baumannii isolates. The risk factors for carriage of OXA-72-producing or OXA-23-producing A. baumannii were analyzed through univariate and multivariate logistic regression. RESULTS Of the 107 Acb isolates collected, 101 isolates (94.4%) and 6 isolates (5.6%) were identified as A. baumannii and A. pittii, respectively. 78 A. baumannii isolates (77.2%) were carbapenem resistant and mainly cultured from intensive care unit (ICU). blaOXA-72 and blaOXA-23 genes were identified in 45(57.7%) and 33(42.3%) carbapenem-resistant A. baumannii (CRAB), respectively. Multivariate risk factor analyses showed that prior carbapenem usage and nasogastric intubation were significantly associated with carriage of OXA-72-producing A. baumannii or OXA-23-producing A. baumannii. Rep-PCR analysis showed that 9 and 22 Rep-PCR types were assigned to 78 CRAB isolates and 23 carbapenem-susceptible A. baumannii (CSAB) isolates, respectively. A higher diverstiy of Rep-PCR patterns was observed among OXA-72-producing A. baumannii isolates than OXA-23-producing A. baumannii isolates, but all of them belonged to the same clone complex. MLST analysis suggested that the OXA-72 isolates from this study correspond to CC92/CC2 clone complex. CONCLUSIONS This study demonstrates high prevalence and potential clonal spread of closely related genotypes of OXA-72-producing A. baumannii within a Chinese hospital. Continuous surveillance is necessary to monitor the dissemination of these strains in other healthcare settings to guide infection control policies in order to curb the spread of this bacterium.
Collapse
Affiliation(s)
- Yong Chen
- Department of Hospital Infection Control, Chinese PLA Institute for Disease Control and Prevention, 20# Dongda Str, Beijing, 100071 China
| | - Yuying Yang
- School of Public Health, Shenyang Medical College, Shenyang, China
- The 202nd Hospital of PLA, Shenyang, 110003 China
| | - Lin Liu
- Department of Hospital Infection Control, Chinese PLA Institute for Disease Control and Prevention, 20# Dongda Str, Beijing, 100071 China
- Laboratory of Tropical Biomedicine Technology, School of Tropical Medicine and Laboratory Medicine, Hainan Medical University, Haikou, China
| | - Guangbin Qiu
- Department of Clinical Microbiology, The 202nd Hospital of PLA, Shenyang, China
| | - Xuelin Han
- Department of Hospital Infection Control, Chinese PLA Institute for Disease Control and Prevention, 20# Dongda Str, Beijing, 100071 China
| | - Shuguang Tian
- Department of Hospital Infection Control, Chinese PLA Institute for Disease Control and Prevention, 20# Dongda Str, Beijing, 100071 China
| | - Jingya Zhao
- Department of Hospital Infection Control, Chinese PLA Institute for Disease Control and Prevention, 20# Dongda Str, Beijing, 100071 China
| | - Fangyan Chen
- Department of Hospital Infection Control, Chinese PLA Institute for Disease Control and Prevention, 20# Dongda Str, Beijing, 100071 China
| | - Hajo Grundmann
- Department of Infection Prevention and Hospital Hygiene, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Medical Microbiology, University Medical Center Groningen, Rijksuniversteit Groningen, Groningen, The Netherlands
| | - Haifeng Li
- Department of Hospital Infection Control, The 202nd Hospital of PLA, Shenyang, 110003 China
| | - Jinke Sun
- School of Public Health, Shenyang Medical College, Shenyang, China
- The 202nd Hospital of PLA, Shenyang, 110003 China
- Chinese PLA 202 Hospital, Shenyang, 110003 China
| | - Li Han
- Department of Hospital Infection Control, Chinese PLA Institute for Disease Control and Prevention, 20# Dongda Str, Beijing, 100071 China
| |
Collapse
|
33
|
Lim TP, Wang R, Poh GQ, Koh TH, Tan TY, Lee W, Teo JQM, Cai Y, Tan TT, Ee PLR, Kwa AL. Integrated pharmacokinetic-pharmacodynamic modeling to evaluate empiric carbapenem therapy in bloodstream infections. Infect Drug Resist 2018; 11:1591-1596. [PMID: 30310294 PMCID: PMC6166767 DOI: 10.2147/idr.s168191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Treatment for nosocomial bloodstream infections (BSI) caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB) is challenging. Rising antimicrobial resistance, especially in extended spectrum beta-lactamase production, inadvertently increases empiric carbapenem consumption. Three antipseudomonal carbapenems (imipenem, meropenem [MER], and doripenem [DOR]) are available commercially against MDR GNB in Singapore. The study aims to determine the most optimal empiric carbapenem dosing regimens (CDR) and evaluate their cost-effectiveness for GNB-BSI in the face of increasing MDR GNB. Methods Carbapenem minimum inhibitory concentrations (MICs) were generated for non-repeat GNB-BSI obtained in 2013–2014 from two hospitals. Monte Carlo simulations were used to assess the cumulative fraction of response (CFR) of various CDRs using the percentage of time above MIC for 40% (%T > MIC of 40%) as the pharmacokinetic (PK)–pharmacodynamic (PD) parameter for efficacy. Carbapenem costs were based on patient antibiotic costs. Antibiotic cost-effectiveness was calculated as total daily drug cost/CFR. Results A total of 1,140 bloodstream isolates were collected. They comprised 116 Acinetobacter baumannii, 237 Pseudomonas aeruginosa, and 787 Enterobacteriaceae. All CDRs achieved ~40, ~80, and ≥90% CFRs against A. baumannii, P. aeruginosa, and Enterobacteriaceae, respectively. Against P. aeruginosa, MER 2 g every 8 h infused over 3 h and DOR 1 g every 8 h infused over 4 h achieved CFRs 84 and 81%, respectively. Against Enterobacteriaceae, the cost of MER 2 g every 8 h infused over 3 h was the lowest among the three carbapenems at $0.40/percentage of CFR. Conclusion This study demonstrates the utility of PK–PD modeling to formulate the optimal selection of a cost-effective empiric CDR in antibiotics guidelines and formulary inclusion. The findings support the selection of high MER doses of prolonged infusions as empiric coverage for GNB-BSI in our institutions.
Collapse
Affiliation(s)
- Tze-Peng Lim
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore, .,SingHealth Duke-NUS Medicine Academic Clinical Programme, Singapore, Singapore
| | - Reyna Wang
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore,
| | - Gang Quan Poh
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore,
| | - Tse-Hsien Koh
- Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - Thean-Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore, Singapore
| | - Winnie Lee
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore,
| | - Jocelyn Qi-Min Teo
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore,
| | - Yiying Cai
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore,
| | - Thuan-Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Pui Lai Rachel Ee
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore,
| | - Andrea L Kwa
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore, .,Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore, .,Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore,
| |
Collapse
|
34
|
Kuntaman K, Shigemura K, Osawa K, Kitagawa K, Sato K, Yamada N, Nishimoto K, Yamamichi F, Rahardjo D, Hadi U, Mertaniasih NM, Kinoshita S, Fujisawa M, Shirakawa T. Occurrence and characterization of carbapenem-resistant Gram-negative bacilli: A collaborative study of antibiotic-resistant bacteria between Indonesia and Japan. Int J Urol 2018; 25:966-972. [PMID: 30253445 DOI: 10.1111/iju.13787] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 07/26/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To explore the occurrence and characterization of carbapenemase-producing pathogens among carbapenem-resistant Gram-negative bacilli isolated from hospitalized patients with urinary tract infection in Indonesia. METHODS This was a study promoted by the Japanese-Indonesian collaborative research program in the Japan Initiative for Global Research Network on Infectious Diseases. Bacterial pathogens were prospectively isolated from urine specimens of hospitalized urinary tract infection patients at Dr. Soetomo Hospital (Surabaya, Indonesia). All Gram-negative bacteria resistant to third-generation cephalosporin or carbapenem were included in this study. Carbapenemase genes were investigated for phenotype and genotype. RESULTS In total, 1082 Gram-negative bacilli were isolated, of which 116 strains were resistant to imipenem or meropenem (carbapenem-resistant Gram-negative bacilli), and 22 strains were carbapenemase-producing Gram-negative bacilli. Carbapenemase-producing Gram-negative bacilli consisted of Acinetobacter baumannii (n = 4), Pseudomonas aeruginosa (n = 4), Klebsiella pneumoniae (n = 5), Providencia rettgeri (n = 4) and five others. The carbapenemase-producing Gram-negative bacilli included NDM-1 (n = 18, 81.8%, in Enterobacteriaceae and Acinetobacter spp.) and IMP-7 (n = 4, 18.2%, all in P. aeruginosa). Among carbapenem-resistant Gram-negative bacilli, all four P. aeruginosa were sensitive to colistin, and all six Acinetobacter spp. were sensitive to minocycline, colistin and tigecycline. Of those patients harboring carbapenemase-producing Gram-negative bacilli, 12 (54.5%) were seriously ill at the time of admission, with longer hospital stays and three deaths (13.6% mortality rate). CONCLUSIONS Urinary tract infection-causing carbapenem-resistant Gram-negative bacilli are widely disseminated in Indonesia. The NDM-1 phenotype seems to be dominant, and it can be treated with colistin and tigecycline in most cases. Most patients harboring carbapenemase-producing Gram-negative bacilli are seriously ill, have a bad prognosis, with a longer hospital stay and a significant mortality rate.
Collapse
Affiliation(s)
- Kuntaman Kuntaman
- Department of Microbiology, Faculty of Medicine, Airlangga University and Dr. Soetomo Hospital, Surabaya, Indonesia.,Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | - Katsumi Shigemura
- Division of Infectious Diseases, Department of International Health, Kobe University Graduate School of Health Sciences, Kobe, Japan.,Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kayo Osawa
- Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Koichi Kitagawa
- Division of Translational Research for Biologics, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koharu Sato
- Division of Infectious Diseases, Department of International Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Naoki Yamada
- Division of Infectious Diseases, Department of International Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Kento Nishimoto
- Division of Infectious Diseases, Department of International Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Fukashi Yamamichi
- Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Dadik Rahardjo
- Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | - Usman Hadi
- Department of Microbiology, Faculty of Medicine, Airlangga University and Dr. Soetomo Hospital, Surabaya, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Airlangga University and Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Ni Made Mertaniasih
- Department of Microbiology, Faculty of Medicine, Airlangga University and Dr. Soetomo Hospital, Surabaya, Indonesia.,Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | - Shohiro Kinoshita
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshiro Shirakawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.,Division of Translational Research for Biologics, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan.,Division of Advanced Medical Science, Kobe University Graduate School of Science, Technology and Innovation, Kobe, Japan
| |
Collapse
|
35
|
Khalili H, Shojaei L, Mohammadi M, Beigmohammadi MT, Abdollahi A, Doomanlou M. Meropenem/colistin versus meropenem/ampicillin-sulbactam in the treatment of carbapenem-resistant pneumonia. J Comp Eff Res 2018; 7:901-911. [PMID: 30192166 DOI: 10.2217/cer-2018-0037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIM Efficacy of colistin and ampicillin-sulbactam have not been compared in treatment of ventilator-associated pneumonia due to A. baumannii. Efficacy of colistin and ampicillin-sulbactam in combination with meropenem were compared in treatment of ventilator-associated pneumonia due to carbapenem-resistant A. baumannii. METHOD 47 patients with ventilator-associated pneumonia due to carbapenem-resistant A. baumannii were randomized to receive meropenem/colistin or meropenem/ampicillin-sulbactam for 14 days. Clinical and microbiological responses and 28-day mortality were considered as outcomes. RESULTS Clinical response (75 vs 69.6%; p = 0.75) and microbial eradication (87.50 vs 91.3%; p = 0.59) were comparable between meropenem/colistin and meropenem/ampicillin-sulbactam groups, respectively. CONCLUSION In this study, clinical and microbiological response were comparable between the meropenem/colistin and meropenem/ampicillin-sulbactam groups.
Collapse
Affiliation(s)
- Hossein Khalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Lida Shojaei
- Department of Clinical Pharmacy, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mostafa Mohammadi
- Department of Intensive Care Unit, Imam Khomeini Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Taghi Beigmohammadi
- Department of Intensive Care Unit, Imam Khomeini Hospital, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Abdollahi
- Department of Pathology, Faculty of Medicine, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Iran
| | - Mahsa Doomanlou
- Central Laboratory, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
36
|
In situ detection of live-to-dead bacteria ratio after inactivation by means of synchronous fluorescence and PCA. Proc Natl Acad Sci U S A 2018; 115:668-673. [PMID: 29311322 DOI: 10.1073/pnas.1716514115] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The determination of live and dead bacteria is of considerable significance for preventing health care-associated infection in hospitals, field clinics, and other areas. In this study, the viable (live) and nonviable (dead) bacteria in a sample were determined by means of their fluorescence spectra and principal component analysis (PCA). Data obtained in this study show that it is possible to identify bacteria strains and determine the live/dead ratio after UV light inactivation and antibiotic treatment, in situ, within minutes. In addition, synchronous fluorescence scans enable the identification of bacterial components such as tryptophan, tyrosine, and DNA. Compared with the time-consuming plating and culturing methods, this study renders a means for rapid detection and determination of live and dead bacteria.
Collapse
|
37
|
Raible KM, Sen B, Law N, Bias TE, Emery CL, Ehrlich GD, Joshi SG. Molecular characterization of β-lactamase genes in clinical isolates of carbapenem-resistant Acinetobacter baumannii. Ann Clin Microbiol Antimicrob 2017; 16:75. [PMID: 29145853 PMCID: PMC5691885 DOI: 10.1186/s12941-017-0248-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 11/08/2017] [Indexed: 01/26/2023] Open
Abstract
Background Acinetobacter baumannii is a nosocomial pathogen which is establishing as a major cause of morbidity and mortality within the healthcare community. The success of this pathogen is largely due to its ability to rapidly gain resistance to antimicrobial therapies and its capability to persist in an abiotic environment through the production of a biofilm. Our tertiary-care hospital has showed high incidence of carbapenem-resistant Acinetobacter baumannii (CRAB) isolates. Methods In this study we explore both genotypic and phenotypic properties of 26 CRAB isolates: 16 isolates were collected from January 2010 to March 2011, and 10 were collected between February and May 2015. Results We determined that all 26 CRAB isolates possessed multiple β-lactamase genes, including genes from Groups A, C, and D. Specifically, 42% of the isolates possesses the potentially plasmid-borne genes of OXA-23-like or OXA-40-like β-lactamase. The presence of mobile gene element integron cassettes and/or integrases in 88% of the isolates suggests a possible mechanism of dissemination of antibiotic resistance genes. Additionally, the location of insertion sequence (IS) ISAba1 in promotor region of of the OXA-51-like, ADC-7, and ampC genes was confirmed. Multilocus sequence typing (MLST) demonstrated that all 26 CRAB isolates were either sequence type (ST)-229 or ST-2. Interestingly, ST-2 went from being the minority CRAB strain in the 2010–2011 isolates to the predominant strain in the 2015 isolates (from 32 to 90%). We show that the ST-2 strains have an enhanced ability to produce biofilms in comparison to the ST-229 strains, and this fact has potentially led to more successful colonization of the clinical environment over time. Conclusions This study provides a longitudinal genetic and phenotypic survey of two CRAB sequence types, and suggests how their differing phenotypes may interact with the selective pressures of a hospital setting effecting strain dominance over a 5-year period. Electronic supplementary material The online version of this article (10.1186/s12941-017-0248-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kevin M Raible
- Center for Surgical Infections & Biofilms, Institute of Molecular Medicine and Infectious diseases, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA.,Center for Genomic Sciences, Institute of Molecular Medicine and Infectious diseases, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA
| | - Bhaswati Sen
- Center for Surgical Infections & Biofilms, Institute of Molecular Medicine and Infectious diseases, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA.,Center for Genomic Sciences, Institute of Molecular Medicine and Infectious diseases, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA
| | - Nancy Law
- Center for Surgical Infections & Biofilms, Institute of Molecular Medicine and Infectious diseases, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA
| | - Tiffany E Bias
- Center for Surgical Infections & Biofilms, Institute of Molecular Medicine and Infectious diseases, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA
| | - Christopher L Emery
- Center for Surgical Infections & Biofilms, Institute of Molecular Medicine and Infectious diseases, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA.,Department of Pathology and Lab Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Garth D Ehrlich
- Center for Surgical Infections & Biofilms, Institute of Molecular Medicine and Infectious diseases, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA.,Center for Genomic Sciences, Institute of Molecular Medicine and Infectious diseases, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA.,Center for Advanced Microbial Processing, Institute of Molecular Medicine and Infectious Diseases, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA.,Department of Microbiology and Immunology, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA.,Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA
| | - Suresh G Joshi
- Center for Surgical Infections & Biofilms, Institute of Molecular Medicine and Infectious diseases, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA. .,Center for Genomic Sciences, Institute of Molecular Medicine and Infectious diseases, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA. .,Department of Microbiology and Immunology, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA, 19102, USA.
| |
Collapse
|
38
|
Failure to Communicate: Transmission of Extensively Drug-Resistant bla OXA-237-Containing Acinetobacter baumannii-Multiple Facilities in Oregon, 2012-2014. Infect Control Hosp Epidemiol 2017; 38:1335-1341. [PMID: 28870269 DOI: 10.1017/ice.2017.189] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the scope, source, and mode of transmission of a multifacility outbreak of extensively drug-resistant (XDR) Acinetobacter baumannii. DESIGN Outbreak investigation. SETTING AND PARTICIPANTS Residents and patients in skilled nursing facilities, long-term acute-care hospital, and acute-care hospitals. METHODS A case was defined as the incident isolate from clinical or surveillance cultures of XDR Acinetobacter baumannii resistant to imipenem or meropenem and nonsusceptible to all but 1 or 2 antibiotic classes in a patient in an Oregon healthcare facility during January 2012-December 2014. We queried clinical laboratories, reviewed medical records, oversaw patient and environmental surveillance surveys at 2 facilities, and recommended interventions. Pulsed-field gel electrophoresis (PFGE) and molecular analysis were performed. RESULTS We identified 21 cases, highly related by PFGE or healthcare facility exposure. Overall, 17 patients (81%) were admitted to either long-term acute-care hospital A (n=8), or skilled nursing facility A (n=8), or both (n=1) prior to XDR A. baumannii isolation. Interfacility communication of patient or resident XDR status was not performed during transfer between facilities. The rare plasmid-encoded carbapenemase gene bla OXA-237 was present in 16 outbreak isolates. Contact precautions, chlorhexidine baths, enhanced environmental cleaning, and interfacility communication were implemented for cases to halt transmission. CONCLUSIONS Interfacility transmission of XDR A. baumannii carrying the rare blaOXA-237 was facilitated by transfer of affected patients without communication to receiving facilities. Infect Control Hosp Epidemiol 2017;38:1335-1341.
Collapse
|
39
|
Ladavac R, Bedenić B, Vranić-Ladavac M, Barišić N, Karčić N, Pompe K, Ferenčić A, Stojanović A, Seifert H, Katić S, Higgins PG. Emergence of different Acinetobacter baumannii clones in a Croatian hospital and correlation with antibiotic susceptibility. J Glob Antimicrob Resist 2017; 10:213-218. [PMID: 28735048 DOI: 10.1016/j.jgar.2017.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/07/2017] [Accepted: 07/09/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES During routine diagnostic laboratory work, the clinical microbiologist observed an increase of Acinetobacter baumannii isolates with three different carbapenem susceptibility patterns: susceptible, intermediate and resistant. Isolates belonging to the same carbapenem susceptibility phenotype exhibited identical susceptibility/resistance patterns to non-β-lactam antibiotics. This prompted us to analyse the mechanisms of carbapenem-resistance and the molecular epidemiology of the isolates. A total of 59 A. baumannii isolates were analysed and grouped according to their susceptibility to imipenem: group 1 were susceptible (N=24), group 2 were intermediate (N=8) and group 3 were resistant (N=27) to imipenem. MATERIAL AND METHODS PCR and sequencing was used to detect resistance genes. Genotyping of the isolates was performed by PFGE and MLST. RESULTS Out of 27 resistant isolates, 20 harboured blaOXA-40-like and 7 blaOXA-23-like genes. ISAba1 was found upstream of blaOXA-51 and blaOXA-23 genes. PFGE genotyping demonstrated the existence of three major A. baumannii clones in GH Pula and determination of sequence groups showed that the isolates belonged to international clones commonly associated with multidrug-resistance. MLST (performed on six isolates) showed diverse population structure of isolates belonging to the same cluster, including ST 195, ST 231, ST 775 and ST 1095. CONCLUSIONS A previous study conducted in 2009-2010 showed that reduced susceptibility to carbapenems in GH Pula was only associated with upregulation of the intrinsic OXA-51 β-lactamase. In this study a shift to isolates with acquired oxacillinases, belonging to two major clones was reported.
Collapse
Affiliation(s)
- Ranko Ladavac
- Department for Nephrology, General Hospital Pula, Pula, Croatia
| | - Branka Bedenić
- Department for Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; Clinical Department for Clinical and Molecular Microbiology, University Hospital Center Zagreb, Zagreb, Croatia.
| | - Mirna Vranić-Ladavac
- Department for Microbiology, Public Health Institute of Istria County, Pula, Croatia
| | - Nada Barišić
- Department for Microbiology, Public Health Institute of Istria County, Pula, Croatia
| | - Natalie Karčić
- Department for Microbiology, Public Health Institute of Istria County, Pula, Croatia
| | - Karoline Pompe
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstrasse 19-21, Cologne, Germany
| | - Antun Ferenčić
- School of Medicin, University of Rijeka, Rijeka, Croatia
| | - Aleksandar Stojanović
- Department for Microbiology, Public Health Institute of Istria County, Pula, Croatia
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstrasse 19-21, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Stjepan Katić
- Clinical Department for Clinical and Molecular Microbiology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Paul G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstrasse 19-21, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| |
Collapse
|
40
|
Alfouzan WA, Noel AR, Bowker KE, Attwood MLG, Tomaselli SG, MacGowan AP. Pharmacodynamics of minocycline against Acinetobacter baumannii studied in a pharmacokinetic model of infection. Int J Antimicrob Agents 2017; 50:715-717. [PMID: 28705678 DOI: 10.1016/j.ijantimicag.2017.06.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/16/2017] [Accepted: 06/24/2017] [Indexed: 11/30/2022]
Abstract
Minocycline (MNO) is an old antibiotic that may have an important role in the treatment of multidrug-resistant Gram-negative bacterial infections as the burden of such infections increases. In this study, a single-compartment dilutional pharmacokinetic model was used to determine the relationship between MNO exposure and antibacterial effect, including the risk of resistance emergence, against strains of Acinetobacter baumannii. The mean ± standard deviation area under the unbound drug concentration-time curve to minimum inhibitory concentration ratio (fAUC/MIC) associated with a 24-h bacteriostatic effect was 16.4 ± 2.6 and with a -1 log reduction in bacterial load at 24 h was 23.3 ± 3.7. None of the strains reached a -2 log reduction over 48 h. Changes in population profiles were noted for two of the three strains studied, especially at fAUC/MIC ratios of >5-15. A reasonable translational pharmacodynamic target for MNO against A. baumannii could be an fAUC/MIC of 20-25. However, if maximum standard 24-h doses of intravenous MNO are used (400 mg/day), many strains would be exposed to MNO concentrations likely to change population profiles and associated with the emergence of resistance. Either MNO combination therapy or an increased MNO dose (>400 mg/day) should be considered when treating A. baumannii infections.
Collapse
Affiliation(s)
- Wadha A Alfouzan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait; Microbiology Unit, Department of Laboratories, Farwaniya Hospital, Farwaniya, Kuwait
| | - A R Noel
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), Department of Infection Sciences, Pathology Sciences, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - Karen E Bowker
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), Department of Infection Sciences, Pathology Sciences, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - M L G Attwood
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), Department of Infection Sciences, Pathology Sciences, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - S G Tomaselli
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), Department of Infection Sciences, Pathology Sciences, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - Alasdair P MacGowan
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), Department of Infection Sciences, Pathology Sciences, North Bristol NHS Trust, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK.
| |
Collapse
|
41
|
Lee CR, Lee JH, Park M, Park KS, Bae IK, Kim YB, Cha CJ, Jeong BC, Lee SH. Biology of Acinetobacter baumannii: Pathogenesis, Antibiotic Resistance Mechanisms, and Prospective Treatment Options. Front Cell Infect Microbiol 2017; 7:55. [PMID: 28348979 PMCID: PMC5346588 DOI: 10.3389/fcimb.2017.00055] [Citation(s) in RCA: 504] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/13/2017] [Indexed: 12/27/2022] Open
Abstract
Acinetobacter baumannii is undoubtedly one of the most successful pathogens responsible for hospital-acquired nosocomial infections in the modern healthcare system. Due to the prevalence of infections and outbreaks caused by multi-drug resistant A. baumannii, few antibiotics are effective for treating infections caused by this pathogen. To overcome this problem, knowledge of the pathogenesis and antibiotic resistance mechanisms of A. baumannii is important. In this review, we summarize current studies on the virulence factors that contribute to A. baumannii pathogenesis, including porins, capsular polysaccharides, lipopolysaccharides, phospholipases, outer membrane vesicles, metal acquisition systems, and protein secretion systems. Mechanisms of antibiotic resistance of this organism, including acquirement of β-lactamases, up-regulation of multidrug efflux pumps, modification of aminoglycosides, permeability defects, and alteration of target sites, are also discussed. Lastly, novel prospective treatment options for infections caused by multi-drug resistant A. baumannii are summarized.
Collapse
Affiliation(s)
- Chang-Ro Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Jung Hun Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Moonhee Park
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji UniversityYongin, South Korea; DNA Analysis Division, Seoul Institute, National Forensic ServiceSeoul, South Korea
| | - Kwang Seung Park
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Il Kwon Bae
- Department of Dental Hygiene, College of Health and Welfare, Silla University Busan, South Korea
| | - Young Bae Kim
- Biotechnology Program, North Shore Community College Danvers, MA, USA
| | - Chang-Jun Cha
- Department of Systems Biotechnology, College of Biotechnology and Natural Resources, Chung-Ang University Anseong, South Korea
| | - Byeong Chul Jeong
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Sang Hee Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| |
Collapse
|
42
|
Mayanskiy N, Chebotar I, Alyabieva N, Kryzhanovskaya O, Savinova T, Turenok A, Bocharova Y, Lazareva A, Polikarpova S, Karaseva O. Emergence of the Uncommon Clone ST944/ST78 Carrying bla OXA-40-like and bla CTX-M-like Genes Among Carbapenem-Nonsusceptible Acinetobacter baumannii in Moscow, Russia. Microb Drug Resist 2017; 23:864-870. [PMID: 28437227 DOI: 10.1089/mdr.2016.0302] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Carbapenem-nonsusceptible (Carba-NS) Acinetobacter baumannii has emerged as an important cause of nosocomial infections. In the present study, we characterized 91 Carba-NS A. baumannii isolates collected from patients of surgical departments and intensive care units at three hospitals in Moscow in 2012-2015. Multilocus sequence typing (MLST) using the Oxford (Oxf) scheme identified 16 sequence types (STs) of three clonal complexes (CCs), including CC92Oxf (67%), CC109Oxf (1%), CC944Oxf (29%), and the singleton ST1100Oxf (3%). CC944Oxf was composed of ST944Oxf (n = 16) and two of its newly described single locus variants ST1103Oxf (n = 3) and ST1104Oxf (n = 7); all the three STs were identical to the Pasteur (Pas) MLST scheme ST78. All CC944Oxf/ST78Pas isolates were blaOXA-40-like positive and all but one isolate harbored a blaCTX-M-like gene. ST944Oxf was the only ST found in each of the three study hospitals. Biofilm growth capacity was similar among Carba-NS and nonclonal carbapenem-susceptible isolates. Our data demonstrate the predominance of two clonal lineages among Carba-NS A. baumannii. One of these, the uncommon blaOXA-40-like/blaCTX-M-like-positive clone of CC944Oxf/ST78Pas, seems to be endemic in Russia.
Collapse
Affiliation(s)
- Nikolay Mayanskiy
- 1 Scientific Center of Children's Health , Moscow, Russia .,2 I.M. Sechenov First Moscow State Medical University , Moscow, Russia
| | - Igor Chebotar
- 1 Scientific Center of Children's Health , Moscow, Russia
| | | | | | | | - Andrej Turenok
- 2 I.M. Sechenov First Moscow State Medical University , Moscow, Russia
| | | | - Anna Lazareva
- 1 Scientific Center of Children's Health , Moscow, Russia
| | | | - Olga Karaseva
- 4 Scientific Research Institute for Children's Surgery and Traumatology , Moscow, Russia
| |
Collapse
|
43
|
Lee S, Razqan GSA, Kwon DH. Antibacterial activity of epigallocatechin-3-gallate (EGCG) and its synergism with β-lactam antibiotics sensitizing carbapenem-associated multidrug resistant clinical isolates of Acinetobacter baumannii. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2017; 24:49-55. [PMID: 28160861 DOI: 10.1016/j.phymed.2016.11.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/02/2016] [Accepted: 11/10/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Infections caused by Acinetobacter baumannii were responsive to conventional antibiotic therapy. However, recently, carbapenem-associated multidrug resistant isolates have been reported worldwide and present a major therapeutic challenge. Epigallocatechin-3-Gallate (EGCG) extracted from green tea exhibits antibacterial activity. PURPOSE We evaluated the antibacterial activity of EGCG and possible synergism with antibiotics in carbapenem-associated multidrug resistant A. baumannii. A potential mechanism for synergism was also explored. MATERIALS AND METHODS Seventy clinical isolates of A. baumannii collected from geographically different areas were analyzed by minimal inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of EGCG. Checkerboard and time-killing assays were performed to exam the synergism between EGCG and antibiotics. The effects of EGCG on a multidrug efflux pump inhibitor (1-[1-naphthylmethyl] piperazine; NMP) and β-lactamase production were also examined in A. baumannii. RESULTS Sixty-three of 70 clinical isolates of A. baumannii carried carbapenemase-encoding genes with carbapenem-associated multidrug resistance. Levels of MIC and MBC of EGCG ranged from 64 to 512µg/ml and from 128 to ≥1024µg/ml, respectively among the clinical isolates. MIC90 and MBC86 levels were 256µg/ml and 512µg/ml of EGCG, respectively. Subinhibitory concentration of EGCG in combination with all antibiotics tested, including carbapenem, sensitized (MICs fall≤1.0µg/ml) all carbapenem-associated multidrug resistant isolates. Checkerboard and time-killing assays showed synergism between EGCG and meropenem (or carbenicillin) counted as fractional inhibitory concentration of < 0.5 and cell numbers' decrease per ml of >2log10 within 12h, respectively. EGCG significantly increased the effect of NMP but was unrelated to β-lactamase production in A. baumannii, suggesting EGCG may be associated with inhibition of efflux pumps. CONCLUSION Overall we suggest that EGCG-antibiotic combinations might provide an alternative approach to treat infections with A. baumannii regardless of antibiotic resistance.
Collapse
Affiliation(s)
- Spencer Lee
- Jericho Senior High School, Jericho, New York 11753, United States
| | | | - Dong H Kwon
- Department of Biology, Long Island University, Brooklyn, New York, 11201, United States ; Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, 77030, United States.
| |
Collapse
|
44
|
Insights on the Horizontal Gene Transfer of Carbapenemase Determinants in the Opportunistic Pathogen Acinetobacter baumannii. Microorganisms 2016; 4:microorganisms4030029. [PMID: 27681923 PMCID: PMC5039589 DOI: 10.3390/microorganisms4030029] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/21/2016] [Accepted: 08/09/2016] [Indexed: 12/23/2022] Open
Abstract
Horizontal gene transfer (HGT) is a driving force to the evolution of bacteria. The fast emergence of antimicrobial resistance reflects the ability of genetic adaptation of pathogens. Acinetobacter baumannii has emerged in the last few decades as an important opportunistic nosocomial pathogen, in part due to its high capacity of acquiring resistance to diverse antibiotic families, including to the so-called last line drugs such as carbapenems. The rampant selective pressure and genetic exchange of resistance genes hinder the effective treatment of resistant infections. A. baumannii uses all the resistance mechanisms to survive against carbapenems but production of carbapenemases are the major mechanism, which may act in synergy with others. A. baumannii appears to use all the mechanisms of gene dissemination. Beyond conjugation, the mostly reported recent studies point to natural transformation, transduction and outer membrane vesicles-mediated transfer as mechanisms that may play a role in carbapenemase determinants spread. Understanding the genetic mobilization of carbapenemase genes is paramount in preventing their dissemination. Here we review the carbapenemases found in A. baumannii and present an overview of the current knowledge of contributions of the various HGT mechanisms to the molecular epidemiology of carbapenem resistance in this relevant opportunistic pathogen.
Collapse
|
45
|
Abstract
The OXA β-lactamases were among the earliest β-lactamases detected; however, these molecular class D β-lactamases were originally relatively rare and always plasmid mediated. They had a substrate profile limited to the penicillins, but some became able to confer resistance to cephalosporins. From the 1980s onwards, isolates of Acinetobacter baumannii that were resistant to the carbapenems emerged, manifested by plasmid-encoded β-lactamases (OXA-23, OXA-40, and OXA-58) categorized as OXA enzymes because of their sequence similarity to earlier OXA β-lactamases. It was soon found that every A. baumannii strain possessed a chromosomally encoded OXA β-lactamase (OXA-51-like), some of which could confer resistance to carbapenems when the genetic environment around the gene promoted its expression. Similarly, Acinetobacter species closely related to A. baumannii also possessed their own chromosomally encoded OXA β-lactamases; some could be transferred to A. baumannii, and they formed the basis of transferable carbapenem resistance in this species. In some cases, the carbapenem-resistant OXA β-lactamases (OXA-48) have migrated into the Enterobacteriaceae and are becoming a significant cause of carbapenem resistance. The emergence of OXA enzymes that can confer resistance to carbapenems, particularly in A. baumannii, has transformed these β-lactamases from a minor hindrance into a major problem set to demote the clinical efficacy of the carbapenems.
Collapse
|
46
|
Nuñez Quezada T, Rodríguez CH, Castro Cañarte G, Nastro M, Balderrama Yarhui N, Dabos L, Acosta Mosquera Y, Plaza Moreira N, Famiglietti A. Outbreak of bla OXA-72-producing Acinetobacter baumannii in South America. J Chemother 2016; 29:321-324. [PMID: 27077936 DOI: 10.1080/1120009x.2016.1158936] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Thirty-five Acinetobacter baumannii isolates were recovered from two medical centres in Guayaquil City, Ecuador, from November 2012 to October 2013. Isolates were identified using MALDI-TOF and confirmed by rpoB. PCR methods were employed for epidemiological analysis.Thirty-three A. baumannii isolates were resistant to all β-lactams. The blaOXA-24/40-like gene was detected in 30 isolates. DNA sequencing identified the blaOXA-24/40-like amplicon as blaOXA-72. The 30 isolates harbouring blaOXA-72 strains showed the same PCR pattern. We report the first outbreak of blaOXA-72-producing A. baumannii in South America. This is the first study carried out in the Republic of Ecuador.
Collapse
Affiliation(s)
| | - Carlos Hernan Rodríguez
- b Laboratorio de Bacteriología, Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica , Hospital de Clínicas José de San Martín, Universidad de Buenos Aires , Buenos Aires , Argentina
| | | | - Marcela Nastro
- b Laboratorio de Bacteriología, Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica , Hospital de Clínicas José de San Martín, Universidad de Buenos Aires , Buenos Aires , Argentina
| | - Nora Balderrama Yarhui
- b Laboratorio de Bacteriología, Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica , Hospital de Clínicas José de San Martín, Universidad de Buenos Aires , Buenos Aires , Argentina
| | - Laura Dabos
- b Laboratorio de Bacteriología, Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica , Hospital de Clínicas José de San Martín, Universidad de Buenos Aires , Buenos Aires , Argentina
| | | | | | - Angela Famiglietti
- b Laboratorio de Bacteriología, Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica , Hospital de Clínicas José de San Martín, Universidad de Buenos Aires , Buenos Aires , Argentina
| |
Collapse
|
47
|
Sen B, Joshi S. Studies on Acinetobacter baumannii
involving multiple mechanisms of carbapenem resistance. J Appl Microbiol 2016; 120:619-29. [DOI: 10.1111/jam.13037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/15/2015] [Accepted: 12/17/2015] [Indexed: 01/26/2023]
Affiliation(s)
- B. Sen
- Department of Microbiology and Immunology; Center for Surgical Infections and Biofilms; Drexel University; Philadelphia 19102 PA USA
| | - S.G. Joshi
- Department of Microbiology and Immunology; Center for Surgical Infections and Biofilms; Drexel University; Philadelphia 19102 PA USA
- School of Biomedical Engineering, Science and Health Systems; Center for Surgical Infections and Biofilms; Drexel University; Philadelphia 19102 PA USA
| |
Collapse
|
48
|
Esterly JS, Richardson CL, Eltoukhy NS, Qi C, Scheetz MH. Genetic Mechanisms of Antimicrobial Resistance of Acinetobacter baumannii. Ann Pharmacother 2015; 45:218-28. [PMID: 21304033 DOI: 10.1345/aph.1p084] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To summarize published data identifying known genetic mechanisms of antibiotic resistance in Acinetobacter baumannii and the correlating phenotypic expression of antibiotic resistance. DATA SOURCES MEDLINE databases (1966-July 15, 2010) were searched to identify original reports of genetic mechanisms of antibiotic resistance in A. baumannii. DATA SYNTHESIS Numerous genetic mechanisms of resistance to multiple classes of antibiotics are known to exist in A. baumannii, a gram-negative bacterium increasingly implicated in nosocomial infections. Mechanisms may be constitutive or acquired via plasmids, integrons, and transposons. Methods of resistance include enzymatic modification of antibiotic molecules, modification of antibiotic target sites, expression of efflux pumps, and downregulation of cell membrane porin channel expression. Resistance to β-lactams appears to be primarily caused by β-lactamase production, including extended spectrum β-lactamases (b/aTEM, blaSHV, b/aTX-M,b/aKPC), metallo-β-lactamases (blaMP, blaVIM, bla, SIM), and most commonly, oxacillinases (blaOXA). Antibiotic target site alterations confer resistance to fluoroquinolones (gyrA, parC) and aminoglycosides (arm, rmt), and to a much lesser extent, β-lactams. Efflux pumps (tet, ade, abe) contribute to resistance against β-lactams, tetracyclines, fluoroquinolones, and aminoglycosides. Finally, porin channel deletion (carO, oprD) appears to contribute to β-lactam resistance and may contribute to rarely seen polymyxin resistance. Of note, efflux pumps and porin deletions as solitary mechanisms may not render clinical resistance to A. baumannii. CONCLUSIONS A. baumannii possesses copious genetic resistance mechanisms. Knowledge of local genotypes and expressed phenotypes for A. baumannii may aid clinicians more than phenotypic susceptibilities reported in large epidemiologic studies.
Collapse
Affiliation(s)
- John S Esterly
- John S Esterly PharmD BCPS, at time of writing, Infectious Diseases Pharmacotherapy Fellow, Department of Pharmacy Practice, College of Pharmacy, Midwestern University Chicago, Downers Grove, IL; now, Assistant Professor of Pharmacy Practice, College of Pharmacy, Chicago State University, Chicago, IL; Infectious Diseases Pharmacist, Northwestern Memorial Hospital, Chicago
| | - Chad L Richardson
- Chad L Richardson PharmD, at time of writing, Infectious Diseases Pharmacotherapy Resident, Department of Pharmacy Practice, College of Pharmacy, Midwestern University Chicago; now, Solid Organ Transplant Pharmacist, Northwestern Memorial Hospital
| | - Noha S Eltoukhy
- Noha S Eltoukhy PharmD BCPS, at time of writing, Infectious Diseases Pharmacy Resident, Department of Pharmacy Practice, College of Pharmacy, Midwestern University Chicago; Rush University Medical Center, Chicago; now, Infectious DIseases Clinical Pharmacy Specialist, St. Mary Medical Center, Langhorne, PA
| | - Chao Qi
- Chao Qi PhD, Assistant Professor of Pathology, Feinberg School of Medicine, Northwestern University; Assistant Director, Clinical Microbiology Laboratory, Northwestern Memorial Hospital, Chicago
| | - Marc H Scheetz
- Marc H Scheetz PharmD MSc BCPS, Assistant Professor of Pharmacy Practice, College of Pharmacy, Midwestern University Chicago; Infectious Diseases Pharmacist, Northwestern Memorial Hospital
| |
Collapse
|
49
|
Acinetobacter baumannii Genes Required for Bacterial Survival during Bloodstream Infection. mSphere 2015; 1:mSphere00013-15. [PMID: 27303682 PMCID: PMC4863628 DOI: 10.1128/msphere.00013-15] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 09/28/2015] [Indexed: 11/25/2022] Open
Abstract
A. baumannii is a significant cause of bacterial bloodstream infection in humans. Since multiple antibiotic resistance is becoming more common among strains of A. baumannii, there is an urgent need to develop novel tools to treat infections caused by this dangerous pathogen. To develop knowledge-guided treatment approaches for A. baumannii, a thorough understanding of the mechanism by which this pathogen causes bloodstream infection is required. Here, using a mouse model of infection, we report the identification of A. baumannii genes that are critical for the ability of this pathogen to cause bloodstream infections. This study lays the foundation for future research on A. baumannii genes that can be targeted to develop novel therapeutics against this emerging human pathogen. Acinetobacter baumannii is emerging as a leading global multiple-antibiotic-resistant nosocomial pathogen. The identity of genes essential for pathogenesis in a mammalian host remains largely unknown. Using transposon-directed insertion-site sequencing (TraDIS), we identified A. baumannii genes involved in bacterial survival in a leukopenic mouse model of bloodstream infection. Mice were inoculated with a pooled transposon mutant library derived from 109,000 mutants, and TraDIS was used to map transposon insertion sites in the genomes of bacteria in the inoculum and of bacteria recovered from mouse spleens. Unique transposon insertion sites were mapped and used to calculate a fitness factor for every insertion site based on its relative abundance in the inoculum and postinfection libraries. Eighty-nine transposon insertion mutants that were underrepresented after experimental infection in mice compared to their presence in the inocula were delineated as candidates for further evaluation. Genetically defined mutants lacking feoB (ferrous iron import), ddc (d-ala-d-ala-carboxypeptidase), and pntB (pyridine nucleotide transhydrogenase subunit) exhibited a fitness defect during systemic infection resulting from bacteremia. In vitro, these mutants, as well as a fepA (ferric enterobactin receptor) mutant, are defective in survival in human serum and within macrophages and are hypersensitive to killing by antimicrobial peptides compared to the survival of the parental strain under these conditions. Our data demonstrate that FepA is involved in the uptake of exogenous enterobactin in A. baumannii. Genetic complementation rescues the phenotypes of mutants in assays that emulate conditions encountered during infection. In summary, we have determined novel A. baumannii fitness genes involved in the pathogenesis of mammalian infection. IMPORTANCEA. baumannii is a significant cause of bacterial bloodstream infection in humans. Since multiple antibiotic resistance is becoming more common among strains of A. baumannii, there is an urgent need to develop novel tools to treat infections caused by this dangerous pathogen. To develop knowledge-guided treatment approaches for A. baumannii, a thorough understanding of the mechanism by which this pathogen causes bloodstream infection is required. Here, using a mouse model of infection, we report the identification of A. baumannii genes that are critical for the ability of this pathogen to cause bloodstream infections. This study lays the foundation for future research on A. baumannii genes that can be targeted to develop novel therapeutics against this emerging human pathogen.
Collapse
|
50
|
Teng SO, Yen MY, Ou TY, Chen FL, Yu FL, Lee WS. Comparison of pneumonia- and non-pneumonia-related Acinetobacter baumannii bacteremia: Impact on empiric therapy and antibiotic resistance. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 48:525-30. [DOI: 10.1016/j.jmii.2014.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 06/15/2014] [Accepted: 06/16/2014] [Indexed: 11/15/2022]
|