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Gomes MZR, de Lima EM, Martins Aires CA, Pereira PS, Yim J, Silva FH, Rodrigues CAS, Oliveira TRTE, da Silva PP, Eller CM, de Souza CMR, Rybak MJ, Albano RM, de Miranda AB, Machado E, Catanho M. Outbreak report of polymyxin-carbapenem-resistant Klebsiella pneumoniae causing untreatable infections evidenced by synergy tests and bacterial genomes. Sci Rep 2023; 13:6238. [PMID: 37069157 PMCID: PMC10110528 DOI: 10.1038/s41598-023-31901-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/20/2023] [Indexed: 04/19/2023] Open
Abstract
Polymyxin-carbapenem-resistant Klebsiella pneumoniae (PCR-Kp) with pan (PDR)- or extensively drug-resistant phenotypes has been increasingly described worldwide. Here, we report a PCR-Kp outbreak causing untreatable infections descriptively correlated with bacterial genomes. Hospital-wide surveillance of PCR-Kp was initiated in December-2014, after the first detection of a K. pneumoniae phenotype initially classified as PDR, recovered from close spatiotemporal cases of a sentinel hospital in Rio de Janeiro. Whole-genome sequencing of clinical PCR-Kp was performed to investigate similarities and dissimilarities in phylogeny, resistance and virulence genes, plasmid structures and genetic polymorphisms. A target phenotypic profile was detected in 10% (12/117) of the tested K. pneumoniae complex bacteria recovered from patients (8.5%, 8/94) who had epidemiological links and were involved in intractable infections and death, with combined therapeutic drugs failing to meet synergy. Two resistant bacterial clades belong to the same transmission cluster (ST437) or might have different sources (ST11). The severity of infection was likely related to patients' comorbidities, lack of antimicrobial therapy and predicted bacterial genes related to high resistance, survival, and proliferation. This report contributes to the actual knowledge about the natural history of PCR-Kp infection, while reporting from a time when there were no licensed drugs in the world to treat some of these infections. More studies comparing clinical findings with bacterial genetic markers during clonal spread are needed.
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Affiliation(s)
- Marisa Zenaide Ribeiro Gomes
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
- Hospital Federal Servidores do Estado, Ministry of Health, Rio de Janeiro, Brazil.
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
- Hospital Infection Control Committee, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | - Caio Augusto Martins Aires
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
- Departamento de Ciência da Saúde, Universidade Federal Rural do Semi-Árido (UFERSA), Mossoró, Rio Grande do Norte, Brazil
| | - Polyana Silva Pereira
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Juwon Yim
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Fernando Henrique Silva
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | - Priscila Pinho da Silva
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Cristiane Monteiro Eller
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Claudio Marcos Rocha de Souza
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Rodolpho Mattos Albano
- Departamento de Bioquímica, IBRAG, Universidade do Estado do Rio de Janeiro,, Rio de Janeiro, Brazil
| | - Antonio Basílio de Miranda
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Edson Machado
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Laboratório de Biologia Molecular Aplicada a Micobactérias, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marcos Catanho
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
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Costa-Júnior SD, Ferreira YLA, Agreles MAA, Alves ÁEF, Melo de Oliveira MB, Cavalcanti IMF. Gram-negative bacilli carrying mcr gene in Brazil: a pathogen on the rise. Braz J Microbiol 2023:10.1007/s42770-023-00948-w. [PMID: 36943639 PMCID: PMC10028778 DOI: 10.1007/s42770-023-00948-w] [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: 09/02/2022] [Accepted: 03/04/2023] [Indexed: 03/23/2023] Open
Abstract
The incidence of infections caused by resistant Gram-negative pathogens has become a critical factor in public health due to the limitation of therapeutic options for the control of infections caused, especially, by Enterobacteriaceae (Escherichia coli and Klebsiella pneumoniae), Pseudomonas spp., and Acinetobacter spp. Thus, given the increase in resistant pathogens and the reduction of therapeutic options, polymyxins were reintroduced into the clinic. As the last treatment option, polymyxins were regarded as the therapeutic key, since they were one of the few classes of antimicrobials that had activity against multidrug-resistant Gram-negative bacilli. Nonetheless, over the years, the frequent use of this antimicrobial has led to reports of resistance cases. In 2015, mcr (mobile colistin resistance), a colistin resistance gene, was described in China. Due to its location on carrier plasmids, this gene is characterized by rapid spread through conjugation. It has thus been classified as a rising threat to public health worldwide. In conclusion, based on several reports that show the emergence of mcr in different regional and climatic contexts and species of isolates, this work aims to review the literature on the incidence of the mcr gene in Brazil in different regions, types of samples identified, species of isolates, and type of carrier plasmid.
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Affiliation(s)
- Sérgio Dias Costa-Júnior
- Department of Physiology and Pathology, Federal University of Paraíba (UFPB), 58.051-900, João Pessoa, Brazil
| | | | | | | | - Maria Betânia Melo de Oliveira
- Department of Bio of Biochemistry, Center for Biosciences, Federal University of Pernambuco (UFPE), Av. Moraes Rego S/N, Recife, PE, Brazil
| | - Isabella Macário Ferro Cavalcanti
- Keizo Asami Institute, Federal University of Pernambuco (iLIKA/UFPE), 50.670-901, Recife, Brazil.
- Microbiology and Immunology Laboratory, Academic Center of Vitória, Federal University of Pernambuco (CAV/UFPE), Centro Acadêmico de Vitória, Rua Do Alto Do Reservatório S/N, Bela Vista, Vitória de Santo Antão, PE, 55608-680, Brazil.
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3
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Rocha VFD, Barbosa MS, Leal HF, Silva GEO, Sales NMMD, Monteiro ADSS, Azevedo J, Malheiros ARX, Ataide LA, Moreira BM, Reis MG, Bahia FMM, Reis JN. Prolonged Outbreak of Carbapenem and Colistin-Resistant Klebsiella pneumoniae at a Large Tertiary Hospital in Brazil. Front Microbiol 2022; 13:831770. [PMID: 35356529 PMCID: PMC8959819 DOI: 10.3389/fmicb.2022.831770] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/04/2022] [Indexed: 11/21/2022] Open
Abstract
Multidrug-resistant gram-negative bacteria, such as carbapenem and colistin-resistant Klebsiella pneumoniae (ColR-CRKP), represent a major problem for health systems worldwide and have high lethality. This study investigated the genetic relationship, antimicrobial susceptibility profile, and resistance mechanisms to ColR-CRKP isolates from patients infected/colonized in a tertiary hospital in Salvador, Bahia/Brazil. From September 2016 to January 2018, 46 patients (56 ColR-CRKP positive cultures) were enrolled in the investigation but clinical and demographic data were obtained from 31 patients. Most of them were men (67.7%) and elderly (median age of 62 years old), and the median Charlson score was 3. The main comorbidities were systemic arterial hypertension (38.7%), diabetes (32.2%), and cerebrovascular disease (25.8%). The average hospitalization stay until ColR-CRKP identification in days were 35.12. A total of 90.6% used mechanical ventilation and 93.7% used a central venous catheter. Of the 31 patients who had the data evaluated, 12 had ColR-CRKP infection, and seven died (58.4%). Previous use of polymyxins was identified in 32.2% of the cases, and carbapenems were identified in 70.9%. The minimum inhibitory concentration (MIC) for colistin was > 16 μg/mL, with more than half of the isolates (55%) having a MIC of 256 μg/mL. The blaKPC gene was detected in 94.7% of the isolates, blaNDM in 16.0%, and blaGES in 1.7%. The blaOXA–48, blaVIM, and blaIMP genes were not detected. The mcr-1 test was negative in all 56 isolates. Alteration of the mgrB gene was detected in 87.5% (n = 49/56) of the isolates, and of these, 49.0% (24/49) had alteration in size probably due to IS903B, 22.4% (11/49) did not have the mgrB gene detected, 20.4% (10/49) presented the IS903B, 6.1% (3/49) had a premature stop codon (Q30*), and 2.1% (1/49) presented a thymine deletion at position 104 – 104delT (F35fs). The PFGE profile showed a monoclonal profile in 84.7% of the isolates in different hospital sectors, with ST11 (CC-258) being the most frequent sequence type. This study presents a prolonged outbreak of ColR-CRKP in which 83.9% of the isolates belonged to the same cluster, and 67.6% of the patients evaluated had not used polymyxin, suggesting the possibility of cross-transmission of ColR-CRKP isolates.
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Affiliation(s)
- Verônica França Diniz Rocha
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Brazil
| | | | - Helena Ferreira Leal
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Brazil
| | | | | | - Adriano de Souza Santos Monteiro
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Brazil
| | - Jailton Azevedo
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Brazil
| | | | | | - Beatriz Meurer Moreira
- Instituto de Microbiologia Paulo de Góes, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mitermayer Galvão Reis
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Yale School of Public Health, Yale University, New Haven, CT, United States
| | | | - Joice Neves Reis
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Brazil
- Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brazil
- *Correspondence: Joice Neves Reis,
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Cheng YH, Chou SH, Huang PH, Yang TC, Juan YF, Kreiswirth BN, Lin YT, Chen L. Characterization of a mcr-1 and CRISPR-Cas System Co-harboring Plasmid in a Carbapenemase-Producing High-Risk ST11 Klebsiella pneumoniae Strain. Front Microbiol 2021; 12:762947. [PMID: 34777318 PMCID: PMC8579119 DOI: 10.3389/fmicb.2021.762947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/07/2021] [Indexed: 11/21/2022] Open
Abstract
We set out to study the prevalence of the mcr-1 gene in carbapenemase-producing Klebsiella pneumoniae (CPKP) strains, and to determine whether its presence is associated with a fitness cost. A total of 234 clinical CPKP isolates were collected from a tertiary medical center in Taiwan from January 2018 to January 2019. The mcr-1 and carbapenemase genes were detected by polymerase chain reaction (PCR) followed by Sanger sequencing. The mcr-1-positive carbapenemase-producing strain was characterized by whole genome sequencing, a plasmid stability test and a conjugation assay. In vitro growth rate and an in vivo virulence test were compared between the parental mcr-1-positive strain and its mcr-1 plasmid-cured strain. We identified only one mcr-1 positive strain (KP2509), co-harboring bla KPC- 2 and bla OXA- 48, among 234 (1/234, 0.43%) CPKP strains. KP2509 and its Escherichia coli mcr-1 transconjugant showed moderate colistin resistance (MIC = 8 mg/L). The mcr-1 is located on a large conjugative plasmid (317 kb), pKP2509-MCR, with three replicons, IncHI, IncFIB, and IncN. Interestingly, a complete Type IV-A3 CRISPR-Cas system was identified in pKP2509-MCR. Plasmid pKP2509-MCR was highly stable in KP2509 after 270 generation of passage, and the pKP2509-MCR cured strain PC-KP2509 showed similar growth rate and in vivo virulence in comparison to KP2509. The prevalence of mcr-1 in CPKP strains remains low in our center. Notably, we identified a large plasmid with multiple replicons containing both the mcr-1 and the Type IV-3A CRISPR-Cas genes. The further spread of this highly stable plasmid raises concern that it may promote the increase of mcr-1 prevalence in CPKP.
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Affiliation(s)
- Yi-Hsiang Cheng
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Hua Chou
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Han Huang
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tsuey-Ching Yang
- Department of Biotechnology and Laboratory Science in Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Fan Juan
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Barry N. Kreiswirth
- Hackensack Meridian Health Center for Discovery and Innovation, Nutley, NJ, United States
| | - Yi-Tsung Lin
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Liang Chen
- Hackensack Meridian Health Center for Discovery and Innovation, Nutley, NJ, United States
- Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ, United States
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5
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Gonzales-Escalante E, Ruggiero M, Cerdeira L, Esposito F, Fontana H, Lincopan N, Gutkind G, Di Conza J. Whole-Genome Analysis of a High-Risk Clone of Klebsiella pneumoniae ST147 Carrying Both mcr-1 and blaNDM-1 Genes in Peru. Microb Drug Resist 2021; 28:171-179. [PMID: 34698586 DOI: 10.1089/mdr.2021.0128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The increasing prevalence and dissemination of carbapenemase-producing Enterobacterales represent a serious concern for public health. We studied the genetic features of a multidrug-resistant isolate of high-risk clone ST147 Klebsiella pneumoniae coharboring mcr-1 and blaNDM-1 recovered from a human clinical urine sample in 2017 in Peru. Whole-genome sequencing and conjugation assays identified mcr-1 and blaNDM-1 genes on two different conjugative plasmids, which belong to IncI2 and IncFIB/HI1B incompatibility groups, respectively. The presence of blaCTX-M-15 (in the studied isolate, located on the chromosome) and mutations in GyrA S83I and ParC S80I were detected, as expected for ST147. In addition, other β-lactamases (blaTEM-26 and blaOXA-1) and PMQR (qnrE2 and aac(6')-Ib-cr) among several resistance determinants were identified. The coexistence not previously described of these genes in the same high-risk clone is a cause for serious concern that supports the need for implementation of genomic surveillance studies.
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Affiliation(s)
- Edgar Gonzales-Escalante
- Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Universidad de Buenos Aires, Buenos Aires, Argentina.,Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales - CITBM, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Melina Ruggiero
- Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Universidad de Buenos Aires, Buenos Aires, Argentina.,CONICET, Buenos Aires, Argentina
| | - Louise Cerdeira
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Australia.,Department of Microbiology, Instituto de Ciências Biomédicas, Universidade de São Paulo, Sao Paulo, Brazil
| | - Fernanda Esposito
- Department of Microbiology, Instituto de Ciências Biomédicas, Universidade de São Paulo, Sao Paulo, Brazil
| | - Herrison Fontana
- Department of Microbiology, Instituto de Ciências Biomédicas, Universidade de São Paulo, Sao Paulo, Brazil
| | - Nilton Lincopan
- Department of Microbiology, Instituto de Ciências Biomédicas, Universidade de São Paulo, Sao Paulo, Brazil
| | - Gabriel Gutkind
- Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Universidad de Buenos Aires, Buenos Aires, Argentina.,CONICET, Buenos Aires, Argentina
| | - Jose Di Conza
- Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Universidad de Buenos Aires, Buenos Aires, Argentina.,CONICET, Buenos Aires, Argentina
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6
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Genotyping of paired KPC-producing Klebsiella pneumoniae isolates with and without divergent polymyxin B susceptibility profiles. Braz J Microbiol 2021; 52:1981-1989. [PMID: 34460074 DOI: 10.1007/s42770-021-00600-5] [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: 04/26/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022] Open
Abstract
Polymyxins are still used mainly in treating infections caused by carbapenem-resistant Klebsiella pneumoniae worldwide. The most frequent mechanism of acquired resistance to polymyxins in Gram-negative bacilli is the occurrence of mutations in chromosomal genes regulating operons responsible for lipopolysaccharide modification. As we observed at Santa Casa de São Paulo hospital the occurrence of infections caused by isolates resistant to polymyxins in patients previously treated with this antimicrobial, and new infections caused by the same polymyxin-susceptible species, in this study, we aimed to determine the clonality of consecutive K. pneumoniae isolates from the same patients and characterize the molecular determinants of polymyxin resistance in paired or clonal isolates. A total of 24 pairs and one trio of K. pneumoniae isolates were included in this study. Species identification was achieved by mass spectrometry and multiplex PCR. Polymyxin B minimal inhibitory concentrations were determined by broth microdilution. Clonality was evaluated using pulsed-field gel electrophoresis. The presence of insertions in mgrB gene was tested by PCR, and mutations on pmrA, pmrB, phoP, and phoQ were evaluated by PCR and complete nucleotide sequencing. A fraction of 23.8% of strains resistant to polymyxin B had an insertion in mgrB. Amino acid substitution F204L in PmrB may be implicated in polymyxin resistance. Substitutions T246A and R256G in PmrB were not implicated in polymyxin resistance. In this study, polymyxin resistance after a first susceptible isolate was detected was most frequently due to an infection caused by a distinct clone.
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7
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Rodríguez-Santiago J, Cornejo-Juárez P, Silva-Sánchez J, Garza-Ramos U. Polymyxin resistance in Enterobacterales: overview and epidemiology in the Americas. Int J Antimicrob Agents 2021; 58:106426. [PMID: 34419579 DOI: 10.1016/j.ijantimicag.2021.106426] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/07/2021] [Accepted: 08/15/2021] [Indexed: 12/30/2022]
Abstract
The worldwide spread of carbapenem- and polymyxin-resistant Enterobacterales represents an urgent public-health threat. However, for most countries in the Americas, the available data are limited, although Latin America has been suggested as a silent spreading reservoir for isolates carrying plasmid-mediated polymyxin resistance mechanisms. This work provides an overall update on polymyxin and polymyxin resistance and focuses on uses, availability and susceptibility testing. Moreover, a comprehensive review of the current polymyxin resistance epidemiology in the Americas is provided. We found that reports in the English and Spanish literature show widespread carbapenemase-producing and colistin-resistant Klebsiella pneumoniae in the Americas determined by the clonal expansion of the pandemic clone ST258 and mgrB-mediated colistin resistance. In addition, widespread IncI2 and IncX4 plasmids carrying mcr-1 in Escherichia coli come mainly from human sources; however, plasmid-mediated colistin resistance in the Americas is underreported in the veterinary sector. These findings demonstrate the urgent need for the implementation of polymyxin resistance surveillance in Enterobacterales as well as appropriate regulatory measures for antimicrobial use in veterinary medicine.
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Affiliation(s)
- J Rodríguez-Santiago
- Instituto Nacional de Salud Pública (INSP), Centro de Investigación sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana, Cuernavaca, Morelos, México; Programa de Doctorado en Ciencias Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - P Cornejo-Juárez
- Departamento de Infectología, Instituto Nacional de Cancerología (INCan), Ciudad de México, México
| | - J Silva-Sánchez
- Instituto Nacional de Salud Pública (INSP), Centro de Investigación sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana, Cuernavaca, Morelos, México
| | - U Garza-Ramos
- Instituto Nacional de Salud Pública (INSP), Centro de Investigación sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana, Cuernavaca, Morelos, México.
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8
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Campos PAD, Fuga B, Ferreira ML, Brígido RTES, Lincopan N, Gontijo-Filho PP, Ribas RM. Genetic Alterations Associated with Polymyxin B Resistance in Nosocomial KPC-2-Producing Klebsiella pneumoniae from Brazil. Microb Drug Resist 2021; 27:1677-1684. [PMID: 34129401 DOI: 10.1089/mdr.2020.0531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The rapid increased multidrug resistance in Klebsiella pneumoniae has led to a renewed interest in polymyxin antibiotics, such as colistin, as antibiotics of last resort, not least in low/middle income countries. We conducted a genomic survey of clinical polymyxin-resistant K. pneumoniae to investigate the genetic alterations in isolates harboring blaKPC-2. Whole-genome sequencing was performed using an Illumina NextSeq 500 paired-end reads. Mutations and insertion sequence detection were analyzed to seven isolates recovered from clinical specimens of patients hospitalized in Brazil, focusing on key genes associated with polymyxin resistance. Furthermore, the levels of mRNA expression of genes associated with resistance to polymyxin B and other antimicrobials were evaluated by quantitative real-time PCR. Eighty-five percent of the isolates were assigned to clonal complex 258, with a minimum inhibitory concentration range of 4 to >256 mg/L for polymyxin B. It was possible to observe the presence of one important insertion element, ISKpn13, in a strain recovered from the blood that have blaKPC-2. Deleterious mutations reported in PmrB (R256G), YciM (N212T), and AcrB (T598A) were common, and mobile colistin resistance (mcr) genes were absent in all the isolates. RT-qPCR analysis revealed an overexpression of the pmrC (1.160-fold), pmrD (2.258-fold), and kpnE (1.530-fold) genes in the polymyxin B-resistant isolates compared with the expression of the polymyxin B-susceptible K. pneumoniae isolate. Overall, these results demonstrate the diversity of genetic variations in polymyxin-resistant populations derived from the different clonal strains, but the same sequence types, and suggest that there are still unknown mechanisms of polymyxin resistance in K. pneumoniae.
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Affiliation(s)
- Paola Amaral de Campos
- Laboratório de Microbiologia Molecular, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Brazil
| | - Bruna Fuga
- Laboratório de Microbiologia Molecular, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Brazil.,Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Melina Lorraine Ferreira
- Laboratório de Microbiologia Molecular, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Brazil
| | | | - Nilton Lincopan
- Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo P Gontijo-Filho
- Laboratório de Microbiologia Molecular, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Brazil
| | - Rosineide Marques Ribas
- Laboratório de Microbiologia Molecular, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Brazil
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9
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Girardello R, Piroupo CM, Martins J, Maffucci MH, Cury AP, Franco MRG, Malta FDM, Rocha NC, Pinho JRR, Rossi F, Duarte AJDS, Setubal JC. Genomic Characterization of mcr-1.1-Producing Escherichia coli Recovered From Human Infections in São Paulo, Brazil. Front Microbiol 2021; 12:663414. [PMID: 34177843 PMCID: PMC8221240 DOI: 10.3389/fmicb.2021.663414] [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: 02/02/2021] [Accepted: 05/12/2021] [Indexed: 11/25/2022] Open
Abstract
Polymyxins are one of most important antibiotics available for multidrug-resistant Gram-negative infections. Diverse chromosomal resistance mechanisms have been described, but the polymyxin resistance phenotype is not yet completely understood. The objective of this study was to characterize colistin resistant mcr-1-producing strains isolated from human infections over one year in a hospital setting (Hospital das Clínicas, São Paulo, Brazil). We isolated 490 colistin-resistant Gram-negative rods, of which eight were mcr-1.1-positive Escherichia coli, the only species with this result, indicating a low incidence of the mcr-1 production mechanism among colistin-resistant isolates. All mcr-1.1 positive isolates showed similarly low MICs for colistin and were susceptible to most antibiotics tested. The isolates showed diversity of MLST classification. The eight mcr-1.1-positive E. coli genomes were sequenced. In seven of eight isolates the mcr-1.1 gene is located in a contig that is presumed to be a part of an IncX4 plasmid; in one isolate, it is located in a contig that is presumed to be part of an IncHI2A plasmid. Three different genomic contexts for mcr-1.1 were observed, including a genomic cassette mcr-1.1-pap2 disrupting a DUF2806 domain-containing gene in six isolates. In addition, an IS1-family transposase was found inserted next to the mcr-1.1 cassette in one isolate. An mcr-1.1-pap2 genomic cassette not disrupting any gene was identified in another isolate. Our results suggest that plasmid dissemination of hospital-resident strains took place during the study period and highlight the need for continued genomic surveillance.
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Affiliation(s)
- Raquel Girardello
- Laboratório de Microbiologia Molecular e Clínica, Programa de Pós-Graduação em Ciências da Saúde, Universidade São Francisco, Braganca Paulista, Brazil
| | - Carlos Morais Piroupo
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo, Brazil
| | - Joaquim Martins
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo, Brazil
| | - Marcia Helena Maffucci
- Hospital das Clínicas, Divisão Laboratório Central, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ana Paula Cury
- Hospital das Clínicas, Divisão Laboratório Central, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Renata Gomes Franco
- Hospital das Clínicas, Divisão Laboratório Central, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Natália Conceição Rocha
- Laboratório de Microbiologia Molecular e Clínica, Programa de Pós-Graduação em Ciências da Saúde, Universidade São Francisco, Braganca Paulista, Brazil.,Hospital das Clínicas, Divisão Laboratório Central, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - João Renato Rebello Pinho
- Hospital das Clínicas, Divisão Laboratório Central, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Laboratório de Técnicas Especiais, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Flavia Rossi
- Hospital das Clínicas, Divisão Laboratório Central, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alberto José da Silva Duarte
- Hospital das Clínicas, Divisão Laboratório Central, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - João Carlos Setubal
- Departamento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo, Brazil
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10
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Nguyen LP, Park CS, Pinto NA, Lee H, Seo HS, Vu TN, Mai H, Pham AHT, Jang E, Cho YL, Goglin K, Nguyen K, White R, D’Souza R, Fouts DE, Yong D. In Vitro Activity of a Novel Siderophore-Cephalosporin LCB10-0200 (GT-1), and LCB10-0200/Avibactam, against Carbapenem-Resistant Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa Strains at a Tertiary Hospital in Korea. Pharmaceuticals (Basel) 2021; 14:370. [PMID: 33923801 PMCID: PMC8072773 DOI: 10.3390/ph14040370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/17/2022] Open
Abstract
The siderophore-antibiotic conjugate LCB10-0200 (a.k.a. GT-1) has been developed to combat multidrug-resistant Gram-negative bacteria. In this study, the in vitro activity of LCB10-0200 and LCB10-0200/avibactam (AVI) has been investigated against carbapenem-resistant Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Minimal inhibitory concentrations (MICs) of LCB10-0200, LCB10-0200/AVI, aztreonam, aztreonam/AVI, ceftazidime, ceftazidime/AVI, and meropenem were measured using the agar dilution method. Whole genome sequencing was performed using Illumina and the resistome was analyzed. LCB10-0200 displayed stronger activity than the comparator drugs in meropenem-resistant E. coli and K. pneumoniae, and the addition of AVI enhanced the LCB10-0200 activity to MIC ≤ 0.12 mg/L for 90.5% of isolates. In contrast, whereas LCB10-0200 alone showed potent activity against meropenem-resistant A. baumannii and P. aeruginosa at MIC ≤ 4 mg/L for 84.3% of isolates, the combination with AVI did not improve its activity. LCB10-0200/AVI was active against CTX-M-, SHV-, CMY-, and KPC- producing E. coli and K. pneumoniae, while LCB10-0200 alone was active against ADC-, OXA-, and VIM- producing A. baumannii and P. aeruginosa. Both LCB10-0200 and LCB10-0200/AVI displayed low activity against IMP- and NDM- producing strains. LCB10-0200 alone exhibited strong activity against selected strains. The addition of AVI significantly increased LCB10-0200 activity against carbapenem-resistant E. coli, K. pneumoniae.
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Affiliation(s)
- Le Phuong Nguyen
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | - Chul Soon Park
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
| | - Naina Adren Pinto
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | - Hyunsook Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | - Hyun Soo Seo
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
| | - Thao Nguyen Vu
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | - Hung Mai
- School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - An H. T. Pham
- UCI School of Biological Sciences, University of California, Irvine, CA 92617, USA;
| | - Eris Jang
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
| | | | | | - Kevin Nguyen
- J. Craig Venter Institute, Rockville, MD 20850, USA; (K.N.); (R.W.); (R.D.); (D.E.F.)
| | - Richard White
- J. Craig Venter Institute, Rockville, MD 20850, USA; (K.N.); (R.W.); (R.D.); (D.E.F.)
| | - Roshan D’Souza
- J. Craig Venter Institute, Rockville, MD 20850, USA; (K.N.); (R.W.); (R.D.); (D.E.F.)
| | - Derrick E. Fouts
- J. Craig Venter Institute, Rockville, MD 20850, USA; (K.N.); (R.W.); (R.D.); (D.E.F.)
| | - Dongeun Yong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
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11
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Hameed MF, Chen Y, Wang Y, Shafiq M, Bilal H, Liu L, Ma J, Gu P, Ge H. Epidemiological Characterization of Colistin and Carbapenem Resistant Enterobacteriaceae in a Tertiary: A Hospital from Anhui Province. Infect Drug Resist 2021; 14:1325-1333. [PMID: 33854345 PMCID: PMC8040073 DOI: 10.2147/idr.s303739] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/13/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Antimicrobial resistance, especially carbapenem resistance Enterobacteriaceae and plasmid mediated mobile colistin resistance, is a serious issue worldwide. This study was designed to determine the epidemiological characteristics of plasmid mediated colistin resistance and carbapenem resistant Enterobacteriaceae from tertiary A hospital located in Hefei, China. METHODS Totally, 158 carbapenems resistant Enterobacteriaceae (CRE) were screened for antibiotic susceptibility, mcr-1, extended spectrum β-lactamases (ESBLs), metallo-β-lactamases (MBLs), and fosfomycin resistance genes using PCR and sequencing. The sequence types were identified by multilocus sequence typing (MLST). Plasmid profiles were determined by PCR based replicon typing (PBRT), and the plasmid sizes were confirmed by southern blotting. RESULTS The isolates showed high MIC50 and MIC90 for all antimicrobials, except tigecycline, meropenem, and colistin. The main Carbapenemase genes were bla KPC-2 (90.5%), bla NDM-1(3.7%), bla OXA-48(5.6%) and fosA3 (14.5%). The bla CTXM-15 found 36.7%, mcr-1 (3.7%) recorded in six isolates. PBRT revealed bla KPC-2 in K. pneumoniae on IncR, IncFII, and IncA/C. bla NDM-1 in E. coli on IncFII, whereas in E. cloacae noticed on IncHI2 plasmid. mcr-1 was recorded among IncFIIK, IncFII, and IncF in E. coli, K. pneumoniae, and E. cloacae. Resistance genes (mcr-1, bla NDM-1, bla KPC-2) harboring plasmids are successfully trans-conjugant to EC-600. A high incidence of ST11 was observed in K. pneumoniae carbapenem resistant isolates. While in E. coli, multiple STs were identified. However, mcr-1 in ST23 was identified for the first time in Anhui Province. Among Enterobacter cloacae, ST270 detected carrying bla NDM-1. Southern-hybridization confirmed the plasmid sizes 35-150kb. CONCLUSION This study indicates the co-carrying of mcr-1, bla KPC-2, and bla NDM-1 among clinical isolates, the prevalence of different Enterobacteriaceae STs is alarming, especially in E. coli. Holding such a resistance profile is a threat for humans and animals, which may be transferred between the strains through plasmid transfusion. Persistent control actions are immediately necessary to combat this hazard.
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Affiliation(s)
- Muhammad Fazal Hameed
- Institutes of Physical Science and Information Technology, Anhui University, Hefei, Anhui, 230601, People’s Republic of China
| | - Yanan Chen
- Institutes of Physical Science and Information Technology, Anhui University, Hefei, Anhui, 230601, People’s Republic of China
| | - Ying Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, People’s Republic of China
| | - Muhammad Shafiq
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, 210095, People’s Republic of China
| | - Hazrat Bilal
- Institutes of Physical Science and Information Technology, Anhui University, Hefei, Anhui, 230601, People’s Republic of China
| | - Linqing Liu
- The Department of Geriatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, People’s Republic of China
| | - Jinming Ma
- Institutes of Physical Science and Information Technology, Anhui University, Hefei, Anhui, 230601, People’s Republic of China
| | - Pengying Gu
- The Department of Geriatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230036, People’s Republic of China
| | - Honghua Ge
- Institutes of Physical Science and Information Technology, Anhui University, Hefei, Anhui, 230601, People’s Republic of China
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12
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Silva DMD, Faria-Junior C, Nery DR, Oliveira PMD, Silva LDOR, Alves EG, Lima GRDCEC, Pereira AL. Insertion sequences disrupting mgrB in carbapenem-resistant Klebsiella pneumoniae strains in Brazil. J Glob Antimicrob Resist 2020; 24:53-57. [PMID: 33246210 DOI: 10.1016/j.jgar.2020.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES This study aimed to characterise insertional mutations disturbing themgrB gene in carbapenem-resistant Klebsiella pneumoniae (CRKp). METHODS A total of 118 clinical CRKp isolates were surveyed for polymyxin resistance and insertion sequence (IS) elements disruptingmgrB. RESULTS Of the 118 isolates, 78 (66.1%) displayed polymyxin resistance, of which 54% (42/78) hadmgrB::IS inserts. Sequencing analyses showed 13 insertion sites in mgrB. mgrB::ISSen4(IS3) was observed for the first time in CRKp. CONCLUSIONS Ten different IS elements disruptedmgrB, with a predominance (76%) of IS5 sequences.
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Affiliation(s)
- Daniely Martins da Silva
- Campus of Ceilândia, University of Brasília, Centro Metropolitano, Conjunto A, Ceilândia Sul, Brasília (DF), CEP: 72220-275, Brazil
| | - Célio Faria-Junior
- Central Laboratory for Public Health (LACEN-DF), SGAN 601, Asa Norte, Brasília (DF), CEP: 70830-010, Brazil
| | - Danielly Rocha Nery
- Campus of Ceilândia, University of Brasília, Centro Metropolitano, Conjunto A, Ceilândia Sul, Brasília (DF), CEP: 72220-275, Brazil
| | - Pâmela Maria de Oliveira
- Campus of Ceilândia, University of Brasília, Centro Metropolitano, Conjunto A, Ceilândia Sul, Brasília (DF), CEP: 72220-275, Brazil
| | | | - Everton Giovanni Alves
- Central Laboratory for Public Health (LACEN-DF), SGAN 601, Asa Norte, Brasília (DF), CEP: 70830-010, Brazil
| | | | - Alex Leite Pereira
- Campus of Ceilândia, University of Brasília, Centro Metropolitano, Conjunto A, Ceilândia Sul, Brasília (DF), CEP: 72220-275, Brazil.
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13
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Hu Y, Anes J, Devineau S, Fanning S. Klebsiella pneumoniae: Prevalence, Reservoirs, Antimicrobial Resistance, Pathogenicity, and Infection: A Hitherto Unrecognized Zoonotic Bacterium. Foodborne Pathog Dis 2020; 18:63-84. [PMID: 33124929 DOI: 10.1089/fpd.2020.2847] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Klebsiella pneumoniae is considered an opportunistic pathogen, constituting an ongoing health concern for immunocompromised patients, the elderly, and neonates. Reports on the isolation of K. pneumoniae from other sources are increasing, many of which express multidrug-resistant (MDR) phenotypes. Three phylogroups were identified based on nucleotide differences. Niche environments, including plants, animals, and humans appear to be colonized by different phylogroups, among which KpI (K. pneumoniae) is commonly associated with human infection. Infections with K. pneumoniae can be transmitted through contaminated food or water and can be associated with community-acquired infections or between persons and animals involved in hospital-acquired infections. Increasing reports are describing detections along the food chain, suggesting the possibility exists that this could be a hitherto unexplored reservoir for this opportunistic bacterial pathogen. Expression of MDR phenotypes elaborated by these bacteria is due to the nature of various plasmids carrying antimicrobial resistance (AMR)-encoding genes, and is a challenge to animal, environmental, and human health alike. Raman spectroscopy has the potential to provide for the rapid identification and screening of antimicrobial susceptibility of Klebsiella isolates. Moreover, hypervirulent isolates linked with extraintestinal infections express phenotypes that may support their niche adaptation. In this review, the prevalence, reservoirs, AMR, Raman spectroscopy detection, and pathogenicity of K. pneumoniae are summarized and various extraintestinal infection pathways are further narrated to extend our understanding of its adaptation and survival ability in reservoirs, and associated disease risks.
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Affiliation(s)
- Yujie Hu
- UCD-Centre for Food Safety, UCD School of Public Health, Physiotherapy and Sports Science, Science Centre South, College of Health and Agricultural Sciences, University College Dublin (UCD), Dublin, Ireland.,Key Laboratory of Food Safety Risk Assessment, Ministry of Health, China National Center for Food Safety Risk Assessment, Beijing, China
| | - João Anes
- UCD-Centre for Food Safety, UCD School of Public Health, Physiotherapy and Sports Science, Science Centre South, College of Health and Agricultural Sciences, University College Dublin (UCD), Dublin, Ireland
| | | | - Séamus Fanning
- UCD-Centre for Food Safety, UCD School of Public Health, Physiotherapy and Sports Science, Science Centre South, College of Health and Agricultural Sciences, University College Dublin (UCD), Dublin, Ireland.,Key Laboratory of Food Safety Risk Assessment, Ministry of Health, China National Center for Food Safety Risk Assessment, Beijing, China.,Institute for Global Food Security, Queen's University Belfast, Belfast, United Kingdom
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14
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Rocha IV, Dos Santos Silva N, das Neves Andrade CA, de Lacerda Vidal CF, Leal NC, Xavier DE. Diverse and emerging molecular mechanisms award polymyxins resistance to Enterobacteriaceae clinical isolates from a tertiary hospital of Recife, Brazil. INFECTION GENETICS AND EVOLUTION 2020; 85:104584. [PMID: 33022426 DOI: 10.1016/j.meegid.2020.104584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/21/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe the molecular mechanisms of polymyxins resistance in five Enterobacteriaceae clinical isolates from a tertiary hospital of Recife, Brazil. METHODS The species identification and the susceptibility to antimicrobials were firstly performed by automatized methods and polymyxin resistance was confirmed by broth microdilution methods. The genetic basis of resistance was characterized with WGS analyses to study their resistome, plasmidome and mobilome, by BLAST searches on reference databases. RESULTS Five (5%) Enterobacteriaceae isolates, comprising Escherichia coli (n = 2), Klebsiella pneumoniae (n = 2) and Citrobacter freundii (n = 1) species, exhibited polymyxin resistance. The mcr-1.1 gene was found in identical IncX4-plasmids harbored by both K. pneumoniae C119 (PolB MIC = 512 mg/L) and E. coli C153 (PolB MIC = 8 mg/L). The remaining E. coli strain C027 harbored the mcr-5.1 gene on an undefined Inc-plasmid (PolB MIC 256 mg/L). Some amino acid substitutions in PmrA (S29G, G144S), PmrB (S202P; D283G, W350*, Y258N) and PhoP (I44L) was detected among the E. coli clinical isolates, however they were also found in colistin-susceptible strains and predicted as neutral alterations. The mgrB of the ST54 KPC-2-producing K. pneumoniae C151 (PolB MIC = 32 g/mL) was interrupted at 69 nt by the IS903 element. The ST117 C. freundii C156 (PolB MIC = 256 mg/L) showed the A91T substitution on HAMP domain of the histidine kinase sensor CrrB, predicted as deleterious and deemed the remarkable determinant to polymyxins resistance in this strain. CONCLUSIONS Diverse mechanisms of polymyxins resistance were identified among clinical Enterobacteriaceae from a tertiary hospital of Recife, Brazil, such as plasmid-mediated MCR-1 and MCR-5; IS903-interruption of mgrB and mutation in CrrAB regulatory system. These findings highlight the involvement of the identified plasmids on mcr dissemination among Enterobacteriaceae; warn about co-selection of the polymyxin-resistant and KPC-producer K. pneumoniae ΔmgrB lineage by carbapenems usage; and demonstrate potential role of CrrAB on emerging of polymyxin resistance among Enterobacteriaceae, besides Klebsiella species.
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15
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García-Betancur JC, Appel TM, Esparza G, Gales AC, Levy-Hara G, Cornistein W, Vega S, Nuñez D, Cuellar L, Bavestrello L, Castañeda-Méndez PF, Villalobos-Vindas JM, Villegas MV. Update on the epidemiology of carbapenemases in Latin America and the Caribbean. Expert Rev Anti Infect Ther 2020; 19:197-213. [PMID: 32813566 DOI: 10.1080/14787210.2020.1813023] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Carbapenemases are β-lactamases able to hydrolyze a wide range of β-lactam antibiotics, including carbapenems. Carbapenemase production in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter spp., with and without the co-expression of other β-lactamases is a serious public health threat. Carbapenemases belong to three main classes according to the Ambler classification: class A, class B, and class D. AREAS COVERED Carbapenemase-bearing pathogens are endemic in Latin America. In this review, we update the status of carbapenemases in Latin America and the Caribbean. EXPERT OPINION Understanding the current epidemiology of carbapenemases in Latin America and the Caribbean is of critical importance to improve infection control policies limiting the dissemination of multi-drug-resistant pathogens and in implementing appropriate antimicrobial therapy.
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Affiliation(s)
| | - Tobias Manuel Appel
- Grupo de Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque . Bogotá, Colombia
| | - German Esparza
- Programa de Aseguramiento de Calidad. PROASECAL SAS, Bogotá, Colombia
| | - Ana C Gales
- Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina/Universidade Federal de São Paulo - UNIFESP , São Paulo, Brazil
| | | | | | - Silvio Vega
- Complejo Hospitalario Metropolitano , Ciudad de Panamá, Panama
| | - Duilio Nuñez
- Infectious Diseases División, IPS Hospital Central , Asunción, Paraguay
| | - Luis Cuellar
- Servicio de Infectologia, Instituto Nacional de Enfermedades Neoplasicas , Lima, Peru
| | | | - Paulo F Castañeda-Méndez
- Department of Infectious Diseases, Hospital San Angel Inn Universidad , Ciudad de México, Mexico
| | | | - María Virginia Villegas
- Grupo de Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque . Bogotá, Colombia.,Centro Médico Imbanaco . Cali, Colombia
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16
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Conceição-Neto OC, da Costa BS, Pontes LS, Santos ICO, Silveira MC, Cordeiro-Moura JR, Pereira NF, Tavares-Teixeira CB, Picão RC, Rocha-de-Souza CM, Carvalho-Assef APD. Difficulty in detecting low levels of polymyxin resistance in clinical Klebsiella pneumoniae isolates: evaluation of Rapid Polymyxin NP test, Colispot Test and SuperPolymyxin medium. New Microbes New Infect 2020; 36:100722. [PMID: 32642069 PMCID: PMC7334411 DOI: 10.1016/j.nmni.2020.100722] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/06/2020] [Accepted: 06/22/2020] [Indexed: 01/29/2023] Open
Abstract
Polymyxins are important therapeutic options for treating infections, mainly those caused by carbapenem-resistant Klebsiella pneumoniae. Specific chemical characteristics of polymyxins make it difficult to perform antimicrobial susceptibility testing, especially within the clinical laboratory. Here we aimed to evaluate the performance of three phenotypic methods: Rapid NP Polymyxin Test, ColiSpot test and the SuperPolymyxin medium. To accomplish this, 170 non-duplicate clinical K. pneumoniae isolates were analysed (123 colistin-resistant and 47 susceptible). The sensitivity and specificity obtained for Rapid Polymyxin NP Test, Colispot and SuperPolymyxin medium were, respectively, 90% and 94%, 74% and 100%, and 82% and 85%. Very major errors occurred more frequently in low-level colistin-resistant isolates (MICs 4 and 8 μg/mL). Rapid Polymyxin NP proved to be a method capable of identifying colistin-resistant strains in acceptable categorical agreement. However, major errors and very major errors of this method were considered unacceptable for colistin-resistance screening. Although the Colispot test is promising and easy to perform and interpret, the results did not reproduce well in the isolates tested. The colistin-containing selective medium (SuperPolymyxin) showed limitations, including quantification of mucoid colonies and poor stability. Nevertheless, Colispot and SuperPolymyxin medium methods did not present acceptable sensitivity, specificity and categorical agreement. It is essential to use analytical tools that faithfully reproduce bacterial resistance in vitro, especially in last-line drugs, such as polymyxins, when misinterpretation of a test can result in therapeutic ineffectiveness.
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Affiliation(s)
- O C Conceição-Neto
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro, Brazil
| | - B S da Costa
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro, Brazil
| | - L S Pontes
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro, Brazil
| | - I C O Santos
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro, Brazil
| | - M C Silveira
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro, Brazil
| | - J R Cordeiro-Moura
- Laboratório de Investigação em Microbiologia Médica, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - N F Pereira
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro, Brazil
| | - C B Tavares-Teixeira
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro, Brazil
| | - R C Picão
- Laboratório de Investigação em Microbiologia Médica, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - C M Rocha-de-Souza
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro, Brazil
| | - A P D Carvalho-Assef
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro, Brazil
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17
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Nguyen LP, Pinto NA, Vu TN, Lee H, Cho YL, Byun JH, D’Souza R, Yong D. In Vitro Activity of a Novel Siderophore-Cephalosporin, GT-1 and Serine-Type β-Lactamase Inhibitor, GT-055, against Escherichia coli, Klebsiella pneumoniae and Acinetobacter spp. Panel Strains. Antibiotics (Basel) 2020; 9:antibiotics9050267. [PMID: 32443875 PMCID: PMC7277296 DOI: 10.3390/antibiotics9050267] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022] Open
Abstract
This study investigates GT-1 (also known as LCB10-0200), a novel-siderophore cephalosporin, inhibited multidrug-resistant (MDR) Gram-negative pathogen, via a Trojan horse strategy exploiting iron-uptake systems. We investigated GT-1 activity and the role of siderophore uptake systems, and the combination of GT-1 and a non-β-lactam β-lactamase inhibitor (BLI) of diazabicyclooctane, GT-055, (also referred to as LCB18-055) against molecularly characterised resistant Escherichia coli, Klebsiella pneumoniae and Acinetobacter spp. isolates. GT-1 and GT-1/GT-055 were tested in vitro against comparators among three different characterised panel strain sets. Bacterial resistome and siderophore uptake systems were characterised to elucidate the genetic basis for GT-1 minimum inhibitory concentrations (MICs). GT-1 exhibited in vitro activity (≤2 μg/mL MICs) against many MDR isolates, including extended-spectrum β-lactamase (ESBL)- and carbapenemase-producing E. coli and K. pneumoniae and oxacillinase (OXA)-producing Acinetobacter spp. GT-1 also inhibited strains with mutated siderophore transporters and porins. Although BLI GT-055 exhibited intrinsic activity (MIC 2-8 μg/mL) against most E. coli and K. pneumoniae isolates, GT-055 enhanced the activity of GT-1 against many GT-1-resistant strains. Compared with CAZ-AVI, GT-1/GT-055 exhibited lower MICs against E. coli and K. pneumoniae isolates. GT-1 demonstrated potent in vitro activity against clinical panel strains of E. coli, K. pneumoniae and Acinetobacter spp. GT-055 enhanced the in vitro activity of GT-1 against many GT-1-resistant strains.
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Affiliation(s)
- Le Phuong Nguyen
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, College of Medicine, Yonsei University, Seoul 03722, Korea; (L.P.N.); (N.A.P.); (T.N.V.); (H.L.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | - Naina Adren Pinto
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, College of Medicine, Yonsei University, Seoul 03722, Korea; (L.P.N.); (N.A.P.); (T.N.V.); (H.L.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | - Thao Nguyen Vu
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, College of Medicine, Yonsei University, Seoul 03722, Korea; (L.P.N.); (N.A.P.); (T.N.V.); (H.L.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | - Hyunsook Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, College of Medicine, Yonsei University, Seoul 03722, Korea; (L.P.N.); (N.A.P.); (T.N.V.); (H.L.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | | | - Jung-Hyun Byun
- Department of Laboratory Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju 52727, Korea;
| | - Roshan D’Souza
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, College of Medicine, Yonsei University, Seoul 03722, Korea; (L.P.N.); (N.A.P.); (T.N.V.); (H.L.)
- J. Craig Venter Institute, Rockville, MD 20850, USA
- Correspondence: (R.D.); (D.Y.); Tel.: +1-301-795-7342 (R.D.); +82-2-2228-2442 (D.Y.); Fax: +82-2-364-1583 (D.Y.)
| | - Dongeun Yong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, College of Medicine, Yonsei University, Seoul 03722, Korea; (L.P.N.); (N.A.P.); (T.N.V.); (H.L.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
- Correspondence: (R.D.); (D.Y.); Tel.: +1-301-795-7342 (R.D.); +82-2-2228-2442 (D.Y.); Fax: +82-2-364-1583 (D.Y.)
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18
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F. Rabello R, R. Bonelli R, A. Penna B, P. Albuquerque J, M. Souza R, M. F. Cerqueira A. Antimicrobial Resistance in Farm Animals in Brazil: An Update Overview. Animals (Basel) 2020; 10:E552. [PMID: 32224900 PMCID: PMC7222418 DOI: 10.3390/ani10040552] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/10/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023] Open
Abstract
In animal husbandry, antimicrobial agents have been administered as supplements to increase production over the last 60 years. Large-scale animal production has increased the importance of antibiotic management because it may favor the evolution of antimicrobial resistance and select resistant strains. Brazil is a significant producer and exporter of animal-derived food. Although Brazil is still preparing a national surveillance plan, several changes in legislation and timely programs have been implemented. Thus, Brazilian data on antimicrobial resistance in bacteria associated with animals come from official programs and the scientific community. This review aims to update and discuss the available Brazilian data on this topic, emphasizing legal aspects, incidence, and genetics of the resistance reported by studies published since 2009, focusing on farm animals and derived foods with the most global public health impact. Studies are related to poultry, cattle, and pigs, and mainly concentrate on non-typhoid Salmonella, Escherichia coli, and Staphylococcus aureus. We also describe legal aspects of antimicrobial use in this context; and the current occurrence of genetic elements associated with resistance to beta-lactams, colistin, and fluoroquinolones, among other antimicrobial agents. Data here presented may be useful to provide a better understanding of the Brazilian status on antimicrobial resistance related to farm animals and animal-derived food products.
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Affiliation(s)
- Renata F. Rabello
- Departamento de Microbiologia e Parasitologia, Universidade Federal Fluminense, Niterói 24210-130, Brazil (B.A.P.); (J.P.A.)
| | - Raquel R. Bonelli
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Bruno A. Penna
- Departamento de Microbiologia e Parasitologia, Universidade Federal Fluminense, Niterói 24210-130, Brazil (B.A.P.); (J.P.A.)
| | - Julia P. Albuquerque
- Departamento de Microbiologia e Parasitologia, Universidade Federal Fluminense, Niterói 24210-130, Brazil (B.A.P.); (J.P.A.)
| | - Rossiane M. Souza
- Centro Estadual de Pesquisa em Sanidade Animal, Empresa de Pesquisa Agropecuária do Estado do Rio de Janeiro, Niterói 24120-191, Brazil
| | - Aloysio M. F. Cerqueira
- Departamento de Microbiologia e Parasitologia, Universidade Federal Fluminense, Niterói 24210-130, Brazil (B.A.P.); (J.P.A.)
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19
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Rabello RF, Bonelli RR, Penna BA, Albuquerque JP, Souza RM, Cerqueira AMF. Antimicrobial Resistance in Farm Animals in Brazil: An Update Overview. Animals (Basel) 2020. [PMID: 32224900 DOI: 10.3390/ani1004055210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023] Open
Abstract
In animal husbandry, antimicrobial agents have been administered as supplements to increase production over the last 60 years. Large-scale animal production has increased the importance of antibiotic management because it may favor the evolution of antimicrobial resistance and select resistant strains. Brazil is a significant producer and exporter of animal-derived food. Although Brazil is still preparing a national surveillance plan, several changes in legislation and timely programs have been implemented. Thus, Brazilian data on antimicrobial resistance in bacteria associated with animals come from official programs and the scientific community. This review aims to update and discuss the available Brazilian data on this topic, emphasizing legal aspects, incidence, and genetics of the resistance reported by studies published since 2009, focusing on farm animals and derived foods with the most global public health impact. Studies are related to poultry, cattle, and pigs, and mainly concentrate on non-typhoid Salmonella, Escherichia coli, and Staphylococcus aureus. We also describe legal aspects of antimicrobial use in this context; and the current occurrence of genetic elements associated with resistance to beta-lactams, colistin, and fluoroquinolones, among other antimicrobial agents. Data here presented may be useful to provide a better understanding of the Brazilian status on antimicrobial resistance related to farm animals and animal-derived food products.
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Affiliation(s)
- Renata F Rabello
- Departamento de Microbiologia e Parasitologia, Universidade Federal Fluminense, Niterói 24210-130, Brazil
| | - Raquel R Bonelli
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Bruno A Penna
- Departamento de Microbiologia e Parasitologia, Universidade Federal Fluminense, Niterói 24210-130, Brazil
| | - Julia P Albuquerque
- Departamento de Microbiologia e Parasitologia, Universidade Federal Fluminense, Niterói 24210-130, Brazil
| | - Rossiane M Souza
- Centro Estadual de Pesquisa em Sanidade Animal, Empresa de Pesquisa Agropecuária do Estado do Rio de Janeiro, Niterói 24120-191, Brazil
| | - Aloysio M F Cerqueira
- Departamento de Microbiologia e Parasitologia, Universidade Federal Fluminense, Niterói 24210-130, Brazil
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20
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Abd El-Baky RM, Masoud SM, Mohamed DS, Waly NG, Shafik EA, Mohareb DA, Elkady A, Elbadr MM, Hetta HF. Prevalence and Some Possible Mechanisms of Colistin Resistance Among Multidrug-Resistant and Extensively Drug-Resistant Pseudomonas aeruginosa. Infect Drug Resist 2020; 13:323-332. [PMID: 32099423 PMCID: PMC7006860 DOI: 10.2147/idr.s238811] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/11/2020] [Indexed: 12/20/2022] Open
Abstract
Background and Aim The emergence of colistin-resistant strains is considered a great threat for patients with severe infections. Here, we investigate the prevalence and some possible mechanisms of colistin resistance among multidrug-resistant (MDR) and extensively drug-resistant (XDR) Pseudomonas aeruginosa (P. aeruginosa). Methods Antimicrobial susceptibility was performed using disc diffusion methods while colistin resistance was detected by agar dilution method. Possible mechanisms for colistin resistance were studied by detection of mcr-1 and mcr-2 genes by conventional PCR, detection of efflux mechanisms using Carbonyl Cyanide 3-Chlorophenylhydrazone (CCCP), studying outer membrane protein profile and Lipopolysaccharide (LPS) profile of resistant isolates. Results It was found that MDR and XDR represented 96% and 87% of the isolated P. aeruginosa, respectively, and colistin resistance represented 21.3%. No isolates were positive for mcr-2 gene while 50% of colistin-resistant isolates were positive for mcr-1. Efflux mechanisms were detected in 3 isolates. Protein profile showed the presence of a band of 21.4 KDa in the resistant strains which may represent OprH while LPS profile showed differences among colistin-resistant mcr-1 negative strains, colistin-resistant mcr-1 positive strains and susceptible strains. Conclusion The current study reports a high prevalence of colistin resistance and mcr-1 gene in P. aeruginosa strains isolated from Egypt that may result in untreatable infections. Our finding makes it urgent to avoid unnecessary clinical use of colistin.
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Affiliation(s)
- Rehab M Abd El-Baky
- Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia 61519, Egypt.,Department of Microbiology and Immunology, Faculty of Pharmacy, Deraya University, Minia 11566, Egypt
| | - Salwa M Masoud
- Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia 61519, Egypt
| | - Doaa S Mohamed
- Department of Microbiology and Immunology, Faculty of Pharmacy, Deraya University, Minia 11566, Egypt
| | - Nancy Gfm Waly
- Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia 61519, Egypt
| | - Engy A Shafik
- Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Dina A Mohareb
- Department of Clinical Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Mohamed M Elbadr
- Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Helal F Hetta
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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21
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Zamparette CP, Schorner M, Campos E, Moura Q, Cerdeira L, Tartari DC, Sereia AFR, Cunha P, Fontana H, de Oliveira LFV, Grisard EC, Lincopan N, Bazzo ML, Sincero TCM. IncX4 Plasmid-Mediated mcr-1.1 in Polymyxin-Resistant Escherichia coli from Outpatients in Santa Catarina, Southern Brazil. Microb Drug Resist 2020; 26:1326-1333. [PMID: 32004096 DOI: 10.1089/mdr.2019.0203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Plasmid-mediated polymyxin resistance has become a global health concern, not only because its dissemination has occurred drastically but also because it has begun to be reported in multidrug-resistant (MDR) pathogens. We hereby report microbiological and genomic characteristics of two mcr-1.1-positive polymyxin-resistant Escherichia coli isolates identified for the first time in community patients, in Santa Catarina, Southern Brazil. E. coli strains belonging to ST206 and ST354 and the resistome analysis revealed the presence of clinically important genes responsible for MDR profile. Interestingly, in both polymyxin-resistant E. coli strains, mcr-1.1 genes were carried by IncX4 plasmids, responsible for the worldwide dissemination of mcr-type genes. In this regard, plasmid backbones were almost identical to the first IncX4 plasmid reported in Brazil and sharing more than 99.9% identity to IncX4 plasmids from China, also lacking the ISApl1 insertion sequence upstream of mcr-1. In conclusion, these data confirm the presence of international ST206 and ST354 carrying mcr-1.1 genes and that the IncX4 plasmids have been key vectors contributing to the endemic status of mcr-1.1-positive polymyxin-resistant E. coli in Brazil. Also, we described the first known clinical isolate with the mrc1.1 gene in Santa Catarina state, Brazil, showing that plasmid-mediated polymyxin resistance has been affecting humans earlier than has been known so far.
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Affiliation(s)
- Caetana P Zamparette
- Department of Clinical Analysis, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Marcos Schorner
- Department of Clinical Analysis, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Elizandra Campos
- Department of Clinical Analysis, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Quézia Moura
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Louise Cerdeira
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Daniela C Tartari
- Department of Clinical Analysis, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Brazil
| | | | - Patricia Cunha
- Neoprospecta Microbiome Technologies, Florianopolis, Brazil
| | - Herrison Fontana
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | | | - Edmundo C Grisard
- Department of Microbiology, Imunology and Parasitology, Biological Sciences Center, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Nilton Lincopan
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Maria Luiza Bazzo
- Department of Clinical Analysis, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Thaís C M Sincero
- Department of Clinical Analysis, Health Sciences Center, Federal University of Santa Catarina, Florianopolis, Brazil
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22
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Huang H, Dong N, Shu L, Lu J, Sun Q, Chan EWC, Chen S, Zhang R. Colistin-resistance gene mcr in clinical carbapenem-resistant Enterobacteriaceae strains in China, 2014-2019. Emerg Microbes Infect 2020; 9:237-245. [PMID: 31996107 PMCID: PMC7034111 DOI: 10.1080/22221751.2020.1717380] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To investigate whether introduction of colistin into the clinical settings selected colistin-resistant CRE, we performed molecular epidemiological study of 1868 CRE strains collected from different geographical locales in China during the period 2014–2019. 1755 (96.18%) isolates carried the carbapenemase genes blaKPC and blaNDM; 14 Escherichia coli isolates (0.75%) carrying mcr-1 and blaNDM (MCR-CREC) were also identified. Importantly, the number and relative prevalence of MCR-CREC isolates increased from 5 (0.41%) to 9 (1.38%) after introduction of polymyxin into clinical practice. Consistently, results of genetic analysis indicated that MCR-CREC strains collected before December 2017 were genetically diverse, yet those collected after that date exhibited more closely related genetic profiles, indicating that specific MCR-CREC strains were rapidly selected as a result of increased usage of colistin in clinical settings. The resistance level of MCR-CREC isolates to colistin increased after the introduction of polymyxin into clinical use with the MIC to colistin from <2 mg/L in 80% strains to 2 mg/L in 100% strains. Further dissemination of MCR-CREC strains, which exhibit resistance to the last-line drugs of carbapenems and colistin, is expected to pose a severe threat to human health.
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Affiliation(s)
- Hong Huang
- Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, People's Republic of China
| | - Ning Dong
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Lingbin Shu
- Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, People's Republic of China
| | - Jiayue Lu
- Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, People's Republic of China
| | - Qiaoling Sun
- Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, People's Republic of China
| | - Edward Wai-Chi Chan
- Department of Applied Biology and Chemical Technology, State Key Lab of Chemical Biology and Drug Discovery, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Sheng Chen
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Rong Zhang
- Department of Clinical Laboratory, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, People's Republic of China
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23
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Aires CAM, Pereira PS, Rocha-de-Souza CM, Silveira MC, Carvalho-Assef APD, Asensi MD. Population Structure of KPC-2-Producing Klebsiella pneumoniae Isolated from Surveillance Rectal Swabs in Brazil. Microb Drug Resist 2019; 26:652-660. [PMID: 31851584 DOI: 10.1089/mdr.2019.0166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
KPC-producing Klebsiella pneumoniae (KPC-Kp) has become an important public health issue. The previous intestinal colonization by KPC-Kp has been an important risk factor associated with the progression to infections. The objective of this study was to assess the genetic characterization of KPC-Kp isolates recovered from human rectal swabs in Brazil. We selected 102 KPC-Kp isolates collected during 2009-2013 in 11 states. Antimicrobial susceptibility was determined by disk diffusion, E-test, and broth microdilution. The resistance and virulence genes were investigated by PCR. Molecular typing was performed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). The isolates were mostly resistant to β-lactams, sulfonamides, chloramphenicol, quinolones, and aminoglycosides but susceptible to fosfomycin/trometamol, polymyxin B, and tigecycline. The blaKPC-2 was mostly associated with Tn4401b. Besides that, the isolates carried blaCTX-M, blaSHV, blaTEM, and aac(6')-Ib in high frequency and aac(3')IIa and qnr genes in moderate frequency. The PFGE revealed 26 pulsotypes and MLST performed in representative strains revealed 23 sequence types, 45% belonging to clonal complex 258 (CC258). Isolates of CC258 were found in all states. Seventy percent of the 102 KPC-Kp isolates belonged to CC258-associated pulsotypes. We describe the dissemination of KPC-2-Kp associated with Tn4401b belonging to CC258 colonizing patients in Brazil, which is also prevalent in infected patients, suggesting a clear colonization-infection correlation.
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Affiliation(s)
- Caio Augusto Martins Aires
- Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro, Brazil.,Departamento de Ciências da Saúde, Universidade Federal Rural do Semi-Árido (UFERSA), Mossoró, Brazil
| | - Polyana Silva Pereira
- Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Melise Chaves Silveira
- Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Marise Dutra Asensi
- Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro, Brazil
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24
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Ferrari C, Corbella M, Gaiarsa S, Comandatore F, Scaltriti E, Bandi C, Cambieri P, Marone P, Sassera D. Multiple Klebsiella pneumoniae KPC Clones Contribute to an Extended Hospital Outbreak. Front Microbiol 2019; 10:2767. [PMID: 31849904 PMCID: PMC6896718 DOI: 10.3389/fmicb.2019.02767] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/13/2019] [Indexed: 12/20/2022] Open
Abstract
The circulation of carbapenem-resistant Klebsiella pneumoniae (CRKP) is a significant problem worldwide. In this work we characterize the isolates and reconstruct the spread of a multi-clone epidemic event that occurred in an Intensive Care Unit in a hospital in Northern Italy. The event took place from August 2015 to May 2016 and involved 23 patients. Twelve of these patients were colonized by CRKP at the gastrointestinal level, while the other 11 were infected in various body districts. We retrospectively collected data on the inpatients and characterized a subset of the CRKP isolates using antibiotic resistance profiling and whole genome sequencing. A SNP-based phylogenetic approach was used to depict the evolutionary context of the obtained genomes, showing that 26 of the 32 isolates belong to three genome clusters, while the remaining six were classified as sporadic. The first genome cluster was composed of multi-resistant isolates of sequence type (ST) 512. Among those, two were resistant to colistin, one of which indicating the insurgence of resistance during an infection. One patient hospitalized in this period was colonized by two strains of CRKP, both carrying the blaKPC gene (variant KPC-3). The analysis of the genome contig containing the blaKPC locus indicates that the gene was not transmitted between the two isolates. The second infection cluster comprised four other genomes of ST512, while the third one (ST258) colonized 12 patients, causing five clinical infections and resulting in seven deaths. This cluster presented the highest level of antibiotic resistance, including colistin resistance in all 17 analyzed isolates. The three outbreaking clones did not present more virulence genes than the sporadic isolates and had different patterns of antibiotic resistance, however, were clearly distinct from the sporadic ones in terms of infection status, being the only ones causing overt infections.
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Affiliation(s)
- Carolina Ferrari
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marta Corbella
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Biometric and Medical Statistics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Gaiarsa
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Comandatore
- Pediatric Research Center Romeo ed Enrica Invernizzi, University of Milan, Milan, Italy.,Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Erika Scaltriti
- Risk Analysis and Genomic Epidemiology Unit, Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna (IZSLER), Brescia, Italy
| | - Claudio Bandi
- Pediatric Research Center Romeo ed Enrica Invernizzi, University of Milan, Milan, Italy.,Department of Biosciences, University of Milan, Milan, Italy
| | - Patrizia Cambieri
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Piero Marone
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Davide Sassera
- Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy
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25
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Park JY, Heo ST, Kwon KT, Song DY, Lee KJ, Choi JA. MCR1 and KPC2 Co-producing Klebsiella pneumoniae Bacteremia: First Case in Korea. Infect Chemother 2019; 51:399-404. [PMID: 31668026 PMCID: PMC6940374 DOI: 10.3947/ic.2019.51.4.399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/18/2019] [Indexed: 01/17/2023] Open
Abstract
Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) has been disseminating nationwide due to clonal spread and is taking a serious action at the national level in Korea. The mobilized colistin resistance (MCR1) gene confers plasmid-mediated resistance to colistin and is known to be capable of horizontal transfer between different strains of a bacterial species. We have experienced a fatal case of the patient who developed MCR1-possessing, ST307/Tn4401a[blaKPC2] K. pneumonia bacteremia in the community of non-capital region after being diagnosed as pancreatic cancer with multiple liver metastases and treated in the capital region. The ST307/Tn4401a[blaKPC2] K. pneumonia was the most commonly disseminated clone in Korea. Our strain is the first MCR1 and KPC2 co-producing K. pneumonia in Korea and our case is the critical example that the multi-drug resistant clone can cause inter-regional spread and the community-onset fatal infections. Fortunately, our patient was admitted to the intensive care unit on the day of visit, and the contact precaution was well maintained throughout and KPC-KP was not spread to other patients. The high risk patients for KPC-KP need to be screened actively, detected rapidly and preemptively isolated to prevent outbreak of KPC-KP. Inter-facility communications are essential and the nationwide epidemiologic data of KPC-KP should be analyzed and reported regularly to prevent spread of KPC-KP. The prompt identification of species and antimicrobial susceptibilities for successful treatment against KPC-KP should be emphasized as well.
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Affiliation(s)
- Ji Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Taek Heo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Ki Tae Kwon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Do Young Song
- Department of Laboratory Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Kwang Jun Lee
- Division of Antimicrobial Resistance, National Institute of Health, Centers for Disease Control and Prevention, Cheongju, Korea
| | - Ji Ae Choi
- Division of Antimicrobial Resistance, National Institute of Health, Centers for Disease Control and Prevention, Cheongju, Korea
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Rau RB, de Lima-Morales D, Wink PL, Ribeiro AR, Barth AL. Salmonella enterica mcr-1 Positive from Food in Brazil: Detection and Characterization. Foodborne Pathog Dis 2019; 17:202-208. [PMID: 31556704 DOI: 10.1089/fpd.2019.2700] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The mcr-1 gene has been identified in bacterial isolates obtained from humans, animals, environment, and food, including Salmonella spp., which is one of the major foodborne pathogens worldwide. The aim of this study was to evaluate the presence of mcr-1 gene in Salmonella spp. from food produced in Brazil and to characterize the isolates harboring this gene. A total of 490 Salmonella spp. isolates from the Brazilian National Program for the Control of Foodborne Pathogens were screened for the presence of mcr-1 gene by polymerase chain reaction (PCR). Whole genome sequencing (WGS) was performed in positive isolates to characterize the sequence type (ST), plasmid families and resistance genes. Antimicrobial susceptibility tests were performed by broth microdilution. Selected isolates were submitted to conjugation experiments using the Escherichia coli J53 as a receptor. We detected eight isolates harboring the mcr-1 gene; seven belonged to Salmonella enterica serovar Typhimurium and its monophasic variant 4,[5],12:i:-, and one belonged to serovar Saintpaul. Seven of the mcr-1 positive isolates displayed a high rate of resistance to other antibiotics in addition to colistin. Analysis of the WGS indicated that the ST 19 was the most common ST among the mcr-1 positive isolates. The mcr-1 gene was located in an IncX4 plasmid of ∼33 kb, with no additional resistance genes and with high identity with a plasmid obtained from a clinical isolate of E. coli mcr-1 positive in Brazil. All plasmids harboring the mcr-1 gene were able to conjugate. Our results suggest the spread of a single plasmid type in Brazil harboring the mcr-1 among Salmonella spp. The horizontal transfer of this mobile element has been contributing to the spread of the colistin resistance in the country.
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Affiliation(s)
- Renata Batista Rau
- Laboratório Federal de Defesa Agropecuária-RS (LFDA-RS), Ministério da Agricultura, Pecuária e Abastecimento (MAPA), Porto Alegre, Brazil.,Laboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Daiana de Lima-Morales
- Laboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Priscila Lamb Wink
- Laboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Aldemir Reginato Ribeiro
- Laboratório Federal de Defesa Agropecuária-RS (LFDA-RS), Ministério da Agricultura, Pecuária e Abastecimento (MAPA), Porto Alegre, Brazil
| | - Afonso Luis Barth
- Laboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Programa de Pós-Graduação em Ciências Farmacêuticas (PPGCF), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Mendes Oliveira VR, Paiva MC, Lima WG. Plasmid-mediated colistin resistance in Latin America and Caribbean: A systematic review. Travel Med Infect Dis 2019; 31:101459. [DOI: 10.1016/j.tmaid.2019.07.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 11/29/2022]
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Acquired Resistance to Colistin via Chromosomal And Plasmid-Mediated Mechanisms in Klebsiella pneumoniae. ACTA ACUST UNITED AC 2019. [DOI: 10.1097/im9.0000000000000002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhang R, Hu YY, Zhou HW, Wang SL, Shu LB, Chen GX. Emergence of mcr-1 and the tet(A) variant in a Klebsiella pneumoniae isolate from the faeces of a healthy person. J Med Microbiol 2019; 68:1267-1268. [PMID: 31329094 DOI: 10.1099/jmm.0.000932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Rong Zhang
- Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou, PR China
| | - Yan-Yan Hu
- Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou, PR China
| | - Hong-Wei Zhou
- Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou, PR China
| | - Shao-Lin Wang
- College of Veterinary Medicine, China Agricultural University, Beijing, PR China
| | - Ling-Bin Shu
- Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou, PR China
| | - Gong-Xiang Chen
- Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou, PR China
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Bartley PS, Domitrovic TN, Moretto VT, Santos CS, Ponce-Terashima R, Reis MG, Barbosa LM, Blanton RE, Bonomo RA, Perez F. Antibiotic Resistance in Enterobacteriaceae from Surface Waters in Urban Brazil Highlights the Risks of Poor Sanitation. Am J Trop Med Hyg 2019; 100:1369-1377. [PMID: 30994094 PMCID: PMC6553890 DOI: 10.4269/ajtmh.18-0726] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/30/2018] [Indexed: 01/11/2023] Open
Abstract
Surface waters are an unappreciated reservoir of antimicrobial resistance (AMR). Poor sanitation brings different species of environmental bacteria into contact, facilitating horizontal gene transfer. To investigate the role of surface waters as potential reservoirs of AMR, we studied the point prevalence of fecal contamination, AMR genes, and Enterobacteriaceae in an urban lake and rural river system in Northeast Brazil in comparison with a lake and sewer system in Northeast Ohio in the United States. Surface water samples were examined for evidence of human fecal contamination using microbial source tracking and screened for plasmid-mediated fluoroquinolone resistance and carbapenemase genes. Enterobacteriaceae were detected using selective agar followed by antimicrobial susceptibility testing and detection of AMR genes by microarray, and classified by repetitive sequence-based polymerase chain reaction and multilocus sequence typing. Concentrations of human fecal bacteria in the Brazilian urban lake and sewage in Northeast Ohio were similarly high. Filtered water samples from the Brazilian urban lake, however, showed the presence of bla OXA-48, bla KPC, bla VIM-2, qnrS, and aac(6')-lb-cr, whereas only bla VIM-2 was identified in raw sewage from Northeast Ohio. From the Brazilian urban lake, 85% of the Enterobacteriaceae (n = 40) cultured were resistant to at least one clinically important antibiotic, including ST131 Escherichia coli harboring the extended-spectrum beta-lactamase CTX-M. Although two isolates demonstrated polymyxin resistance, mcr-1/2 was not detected. Our findings indicate that surface waters in an urban Brazilian site can serve as an environmental reservoir of AMR and that improving wastewater treatment and sanitation generally may ameliorate AMR dissemination.
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Affiliation(s)
- Patricia S. Bartley
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - T. Nicholas Domitrovic
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
| | | | | | - Rafael Ponce-Terashima
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Mitermayer G. Reis
- Laboratory Oswaldo Cruz Foundation, Salvador, Brazil
- Division of Infectious Diseases, School of Medicine and Public Health, Bahiana University, Salvador, Brazil
| | - Lucio M. Barbosa
- Laboratory Oswaldo Cruz Foundation, Salvador, Brazil
- Division of Infectious Diseases, School of Medicine and Public Health, Bahiana University, Salvador, Brazil
| | - Ronald E. Blanton
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Robert A. Bonomo
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Biochemistry, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Medical Service and Geriatrics Research, Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
- Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Case Western Reserve University, Cleveland, Ohio
| | - Federico Perez
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
- Medical Service and Geriatrics Research, Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
- Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Case Western Reserve University, Cleveland, Ohio
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Abstract
Polymyxins are important lipopeptide antibiotics that serve as the last-line defense against multidrug-resistant (MDR) Gram-negative bacterial infections. Worryingly, the clinical utility of polymyxins is currently facing a serious threat with the global dissemination of mcr, plasmid-mediated polymyxin resistance. The first plasmid-mediated polymyxin resistance gene, termed as mcr-1 was identified in China in November 2015. Following its discovery, isolates carrying mcr, mainly mcr-1 and less commonly mcr-2 to -7, have been reported across Asia, Africa, Europe, North America, South America and Oceania. This review covers the epidemiological, microbiological and genomics aspects of this emerging threat to global human health. The mcr has been identified in various species of Gram-negative bacteria including Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Salmonella enterica, Cronobacter sakazakii, Kluyvera ascorbata, Shigella sonnei, Citrobacter freundii, Citrobacter braakii, Raoultella ornithinolytica, Proteus mirabilis, Aeromonas, Moraxella and Enterobacter species from animal, meat, food product, environment and human sources. More alarmingly is the detection of mcr in extended-spectrum-β-lactamases- and carbapenemases-producing bacteria. The mcr can be carried by different plasmids, demonstrating the high diversity of mcr plasmid reservoirs. Our review analyses the current knowledge on the emergence of mcr-mediated polymyxin resistance.
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Affiliation(s)
- Sue C Nang
- a Department of Microbiology, Monash Biomedicine Discovery Institute , Monash University , Melbourne , Australia
| | - Jian Li
- a Department of Microbiology, Monash Biomedicine Discovery Institute , Monash University , Melbourne , Australia
| | - Tony Velkov
- b Department of Pharmacology and Therapeutics, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences , The University of Melbourne , Parkville , Australia
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da Silva IR, Aires CAM, Conceição-Neto OC, de Oliveira Santos IC, Ferreira Pereira N, Moreno Senna JP, Carvalho-Assef APD, Asensi MD, Rocha-de-Souza CM. Distribution of Clinical NDM-1-Producing Gram-Negative Bacteria in Brazil. Microb Drug Resist 2019; 25:394-399. [PMID: 30676240 DOI: 10.1089/mdr.2018.0240] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
New Delhi metallo-β-lactamase (NDM)-producing bacteria have been identified at a worrying rate in Brazil since 2013. Owing to the need to understand the extent of their spread, this study reports the dissemination of blaNDM in different species of Gram-negative bacilli in different regions and states of Brazil. A total of 81 isolates from nine states were studied, including 11 species. All isolates carried blaNDM-1 variant and were considered multidrug resistant. Colistin and amikacin were the agents with higher activity compared with the other drugs tested. The findings indicate that the NDM-1 enzyme is already widespread in the country.
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Affiliation(s)
- Isadora Rodrigues da Silva
- 1 Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Brasil
| | - Caio Augusto Martins Aires
- 1 Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Brasil.,2 Departamento de Ciências da Saúde, Universidade Federal Rural do Semi-Árido (UFERSA), Mossoró, Brasil
| | | | | | - Natacha Ferreira Pereira
- 1 Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Brasil
| | - José Procópio Moreno Senna
- 3 Laboratório de Tecnologia Recombinante (LATER), Instituto de Tecnologia de Imunobiológicos-Fiocruz, Rio de Janeiro, Brasil
| | | | - Marise Dutra Asensi
- 1 Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, Brasil
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First report of mcr-1-harboring Salmonella enterica serovar Schwarzengrund isolated from poultry meat in Brazil. Diagn Microbiol Infect Dis 2018; 93:376-379. [PMID: 30477952 DOI: 10.1016/j.diagmicrobio.2018.10.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 10/03/2018] [Accepted: 10/24/2018] [Indexed: 11/22/2022]
Abstract
Brazilian poultry meat samples were screened for colistin-resistant Salmonella enterica. Sixty Salmonella isolates were tested for in vitro colistin resistance and mcr-1, mcr-2, mcr-3 and mcr-4 genes. Two isolates harbored the mcr-1 gene and whole-genome analysis determined the serovar to be Schwarzengrund, ST96, harboring the IncX4 plasmid. This is the first report of mcr-1-harboring Salmonella enterica serovar Schwarzengrund in Brazil.
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Giani T, Sennati S, Antonelli A, Di Pilato V, di Maggio T, Mantella A, Niccolai C, Spinicci M, Monasterio J, Castellanos P, Martinez M, Contreras F, Balderrama Villaroel D, Damiani E, Maury S, Rocabado R, Pallecchi L, Bartoloni A, Rossolini GM. High prevalence of carriage of mcr-1-positive enteric bacteria among healthy children from rural communities in the Chaco region, Bolivia, September to October 2016. Euro Surveill 2018; 23. [PMID: 30424831 PMCID: PMC6234532 DOI: 10.2807/1560-7917.es.2018.23.45.1800115] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundThe mcr-1 gene is a transferable resistance determinant against colistin, a last-resort antimicrobial for infections caused by multi-resistant Gram-negatives.AimTo study carriage of antibiotic-resistant bacteria in healthy school children as part of a helminth control and antimicrobial resistance survey in the Bolivian Chaco region.MethodsFrom September to October 2016 we collected faecal samples from healthy children in eight rural villages. Samples were screened for mcr-1- and mcr-2 genes. Antimicrobial susceptibility testing was performed, and a subset of 18 isolates representative of individuals from different villages was analysed by whole genome sequencing (WGS).ResultsWe included 337 children (mean age: 9.2 years, range: 7-11; 53% females). The proportion of mcr-1 carriers was high (38.3%) and present in all villages; only four children had previous antibiotic exposure. One or more mcr-1-positive isolates were recovered from 129 positive samples, yielding a total of 173 isolates (171 Escherichia coli, 1 Citrobacter europaeus, 1 Enterobacter hormaechei). No mcr-2 was detected. Co-resistance to other antimicrobials varied in mcr-positive E. coli. All 171 isolates were susceptible to carbapenems and tigecycline; 41 (24.0%) were extended-spectrum β-lactamase producers and most of them (37/41) carried blaCTX-M-type genes. WGS revealed heterogeneity of clonal lineages and mcr-genetic supports.ConclusionThis high prevalence of mcr-1-like carriage, in absence of professional exposure, is unexpected. Its extent at the national level should be investigated with priority. Possible causes should be studied; they may include unrestricted use of colistin in veterinary medicine and animal breeding, and importation of mcr-1-positive bacteria via food and animals.
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Affiliation(s)
- Tommaso Giani
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Samanta Sennati
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alberto Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Vincenzo Di Pilato
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Tiziana di Maggio
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Antonia Mantella
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Claudia Niccolai
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Joaquín Monasterio
- Servicio Departamental de Salud (SEDES) de Santa Cruz, Santa Cruz, Bolivia
| | - Paul Castellanos
- Servicio Departamental de Salud (SEDES) de Tarija, Tarija, Bolivia
| | - Mirtha Martinez
- Servicio Nacional de Sanidad Agropecuaria e Inocuidad Alimentaria (SENASAG), Ministerio de Desarrollo Rural y Tierras, Santa Cruz, Bolivia
| | - Fausto Contreras
- Servicio Nacional de Sanidad Agropecuaria e Inocuidad Alimentaria (SENASAG), Ministerio de Desarrollo Rural y Tierras, Santa Cruz, Bolivia
| | - Dorian Balderrama Villaroel
- Servicio Nacional de Sanidad Agropecuaria e Inocuidad Alimentaria (SENASAG), Ministerio de Desarrollo Rural y Tierras, Santa Cruz, Bolivia
| | - Esther Damiani
- Instituto Nacional de Laboratorios de Salud (INLASA), Ministerio de Salud, La Paz, Bolivia
| | - Sdenka Maury
- Unidad Epidemiología, Ministerio de Salud, La Paz, Bolivia
| | - Rodolfo Rocabado
- Servicios Generales de Salud, Ministerio de Salud, La Paz, Bolivia
| | - Lucia Pallecchi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Gian Maria Rossolini
- Clinical Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Lorenzoni VV, Dalmolin TV, Franco LN, Barth AL, Hörner R. Bloodstream infection by mcr-1-harboring Escherichia coli in a cancer patient in southern Brazil. Braz J Infect Dis 2018; 22:356-357. [PMID: 30092177 PMCID: PMC9428017 DOI: 10.1016/j.bjid.2018.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/03/2018] [Accepted: 07/09/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Vinícius Victor Lorenzoni
- Universidade Federal de Santa Maria, Departamento de Análises Clínicas e Toxicológicas, Laboratório de Bacteriologia, Santa Maria, RS, Brazil; Universidade Federal de Santa Maria, Programa de Pós-Graduação em Ciências Farmacêuticas, Santa Maria, RS, Brazil
| | - Tanise Vendruscolo Dalmolin
- Hospital de Clínicas, LABRESIS - Laboratório de Pesquisa em Resistência Bacteriana, Porto Alegre, RS, Brazil
| | - Laísa Nunes Franco
- Universidade Federal de Santa Maria, Departamento de Análises Clínicas e Toxicológicas, Laboratório de Bacteriologia, Santa Maria, RS, Brazil
| | - Afonso Luis Barth
- Hospital de Clínicas, LABRESIS - Laboratório de Pesquisa em Resistência Bacteriana, Porto Alegre, RS, Brazil
| | - Rosmari Hörner
- Universidade Federal de Santa Maria, Departamento de Análises Clínicas e Toxicológicas, Laboratório de Bacteriologia, Santa Maria, RS, Brazil; Universidade Federal de Santa Maria, Programa de Pós-Graduação em Ciências Farmacêuticas, Santa Maria, RS, Brazil.
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Genetic and Functional Characterization of an MCR-3-Like Enzyme-Producing Escherichia coli Isolate Recovered from Swine in Brazil. Antimicrob Agents Chemother 2018; 62:AAC.00278-18. [PMID: 29712655 DOI: 10.1128/aac.00278-18] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/13/2018] [Indexed: 11/20/2022] Open
Abstract
A collection of 126 pigs was screened for carriage of colistin-resistant Enterobacteriaceae in a farm in Minas Gerais, Brazil. Out of this collection, eight colistin-resistant Escherichia coli isolates were recovered, including one from Minas Gerais State producing a new MCR-3 variant (MCR-3.12). Analysis of the lipopolysaccharide revealed that MCR-3.12 had a function similar to that of MCR-1 and MCR-2 as a result of the addition of a phosphoethanolamine group to the lipid A moiety. Genetic analysis showed that the mcr-3.12 gene was carried by an IncA/C2 plasmid and was embedded in an original genetic environment. This study reports the occurrence of the MCR-3-like determinant in South America and is the first to demonstrate the functionality of this group of enzymes as a phosphoethanolamine transferase.
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Quiroga C, Nastro M, Di Conza J. Current scenario of plasmid-mediated colistin resistance in Latin America. Rev Argent Microbiol 2018; 51:93-100. [PMID: 29945744 DOI: 10.1016/j.ram.2018.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/15/2018] [Accepted: 05/09/2018] [Indexed: 11/30/2022] Open
Abstract
Colistin resistance can occur by chromosomal mutations and by acquisition of plasmid-carrying determinants, mainly mcr-1. In the recent years, we have observed the outburst of this resistance gene in our region. Due to the risk of the rapid dissemination of mcr-1, this finding has worried and alerted different actors from the health field and has become one of the most prolific topics. Our review compiles available reports of well-documented mcr-1-positive strains of Enterobacteriaceae, obtained from different samples in Argentina and other countries of Latin America. Furthermore, it addresses the association of mcr-1 with ESBL resistance markers and outlines the platforms involved in their dissemination.
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Affiliation(s)
- Cecilia Quiroga
- Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Tecnológicas, Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPAM), Facultad de Medicina, Paraguay 2155, C1121ABG, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290 (1425), Ciudad Autónoma de Buenos Aires, Argentina
| | - Marcela Nastro
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Junín 954, C1113AAD, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - José Di Conza
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Junín 954, C1113AAD, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290 (1425), Ciudad Autónoma de Buenos Aires, Argentina.
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Carbapenem-susceptible Escherichia coli ST3901 carrying mcr-1 and bla CTX-M genes isolated from a diabetic foot infection in Brazil. J Glob Antimicrob Resist 2018; 13:209-210. [PMID: 29753756 DOI: 10.1016/j.jgar.2018.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 04/27/2018] [Accepted: 05/03/2018] [Indexed: 11/20/2022] Open
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New therapy from old drugs: synergistic bactericidal activity of sulfadiazine with colistin against colistin-resistant bacteria, including plasmid-mediated colistin-resistant mcr-1 isolates. Int J Antimicrob Agents 2018; 51:775-783. [DOI: 10.1016/j.ijantimicag.2018.01.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/25/2018] [Accepted: 01/29/2018] [Indexed: 01/02/2023]
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40
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Siljander MP, Sobh AH, Baker KC, Baker EA, Kaplan LM. Multidrug-Resistant Organisms in the Setting of Periprosthetic Joint Infection-Diagnosis, Prevention, and Treatment. J Arthroplasty 2018; 33:185-194. [PMID: 28869114 DOI: 10.1016/j.arth.2017.07.045] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 07/22/2017] [Accepted: 07/25/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a rare yet challenging problem in total hip and knee arthroplasties. The management of PJI remains difficult primarily due to the evolution of resistance by the infecting organisms. METHODS This review profiles acquired mechanisms of bacterial resistance and summarizes established and emerging techniques in PJI diagnosis, prevention, and treatment. RESULTS New techniques in PJI diagnosis and prevention continue to be explored. Antibiotics combined with 1 or 2-stage revision are associated with the higher success rates and remain the mainstay of treatment. CONCLUSION With higher prevalence of antibiotic-resistant organisms, novel antibiotic implant and wound care materials, improved methods for organism identification, and well-defined organism-specific treatment algorithms are needed to optimize outcomes of PJI.
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Affiliation(s)
- Matthew P Siljander
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, Michigan
| | - Ali H Sobh
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, Michigan
| | - Kevin C Baker
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, Michigan
| | - Erin A Baker
- Department of Orthopaedic Research, Beaumont Health System, Royal Oak, Michigan
| | - Lige M Kaplan
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, Michigan
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Rau RB, de Lima-Morales D, Wink PL, Ribeiro AR, Martins AF, Barth AL. Emergence of mcr-1 Producing Salmonella enterica serovar Typhimurium from Retail Meat: First Detection in Brazil. Foodborne Pathog Dis 2017; 15:58-59. [PMID: 29048947 DOI: 10.1089/fpd.2017.2346] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Renata Batista Rau
- 1 LANAGRO-RS, Laboratório Nacional Agropecuário no Rio Grande do Sul , Porto Alegre, Brazil
- 2 LABRESIS, Laboratory de Pesquisa em Resistência Bacteriana, HCPA-Hospital de Clínicas de Porto Alegre , Porto Alegre, Brazil
| | - Daiana de Lima-Morales
- 2 LABRESIS, Laboratory de Pesquisa em Resistência Bacteriana, HCPA-Hospital de Clínicas de Porto Alegre , Porto Alegre, Brazil
| | - Priscila Lamb Wink
- 2 LABRESIS, Laboratory de Pesquisa em Resistência Bacteriana, HCPA-Hospital de Clínicas de Porto Alegre , Porto Alegre, Brazil
| | | | - Andreza Francisco Martins
- 2 LABRESIS, Laboratory de Pesquisa em Resistência Bacteriana, HCPA-Hospital de Clínicas de Porto Alegre , Porto Alegre, Brazil
- 3 ICBS-Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul , Porto Alegre, Brazil
| | - Afonso Luis Barth
- 2 LABRESIS, Laboratory de Pesquisa em Resistência Bacteriana, HCPA-Hospital de Clínicas de Porto Alegre , Porto Alegre, Brazil
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Acquisition of the mcr-1 gene by a high-risk clone of KPC-2-producing Klebsiella pneumoniae ST437/CC258, Brazil. Diagn Microbiol Infect Dis 2017; 90:132-133. [PMID: 29169659 DOI: 10.1016/j.diagmicrobio.2017.09.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/24/2017] [Accepted: 09/18/2017] [Indexed: 11/20/2022]
Abstract
We identified one clinical isolate of K. pneumoniae harboring the mcr 1 (plasmid of IncX4 family) and blaKPC-2 (plasmid of IncFIB family) genes in southern Brazil. These findings highlight that K. pneumoniae isolates carrying both mcr-1 and blaKPC-2 may emergence as a serious threat to antimicrobial therapy.
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Detection of Colistin-Resistant MCR-1-Positive Escherichia coli by Use of Assays Based on Inhibition by EDTA and Zeta Potential. J Clin Microbiol 2017; 55:3454-3465. [PMID: 28978685 DOI: 10.1128/jcm.00835-17] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/28/2017] [Indexed: 01/05/2023] Open
Abstract
The emergence and rapid dissemination of colistin-resistant Escherichia coli carrying the plasmid-mediated mcr-1 gene have created an urgent need to develop specific screening methods. In this study, we evaluated four assays based on the inhibition of MCR-1 activity by EDTA: (i) a combined-disk test (CDT) comparing the inhibition zones of colistin and colistin (10 μg) plus EDTA (100 mM); (ii) reduction of colistin MIC (CMR) in the presence of EDTA (80 μg/ml); (iii) a modified rapid polymyxin Nordmann/Poirel test (MPNP); and (iv) alteration of zeta potential (RZP = ZP+EDTA/ZP-EDTA). We obtained encouraging results for the detection of MCR-1 in E. coli isolates recovered from human, food, and animal samples, using the following assay parameters: ≥3 mm difference in the inhibition zones between colistin disks without and with EDTA; ≥4-fold colistin MIC decrease in the presence of EDTA; RZP of ≥2.5; and the absence of metabolic activity and proliferation, indicated by unchanged color of phenol red in the presence of colistin-EDTA, in the MPNP test. In this regard, the CDT, CMR, RZP, and MPNP assays exhibited sensitivities of 96.7, 96.7, 95.1, and 96.7% and specificities of 89.6, 83.3, 100, and 100%, respectively, for detecting MCR-1-positive E. coli Our results demonstrate that inhibition by EDTA and zeta potential assays may provide simple and inexpensive methods for the presumptive detection of MCR-1-producing E. coli isolates in human and veterinary diagnostic laboratories.
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Rossi F, Girardello R, Morais C, Cury AP, Martins LF, da Silva AM, Abdala E, Setubal JC, da Silva Duarte AJ. Plasmid-mediated mcr-1 in carbapenem-susceptible Escherichia coli ST156 causing a blood infection: an unnoticeable spread of colistin resistance in Brazil? Clinics (Sao Paulo) 2017; 72:642-644. [PMID: 29160428 PMCID: PMC5666441 DOI: 10.6061/clinics/2017(10)09] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/30/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We describe an IncX4 pHC891/16mcr plasmid carrying mcr-1 in a colistin-resistant and carbapenem-susceptible E. coli isolate (HC891/16), ST156, which caused a blood infection in a Brazilian patient with gallbladder adenocarcinoma. METHODS Strain HC891/16 was subjected to whole genome sequencing using the MiSeq Platform (Illumina, Inc., USA). Assembly was performed using Mira and ABACAS. RESULTS The isolates showed resistance only to ciprofloxacin, ampicillin and cefoxitin, and whole-genome sequencing revealed the presence of aac(6')Ib-cr and blaTEM1. CONCLUSION Our findings warn of the possible silent dissemination of colistin resistance by carbapenem-susceptible mcr-1 producers, as colistin susceptibility is commonly tested only among carbapenem-resistant isolates.
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Affiliation(s)
- Flavia Rossi
- Divisao Laboratorio Central – LIM03, Setor de Microbiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Raquel Girardello
- Divisao Laboratorio Central – LIM03, Setor de Microbiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Carlos Morais
- Departamento de Bioquímica, Instituto de Química, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Nucleo de Apoio a Pesquisa em Biologia Computacional e Genomica (NUBIC), Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ana Paula Cury
- Divisao Laboratorio Central – LIM03, Setor de Microbiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Layla Farage Martins
- Departamento de Bioquímica, Instituto de Química, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Aline Maria da Silva
- Departamento de Bioquímica, Instituto de Química, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Edson Abdala
- Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - João Carlos Setubal
- Departamento de Bioquímica, Instituto de Química, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Nucleo de Apoio a Pesquisa em Biologia Computacional e Genomica (NUBIC), Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alberto José da Silva Duarte
- Divisao Laboratorio Central – LIM03, Setor de Microbiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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