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Azargun R, Gholizadeh P, Sadeghi V, Hosainzadegan H, Tarhriz V, Memar MY, Pormohammad A, Eyvazi S. Molecular mechanisms associated with quinolone resistance in Enterobacteriaceae: review and update. Trans R Soc Trop Med Hyg 2021; 114:770-781. [PMID: 32609840 DOI: 10.1093/trstmh/traa041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/09/2020] [Accepted: 05/20/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Quinolones are broad-spectrum antibiotics, which are used for the treatment of different infectious diseases associated with Enterobacteriaceae. During recent decades, the wide use as well as overuse of quinolones against diverse infections has led to the emergence of quinolone-resistant bacterial strains. Herein, we present the development of quinolone antibiotics, their function and also the different quinolone resistance mechanisms in Enterobacteriaceae by reviewing recent literature. METHODS All data were extracted from Google Scholar search engine and PubMed site, using keywords; quinolone resistance, Enterobacteriaceae, plasmid-mediated quinolone resistance, etc. RESULTS AND CONCLUSION The acquisition of resistance to quinolones is a complex and multifactorial process. The main resistance mechanisms consist of one or a combination of target-site gene mutations altering the drug-binding affinity of target enzymes. Other mechanisms of quinolone resistance are overexpression of AcrAB-tolC multidrug-resistant efflux pumps and downexpression of porins as well as plasmid-encoded resistance proteins including Qnr protection proteins, aminoglycoside acetyltransferase (AAC(6')-Ib-cr) and plasmid-encoded active efflux pumps such as OqxAB and QepA. The elucidation of resistance mechanisms will help researchers to explore new drugs against the resistant strains.
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Affiliation(s)
- Robab Azargun
- Department of Microbiology, Faculty of Medicine, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Pourya Gholizadeh
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Sadeghi
- Faculty of Veterinary Medicine, Islamic Azad University, Urmia, Iran
| | - Hasan Hosainzadegan
- Department of Microbiology, Faculty of Medicine, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Vahideh Tarhriz
- Molecular Medicine Research Center, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Yousef Memar
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Pormohammad
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shirin Eyvazi
- Department of Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kim JO, Yoo IY, Yu JK, Kwon JA, Kim SY, Park YJ. Predominance and clonal spread of CTX-M-15 in cefotaxime-resistant Klebsiella pneumoniae in Korea and their association with plasmid-mediated quinolone resistance determinants. J Infect Chemother 2021; 27:1186-1192. [PMID: 33814350 DOI: 10.1016/j.jiac.2021.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/03/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION β-lactams and fluoroquinolones are extensively used worldwide in the treatment of infections caused by Enterobacterales. In this study, we investigated the prevalence of extended-spectrum β-lactamases (ESBL), their correlation with plasmid-mediated quinolone resistance determinants (PMQR) and clonal distribution among the cefotaxime-resistant K. pneumoniae isolates. METHODS In Korea, a total of 429 K. pneumoniae collected in 2015 were studied. Antimicrobial susceptibility test for cefotaxime, ciprofloxacin and levofloxacin was performed by broth microdilution method. By PCR and/or sequencing, mutations in gyrA and parC genes, PMQR genes and ESBL were identified. Multilocus-sequence-type (MLST) was determined for isolates harboring CTX-M-15. RESULTS Among the 149 K. pneumoniae showing cefotaxime MICs of >1 μg/ml, 142 (95.3%) isolates were ESBL-producers and CTX-M-15 was predominant (99 isolates). Among the 142 ESBL-producers, mutations in gyrA and parC were found in 112 (78.9%) and 93 isolates (65.5%), respectively. PMQR genes were detected in 141 isolates and the non-susceptibility rate to ciprofloxacin and levofloxacin was 95.1% (135/142) and 82.4% (117/142), respectively. The most frequently found PMQR combination was qnrB-aac(6')-Ib-cr-oqxAB, (58/142, 40.8%). By MLST, four major STs/CC: ST48, ST392, ST307 and CC15 accounted for 67% of the CTX-M-15 producers and the prevalence of qnrB was significantly higher in these four major STs/CC than other groups (P = 0.004). Of note, we found the additive effect of PMQR genes; the more PMQR genes, the higher ciprofloxacin MICs. CONCLUSIONS CTX-M-15 was predominant among the cefotaxime-resistant K. pneumoniae and co-harboring CTX-M-15 and PMQR genes, especially qnrB, seems to contribute the spread of high risk clones.
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Affiliation(s)
- Jung Ok Kim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - In Young Yoo
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jin Kyung Yu
- Department of Infectious Disease Team, Seoul Metropolitan Government Research Institute of Public Health and Environment, Gwacheon, Republic of Korea
| | - Joo An Kwon
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Soo Young Kim
- Department of Laboratory Mediicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yeon-Joon Park
- Department of Laboratory Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
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Inventory of Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae in France as Assessed by a Multicenter Study. Antimicrob Agents Chemother 2017; 61:AAC.01911-16. [PMID: 27956424 DOI: 10.1128/aac.01911-16] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/02/2016] [Indexed: 11/20/2022] Open
Abstract
The objective of this study was to perform an inventory of the extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae isolates responsible for infections in French hospitals and to assess the mechanisms associated with ESBL diffusion. A total of 200 nonredundant ESBL-producing Enterobacteriaceae strains isolated from clinical samples were collected during a multicenter study performed in 18 representative French hospitals. Antibiotic resistance genes were identified by PCR and sequencing experiments. The clonal relatedness between isolates was investigated by the use of the DiversiLab system. ESBL-encoding plasmids were compared by PCR-based replicon typing and plasmid multilocus sequence typing. CTX-M-15, CTX-M-1, CTX-M-14, and SHV-12 were the most prevalent ESBLs (8% to 46.5%). The three CTX-M-type EBSLs were significantly observed in Escherichia coli (37.1%, 24.2%, and 21.8%, respectively), and CTX-M-15 was the predominant ESBL in Klebsiella pneumoniae (81.1%). SHV-12 was associated with ESBL-encoding Enterobacter cloacae strains (37.9%). qnrB, aac(6')-Ib-cr, and aac(3)-II genes were the main plasmid-mediated resistance genes, with prevalences ranging between 19.5% and 45% according to the ESBL results. Molecular typing did not identify wide clonal diffusion. Plasmid analysis suggested the diffusion of low numbers of ESBL-encoding plasmids, especially in K. pneumoniae and E. cloacae However, the ESBL-encoding genes were observed in different plasmid replicons according to the bacterial species. The prevalences of ESBL subtypes differ according to the Enterobacteriaceae species. Plasmid spread is a key determinant of this epidemiology, and the link observed between the ESBL-encoding plasmids and the bacterial host explains the differences observed in the Enterobacteriaceae species.
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Multidrug Resistant CTX-M-Producing Escherichia coli: A Growing Threat among HIV Patients in India. J Pathog 2016; 2016:4152704. [PMID: 27123344 PMCID: PMC4829713 DOI: 10.1155/2016/4152704] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/06/2016] [Indexed: 12/01/2022] Open
Abstract
Extended Spectrum β-Lactamases (ESBLs) confer resistance to third-generation cephalosporins and CTX-M types have emerged as the most prominent ESBLs worldwide. This study was designed to determine the prevalence of CTX-M positive ESBL-producing urinary E. coli isolates from HIV patients and to establish the association of multidrug resistance, phylogeny, and virulence profile with CTX-M production. A total of 57 ESBL producers identified among 76 E. coli strains isolated from HIV patients from South India were screened for blaCTX-M, AmpC production, multidrug resistance, and nine virulence associated genes (VAGs), fimH, pap, afa/dra, sfa/foc, iutA, fyuA, iroN, usp, and kpsMII. The majority (70.2%) of the ESBL producers harbored blaCTX-M and were AmpC coproducers. Among the CTX-M producers, 47.5% were found to be UPEC, 10% harbored as many as 7 VAGs, and 45% possessed kpsMII. Multidrug resistance (CIPRSXTRGENR) was significantly more common among the CTX-M producers compared to the nonproducers (70% versus 41.2%). However, 71.4% of the multidrug resistant CTX-M producers exhibited susceptibility to nitrofurantoin thereby making it an effective alternative to cephalosporins/fluoroquinolones. The emergence of CTX-M-producing highly virulent, multidrug resistant uropathogenic E. coli is of significant public health concern in countries like India with a high burden of HIV/AIDS.
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Abstract
Three mechanisms for plasmid-mediated quinolone resistance (PMQR) have been discovered since 1998. Plasmid genes qnrA, qnrB, qnrC, qnrD, qnrS, and qnrVC code for proteins of the pentapeptide repeat family that protects DNA gyrase and topoisomerase IV from quinolone inhibition. The qnr genes appear to have been acquired from chromosomal genes in aquatic bacteria, are usually associated with mobilizing or transposable elements on plasmids, and are often incorporated into sul1-type integrons. The second plasmid-mediated mechanism involves acetylation of quinolones with an appropriate amino nitrogen target by a variant of the common aminoglycoside acetyltransferase AAC(6')-Ib. The third mechanism is enhanced efflux produced by plasmid genes for pumps QepAB and OqxAB. PMQR has been found in clinical and environmental isolates around the world and appears to be spreading. The plasmid-mediated mechanisms provide only low-level resistance that by itself does not exceed the clinical breakpoint for susceptibility but nonetheless facilitates selection of higher-level resistance and makes infection by pathogens containing PMQR harder to treat.
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Le V, Nhu NTK, Cerdeno-Tarraga A, Campbell JI, Tuyen HT, Nhu TDH, Tam PTT, Schultsz C, Thwaites G, Thomson NR, Baker S. Genetic characterization of three qnrS1-harbouring multidrug-resistance plasmids and qnrS1-containing transposons circulating in Ho Chi Minh City, Vietnam. J Med Microbiol 2015; 64:869-878. [PMID: 26272054 PMCID: PMC4635468 DOI: 10.1099/jmm.0.000100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Plasmid-mediated quinolone resistance (PMQR) refers to a family of closely related genes that confer decreased susceptibility to fluoroquinolones. PMQR genes are generally associated with integrons and/or plasmids that carry additional antimicrobial resistance genes active against a range of antimicrobials. In Ho Chi Minh City (HCMC), Vietnam, we have previously shown a high frequency of PMQR genes within commensal Enterobacteriaceae. However, there are limited available sequence data detailing the genetic context in which the PMQR genes reside, and a lack of understanding of how these genes spread across the Enterobacteriaceae. Here, we aimed to determine the genetic background facilitating the spread and maintenance of qnrS1, the dominant PMQR gene circulating in HCMC. We sequenced three qnrS1-carrying plasmids in their entirety to understand the genetic context of these qnrS1-embedded plasmids and also the association of qnrS1-mediated quinolone resistance with other antimicrobial resistance phenotypes. Annotation of the three qnrS1-containing plasmids revealed a qnrS1-containing transposon with a closely related structure. We screened 112 qnrS1-positive commensal Enterobacteriaceae isolated in the community and in a hospital in HCMC to detect the common transposon structure. We found the same transposon structure to be present in 71.4 % (45/63) of qnrS1-positive hospital isolates and in 36.7 % (18/49) of qnrS1-positive isolates from the community. The resulting sequence analysis of the qnrS1 environment suggested that qnrS1 genes are widely distributed and are mobilized on elements with a common genetic background. Our data add additional insight into mechanisms that facilitate resistance to multiple antimicrobials in Gram-negative bacteria in Vietnam.
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Affiliation(s)
- Vien Le
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, CA, USA
| | - Nguyen Thi Khanh Nhu
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Australia
| | | | - James I Campbell
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK
| | - Ha Thanh Tuyen
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Do Hoang Nhu
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Pham Thi Thanh Tam
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Constance Schultsz
- Department of Medical Microbiology, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Guy Thwaites
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK
| | - Nicholas R Thomson
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK.,London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen Baker
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.,Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,London School of Hygiene and Tropical Medicine, London, UK
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Meireles D, Leite-Martins L, Bessa LJ, Cunha S, Fernandes R, de Matos A, Manaia CM, Martins da Costa P. Molecular characterization of quinolone resistance mechanisms and extended-spectrum β-lactamase production in Escherichia coli isolated from dogs. Comp Immunol Microbiol Infect Dis 2015; 41:43-8. [PMID: 25999092 DOI: 10.1016/j.cimid.2015.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 04/26/2015] [Accepted: 04/28/2015] [Indexed: 01/30/2023]
Abstract
The increasing prevalence of antimicrobial resistances is now a worldwide problem. Investigating the mechanisms by which pets harboring resistant strains may receive and/or transfer resistance determinants is essential to better understanding how owners and pets can interact safely. Here, we characterized the genetic determinants conferring resistance to β-lactams and quinolones in 38 multidrug-resistant Escherichia coli isolated from fecal samples of dogs, through PCR and sequencing. The most frequent genotype included the β-lactamase groups TEM (n=5), and both TEM+CTX-M-1 (n=5). Within the CTX-M group, we identified the genes CTX-M-32, CTX-M-1, CTX-M-15, CTX-M-55/79, CTX-M-14 and CTX-M-2/44. Thirty isolates resistant to ciprofloxacin presented two mutations in the gyrA gene and one or two mutations in the parC gene. A mutation in gyrA (reported here for the first time), due to a transversion and transition (TCG→GTG) originating a substitution of a serine by a valine in position 83 was also detected. The plasmid-encoded quinolone resistance gene, qnrs1, was detected in three isolates. Dogs can be a reservoir of genetic determinants conferring antimicrobial resistance and thus may play an important role in the spread of antimicrobial resistance to humans and other co-habitant animals.
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Affiliation(s)
- D Meireles
- Produção Aquática, ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal; Ciências Químicas e das Biomoléculas, Escola Superior de Tecnologia de Saúde do Porto, Instituto Politécnico do Porto, Porto, Portugal
| | - L Leite-Martins
- Produção Aquática, ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal; Clínica Veterinária, ICBAS, Universidade do Porto, Porto, Portugal
| | - L J Bessa
- Produção Aquática, ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal; CIIMAR - Centro Interdisciplinar de Investigação Marinha e Ambiental, Universidade do Porto, Porto, Portugal
| | - S Cunha
- Produção Aquática, ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal; Ciências Químicas e das Biomoléculas, Escola Superior de Tecnologia de Saúde do Porto, Instituto Politécnico do Porto, Porto, Portugal
| | - R Fernandes
- Ciências Químicas e das Biomoléculas, Escola Superior de Tecnologia de Saúde do Porto, Instituto Politécnico do Porto, Porto, Portugal
| | - A de Matos
- Clínica Veterinária, ICBAS, Universidade do Porto, Porto, Portugal; CECA - Centro de Estudos de Ciência Animal, ICETA - Instituto de Ciências e Tecnologias Agrárias e Agro-Alimentares, Universidade do Porto, Porto, Portugal
| | - C M Manaia
- CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Porto, Portugal
| | - P Martins da Costa
- Produção Aquática, ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal; CIIMAR - Centro Interdisciplinar de Investigação Marinha e Ambiental, Universidade do Porto, Porto, Portugal.
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aac(6′)-Ib-cr is the major plasmid-mediated quinolone resistance determinant in extended-spectrum β-lactamase-producing Escherichia coli in eastern France. J Glob Antimicrob Resist 2014; 2:111-113. [DOI: 10.1016/j.jgar.2014.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 01/22/2014] [Accepted: 01/27/2014] [Indexed: 11/24/2022] Open
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Agabou A, Pantel A, Ouchenane Z, Lezzar N, Khemissi S, Satta D, Sotto A, Lavigne JP. First description of OXA-48-producing Escherichia coli and the pandemic clone ST131 from patients hospitalised at a military hospital in Algeria. Eur J Clin Microbiol Infect Dis 2014; 33:1641-6. [DOI: 10.1007/s10096-014-2122-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 04/09/2014] [Indexed: 01/18/2023]
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Martínez-Martínez L, Eliecer Cano M, Manuel Rodríguez-Martínez J, Calvo J, Pascual Á. Plasmid-mediated quinolone resistance. Expert Rev Anti Infect Ther 2014; 6:685-711. [DOI: 10.1586/14787210.6.5.685] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sato T, Yokota SI, Okubo T, Usui M, Fujii N, Tamura Y. Phylogenetic association of fluoroquinolone and cephalosporin resistance of D-O1-ST648 Escherichia coli carrying blaCMY-2 from faecal samples of dogs in Japan. J Med Microbiol 2013; 63:263-270. [PMID: 23429696 DOI: 10.1099/jmm.0.054676-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This study aimed to investigate the genetic association between fluoroquinolone (FQ) and/or cephalosporin (CEP) resistance in Escherichia coli isolates from dogs, and the risk to human health. We characterized E. coli clinical isolates, derived from faecal samples of dogs attending veterinary hospitals, using phylogenetic grouping, determination of virulence factor (VF) prevalence, multilocus sequence typing (MLST) and O serotyping. The D group was the dominant phylogenetic group among strains resistant to FQ and/or CEP. In contrast, the dominant group among susceptible strains was group B2. Group D strains showed a significantly higher prevalence of VFs than strains belonging to groups A and B1, and were resistant to significantly more antimicrobials than group B2 strains. The phylogenetic distribution of FQ-CEP-resistant E. coli groups (FQ-CEPRECs) and FQ-resistant groups was significantly correlated (r = 0.98), but FQ-CEPRECs and CEP-resistant E. coli groups were not correlated (r = 0.58). Data from PFGE, O serotype and MLST analyses indicated that the majority of FQ-resistant strains derived from a particular lineage of phylogenetic group D: serotype O1 and sequence type (ST) 648. Some D-O1-ST648 strains carried blaCMY-2, showed multidrug resistance and possessed a higher prevalence of the VFs kspMT, ompT and PAI compared with other group D strains. Our data indicate that the emergence of FQ-CEP-resistant E. coli is based primarily on FQ-resistant E. coli. Moreover, as strains of the D-O1-ST648 lineage have been found in clinical isolates derived from humans at a relatively high frequency, our findings indicate that the spreading of D-O1-ST648 strains may cause serious difficulties in both veterinary and human clinical fields in the future.
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Affiliation(s)
- Toyotaka Sato
- Laboratory of Food Microbiology and Food Safety, Department of Health and Environmental Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | - Shin-Ichi Yokota
- Department of Microbiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Torahiko Okubo
- Laboratory of Food Microbiology and Food Safety, Department of Health and Environmental Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | - Masaru Usui
- Laboratory of Food Microbiology and Food Safety, Department of Health and Environmental Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | - Nobuhiro Fujii
- Department of Microbiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yutaka Tamura
- Laboratory of Food Microbiology and Food Safety, Department of Health and Environmental Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
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SATO T, YOKOTA SI, OKUBO T, ISHIHARA K, UENO H, MURAMATSU Y, FUJII N, TAMURA Y. Contribution of the AcrAB-TolC Efflux Pump to High-Level Fluoroquinolone Resistance in Escherichia coli Isolated from Dogs and Humans. J Vet Med Sci 2013; 75:407-14. [DOI: 10.1292/jvms.12-0186] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Toyotaka SATO
- Laboratory of Food Microbiology and Food Safety, Department of Health and Environmental Sciences, School of Veterinary Medicine, Rakuno Gakuen University, 582 Midorimachi, Bunkyoudai, Ebetsu, Hokkaido 069–8501, Japan
| | - Shin-ichi YOKOTA
- Department of Microbiology, Sapporo Medical University School of Medicine, South-1, West-17, Chuo-ku, Sapporo 060–8556, Hokkaido, Japan
| | - Torahiko OKUBO
- Laboratory of Food Microbiology and Food Safety, Department of Health and Environmental Sciences, School of Veterinary Medicine, Rakuno Gakuen University, 582 Midorimachi, Bunkyoudai, Ebetsu, Hokkaido 069–8501, Japan
| | - Kanako ISHIHARA
- Laboratory of Food Microbiology and Food Safety, Department of Health and Environmental Sciences, School of Veterinary Medicine, Rakuno Gakuen University, 582 Midorimachi, Bunkyoudai, Ebetsu, Hokkaido 069–8501, Japan
| | - Hiroshi UENO
- Laboratory of Zoonoses, Department of Health and Environmental Sciences, School of Veterinary Medicine, Rakuno Gakuen University, 582 Midorimachi, Bunkyoudai, Ebetsu, Hokkaido 069–8501, Japan
| | - Yasukazu MURAMATSU
- Laboratory of Zoonoses, Department of Health and Environmental Sciences, School of Veterinary Medicine, Rakuno Gakuen University, 582 Midorimachi, Bunkyoudai, Ebetsu, Hokkaido 069–8501, Japan
| | - Nobuhiro FUJII
- Department of Microbiology, Sapporo Medical University School of Medicine, South-1, West-17, Chuo-ku, Sapporo 060–8556, Hokkaido, Japan
| | - Yutaka TAMURA
- Laboratory of Food Microbiology and Food Safety, Department of Health and Environmental Sciences, School of Veterinary Medicine, Rakuno Gakuen University, 582 Midorimachi, Bunkyoudai, Ebetsu, Hokkaido 069–8501, Japan
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Padmavathy K, Padma K, Rajasekaran S. Extended-spectrum β-lactamase/AmpC-producing uropathogenic Escherichia coli from HIV patients: do they have a low virulence score? J Med Microbiol 2012; 62:345-351. [PMID: 23161767 DOI: 10.1099/jmm.0.050013-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Extended-spectrum β-lactamase (ESBL) production and quinolone resistance are often associated in enterobacteria. Prior exposure to 3G cephalosporins/quinolones accelerates the risk of resistance to both these groups of antibiotics. Hence, information on the antimicrobial resistance pattern of uropathogenic Escherichia coli (UPEC) isolates is important to better formulate the guidelines for the empirical therapy of urinary tract infection in the context of HIV/AIDS. The aim of this study was to determine the incidence of ESBL/AmpC and fluoroquinolone (FQ) resistance among urinary E. coli isolates and to establish the association of extraintestinal virulence and phylogenetic distribution with antibiotic resistance and host immunocompromisation. Accordingly, 118 urinary Escherichia coli isolates from HIV (n = 76) and non-HIV antenatal patients (n = 42) from Chennai, South India, were analysed for the presence of five virulence-associated genes (VAGs): pap, sfa/foc, afa/dra, iutA and kpsMII. Compared with the susceptible HIV isolates, the majority of the ESBL(+)AmpC(+)FQ(R) isolates harboured iutA (66.7%) and pap (40%). The FQ-resistant HIV isolates were significantly enriched for iutA (67.8%) and kpsMII (47.5%) and qualified as UPEC (54.2%), while a majority of the FQ-susceptible isolates from the non-HIV patients were found to harbour pap (48.4%), sfa/foc (41.9%) and kpsMII (48.4%) and were classified as UPEC (40.5%). We conclude that antibiotic-resistant (ESBL(+)AmpC(+)and/or FQ(R)) phylogroup D isolates with limited virulence are competent enough to establish infections in HIV patients, while among non-HIV patients, an array of virulence factors is essential for E. coli to overcome host defences irrespective of antibiotic resistance.
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Affiliation(s)
- Kesavaram Padmavathy
- Dept of Microbiology, Sree Balaji Dental College and Hospital, Bharath University, Chennai, India.,Dept of Microbiology, Dr ALM PGIBMS, University of Madras, Chennai, India
| | - Krishnan Padma
- Dept of Microbiology, Dr ALM PGIBMS, University of Madras, Chennai, India
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Xiao YH, Giske CG, Wei ZQ, Shen P, Heddini A, Li LJ. Epidemiology and characteristics of antimicrobial resistance in China. Drug Resist Updat 2011; 14:236-50. [PMID: 21807550 DOI: 10.1016/j.drup.2011.07.001] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 07/05/2011] [Indexed: 10/26/2022]
Abstract
A comprehensive surveillance system for bacterial resistance in tertiary hospitals has been established in China that involves tertiary hospitals in distinct regions nationwide, enabling the collection of a large amount of antimicrobial surveillance data. Antimicrobial resistance in China has become a serious healthcare problem, with high resistance rates of most common bacteria to clinically important antimicrobial agents. Methicillin-resistant S. aureus, ESBL-producing Enterobacteriaceae and carbapenem-resistant Acinetobacter baumannii represent more than 50% of microbial isolates. Additionally, bacterial resistance to fluoroquinolones, macrolides and third-generation cephalosporins is of serious concern. The molecular epidemiology and resistance mechanisms of the antimicrobial strains in China exhibited regional specificity, as well as the influence of dissemination of international clonal complexes. The molecular characteristics of MRSA, ESBL- and carbapenemase-producing Enterobacteriaceae, and macrolide-resistant gram-positive Streptococci in China were significantly different from those in other countries and regions, while S. pneumoniae serotypes appear to have been affected by the global spread of prevalent clones in other parts of the world. Moreover, important antimicrobial resistant bacteria such as community-acquired-MRSA, multidrug-resistant P. aeruginosa and extensive-resistant A. baumannii, and the antimicrobial resistance in primary healthcare and outpatient setting should be intensely monitored and investigated in the future.
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Affiliation(s)
- Yong-Hong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
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Rodríguez-Martínez JM, Velasco C, Pascual Á, Cano ME, Martínez-Martínez L, Martínez-Martínez L, Pascual Á. Plasmid-mediated quinolone resistance: an update. J Infect Chemother 2011; 17:149-82. [DOI: 10.1007/s10156-010-0120-2] [Citation(s) in RCA: 181] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Indexed: 01/27/2023]
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Kim YS, Kim ES, Jeong JY. Genetic organization of plasmid-mediated Qnr determinants in cefotaxime-resistant Enterobacter cloacae isolates in Korea. Diagn Microbiol Infect Dis 2010; 68:318-21. [PMID: 20846811 DOI: 10.1016/j.diagmicrobio.2010.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 06/16/2010] [Accepted: 06/17/2010] [Indexed: 11/24/2022]
Abstract
Because of the strong association between qnr genes and plasmids carrying β-lactamase genes, we screened 176 clinical isolates of Enterobacter cloacae with cefotaxime MICs of ≥16 μg/mL for qnr genes. The qnrA, qnrB, and qnrS genes were detected in 18 (10.2%), 11 (6.2%), and 1 (0.56%) of the isolates, respectively. The genetic environments of the plasmids encoding these qnr genes were analyzed.
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Affiliation(s)
- Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Vranic-Ladavac M, Bosnjak Z, Beader N, Barisic N, Kalenic S, Bedenic B. Clonal spread of CTX-M-15-producing Klebsiella pneumoniae in a Croatian hospital. J Med Microbiol 2010; 59:1069-1078. [DOI: 10.1099/jmm.0.019778-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study was conducted to detect and analyse the presence of extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae associated with a nosocomial outbreak at a Croatian hospital. During 2007, 162 K. pneumoniae isolates with reduced susceptibility to third-generation cephalosporins were collected from various hospital units and patient specimens. Most of the strains were isolated from urine (61 %), followed by blood cultures (13 %), wound swabs (13 %), tracheal aspirates (5 %), intra-abdominal abscess aspirates (4 %), intravascular catheters (3 %) and cerebrospinal fluid (1 %). Medical wards were the most important source of the isolates (46 %); 21 % of the isolates originated from surgical intensive-care units. All patients had infections acquired during their stay in hospital. No community-acquired infections were reported. Sixty of these isolates were chosen for further analysis. A double-disc synergy test (DDST) was used to detect ESBLs. MICs were determined by the broth microdilution method according to CLSI guidelines. The transferability of ceftazidime resistance was tested by conjugation (broth mating method). PCR was used to detect alleles encoding ESBL enzymes. Plasmids encoding ESBLs were extracted with the Macherey Nagel Mini kit according to the manufacturer's recommendations. The genotypes of the strains were compared by analysis of banding patterns generated by PFGE of XbaI-digested genomic DNA. ESBLs were found by DDST in all isolates. All strains were resistant to cefuroxime, ceftazidime, cefotaxime, ceftriaxone, aztreonam, piperacillin/tazobactam and ciprofloxacin. There was variable susceptibility/resistance to cefepime and gentamicin. No resistance to ceftazidime/clavulanate and carbapenems was observed. Only six strains transferred resistance to an Escherichia coli recipient strain, with low frequency. All isolates yielded an amplicon of 545 bp with consensus MA primers. Multiplex PCR was positive for group 1 CTX-M β-lactamases. Sequencing of selected amplicons revealed the presence of bla
CTX-M-15, with coding regions containing identical nucleotide sequences. Similarly to isolates from India, our isolates contained the ISEcpI insertion sequence located upstream of the bla
CTX-M-15 gene, which has recently been demonstrated to mobilize 3′-adjacent genes to transfer between DNA replicons. The isolates contained a large plasmid of approximately 150 kb. The isolates were assigned to five clusters (>85 % similarity), which contained subclusters. The results of this work provided insights into the molecular epidemiology of the spread of ESBLs in K. pneumoniae involved in an outbreak at a Croatian hospital. The hospital antibiotic policy resulted in ceftriaxone being the most heavily prescribed third-generation cephalosporin, which might be expected to select for cefotaximases such as CTX-M-15.
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Affiliation(s)
| | - Zrinka Bosnjak
- Clinical Hospital Center Zagreb, Kispatic Street 12, Zagreb, Croatia
| | - Natasa Beader
- School of Medicine, University of Zagreb, Salata 3, Zagreb, Croatia
- Clinical Hospital Center Zagreb, Kispatic Street 12, Zagreb, Croatia
| | - Nada Barisic
- County of Istria Public Health Institute, Nazorova 23, Pula, Croatia
| | - Smilja Kalenic
- School of Medicine, University of Zagreb, Salata 3, Zagreb, Croatia
- Clinical Hospital Center Zagreb, Kispatic Street 12, Zagreb, Croatia
| | - Branka Bedenic
- School of Medicine, University of Zagreb, Salata 3, Zagreb, Croatia
- Clinical Hospital Center Zagreb, Kispatic Street 12, Zagreb, Croatia
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Han C, Yang Y, Wang M, Wang A, Lu Q, Xu X, Wang C, Liu L, Deng Q, Shen X. The prevalence of plasmid-mediated quinolone resistance determinants among clinical isolates of ESBL or AmpC-producingEscherichia colifrom Chinese pediatric patients. Microbiol Immunol 2010; 54:123-8. [DOI: 10.1111/j.1348-0421.2010.00200.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Leotard S, Negrin N. Épidémiologie des entérobactéries sécrétrices de bêta-lactamases à spectre étendu (E-BLSE) au centre hospitalier de Grasse (2005–2008). ACTA ACUST UNITED AC 2010; 58:35-8. [DOI: 10.1016/j.patbio.2009.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 07/12/2009] [Indexed: 11/28/2022]
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Abstract
Although plasmid-mediated quinolone resistance (PMQR) was thought not to exist before its discovery in 1998, the past decade has seen an explosion of research characterizing this phenomenon. The best-described form of PMQR is determined by the qnr group of genes. These genes, likely originating in aquatic organisms, code for pentapeptide repeat proteins. These proteins reduce susceptibility to quinolones by protecting the complex of DNA and DNA gyrase or topoisomerase IV enzymes from the inhibitory effect of quinolones. Two additional PMQR mechanisms were recently described. aac(6')-Ib-cr encodes a variant aminoglycoside acetyltransferase with two amino acid alterations allowing it to inactivate ciprofloxacin through the acetylation of its piperazinyl substituent. oqxAB and qepA encode efflux pumps that extrude quinolones. All of these genes determine relatively small increases in the MICs of quinolones, but these changes are sufficient to facilitate the selection of mutants with higher levels of resistance. The contribution of these genes to the emergence of quinolone resistance is being actively investigated. Several factors suggest their importance in this process, including their increasing ubiquity, their association with other resistance elements, and their emergence simultaneous with the expansion of clinical quinolone resistance. Of concern, these genes are not yet being taken into account in resistance screening by clinical microbiology laboratories.
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Han C, Yang Y, Wang M, Wang A, Lu Q, Xu X, Wang C, Liu L, Deng Q, Shen X. The prevalence of plasmid-mediated quinolone resistance determinants among clinical isolates of ESBL or AmpC-producing Escherichia coli from Chinese pediatric patients. Microbiol Immunol 2009. [DOI: 10.1111/j.1348-0421.2009.00200.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Deepak RN, Koh TH, Chan KS. Plasmid-mediated Quinolone Resistance Determinants in Urinary Isolates of Escherichia coli and Klebsiella pneumoniae in a Large Singapore Hospital. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n12p1070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Introduction: At the time of the study, 3 plasmid-borne qnr determinants (qnrA, qnrB and qnrS) and 1 plasmid-borne aminoglycoside-modifying enzyme determinant that confers qui-nolone resistance (aac(6')-Ib-cr) had been described in the literature.
Materials and Methods: We studied the prevalence of the 3 qnr determinants in a total of 117 nalidixic acid-resistant urinary isolates of Klebsiella pneumoniae (61 isolates) and Escherichia coli (56 isolates) using multiplex polymerase chain reaction (PCR). Further, a subset of the original strains (compris-ing 14 E. coli and 38 K. pneumoniae) showing reduced susceptibility to the aminoglycosides underwent PCR for aac(6')-Ib, followed by restriction digestion with BtsCI to detect the variant aac(6’)-Ib-cr.
Results: Twenty-eight of 61 (45.9%) Klebsiella isolates were found to possess at least 1 qnr determinant. Only 1/56 (1.8%) E. coli isolates were found to possess a qnr determi-nant. Two of the Klebsiella isolates possessed 2 qnr determinants each (qnrB and qnrS). The predominant determinant was qnrB (19 isolates). There were 11 isolates harbouring qnrS, and only 1 with qnrA. 1/14 (7.1%) E. coli and 35/38 K. pneumoniae (92.1%) were found to possess aac(6’)-Ib-cr. There was pairwise association between each of qnr, aac(6’)-Ib-cr and the presence of an extended-spectrum beta-lactamase.
Conclusions: A high prevalence of plasmid-mediated quinolone resistance determinants [i.e., qnrS, qnrB and aac(6')-Ib-cr] was found in quinolone-resistant K. pneumoniae isolated in a large hospital in Singapore.
Key words: Aminoglycoside, Ciprofloxacin, qnr, Transferable
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Mirzaee M, Owlia P, Mansouri S. Distribution of CTX-M β-lactamase Genes AmongEscherichia coliStrains Isolated from Patients in Iran. Lab Med 2009. [DOI: 10.1309/lmuuwbhmzedytbw5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Corvec S, Crémet L, Reynaud A, Lepelletier D, Caroff N. Vitek2® system: a reliable tool to detect qnr determinants in Enterobacteriaceae without quinolone resistance-determining region modifications. Diagn Microbiol Infect Dis 2009; 64:455-7. [DOI: 10.1016/j.diagmicrobio.2009.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 03/06/2009] [Accepted: 03/26/2009] [Indexed: 11/30/2022]
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Increase in hospital-acquired bloodstream infections caused by extended spectrum beta-lactamase-producing Escherichia coli in a large French teaching hospital. Eur J Clin Microbiol Infect Dis 2008; 28:491-8. [PMID: 19002728 DOI: 10.1007/s10096-008-0656-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Accepted: 10/11/2008] [Indexed: 10/21/2022]
Abstract
Our goal was to determine the characteristics and the mode of acquisition of healthcare-associated bacteraemia due to CTX-M-producing Escherichia coli in a 1,800-bed hospital. Sixteen extended-spectrum beta-lactamase (ESBL)-producing E. coli strains were collected between 2001 and 2006 from patients with bloodstream infections. The incidence density of these infections increased from 0.002 to 0.02 per 1,000 days of hospitalisation during the study period. Most of the strains (87%) produced a CTX-M-type enzyme associated with TEM-1 (86%), OXA-30 (50%), AAC(3)-II (57%), AAC(6') (50%) and QnrS1 (7%). When present (n = 8), the bla (CTX-M-15) gene was always located downstream of the insertion sequence ISEcp1. Co-resistance was generally observed: fluoroquinolones (81%), trimethoprim-sulfamethoxazole (62%) and/or aminoglycosides (69%). Although the strains were found to be genetically unrelated, most of the cases were hospital-acquired (69%) or healthcare-associated (25%), underlining the need for infection control measures to limit the spread of ESBL-producing E. coli in hospital settings.
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Guessennd N, Bremont S, Gbonon V, Kacou-Ndouba A, Ekaza E, Lambert T, Dosso M, Courvalin P. [Qnr-type quinolone resistance in extended-spectrum beta-lactamase producing enterobacteria in Abidjan, Ivory Coast]. ACTA ACUST UNITED AC 2008; 56:439-46. [PMID: 18926644 DOI: 10.1016/j.patbio.2008.07.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 07/04/2008] [Indexed: 11/20/2022]
Abstract
The aim of the study was to show the emergence of the qnr genes in extended spectrum beta-lactamases producing enterobacteria in Abidjan between 2005 and 2006. The whole of 151 strains of extended spectrum beta-lactamases producing enterobacteria were studied: 64 Escherichia coli, 66 Klebsiella pneumoniae, seven Klebsiella oxytoca and 14 Enterobacter spp. isolated from various biological products and from in- and out-patients. The techniques of disks diffusion, double-disk synergy, E-test were respectively used for the antimicrobial susceptibility test, the detection of extended spectrum beta-lactamases and the minimal inhibiting concentration. The bla genes(SHV, TEM, CTXM groups 1, 2, 8, 9), and AmpC were determined by PCR and characterized by sequencing. A global prevalence of 27,2 % (41/151) and rates of 9,9, 14,6, 2,7 % for the qnr genes A, B, A and S were observed. The distribution was 42,9 % for Enterobacter spp, 31,2 % for Escherichia coli, 20,5 % for Klebsiella; 30 strains expressed at least two bla genes; four strains were associated with AmpC. The strains were resistant to the cotrimoxazole (97,6 %), to the céfépime (73,2 %), to the céfoxitine (56,1 %), to the imipénème (0 %) and 43,9 % to all the aminosides. This high qnr gene prevalence associated with several types of bla genes in epidemic matter, the high level of resistance to antibiotics make fear a high risk of the transmission of multi-resistants bacteria and challenge the authorities for a resistance monitoring policy.
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Affiliation(s)
- N Guessennd
- Laboratoire de bactériologie-virologie, institut Pasteur, BP 1563, Abidjan 08, Côte d'Ivoire.
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Shen P, Jiang Y, Zhou Z, Zhang J, Yu Y, Li L. Complete nucleotide sequence of pKP96, a 67 850 bp multiresistance plasmid encoding qnrA1, aac(6')-Ib-cr and blaCTX-M-24 from Klebsiella pneumoniae. J Antimicrob Chemother 2008; 62:1252-6. [PMID: 18812424 DOI: 10.1093/jac/dkn397] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The multiresistance plasmid pKP96 from Klebsiella pneumoniae was sequenced completely and analysed concerning its genetic environment and distributing of antimicrobial resistance genes. METHODS The complete sequence of the plasmid was determined using a whole-genome shotgun approach. MICs of 13 antimicrobial agents were determined using Etests. A conjugation experiment was performed in liquid medium. RESULTS pKP96 is a circularly closed 67 850 bp multiresistance plasmid with an IncN incompatibility group. Seventy putative genes were identified according to the annotation of the finished sequence. The backbone region of the plasmid, comprising the conjugal transfer and plasmid replication regions, showed 91% identity to the IncN plasmid R46. Several mobile elements were found to be inserted into pKP96 together with antimicrobial resistance genes, including qnrA1, aac(6')-Ib-cr and bla(CTX-M-24). CONCLUSIONS Plasmid pKP96 is a chimera that has acquired its multiple antimicrobial resistance determinants horizontally from different sources. It may have evolved from an ancestor plasmid similar to R46 through the stepwise events of integration or recombination.
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Affiliation(s)
- Ping Shen
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China
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Lytsy B, Sandegren L, Tano E, Torell E, Andersson DI, Melhus A. The first major extended-spectrum beta-lactamase outbreak in Scandinavia was caused by clonal spread of a multiresistant Klebsiella pneumoniae producing CTX-M-15. APMIS 2008; 116:302-8. [PMID: 18397465 DOI: 10.1111/j.1600-0463.2008.00922.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Between May and December 2005, 64 multidrug-resistant isolates of Klebsiella pneumoniae were detected from patients admitted to Uppsala University Hospital. This represented a dramatic increase in ESBL-producing K. pneumoniae compared to previous years. To investigate the epidemiology and to characterize the resistance mechanisms of the isolates, a study was initiated. Antibiotic susceptibility was determined by means of the Etest and the disc diffusion method. Extended-spectrum beta-lactamase (ESBL) production was identified by clavulanic acid synergy test and confirmed with PCR amplification followed by DNA sequencing. DNA profiles of the isolates were examined with pulsed-field gel electrophoresis (PFGE). All isolates were resistant or exhibited reduced susceptibility to cefadroxil, cefuroxime, cefotaxime, ceftazidime, aztreonam, piperacillin/tazobactam, ciprofloxacin, tobramycin, and trimethoprim-sulfamethoxazole. They produced ESBL of the CTX-M-15 type, and the involvement of a single K. pneumoniae clone was shown. This is the first major clonal outbreak of multiresistant ESBL-producing K. pneumoniae in Scandinavia. The outbreak demonstrates the epidemic potential of enterobacteria containing ESBLs of the CTX-M type, even in a country with a relatively low selective pressure and a low prevalence of multiresistant bacteria.
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Affiliation(s)
- Birgitta Lytsy
- Department of Clinical Microbiology, Uppsala University Hospital, Uppsala, Sweden.
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Yue L, Jiang HX, Liao XP, Liu JH, Li SJ, Chen XY, Chen CX, Lü DH, Liu YH. Prevalence of plasmid-mediated quinolone resistance qnr genes in poultry and swine clinical isolates of Escherichia coli. Vet Microbiol 2008; 132:414-20. [PMID: 18573620 DOI: 10.1016/j.vetmic.2008.05.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 05/08/2008] [Accepted: 05/09/2008] [Indexed: 11/25/2022]
Abstract
The prevalence of qnr genes was investigated in veterinary clinical isolates of Escherichia coli in Guangdong province, China, and the aac (6')-Ib gene and the mutations in QRDRs of gyrase and topoisomerase IV were examined in qnr-positive strains. A total of 232 E. coli strains isolated from pig and poultry were screened for the presence of the qnrA, qnrB and qnrS genes by PCR and sequencing. The aac (6')-Ib gene was detected in qnr-bearing strains by PCR and sequencing. For all strains carrying qnr, MICs for six quinolones were determined. Mutations within the gyrase and topoisomerase were analyzed by PCR and sequencing for all the QRDRs of gyrA, gyrB, parC and parE. Among 232 E. coli isolates, 14 (6%) isolates were positive for the qnr gene, including one for qnrB, 13 for qnrS, but no qnrA was identified in this population. Detection of the aac (6')-Ib gene showed that one qnrS-positive isolate from pig and one qnrB-positive isolate from duck carried aac (6')-Ib gene, and both were the cr variant allele of aac (6')-Ib. All of the 14 isolates had MICs of ciprofloxacin more than 0.25 mg/L. Mutations in the QRDR of gyrA mutations were observed in 5 (35.7%) of the 14 strains. Three fluoroquinolone-resisting strains showed one mutation S83L of gyrA, while one S83I. One high-level resistance strains harboured gyrA S83L and A87N of gyrA. A singe mutation in site 58 of parC was detected in 3 (21.4%) strains. None mutations were found in QRDRs of gyrB and parE. The emergence of qnr genes in veterinary clinical E. coli isolates is described for the first time. This is also the first report of aac (6')-Ib-cr gene in E. coli isolates from food-producing animals.
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Affiliation(s)
- Lei Yue
- College of Veterinary Medicine, Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, South China Agricultural University, Guangzhou 510642, People's Republic of China
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Yumuk Z, Afacan G, Nicolas-Chanoine MH, Sotto A, Lavigne JP. Turkey: a further country concerned by community-acquired Escherichia coli clone O25-ST131 producing CTX-M-15. J Antimicrob Chemother 2008; 62:284-8. [PMID: 18453527 DOI: 10.1093/jac/dkn181] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the frequency and diversity of extended-spectrum beta-lactamases (ESBLs) produced by exclusively community-acquired Escherichia coli isolates in Izmir (Turkey) and to search for isolates producing CTX-M-15 and belonging to the pandemic clone E. coli O25-ST131. METHODS The patients with E. coli urinary tract infections (UTIs) and no hospitalization in the last 12 months, and no transfer from hospital, no stay in nursing home and no antimicrobial treatment in the previous 3 months were prospectively included over a 1 year period. Those E. coli detected positive for ESBL were characterized and compared with a representative of E. coli clone O25-ST131 with regard to bla genes, antibiotic resistance, phylogenetic groups, PFGE profiles and virulence factor genes (n = 17). O serotyping, multilocus sequence typing (MLST) and AmpC typing were performed to confirm that the Turkish isolate belonged to the clone O25-ST131. RESULTS Among the 3108 UTIs diagnosed, 82 (2.6%) were due to community E. coli isolates and followed the strict inclusion criteria. Seventeen of them (21%) produced an ESBL, of which CTX-M-15 was predominant (53%). These ESBL-positive isolates, distributed equally into three phylogenetic groups, displayed 13 PFGE profiles and three clusters. A Turkish CTX-M-15-producing isolate as a member of the clone ST131 was suggested by a high similarity of its PFGE profile to that of the clone representative and was confirmed by O serotyping, AmpC typing and MLST. CONCLUSIONS This study describes the community emergence of CTX-M-15-producing E. coli isolates, including an isolate of clone O25-ST131, in Turkey.
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Affiliation(s)
- Zeki Yumuk
- Department of Clinical Microbiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Cantón R, Novais A, Valverde A, Machado E, Peixe L, Baquero F, Coque TM. Prevalence and spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae in Europe. Clin Microbiol Infect 2008; 14 Suppl 1:144-53. [PMID: 18154538 DOI: 10.1111/j.1469-0691.2007.01850.x] [Citation(s) in RCA: 408] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Extended-spectrum beta-lactamases (ESBLs) represent a major threat among resistant bacterial isolates. The first types described were derivatives of the TEM-1, TEM-2 and SHV-1 enzymes during the 1980s in Europe, mainly in Klebsiella pneumoniae associated with nosocomial outbreaks. Nowadays, they are mostly found among Escherichia coli isolates in community-acquired infections, with an increasing occurrence of CTX-M enzymes. The prevalence of ESBLs in Europe is higher than in the USA but lower than in Asia and South America. However, important differences among European countries have been observed. Spread of mobile genetic elements, mainly epidemic plasmids, and the dispersion of specific clones have been responsible for the increase in ESBL-producing isolates, such as those with TEM-4, TEM-24, TEM-52, SHV-12, CTX-M-9, CTX-M-14, CTX-M-3, CTX-M-15 and CTX-M-32 enzymes.
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Affiliation(s)
- R Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
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Molecular epidemiology of extended-spectrum beta-lactamases among Escherichia coli isolates collected in a Swedish hospital and its associated health care facilities from 2001 to 2006. J Clin Microbiol 2007; 46:707-12. [PMID: 18094139 DOI: 10.1128/jcm.01943-07] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The genetic characteristics and molecular epidemiology of extended-spectrum beta-lactamases (ESBLs) among Escherichia coli isolates were investigated at a general hospital and its associated health care facilities in Stockholm, Sweden, during the period from 2001 to 2006. Of 87 consecutive nonduplicate ESBL-positive isolates, 80 isolates encoded CTX-M-type ESBLs, 64 of which were group 1 enzymes. TEM-type and OXA-type beta-lactamases were encoded in 63 and 59% of the ESBL isolates, respectively. Pulsed-field gel electrophoresis (PFGE) analysis revealed 40 different pulsotypes, consisting of 11 clones accounting for 66% of all isolates, and 29 unique patterns. Moreover, of the 11 clones, clones 1 and 4 comprised half of the clonally related isolates (28 of 57). Clone 1 was a persistent endemic clone in the area throughout the years, and clone 4 emerged in 2003. However, in recent years, clone 1 isolates were no longer predominant and were gradually replaced by new emerging strains. Concerning beta-lactamase gene profiles in relation to PFGE pulsotypes, clone-related bla profiles were observed in certain clones, while in most cases different bla profiles could be observed in the same clone, and the same bla profile could be present in different clones. The molecular epidemiology of ESBL-positive E. coli in the area shows shifts in predominant strains and increased clonal diversity over time. The study also indicated that both clonal spread of epidemic strains and transfer of transposable genetic elements might contribute to the proliferation of ESBLs.
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Lavigne JP, Defez C, Bouziges N, Mahamat A, Sotto A. Clinical and molecular epidemiology of multidrug-resistant Citrobacter spp. infections in a French university hospital. Eur J Clin Microbiol Infect Dis 2007; 26:439-41. [PMID: 17516102 DOI: 10.1007/s10096-007-0315-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- J-P Lavigne
- Institut National de la Santé et de la Recherche Médicale, ESPRI 26, UFR de Médecine, Avenue Kennedy, 30908, Nîmes Cedex 02, France
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Lartigue MF, Zinsius C, Wenger A, Bille J, Poirel L, Nordmann P. Extended-spectrum beta-lactamases of the CTX-M type now in Switzerland. Antimicrob Agents Chemother 2007; 51:2855-60. [PMID: 17470647 PMCID: PMC1932552 DOI: 10.1128/aac.01614-06] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The epidemiology of clavulanic acid-inhibited extended-spectrum beta-lactamases (ESBLs) was investigated among infection-associated enterobacterial isolates at the University Hospital in Lausanne, Switzerland, from January 2004 to June 2005. Out of 57 nonrepetitive ESBL producers (prevalence rate of 0.7%), 45 produced CTX-M-like ESBLs. CTX-M enzymes were mostly from clonally nonrelated Escherichia coli isolates, from urinary infections and community-acquired infections. Pediatric patients (20 out of 57) accounted for a large number of CTX-M producers. CTX-M-15 was the most frequent CTX-M-type enzyme. The plasmid-located bla(CTX-M) genes were associated with either ISEcp1 or ISCR1 insertion sequences. This study is the first published report of CTX-M-type beta-lactamases in Switzerland.
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Cavaco LM, Hansen DS, Friis-Møller A, Aarestrup FM, Hasman H, Frimodt-Møller N. First detection of plasmid-mediated quinolone resistance (qnrA and qnrS) in Escherichia coli strains isolated from humans in Scandinavia. J Antimicrob Chemother 2007; 59:804-5. [PMID: 17284539 DOI: 10.1093/jac/dkl554] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lavigne JP, Marchandin H, Delmas J, Moreau J, Bouziges N, Lecaillon E, Cavalie L, Jean-Pierre H, Bonnet R, Sotto A. CTX-M beta-lactamase-producing Escherichia coli in French hospitals: prevalence, molecular epidemiology, and risk factors. J Clin Microbiol 2006; 45:620-6. [PMID: 17108071 PMCID: PMC1829058 DOI: 10.1128/jcm.01917-06] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In 2004, 65 CTX-M-producing Escherichia coli isolates were collected from infected patients in four French hospitals. The blaCTX-M-15 genes were predominant. Pulsed-field gel electrophoresis highlighted a clonal propagation of CTX-M-15-producing strains belonging to phylogenetic group B2, notably in the community. The main risk factors for acquiring these isolates were urinary tract infections or the presence of a urinary catheter in diabetic or renal failure patients.
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Affiliation(s)
- Jean-Philippe Lavigne
- Laboratoire Universitaire d'Antibiologie, Faculté de Médecine, CS83021, Avenue Kennedy, 30908 Nîmes Cedex 02, France
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