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Liu S, Fang R, Zhang Y, Chen L, Huang N, Yu K, Zhou C, Cao J, Zhou T. Characterization of resistance mechanisms of Enterobacter cloacae Complex co-resistant to carbapenem and colistin. BMC Microbiol 2021; 21:208. [PMID: 34238225 PMCID: PMC8268410 DOI: 10.1186/s12866-021-02250-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/04/2021] [Indexed: 11/27/2022] Open
Abstract
Background The emergence of carbapenem-resistant and colistin-resistant ECC pose a huge challenge to infection control. The purpose of this study was to clarify the mechanism of the carbapenems and colistin co-resistance in Enterobacter cloacae Complex (ECC) strains. Results This study showed that the mechanisms of carbapenem resistance in this study are: 1. Generating carbapenemase (7 of 19); 2. The production of AmpC or ESBLs combined with decreased expression of out membrane protein (12 of 19). hsp60 sequence analysis suggested 10 of 19 the strains belong to colistin hetero-resistant clusters and the mechanism of colistin resistance is increasing expression of acrA in the efflux pump AcrAB-TolC alone (18 of 19) or accompanied by a decrease of affinity between colistin and outer membrane caused by the modification of lipid A (14 of 19). Moreover, an ECC strain co-harboring plasmid-mediated mcr-4.3 and blaNDM-1 has been found. Conclusions This study suggested that there is no overlap between the resistance mechanism of co-resistant ECC strains to carbapenem and colistin. However, the emergence of strain co-harboring plasmid-mediated resistance genes indicated that ECC is a potential carrier for the horizontal spread of carbapenems and colistin resistance. Supplementary Information The online version contains supplementary material available at 10.1186/s12866-021-02250-x.
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Affiliation(s)
- Shixing Liu
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, China
| | - Renchi Fang
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Ying Zhang
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, 325035, China
| | - Lijiang Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, China
| | - Na Huang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, China
| | - Kaihang Yu
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, 325035, China
| | - Cui Zhou
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, China
| | - Jianming Cao
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, 325035, China.
| | - Tieli Zhou
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, China.
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Hirabayashi A, Yanagisawa H, Takahashi H, Yahara K, Boeing P, Wolfenden B, Nov V, Lorn V, Veng M, Ann V, Darapheak C, Shibayama K, Suzuki M. On-Site Genomic Epidemiological Analysis of Antimicrobial-Resistant Bacteria in Cambodia With Portable Laboratory Equipment. Front Microbiol 2021; 12:675463. [PMID: 34054783 PMCID: PMC8158813 DOI: 10.3389/fmicb.2021.675463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/22/2021] [Indexed: 11/29/2022] Open
Abstract
The rapid emergence of carbapenemase-producing gram-negative bacteria (CPGNB) is a global threat due to the high mortality of infection and limited treatment options. Although there have been many reports of CPGNB isolated from Southeast Asian countries, to date there has been no genetic analysis of CPGNB isolated from Cambodia. Sequence-based molecular epidemiological analysis enables a better understanding of the genotypic characteristics and epidemiological significance of antimicrobial-resistant (AMR) bacteria in each country, and allows countries to enact measures related to AMR issues. In this study, we performed on-site genomic epidemiological analysis of CPGNB isolated in Cambodia using a portable laboratory equipment called Bento Lab, which combines a PCR thermal cycler, microcentrifuge, gel electrophoresis apparatus, and LED transilluminator, along with the MinION nanopore sequencer. PCR targeting of major carbapenemase genes using Bento Lab revealed that two Escherichia coli isolates and one Acinetobacter baumannii isolate harbored carbapenemase genes: blaNDM, blaOXA–48, and blaOXA–23, respectively. The results of phenotypic diagnostic tests for CPGNB, such as the carbapenem inactivation method and double-disk diffusion test using a specific inhibitor of metallo-β-lactamases, were consistent with their AMR genotypes. Whole-genome sequencing analysis using MinION revealed that blaNDM–5 gene was carried on a 93.9-kb plasmid with IncFIA/IncFIB/IncFII/IncQ1 replicons, and blaOXA–181 gene was carried on a 51.5-kb plasmid with the IncX3 replicon in E. coli isolates. blaOXA–23 was encoded in two locations on the chromosome of A. baumannii. Plasmids carrying blaNDM–5 or blaOXA–181 in E. coli were highly structurally identical to plasmids prevalent in Enterobacterales in China and other countries, suggesting that they disseminated from a common evolutionary origin. Our findings demonstrate the potential impact of portable laboratory equipment on AMR bacteria research in hospitals and research centers with limited research facilities, and provide the first glimpse into the genomic epidemiology of CPGNB in Cambodia.
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Affiliation(s)
- Aki Hirabayashi
- AMR Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Hiromizu Takahashi
- Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Koji Yahara
- AMR Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | | | | | - Vandarith Nov
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Vichet Lorn
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Mom Veng
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Vuth Ann
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Chau Darapheak
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Keigo Shibayama
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masato Suzuki
- AMR Research Center, National Institute of Infectious Diseases, Tokyo, Japan
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De La Cadena E, Correa A, Muñoz JS, Rojas LJ, Hernández-Gómez C, Pallares C, Perez F, Bonomo RA, Villegas MV. Molecular characterisation of carbapenem-resistant Enterobacter cloacae complex in Colombia: bla KPC and the 'changing landscape'. J Glob Antimicrob Resist 2017; 13:184-189. [PMID: 29274468 DOI: 10.1016/j.jgar.2017.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 12/11/2017] [Accepted: 12/11/2017] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES The aim of this study was to examine the population structure of representative carbapenem-resistant Enterobacter cloacae complex (CR-Ecl) isolates from eight different Colombian regions and to characterise their associated β-lactamases. METHODS A total of 28 CR-Ecl isolates collected in Colombia between 2009-2013 through the Colombian Nosocomial Network were included in this study. Antimicrobial susceptibility testing was performed by the broth microdilution method. Molecular detection of carbapenemase and extended-spectrum β-lactamase (ESBL) genes and the presence of transposon Tn4401 was evaluated by PCR and DNA sequencing. Genetic relatedness was assessed by multilocus sequencing typing (MLST) and repetitive sequence-based PCR (rep-PCR). RESULTS PCR and DNA sequencing revealed that 19/28 (68%) of the CR-Ecl isolates carried blaKPC-2. Analysis of the genetic environment found blaKPC-2 within transposon Tn4401b in 8/19 isolates (42%). Population genetic analysis using rep-PCR revealed four clonal groups. MLST showed a variety of sequence types (STs), among which ST510 was the most common (10/28 isolates; 36%). CONCLUSIONS blaKPC-2 was discovered as the most common mechanism of carbapenem resistance in CR-Ecl and was disseminated among different STs. Although none of the previously reported major clonal complexes were identified, it appears that local strain lineages are associated with the spread of blaKPC within CR-Ecl in various regions of Colombia.
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Affiliation(s)
- Elsa De La Cadena
- International Center for Medical Research and Training, CIDEIM, Cali, Colombia; Research Group on Antimicrobial Resistance and Hospital Epidemiology, Universidad El Bosque, Bogotá, Colombia
| | - Adriana Correa
- Research Group on Antimicrobial Resistance and Hospital Epidemiology, Universidad El Bosque, Bogotá, Colombia
| | - Juan Sebastián Muñoz
- Research Group on Antimicrobial Resistance and Hospital Epidemiology, Universidad El Bosque, Bogotá, Colombia
| | - Laura J Rojas
- Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Cristhian Hernández-Gómez
- International Center for Medical Research and Training, CIDEIM, Cali, Colombia; Research Group on Antimicrobial Resistance and Hospital Epidemiology, Universidad El Bosque, Bogotá, Colombia
| | - Christian Pallares
- International Center for Medical Research and Training, CIDEIM, Cali, Colombia; Research Group on Antimicrobial Resistance and Hospital Epidemiology, Universidad El Bosque, Bogotá, Colombia
| | - Federico Perez
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Research Service, Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA; Medical Service, Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Robert A Bonomo
- Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Research Service, Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA; Medical Service, Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA; Department of Biochemistry, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Case Western Reserve University-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology, Cleveland, OH, USA
| | - Maria V Villegas
- International Center for Medical Research and Training, CIDEIM, Cali, Colombia; Research Group on Antimicrobial Resistance and Hospital Epidemiology, Universidad El Bosque, Bogotá, Colombia.
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Scavuzzi AML, Maciel MAV, de Melo HRL, Alves LC, Brayner FA, Lopes ACS. Occurrence of qnrB1 and qnrB12 genes, mutation in gyrA and ramR, and expression of efflux pumps in isolates of Klebsiella pneumoniae carriers of bla
KPC-2. J Med Microbiol 2017; 66:477-484. [DOI: 10.1099/jmm.0.000452] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Alexsandra Maria Lima Scavuzzi
- Centro de Pesquisas Aggeu Magalhães (CPqAM-Fiocruz), Recife-PE, Brazil
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco (UFPE), 50.732-970, Recife-PE, Brazil
| | - Maria Amélia Vieira Maciel
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco (UFPE), 50.732-970, Recife-PE, Brazil
| | - Heloísa Ramos Lacerda de Melo
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco (UFPE), 50.732-970, Recife-PE, Brazil
- Departamento de Clínica Médica, Universidade Federal de Pernambuco (UFPE), 50.732-970, Recife-PE, Brazil
| | - Luiz Carlos Alves
- Centro de Pesquisas Aggeu Magalhães (CPqAM-Fiocruz), Recife-PE, Brazil
| | - Fábio André Brayner
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco (UFPE), 50.732-970, Recife-PE, Brazil
- Centro de Pesquisas Aggeu Magalhães (CPqAM-Fiocruz), Recife-PE, Brazil
| | - Ana Catarina Souza Lopes
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco (UFPE), 50.732-970, Recife-PE, Brazil
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5
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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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Izdebski R, Baraniak A, Herda M, Fiett J, Bonten MJM, Carmeli Y, Goossens H, Hryniewicz W, Brun-Buisson C, Gniadkowski M. MLST reveals potentially high-risk international clones of Enterobacter cloacae. J Antimicrob Chemother 2014; 70:48-56. [PMID: 25216820 DOI: 10.1093/jac/dku359] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To perform the first multinational Enterobacter cloacae clonality study, using the MLST scheme newly developed in Japan. METHODS The analysis included 195 rectal carriage E. cloacae isolates resistant to expanded-spectrum cephalosporins (ESCs), collected from patients in 12 hospital units across Europe and Israel. All of the isolates were typed by PFGE and 173 isolates were subjected to MLST. ESC resistance was analysed phenotypically; genes encoding ESBLs and carbapenemases were identified by PCR and sequencing. RESULTS MLST distinguished 88 STs, which correlated with the PFGE data. PFGE was more discriminatory, producing 129 pulsotypes (169 patterns). Numerous STs were observed in several countries each. The most widespread were ST66, ST78, ST108 and ST114, each having at least 10 isolates from three to five countries, diversified into multiple pulsotypes, with clusters of related isolates in one or more centres. Analysis of the STs against the MLST database revealed several epidemic clonal complexes, such as those with central genotypes ST74 (including ST78) or ST114 (including ST66). ESC resistance was equally related to overexpression of the AmpC cephalosporinase and to ESBL production. Among ESBL producers some spreading subclones were identified, including specific ST66, ST78 and ST114 pulsotypes, associated with CTX-M-15 production. Several isolates produced carbapenemase VIM-1 or KPC-2. CONCLUSIONS Together with the information available in the MLST database, our results suggest that, like Escherichia coli and Klebsiella pneumoniae, E. cloacae harbours clonal lineages of increased epidemic potential that may be associated with resistance spread.
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Affiliation(s)
- R Izdebski
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - A Baraniak
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - M Herda
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - J Fiett
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - M J M Bonten
- Department of Medical Microbiology and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Y Carmeli
- Division of Epidemiology and Preventive Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - H Goossens
- Department of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - W Hryniewicz
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - C Brun-Buisson
- Service de reanimation médicale, INSERM, U957 & Université Paris-Est, Créteil, France
| | - M Gniadkowski
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
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7
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Mezzatesta ML, Gona F, Stefani S. Enterobacter cloacae complex: clinical impact and emerging antibiotic resistance. Future Microbiol 2014; 7:887-902. [PMID: 22827309 DOI: 10.2217/fmb.12.61] [Citation(s) in RCA: 316] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Species of the Enterobacter cloacae complex are widely encountered in nature, but they can act as pathogens. The biochemical and molecular studies on E. cloacae have shown genomic heterogeneity, comprising six species: Enterobacter cloacae, Enterobacter asburiae, Enterobacter hormaechei, Enterobacter kobei, Enterobacter ludwigii and Enterobacter nimipressuralis, E. cloacae and E. hormaechei are the most frequently isolated in human clinical specimens. Phenotypic identification of all species belonging to this taxon is usually difficult and not always reliable; therefore, molecular methods are often used. Although the E. cloacae complex strains are among the most common Enterobacter spp. causing nosocomial bloodstream infections in the last decade, little is known about their virulence-associated properties. By contrast, much has been published on the antibiotic-resistance features of these microorganisms. In fact, they are capable of overproducing AmpC β-lactamases by derepression of a chromosomal gene or by the acquisition of a transferable ampC gene on plasmids conferring the antibiotic resistance. Many other resistance determinants that are able to render ineffective almost all antibiotic families have been recently acquired. Most studies on antimicrobial susceptibility are focused on E. cloacae, E. hormaechei and E. asburiae; these studies reported small variations between the species, and the only significant differences had no discriminating features.
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Affiliation(s)
- Maria Lina Mezzatesta
- Department of Bio-Medical Sciences, Section of Microbiology, University of Catania, Via Androne 81, 95124 Catania, Italy.
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8
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Chmelnitsky I, Shklyar M, Leavitt A, Sadovsky E, Navon-Venezia S, Ben Dalak M, Edgar R, Carmeli Y. Mix and match of KPC-2 encoding plasmids in Enterobacteriaceae-comparative genomics. Diagn Microbiol Infect Dis 2014; 79:255-60. [PMID: 24743043 DOI: 10.1016/j.diagmicrobio.2014.03.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 02/28/2014] [Accepted: 03/09/2014] [Indexed: 01/23/2023]
Abstract
We performed comparative sequence analysis of 3 blaKPC-2 encoding plasmids to examine evolution of these plasmids and their dissemination. We found that all of them have an IncN replicon with a newly determined IncN plasmid sequence type (ST), ST15. The 2 Klebsiella pneumoniae (KPN) plasmids also harbor an IncF2A1-B1- replicon. The blaKPC-2 is located in the Tn4401c transposon with a newly discovered mutation in the P2 promoter. Screening of the 27 additional blaKPC-2 carrying plasmids from Enterobacter cloacae, Escherichia coli (EC), and K. pneumoniae showed that: all KPN and EC plasmids are IncN plasmids belonging to ST15; 4/7 KPN and 1/6 EC plasmids contain an additional IncF2A1-B1- replicon; all Enterobacter plasmids belong to neither IncN nor IncF2A1-B1- replicon plasmids; 6/7 KPN and 2/5 EC plasmids carry the mutated P2 promoter. Study of the blaKPC-2 environment, transposon, pMLST, and Inc group suggests transposon and plasmid inter- and intra-species dissemination and evolution.
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Affiliation(s)
- Inna Chmelnitsky
- Molecular Epidemiology and Antimicrobial Resistance Laboratory, Division of Epidemiology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel
| | - Maya Shklyar
- Molecular Epidemiology and Antimicrobial Resistance Laboratory, Division of Epidemiology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel
| | - Azita Leavitt
- Molecular Epidemiology and Antimicrobial Resistance Laboratory, Division of Epidemiology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel
| | - Evgeniya Sadovsky
- Molecular Epidemiology and Antimicrobial Resistance Laboratory, Division of Epidemiology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel
| | - Shiri Navon-Venezia
- Molecular Epidemiology and Antimicrobial Resistance Laboratory, Division of Epidemiology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel; Molecular Biology Department, Ariel University, 44837, Ariel, Israel
| | - Maayan Ben Dalak
- Molecular Epidemiology and Antimicrobial Resistance Laboratory, Division of Epidemiology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel
| | - Rotem Edgar
- Molecular Epidemiology and Antimicrobial Resistance Laboratory, Division of Epidemiology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel
| | - Yehuda Carmeli
- Molecular Epidemiology and Antimicrobial Resistance Laboratory, Division of Epidemiology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel.
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Phytochemistry and Preliminary Assessment of the Antibacterial Activity of Chloroform Extract of Amburana cearensis (Allemão) A.C. Sm. against Klebsiella pneumoniae Carbapenemase-Producing Strains. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:786586. [PMID: 24772183 PMCID: PMC3977124 DOI: 10.1155/2014/786586] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 01/07/2014] [Accepted: 01/10/2014] [Indexed: 12/03/2022]
Abstract
The chloroform extract of the stem bark of Amburana cearensis was chemically characterized and tested for antibacterial activity.The extract was analyzed by gas chromatography and mass spectrometry. The main compounds identified were 4-methoxy-3-methylphenol (76.7%), triciclene (3.9%), α-pinene (1.0%), β-pinene (2.2%), and 4-hydroxybenzoic acid (3.1%). Preliminary antibacterial tests were carried out against species of distinct morphophysiological characteristics: Escherichia coli, Salmonella enterica Serotype Typhimurium, Pseudomonas aeruginosa, Staphylococcus aureus, Listeria monocytogenes, and Bacillus cereus. The minimum inhibitory concentration (MIC) was determinate in 96-well microplates for the chloroform extract and an analogue of themain compound identified, which was purchased commercially.We have shown that plant's extract was only inhibitory (but not bactericidal) at the maximum concentration of 6900 μg/mL against Pseudomonas aeruginosa and Bacillus cereus. Conversely, the analogue 2-methoxy-4-methylphenol produced MICs ranging from215 to 431 μg/mL against all bacterial species.New antibacterial assays conducted with such chemical compound against Klebsiella pneumoniae carbapenemase-producing strains have shown similarMICresults and minimumbactericidal concentration (MBC) of 431 μg/mL.We conclude that A. cearensis is a good source of methoxy-methylphenol compounds,which could be screened for antibacterial activity againstmultiresistant bacteria fromdifferent species
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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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Bush K. Carbapenemases: Partners in crime. J Glob Antimicrob Resist 2013; 1:7-16. [PMID: 27873609 DOI: 10.1016/j.jgar.2013.01.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 01/23/2013] [Indexed: 10/27/2022] Open
Abstract
Carbapenemases, β-lactamases that inactivate carbapenems and most β-lactam antibiotics, are most widely known for their ability to confer resistance to β-lactams. They include serine carbapenemases, such as the widespread KPC family of enzymes, and the metallo-β-lactamases that contain the IMP, NDM and VIM enzyme families acquired by Gram-negative bacteria on transferable elements. These enzymes are almost always produced by organisms that encode at least one other β-lactamase, with as many as eight different β-lactamase genes detected in a single isolate. This consortium of β-lactamases includes a full spectrum of molecular and biochemical characteristics, providing the producing organism with a range of catalytic activities. In addition to the variety of β-lactamases found in carbapenemase-producing Gram-negative pathogens are multiple other resistance factors, especially aminoglycoside-modifying enzymes and 16S rRNA methylases that confer resistance to aminoglycosides. Other acquired genes encode fluoroquinolone, trimethoprim, sulfonamide, rifampicin and chloramphenicol resistance determinants on mobile elements that travel together with β-lactamase genes. Thus, the recent proliferation of transferable carbapenemases serves to magnify resistance to virtually all antibiotic classes. Judicial use of current antibiotics and a quest for novel antibacterial agents are necessary, as multidrug-resistant bacteria continue to multiply.
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Affiliation(s)
- Karen Bush
- Department of Molecular and Cellular Biochemistry, Jordan Hall A311, Indiana University, 1001 E. Third Street, Bloomington, IN 47405, USA.
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12
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Dai W, Sun S, Yang P, Huang S, Zhang X, Zhang L. Characterization of carbapenemases, extended spectrum β-lactamases and molecular epidemiology of carbapenem-non-susceptible Enterobacter cloacae in a Chinese hospital in Chongqing. INFECTION GENETICS AND EVOLUTION 2012; 14:1-7. [PMID: 23220359 DOI: 10.1016/j.meegid.2012.10.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/01/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
Abstract
Carbapenem-resistant Enterobacteriaceae, including strains from multiple species harboring metallo-β-lactamases (IMP, NDM or VIM) and non-metallo (KPC) carbapenemases, as well as those combining an extended-spectrum β-lactamase (ESBL) enzyme with porin loss, present an increasingly urgent clinical danger. The aim of this study was to characterize the carbapenemases and ESBLs in carbapenem-non-susceptible (CNS) Enterobacter cloacae (E. cloacae) isolates from a Chinese teaching hospital. A total of 986 non-duplicated E. cloacae isolates collected between September 2009 and February 2012 were analyzed via antimicrobial susceptibility testing. Carbapenemase and ESBL genes were examined using PCR amplification and DNA sequencing. Clonal relatedness was investigated by pulsed-field gel electrophoresis (PFGE) and dendrogram analysis. We demonstrated that CNSs were prevalent (35/986, 3.55%) in E. cloacae. Phenotypes of carbapenemases and ESBLs were respectively found in 9 (25.7%) and 23 (65.7%) of the 35 CNS E. cloacae strains. KPC-2, IMP-8, IMP-26, NDM-1, TEM-6, CTX-M-3', CTX-M-14' and SHV-12 type β-lactamases were identified in 3 (8.6%), 5 (14.3%), 1 (2.9%), 1 (2.9%), 13 (37.1%), 9 (25.7%), 8 (22.9%) and 9 (25.7%) isolates, respectively. Importantly, multiple resistance genes were found to be co-expressed in the same CNS E. cloacae isolates. PFGE and dendrogram analysis showed clonal diversity among these isolates. Our study suggested that over-production of carbapenemases and ESBLs contributed together to the CNS of E. cloacae in China. Furthermore, the decreased susceptibility to carbapenems in E. cloaca in the hospital might arise via stepwise accumulations of multiple drug-resistance determinants in different clones. The prevalence of CNS E. cloacae isolates was not caused by clonal dissemination. Most importantly, we identified a CNS E. cloacae isolate co-expressing IMP-26 and NDM-1, which is the first reported to the best of our knowledge. This is also the first report of NDM-1-producing Enterobacteriaceae in mainland China.
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Affiliation(s)
- Wei Dai
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Prevalence of plasmid-mediated quinolone resistance and aminoglycoside resistance determinants among carbapeneme non-susceptible Enterobacter cloacae. PLoS One 2012; 7:e47636. [PMID: 23110085 PMCID: PMC3479141 DOI: 10.1371/journal.pone.0047636] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 09/14/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Simultaneous resistance to aminoglycosides and fluoroquinolones in carbapeneme non-susceptible (CNS) isolates will inevitably create problems. The present study was performed to characterize the prevalence of the plasmid-mediated quinolone resistance determinants (QRDs) and aminoglycoside resistance determinants (ARDs) among the CNS Enterobacter cloacae (E. cloacae) isolates in a Chinese teaching hospital, and to acquire their molecular epidemiological characteristics. METHODS The β-lactamases genes (including class A carbapenemase genes bla(KPC) and bla(SME), metallo-β-lactamase genes (MBLs) bla(IMP), bla(VIM) and bla(NDM), and extended spectrum β-lactamases (ESBLs),bla(CTX-M), bla(TEM) and bla(SHV)), QRDs (including qnrA, qnrB, qnrS and aac(6')-Ib-cr) and ARDs (including aac(6')-Ib, armA and rmtB) of these 35 isolates were determined by PCR and sequenced bidirectionally. The clonal relatedness was investigated by pulsed-field gel electrophoresis (PFGE). RESULTS Of the 35 isolates, 9 (25.7%) harbored a carbapenemase gene; 23 (65.7%) carried ESBLs; 24 (68.6%) were QRD positive; and 27 (77.1%) were ARD positive. Among the 5 bla(IMP-8) positive strains, 4 (80%) contained both ESBL and QRD genes, and all the 5 (100%) harbored ARD genes. Of the 23 ESBLs positive isolates, 6 (26.1%) were carbapenemase positive, 14 (60.9%) were QRD positive, and 18 (78.3%) were ARD positive. PFGE revealed genetic diversity among the 35 isolates, indicating that the high prevalence of CNS E. cloacae isolates was not caused by clonal dissemination. CONCLUSION QRD and ARD genes were highly prevalent among the CNS E. cloacae isolates. Multiple resistant genes were co-expressed in the same isolates. The CNS E. cloacae isolate co-expressing bla(NDM-1), bla(IMP-26), qnrA1 and qnrS1 was first reported.
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Huang SY, Zhu XQ, Wang Y, Liu HB, Dai L, He JK, Li BB, Wu CM, Shen JZ. Co-carriage of qnrS1, floR, and blaCTX-M-14 on a Multidrug-Resistant Plasmid in Escherichia coli Isolated from Pigs. Foodborne Pathog Dis 2012; 9:896-901. [DOI: 10.1089/fpd.2012.1131] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Si-Yang Huang
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, CAAS, Lanzhou, China
- Key Laboratory of Development and Evaluation of the Chemical and Herbal Drugs for Animal Use, Ministry of Agriculture of the People's Republic of China, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Xing-Quan Zhu
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, CAAS, Lanzhou, China
| | - Yang Wang
- Key Laboratory of Development and Evaluation of the Chemical and Herbal Drugs for Animal Use, Ministry of Agriculture of the People's Republic of China, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - He-Bing Liu
- Key Laboratory of Development and Evaluation of the Chemical and Herbal Drugs for Animal Use, Ministry of Agriculture of the People's Republic of China, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Lei Dai
- Department of Veterinary Microbiology and Preventative Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Jia-Kang He
- College of Animal Science and Technology, Guangxi University, Nanning Guangxi, China
| | - Bei-Bei Li
- Key Laboratory of Development and Evaluation of the Chemical and Herbal Drugs for Animal Use, Ministry of Agriculture of the People's Republic of China, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Cong-Ming Wu
- Key Laboratory of Development and Evaluation of the Chemical and Herbal Drugs for Animal Use, Ministry of Agriculture of the People's Republic of China, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Jian-Zhong Shen
- Key Laboratory of Development and Evaluation of the Chemical and Herbal Drugs for Animal Use, Ministry of Agriculture of the People's Republic of China, College of Veterinary Medicine, China Agricultural University, Beijing, China
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Vien LTM, Minh NNQ, Thuong TC, Khuong HD, Nga TVT, Thompson C, Campbell JI, de Jong M, Farrar JJ, Schultsz C, van Doorn HR, Baker S. The co-selection of fluoroquinolone resistance genes in the gut flora of Vietnamese children. PLoS One 2012; 7:e42919. [PMID: 22937000 PMCID: PMC3427306 DOI: 10.1371/journal.pone.0042919] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 07/16/2012] [Indexed: 01/18/2023] Open
Abstract
Antimicrobial consumption is one of the major contributing factors facilitating the development and maintenance of bacteria exhibiting antimicrobial resistance. Plasmid-mediated quinolone resistance (PMQR) genes, such as the qnr family, can be horizontally transferred and contribute to reduced susceptibility to fluoroquinolones. We performed an observational study, investigating the copy number of PMQR after antimicrobial therapy. We enrolled 300 children resident in Ho Chi Minh City receiving antimicrobial therapy for acute respiratory tract infections (ARIs). Rectal swabs were taken on enrollment and seven days subsequently, counts for Enterobacteriaceae were performed and qnrA, qnrB and qnrS were quantified by using real-time PCR on metagenomic stool DNA. On enrollment, we found no association between age, gender or location of the participants and the prevalence of qnrA, qnrB or qnrS. Yet, all three loci demonstrated a proportional increase in the number of samples testing positive between day 0 and day 7. Furthermore, qnrB demonstrated a significant increase in copy number between paired samples (p<0.001; Wilcoxon rank-sum), associated with non-fluoroquinolone combination antimicrobial therapy. To our knowledge, this is the first study describing an association between the use of non-fluoroquinolone antimicrobials and the increasing relative prevalence and quantity of qnr genes. Our work outlines a potential mechanism for the selection and maintenance of PMQR genes and predicts a strong effect of co-selection of these resistance determinants through the use of unrelated and potentially unnecessary antimicrobial regimes.
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Affiliation(s)
- Le Thi Minh Vien
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Ngo Ngoc Quang Minh
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Children's Hospital, Ho Chi Minh City, Vietnam
| | | | - Huynh Duy Khuong
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Tran Vu Thieu Nga
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Corinne Thompson
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - James I. Campbell
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Menno de Jong
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Department of Medical Microbiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeremy J. Farrar
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Centre for Tropical Diseases, University of Oxford, Oxford, United Kingdom
| | - Constance Schultsz
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Department of Medical Microbiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - H. Rogier van Doorn
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Centre for Tropical Diseases, University of Oxford, Oxford, United Kingdom
| | - Stephen Baker
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
- Centre for Tropical Diseases, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Comparative evaluation of a prototype chromogenic medium (ChromID CARBA) for detecting carbapenemase-producing Enterobacteriaceae in surveillance rectal swabs. J Clin Microbiol 2012; 50:1841-6. [PMID: 22461675 DOI: 10.1128/jcm.06848-11] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Carbapenemase-producing Enterobacteriaceae (CPE) are an increasing problem worldwide, and rectal swab surveillance is recommended as a component of infection control programs. The performance of a prototype chromogenic medium (chromID CARBA) was evaluated and compared with media tested by four other screening methods: (i) overnight selective enrichment in 5 ml tryptic soy broth with a 10-μg ertapenem disk followed by plating onto MacConkey agar (CDC-TS), (ii) short selective enrichment in 9 ml brain heart infusion broth with a 10-μg ertapenem disk followed by plating onto chromID ESBL medium (ESBL-BH), (iii) direct plating onto chromID ESBL, and (iv) direct plating onto MacConkey agar supplemented with meropenem (1 μg/ml) (MCM). The screening methods were applied to detect CPE in 200 rectal swab specimens taken from different hospitalized patients. Identification and antimicrobial susceptibility were performed by the Vitek 2 system. Carbapenem MICs were checked by Etest. Carbapenemase production was confirmed using the modified Hodge test, combined-disk tests, and PCR assays. In total, 133 presumptive CPE strains were detected. Phenotypic and genotypic assays confirmed 92 strains to be CPE (56 KPC-positive Klebsiella pneumoniae, 29 VIM-positive K. pneumoniae, and 7 KPC-positive Enterobacter aerogenes strains) recovered from 73 patients, while the remaining 41 strains were confirmed to be CPE negative (19 ESBL producers and 22 nonfermenters). chromID CARBA, ESBL-BH, and chromID ESBL exhibited the highest sensitivity (92.4%), followed by CDC-TS and MCM (89.1%) (P = 0.631). The specificity was greater for chromID CARBA (96.9%) and ESBL-BH (93.2%) than for CDC-TS (86.4%), MCM (85.2%), and chromID ESBL (84.7%) (P = 0.014). In conclusion, chromID CARBA was found to be a rapid and accurate culture screening method for active CPE surveillance.
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Laboratory and clinical evaluation of screening agar plates for detection of carbapenem-resistant Enterobacteriaceae from surveillance rectal swabs. J Clin Microbiol 2011; 49:2239-42. [PMID: 21471338 DOI: 10.1128/jcm.02566-10] [Citation(s) in RCA: 98] [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 increased worldwide spread of carbapenem-resistant Enterobacteriaceae (CRE) emphasizes the need for a sensitive screening procedure to identify these microorganisms. Gastrointestinal carriers may serve as the reservoir for cross-transmission in the health care setting, and thus active surveillance is a key part in preventing the spread of such strains. Three agar-based methods for direct CRE detection from rectal swabs were compared: CHROMagar-KPC (Chrom); MacConkey agar with imipenem at 1 μg/ml (MacI); and MacConkey plates with imipenem, meropenem, and ertapenem disks (MacD). First, we compared the levels of detection (LODs) of 10 molecularly characterized carbapenemase-producing Enterobacteriaceae strains by the three methods. Second, we compared their performance in a surveillance study using rectal swabs (n = 139). The LODs of carbapenemase-producing Enterobacteriaceae strains were influenced by their MICs to carbapenems and were best for MacI, followed by Chrom. The MacD method was able to detect only the strains exhibiting MICs of ≥ 32 μg/ml to at least ertapenem. In the surveillance study, both Chrom and MacI had greater sensitivity (85%) than MacD (76%). However, MacI was the most specific method. In conclusion, MacI appears to be most appropriate medium for the detection of CRE in settings in which multiclonal CRE strains with various MICs to carbapenems are circulating.
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Zhang R, Wang XD, Cai JC, Zhou HW, Lv HX, Hu QF, Chen GX. Outbreak of Klebsiella pneumoniae carbapenemase 2-producing K. pneumoniae with high qnr prevalence in a Chinese hospital. J Med Microbiol 2011; 60:977-982. [PMID: 21393450 DOI: 10.1099/jmm.0.015826-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Forty carbapenem-resistant Klebsiella pneumoniae isolates were recovered from 28 patients from various sites in an intensive care unit in Zhejiang Provincial People's Hospital, China, over a 6 month period. PFGE analysis indicated that the 40 strains were all closely related. The MICs of carbapenems varied from 16 to >256 µg ml⁻¹. Conjugation studies with Escherichia coli resulted in the transfer of reduced carbapenem susceptibility from the original isolates. All K. pneumoniae and E. coli transconjugants produced K. pneumoniae carbapenemase 2 (KPC-2), and most of them produced TEM, SHV and CTX-M. Additionally, 27 isolates and 27 E. coli transconjugants carried the qnr gene (25 were qnrB2 and 2 were qnrS1). K. pneumoniae harboured several plasmids, and bla(KPC-2) was located on a 55 kb plasmid. SDS-PAGE and ompK35/36 gene sequence analysis of OMPs suggested that porins in K. pneumoniae are expressed normally. The MICs of the carbapenems did not change in the presence of CCCP. Thus, production of KPC-2 appears to play an important role in resistance to carbapenems, although other mechanisms may be involved. The bla(KPC-2) gene is associated with several antibiotic-resistance genes, such as bla(TEM), bla(SHV), bla(CTX-M) and qnr.
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Affiliation(s)
- Rong Zhang
- 2nd Affiliated Hospital of Zhejiang University, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, PR China
| | - Xuan Ding Wang
- 2nd Affiliated Hospital of Zhejiang University, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, PR China
| | - Jia Chang Cai
- 2nd Affiliated Hospital of Zhejiang University, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, PR China
| | - Hong Wei Zhou
- 2nd Affiliated Hospital of Zhejiang University, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, PR China
| | - Huo Xiang Lv
- Zhejiang Provincial People's Hospital, 158 Shangtang Road, Hangzhou 310009, PR China
| | - Qing Feng Hu
- Zhejiang Provincial People's Hospital, 158 Shangtang Road, Hangzhou 310009, PR China
| | - Gong-Xiang Chen
- 2nd Affiliated Hospital of Zhejiang University, Zhejiang University, 88 Jiefang Road, Hangzhou 310009, PR China
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Fighting bacterial resistance at the root: need for adapted EMEA guidelines. THE LANCET. INFECTIOUS DISEASES 2011; 11:6-8. [PMID: 21183140 DOI: 10.1016/s1473-3099(10)70227-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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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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21
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The KPC type beta-lactamases: new enzymes that confer resistance to carbapenems in Gram-negative bacilli. Folia Histochem Cytobiol 2010; 47:537-43. [PMID: 20430717 DOI: 10.2478/v10042-009-0079-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Antimicrobial resistance due to the continuous selective pressure from widespread use of antimicrobials in humans, animals and agriculture has been a growing problem for last decades. KPC beta-lactamases hydrolyzed beta-lactams of all classes. Especially, carbapenem antibiotics are hydrolyzed more efficiency than other beta-lactam antibiotics. The KPC enzymes are found most often in Enterobacteriaceae. Recently, these enzymes have been found in isolates of Pseudomonas aeruginosa and Acinetobacter spp. The observations of blaKPC genes isolated from different species in other countries indicate that these genes from common but unknown ancestor may have been mobilized in these areas or that blaKPC-carrying bacteria may have been passively by many vectors. The emergence of carbapenem resistance in Gram-negative bacteria is worrisome because the carbapenem resistance often may be associated with resistance to many beta-lactam and non-beta-lactam antibiotics. Treatment of infections caused by KPC-producing bacteria is extremely difficult because of their multidrug resistance, which results in high mortality rates. Therapeutic options to treat infections caused by multiresistant Gram-negative bacteria producing KPC-carbapenemases could be used polymyxin B or tigecycline.
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22
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Gibson JS, Cobbold RN, Heisig P, Sidjabat HE, Kyaw-Tanner MT, Trott DJ. Identification of Qnr and AAC(6′)-1b-cr plasmid-mediated fluoroquinolone resistance determinants in multidrug-resistant Enterobacter spp. isolated from extraintestinal infections in companion animals. Vet Microbiol 2010; 143:329-36. [DOI: 10.1016/j.vetmic.2009.11.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 11/19/2009] [Accepted: 11/24/2009] [Indexed: 11/16/2022]
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23
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Galani I, Souli M, Mitchell N, Chryssouli Z, Giamarellou H. Presence of plasmid-mediated quinolone resistance in Klebsiella pneumoniae and Escherichia coli isolates possessing blaVIM-1 in Greece. Int J Antimicrob Agents 2010; 36:252-4. [PMID: 20580536 DOI: 10.1016/j.ijantimicag.2010.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 05/17/2010] [Indexed: 10/19/2022]
Abstract
Amongst nalidixic acid-resistant, ciprofloxacin-susceptible Escherichia coli and Klebsiella pneumoniae clinical isolates recovered over a 5-month period from inpatients and outpatients of Attikon University General Hospital (Athens, Greece), only one E. coli was positive for qnrB2 and one K. pneumoniae was positive for qnrA1. Both isolates were extended-spectrum beta-lactamase-negative, metallo-beta-lactamase-positive and carried the bla(VIM-1) gene. Neither of the isolates had mutations in gyrA and parC or carried aac(6')-Ib-cr or qepA. The K. pneumoniae isolate also harboured bla(CMY-13) on the same transferable plasmid with qnrA1. This is the first report of a qnrA1-positive K. pneumoniae and qnrB2-positive E. coli harbouring a concurrent bla(VIM-1) gene.
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Affiliation(s)
- I Galani
- 4th Department of Internal Medicine, Molecular Biology Section, Athens University School of Medicine, Athens, Greece.
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Munoz-Price LS, Hayden MK, Lolans K, Won S, Calvert K, Lin M, Stemer A, Weinstein RA. Successful control of an outbreak of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae at a long-term acute care hospital. Infect Control Hosp Epidemiol 2010; 31:341-7. [PMID: 20175685 DOI: 10.1086/651097] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the effect of a bundle of infection control interventions on the horizontal transmission of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae during an outbreak. DESIGN Quasi-experimental study. Setting. Long-term acute care hospital. Intervention. On July 23, 2008, a bundled intervention was implemented: daily 2% chlorhexidine gluconate baths for patients, enhanced environmental cleaning, surveillance cultures at admission, serial point prevalence surveillance (PPS), isolation precautions, and training of personnel. Baseline PPS was performed before the intervention was implemented. Any gram-negative rod isolate suspected of KPC production underwent a modified Hodge test and, if results were positive, confirmatory polymerase chain reaction testing. Clinical cases were defined to occur for patients whose samples yielded KPC-positive gram-negative rods in clinical cultures. RESULTS Baseline PPS performed on June 17, 2008, showed a prevalence of colonization with KPC-producing isolates of 21% (8 of 39 patients screened). After implementation of the intervention, monthly PPS was performed 5 times, which showed prevalences of colonization with KPC-producing isolates of 12%, 5%, 3%, 0%, and 0% (P < .001). From January 1, 2008, until the intervention, 8 KPC-positive clinical cases--suspected to be due to horizontal transmission--were detected. From implementation of the intervention through December 31, 2008, only 2 KPC-positive clinical cases, both in August 2008, were detected. From January 1 through December 31, 2008, 8 patients were detected as carriers of KPC-producing isolates at admission to the institution, 4 patients before and 4 patients after the intervention. CONCLUSION A bundled intervention was successful in preventing horizontal spread of KPC-producing gram-negative rods in a long-term acute care hospital, despite ongoing admission of patients colonized with KPC producers.
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Affiliation(s)
- L Silvia Munoz-Price
- Division of Infectious Diseases, University of Miami, and Jackson Memorial Hospital, Miami, Florida 33136-1096, USA.
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Tsakris A, Poulou A, Pournaras S, Voulgari E, Vrioni G, Themeli-Digalaki K, Petropoulou D, Sofianou D. A simple phenotypic method for the differentiation of metallo- -lactamases and class A KPC carbapenemases in Enterobacteriaceae clinical isolates. J Antimicrob Chemother 2010; 65:1664-71. [DOI: 10.1093/jac/dkq210] [Citation(s) in RCA: 163] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fluoroquinolone resistance mechanisms in multidrug-resistant Escherichia coli isolated from extraintestinal infections in dogs. Vet Microbiol 2010; 146:161-6. [PMID: 20471187 DOI: 10.1016/j.vetmic.2010.04.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Revised: 04/11/2010] [Accepted: 04/13/2010] [Indexed: 11/23/2022]
Abstract
Fluoroquinolone resistance is an emerging problem in companion animal practice. The present study aimed to determine comparative fluoroquinolone minimum inhibitory concentrations (MICs) for enrofloxacin, marbofloxacin and pradofloxacin and identify plasmid-mediated quinolone resistance (PMQR) mechanisms in 41 multidrug-resistant (MDR) Escherichia coli isolates representing three main clonal groups (CGs) cultured from extraintestinal infections in dogs. All isolates were resistant to fluoroquinolones and the PMQR genes qnrA1, qnrB2, qnrS1 and qepA were identified in isolates from each CG. For a subset of 13 representative isolates, fluoroquinolone chromosomal resistance mechanisms were characterized. CG1 isolates had three mutations in the quinolone resistance determining region (QRDR), two in gyrA (Ser TCG-83→Leu TTG and Asp GAC-87→Asn AAC) and one in parC (Ser AGC-80→Ile ATT), whilst CG2 and CG3 isolates also possessed an additional mutation in parC (Glu GAA-84→Gly GGA) which was reflected in higher fluoroquinolone MICs compared to CG1. Organic solvent tolerance was demonstrated in 8 of the 13 isolates, and all 13 isolates demonstrated enhanced efflux on the basis of a 4-fold decrease or greater in the MIC of enrofloxacin when incubated with an efflux pump inhibitor. A mutation in acrR which can cause overexpression of the AcrAB multidrug efflux pump was detected in CG1 strains. These findings indicate that fluoroquinolone resistance in MDR E. coli isolated from extraintestinal infections in dogs is associated with a combination of target mutations in the QRDRs, transferable PMQR mechanisms and enhanced efflux.
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Molecular epidemiology, sequence types, and plasmid analyses of KPC-producing Klebsiella pneumoniae strains in Israel. Antimicrob Agents Chemother 2010; 54:3002-6. [PMID: 20350950 DOI: 10.1128/aac.01818-09] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Sporadic isolates of carbapenem-resistant KPC-2-producing Klebsiella pneumoniae were isolated in Tel Aviv Medical Center during 2005 and 2006, parallel to the emergence of the KPC-3-producing K. pneumoniae sequence type 258 (ST 258). We aimed to study the molecular epidemiology of these isolates and to characterize their bla(KPC)-carrying plasmids and their origin. Ten isolates (8 KPC-2 and 2 KPC-3 producing) were studied. All isolates were extremely drug resistant. They possessed the bla(KPC) gene and varied in their additional beta-lactamase contents. The KPC-2-producing strains belonged to three different sequence types: ST 340 (n = 2), ST 277 (n = 2), and a novel sequence type, ST 376 (n = 4). Among KPC-3-producing strains, a single isolate (ST 327) different from ST 258 was identified, but both strains carried the same plasmid (pKpQIL). The KPC-2-encoding plasmids varied in size (45 to 95 kb) and differed among each of the STs. Two of the Klebsiella bla(KPC-2)-carrying plasmids were identical to plasmids from Escherichia coli, suggesting a common origin of these plasmids. These data indicate that KPC evolution in K. pneumoniae is related to rare events of interspecies spread of bla(KPC-2)-carrying plasmids from E. coli followed by limited clonal spread, whereas KPC-3 carriage in this species is related almost strictly to clonal expansion of ST 258 carrying pKpQIL.
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Carbapenem-resistant KPC-2-producing Escherichia coli in a Tel Aviv Medical Center, 2005 to 2008. Antimicrob Agents Chemother 2010; 54:2687-91. [PMID: 20231393 DOI: 10.1128/aac.01359-09] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
All of the carbapenem-resistant Escherichia coli (CREC) isolates identified in our hospital from 2005 to 2008 (n = 10) were studied. CREC isolates were multidrug resistant, all carried bla(KPC-2), and six of them were also extended-spectrum beta-lactamase producers. Pulsed-field gel electrophoresis indicated six genetic clones; within the same clone, similar transferable bla(KPC-2)-containing plasmids were found whereas plasmids differed between clones. Tn4401 elements were identified in all of these plasmids.
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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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Hussein AIA, Ahmed AM, Sato M, Shimamoto T. Characterization of integrons and antimicrobial resistance genes in clinical isolates of Gram-negative bacteria from Palestinian hospitals. Microbiol Immunol 2009; 53:595-602. [DOI: 10.1111/j.1348-0421.2009.00168.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Deresinski SC, Schirmer P. Management of infections due to KPC-producing Klebsiella pneumoniae. F1000 MEDICINE REPORTS 2009; 1. [PMID: 20948700 PMCID: PMC2948324 DOI: 10.3410/m1-79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The emergence of the Klebsiella pneumoniae carbapenemases in K. pneumoniae and other Gram-negative bacteria, usually on a background of multidrug resistance, has led to difficult therapeutic choices. Among available antibiotics, tigecycline and the polymyxins are the most frequently active against these organisms in vitro. Optimal therapy of infections due to these bacteria may involve maximization of antibiotic dose as well as their use in combination.
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Affiliation(s)
- Stanley C Deresinski
- Division of Infectious Disease and Geographic Medicine, Department of Medicine, Stanford University300 Pasteur Drive, Stanford, CA 94305-5107USA
- 2900 Whipple Avenue, Suite 115, Redwood City, CA 94062USA
| | - Patricia Schirmer
- Division of Infectious Disease and Geographic Medicine, Department of Medicine, Stanford University300 Pasteur Drive, Stanford, CA 94305-5107USA
- Department of Veterans Affairs3801 Miranda Ave (132), Palo Alto, CA 94304USA
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Chmelnitsky I, Hermesh O, Navon-Venezia S, Strahilevitz J, Carmeli Y. Detection of aac(6')-Ib-cr in KPC-producing Klebsiella pneumoniae isolates from Tel Aviv, Israel. J Antimicrob Chemother 2009; 64:718-22. [PMID: 19656782 DOI: 10.1093/jac/dkp272] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We aimed to evaluate the occurrence and characteristics of plasmid-mediated quinolone resistance (PMQR) genes in KPC-producing (KPC-P) Klebsiella pneumoniae (Kpn) isolates in Tel Aviv Medical Center, Israel. METHODS Forty-seven KPC-P Kpn isolates were studied. Antibiotic susceptibilities were determined by Vitek 2, Etest or agar dilution. Beta-lactamases and PMQR determinants were detected by PCR. For plasmid characterization, transformation, transconjugation, restriction mapping and Southern blot analysis were performed. RESULTS Six out of 47 (13%) KPC-P isolates carried aac(6')-Ib-cr. Acquisition of aac(6')-Ib-cr-encoding plasmids increased the MIC of ciprofloxacin by 2-fold. In five of six KPC-P isolates, aac(6')-Ib-cr and bla(KPC-2) were encoded on the same plasmid. CONCLUSIONS The most prevalent PMQR gene in the studied KPC-P K. pneumoniae isolates is aac(6')-Ib-cr. The co-existence of PMQR genes with KPC on the same plasmid poses a serious epidemiological, clinical and public-health threat.
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Affiliation(s)
- Inna Chmelnitsky
- Division of Epidemiology, Tel Aviv Medical Center, Tel Aviv, Israel.
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Govender N, Smith AM, Karstaedt AS, Keddy KH. Plasmid-mediated quinolone resistance in Salmonella from South Africa. J Med Microbiol 2009; 58:1393-1394. [PMID: 19541785 DOI: 10.1099/jmm.0.009621-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Nevashan Govender
- Enteric Diseases Reference Unit, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Anthony M Smith
- University of the Witwatersrand, Johannesburg, South Africa.,Enteric Diseases Reference Unit, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Alan S Karstaedt
- Chris Hani Baragwanath Hospital, Johannesburg, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - Karen H Keddy
- University of the Witwatersrand, Johannesburg, South Africa.,Enteric Diseases Reference Unit, National Institute for Communicable Diseases, Johannesburg, South Africa
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Nordmann P, Cuzon G, Naas T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. THE LANCET. INFECTIOUS DISEASES 2009; 9:228-36. [PMID: 19324295 DOI: 10.1016/s1473-3099(09)70054-4] [Citation(s) in RCA: 1092] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
From early this decade, Enterobacteriaceae that produce Klebsiella pneumoniae carbapenemases (KPC) were reported in the USA and subsequently worldwide. These KPC-producing bacteria are predominantly involved in nosocomial and systemic infections; although they are mostly Enterobacteriaceae, they can also be, rarely, Pseudomonas aeruginosa isolates. KPC beta lactamases (KPC-1 to KPC-7) confer decreased susceptibility or resistance to virtually all beta lactams. Carbapenems (imipenem, meropenem, and ertapenem) may thus become inefficient for treating enterobacterial infections with KPC-producing bacteria, which are, in addition, resistant to many other non-beta-lactam molecules, leaving few available therapeutic options. Detection of KPC-producing bacteria may be difficult based on routine antibiotic susceptibility testing. It is therefore crucial to implement efficient infection control measures to limit the spread of these pathogens.
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Affiliation(s)
- Patrice Nordmann
- Service de Bactériologie-Virologie-Hygiène, INSERM U914 "Emerging Resistance to Antibiotics", Hôpital de Bicêtre, Assistance Publique/Hôpitaux de Paris, Faculté de Médecine and Université Paris Sud, K -Bicêtre, France
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Patel JB, Rasheed JK, Kitchel B. Carbapenemases in Enterobacteriaceae: Activity, Epidemiology, and Laboratory Detection. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.clinmicnews.2009.03.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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