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Canabal R, González-Bello C. Chemical sensors for the early diagnosis of bacterial resistance to β-lactam antibiotics. Bioorg Chem 2024; 150:107528. [PMID: 38852309 DOI: 10.1016/j.bioorg.2024.107528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024]
Abstract
β-Lactamases are bacterial enzymes that inactivate β-lactam antibiotics and, as such, are the most prevalent cause of antibiotic resistance in Gram-negative bacteria. The ever-increasing production and worldwide dissemination of bacterial strains producing carbapenemases is currently a global health concern. These enzymes catalyze the hydrolysis of carbapenems - the β-lactam antibiotics with the broadest spectrum of activity that are often considered as drugs of last resort. The incidence of carbapenem-resistant pathogens such as Pseudomonas aeruginosa, Acinetobacter baumannii and carbapenemase or extended spectrum beta-lactamase (ESBL)-producing Enterobacterales, which are frequent in clinical settings, is worrisome since, in some cases, no therapies are available. These include all metallo-β-lactamases (VIM, IMP, NDM, SMP, and L1), and serine-carbapenemases of classes A (KPC, SME, IMI, and GES), and of classes D (OXA-23, OXA-24/40, OXA-48 and OXA-58). Consequently, the early diagnosis of bacterial strains harboring carbapenemases is a pivotal task in clinical microbiology in order to track antibiotic bacterial resistance and to improve the worldwide management of infectious diseases. Recent research efforts on the development of chromogenic and fluorescent chemical sensors for the specific and sensitive detection and quantification of β-lactamase production in multidrug-resistant pathogens are summarized herein. Studies to circumvent the main limitations of the phenotypic and molecular methods are discussed. Recently reported chromogenic and fluorogenic cephalosporin- and carbapenem-based β-lactamase substrates will be reviewed as alternative options to the currently available nitrocefin and related compounds, a chromogenic cephalosporin-based reagent widely used in clinical microbiology laboratories. The scope of these new chemical sensors, along with the synthetic approaches to synthesize them, is also summarized.
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Affiliation(s)
- Rafael Canabal
- Centro Singular de Investigación en Química Biolóxica e Materiais Moleculares (CiQUS), Departamento de Química Orgánica, Universidade de Santiago de Compostela, Jenaro de la Fuente s/n, 15782 Santiago de Compostela, Spain
| | - Concepción González-Bello
- Centro Singular de Investigación en Química Biolóxica e Materiais Moleculares (CiQUS), Departamento de Química Orgánica, Universidade de Santiago de Compostela, Jenaro de la Fuente s/n, 15782 Santiago de Compostela, Spain.
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McCarley A, Espejo ML, Harmon DE, Ruiz C. Freshwater and Marine Environments in California Are a Reservoir of Carbapenem-Resistant Bacteria. Microorganisms 2024; 12:802. [PMID: 38674746 PMCID: PMC11052360 DOI: 10.3390/microorganisms12040802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/13/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
Carbapenems are last-resort antibiotics used to treat multidrug-resistant bacterial infections. Resistance to carbapenems has been designated as an urgent threat and is increasing in healthcare settings. However, little is still known about the distribution and characteristics of carbapenem-resistant bacteria (CRB) outside of healthcare settings. Here, we surveyed the distribution of CRB in ten diverse freshwater and seawater environments in California, U.S., ranging from San Luis Obispo County to San Bernardino County, combining both direct isolation and enrichment approaches to increase the diversity of isolated CRB. From the locations surveyed, we selected 30 CRB for further characterization. These isolates were identified as members of the genera Aeromonas, Enterobacter, Enterococcus, Paenibacillus, Pseudomonas, Sphingobacterium, and Stenotrophomonas. These isolates were resistant to carbapenems, other β-lactams, and often to other antibiotics (tetracycline, gentamicin, or ciprofloxacin). We also found that nine isolates belonging to the genera Aeromonas, Enterobacter (blaIMI-2), and Stenotrophomonas (blaL1) produced carbapenemases. Overall, our findings indicate that sampling different types of aquatic environments and combining different isolation approaches increase the diversity of the environmental CRB obtained. Moreover, our study supports the increasingly recognized role of natural water systems as an underappreciated reservoir of bacteria resistant to carbapenems and other antibiotics, including bacteria carrying carbapenemase genes.
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Affiliation(s)
| | | | | | - Cristian Ruiz
- Department of Biology, California State University Northridge, Northridge, CA 91330, USA
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Findlay J, Raro OHF, Poirel L, Nordmann P. Molecular analysis of metallo-beta-lactamase-producing Pseudomonas aeruginosa in Switzerland 2022-2023. Eur J Clin Microbiol Infect Dis 2024; 43:551-557. [PMID: 38233610 PMCID: PMC10917820 DOI: 10.1007/s10096-024-04752-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/07/2024] [Indexed: 01/19/2024]
Abstract
OBJECTIVES The occurrence of metallo-beta-lactamase-producing Pseudomonas aeruginosa (MBL-PA) isolates is increasing globally, including in Switzerland. The aim of this study was to characterise, phenotypically and genotypically, the MBL-PA isolates submitted to the Swiss National Reference Center for Emerging Antibiotic Resistance (NARA) reference laboratory over a 12-month period from July 2022 to July 2023. METHODS Thirty-nine non-duplicate MBL-PA Isolates were submitted to NARA over the study period from across Switzerland. Susceptibility was determined by broth microdilution according to EUCAST methodology. Whole-genome sequencing was performed on 34 isolates. Sequence types (STs) and resistance genes were ascertained using the Centre for Genomic Epidemiology platform. MBL genes, blaNDM-1, blaIMP-1, and blaVIM-2, were cloned into vector pUCP24 and transformed into P. aeruginosa PA14. RESULTS The most prevalent MBL types identified in this study were VIM (21/39; 53.8%) followed by NDM (11/39; 28.2%), IMP (6/39; 15.4%), and a single isolate produced both VIM and NDM enzymes. WGS identified 13 different STs types among the 39 isolates. They all exhibited resistance to cephalosporins, carbapenems, and the beta-lactam-beta-lactamase inhibitor combinations, ceftolozane-tazobactam, ceftazidime-avibactam, imipenem-relebactam, and meropenem-vaborbactam, and 8 isolates were cefiderocol (FDC) resistant. Recombinant P. aeruginosa strains producing blaNDM-1, blaIMP-1, and blaVIM-2 exhibited FDC MICs of 16, 8, and 1 mg/L, respectively. CONCLUSIONS This study showed that the MBL-PA in Switzerland could be attributed to the wide dissemination of high-risk clones that accounted for most isolates in this study. Although FDC resistance was only found in 8 isolates, MBL carriage was shown to be a major contributor to this phenotype.
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Affiliation(s)
- Jacqueline Findlay
- Medical and Molecular Microbiology, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée 18, CH-1700, Fribourg, Switzerland.
| | - Otavio Hallal Ferreira Raro
- Medical and Molecular Microbiology, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée 18, CH-1700, Fribourg, Switzerland
| | - Laurent Poirel
- Medical and Molecular Microbiology, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée 18, CH-1700, Fribourg, Switzerland
- Swiss National Reference Center for Emerging Antibiotic Resistance (NARA) Network, Swiss National Reference Center for Emerging Antibiotic Resistance (NARA), University of Fribourg, Fribourg, Switzerland
| | - Patrice Nordmann
- Medical and Molecular Microbiology, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée 18, CH-1700, Fribourg, Switzerland
- Swiss National Reference Center for Emerging Antibiotic Resistance (NARA) Network, Swiss National Reference Center for Emerging Antibiotic Resistance (NARA), University of Fribourg, Fribourg, Switzerland
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4
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Mr. Saddam, Khan M, Jamal M, Rahman SU, Qadeer A, Khan I, Mahmoud MH, Batiha GES, Shah SH. Nutritional analysis and characterization of carbapenemase producing-Klebsiella pneumoniae resistant genes associated with bovine mastitis infected cow's milk. PLoS One 2023; 18:e0293477. [PMID: 37889925 PMCID: PMC10610456 DOI: 10.1371/journal.pone.0293477] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
The current study was designed to analyze nutritional parameters and to characterize carbapenemase producing-Klebsiella pneumoniae isolates from bovine mastitic cow's milk. Out of 700 milk samples K. pneumoniae was identified by phenotypic and molecular techniques along with their antibiogram analysis and nutritional analysis was performed using the procedure of Association of Official Analytical Chemists. Carbapenemase-producing K. pneumoniae was detected by phenotypic CarbaNP test followed by molecular characterization of their associated resistant genes blaVIM, blaKPC, blaOXA-48, blaNDM, and blaIMP along with insertion sequence common region 1 (ISCR1) and integrons (Int1, Int2, and Int3) genes. Among nutritional parameters, fat content was observed (2.99%) followed by protein (2.78%), lactose (4.32%), and total solid (11.34%), respectively. The prevalence of K. pneumoniae among bovine mastitis was found 25.71%. Antibiogram analysis revealed that more effective antibiotics was ceftazidime (80%) followed by amikacin (72%), while highly resistant antibiotics was Fusidic acid (100%). Distribution of carbapenemase producer K. pneumoniae was found 44.4%. Among carbapenem resistant genes blaKPC was found 11.25%, blaVIM 2.75%, blaNDM 17.5%, and blaOXA-48 7.5%, while blaIMP gene was not detected. Furthermore, distribution of ISCR1 was found 40%, while integron 1 was found 61.2% followed by integron 2 (20%), and integron 3 (5%). In conclusion, the recent scenario of carbapenemase resistant K. pneumoniae isolates responsible for mastitis may affect not only the current treatment regime but also possess a serious threat to public health due to its food borne transmission and zoonotic potential.
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Affiliation(s)
- Mr. Saddam
- Department of Microbiology, Abdul Wali Khan University, Marden, Pakistan
| | - Muddasir Khan
- Centre of Biotechnology and Microbiology, University of Peshawar, Peshawar, Pakistan
| | - Muhsin Jamal
- Department of Microbiology, Abdul Wali Khan University, Marden, Pakistan
| | - Sadeeq Ur Rahman
- College of Veterinary Sciences and Animal Husbandry, Abdul Wali Khan University, Mardan, Pakistan
| | - Abdul Qadeer
- Shanghai Tenth People’s Hospital, Institute for Infectious Diseases and Vaccine Development, Tongji University School of Medicine, Shanghai, China
| | - Imad Khan
- College of Veterinary Sciences and Animal Husbandry, Abdul Wali Khan University, Mardan, Pakistan
| | - Mohamed H. Mahmoud
- Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Gaber El-Saber Batiha
- Department of Pharmacology, Faculty of Veterinary Medicine, Damanhour University, Damanhour, AlBeheira, Egypt
| | - Syed Hussain Shah
- Department of Health and Biological Sciences, Abasyn University Peshawar, Peshawar, Pakistan
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Benzaarate I, El Otmani F, Khazaz A, Timinouni M, Bourjilat F, Bogaerts P, Huang TD, Nayme K. Detection of Carbapenemase Encoding Gene and Resistance to Cefiderocol in Hospital and Community eXtensive Drug Resistance and Carbapenem-Resistant Pseudomonas aeruginosa Strains in Morocco. Foodborne Pathog Dis 2023; 20:460-466. [PMID: 37616567 DOI: 10.1089/fpd.2023.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
Pseudomonas aeruginosa (Pa) remains among clinically-significant Gram-negative species. The carbapenems are often the last resort for treating infections due to multidrug resistant isolates such as Pa. The carbapenems' efficacy is increasingly compromised by the emergence and the rapid spread of Pa carrying carbapenemases which represent a serious threat to public health. This study aimed to establish the resistance profile and to identify carbapenemase genes in isolates with imipenem resistant phenotypes. Among 134 Pa isolates collected both in the community (46) and hospital (88) from January 2021 to December 2021 in Morocco, 18 (8 were from the community and 10 from the hospital settings) were carbapenem resistant. The identification of these strains has been confirmed using matrix assisted laser desorption ionization-time of flight (MALDI-TOF). The antibiotic susceptibility testing against 16 antibiotics was carried out and interpreted according to the recommendations of the European Committee on Antimicrobial Susceptibility Testing (2021). The worrying antibiotics resistance profiles, which spread to cefiderocol for two isolates, were obtained for all isolates, which were eXtensive Drug Resistance showing highly resistant to all antibiotic categories tested, even to ceftolozane-tazobactam. Colistin (100% susceptible) and cefiderocol (88.88%) were the most active agents against carbapenem-resistant Pa (CRPa). Phenotypic detection by NP-CARBA and NG-CARBA tests of metallo‑β‑lactamase (MβL) production was confirmed by PCR amplification and sequencing. Three CRPa isolates coharboring blaVIM-2-blaNDM-1 (two isolates) and blaVIM-2-blaIMP-8 (one isolate) genes were detected. In this study, we describe the coexistence of these MβL genes and the cefiderocol resistance in CRPa strains in Morocco. The alarming antibiotic resistance patterns of all these CRPa isolates and their resistance genes emphasize the importance of antimicrobial susceptibility testing in the choice of antibiotics for treating Pa infections.
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Affiliation(s)
- Ihssane Benzaarate
- Microbiology and Antimicrobial Agents Research Team (LB2VE), Department of Biology, Faculty of Sciences, Chouaib Doukkali University, El Jadida, Morocco
- Molecular Bacteriology Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Fatima El Otmani
- Microbiology and Antimicrobial Agents Research Team (LB2VE), Department of Biology, Faculty of Sciences, Chouaib Doukkali University, El Jadida, Morocco
| | - Aboubakr Khazaz
- Microbiology and Antimicrobial Agents Research Team (LB2VE), Department of Biology, Faculty of Sciences, Chouaib Doukkali University, El Jadida, Morocco
- Molecular Bacteriology Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Mohammed Timinouni
- Laboratoire de Biotechnologie et Bioinformatique, Ecoles des Hautes Etudes de Biotechnologie et de santé (EHEB), Casablanca, Morocco
| | - Fatna Bourjilat
- Bacteriology Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Pierre Bogaerts
- National Center for Antimicrobial Resistance in Gram-, CHU UCL Namur, Yvoir, Belgium
| | - Te-Din Huang
- National Center for Antimicrobial Resistance in Gram-, CHU UCL Namur, Yvoir, Belgium
| | - Kaotar Nayme
- Molecular Bacteriology Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
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Coșeriu RL, Mare AD, Toma F, Vintilă C, Ciurea CN, Togănel RO, Cighir A, Simion A, Man A. Uncovering the Resistance Mechanisms in Extended-Drug-Resistant Pseudomonas aeruginosa Clinical Isolates: Insights from Gene Expression and Phenotypic Tests. Microorganisms 2023; 11:2211. [PMID: 37764055 PMCID: PMC10535578 DOI: 10.3390/microorganisms11092211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: The purpose of the study was to describe the activity of mex efflux pumps in Multidrug-Resistant (MDR) clinical isolates of Pseudomonas aeruginosa and to compare the carbapenem-resistance identification tests with PCR; (2) Methods: Sixty MDR P. aeruginosa were analyzed for detection of carbapenemase by disk diffusion inhibitory method, carbapenem inactivation method and Modified Hodge Test. Endpoint PCR was used to detect 7 carbapenemase genes (blaKPC, blaOXA48-like, blaNDM, blaGES-2, blaSPM, blaIMP, blaVIM) and mcr-1 for colistin resistance. The expression of mexA, mexB, mexC, mexE and mexX genes corresponding to the four main efflux pumps was also evaluated; (3) Results: From the tested strains, 71.66% presented at least one carbapenemase gene, with blaGES-2 as the most occurring gene (63.3%). Compared with the PCR, the accuracy of phenotypic tests did not exceed 25% for P. aeruginosa. The efflux pump genes were present in all strains except one. In 85% of the isolates, an overactivity of mexA, mexB and mostly mexC was detected. Previous treatment with ceftriaxone increased the activity of mexC by more than 160 times; (4) Conclusions: In our MDR P. aeruginosa clinical isolates, the carbapenem resistance is not accurately detected by phenotypic tests, due to the overexpression of mex efflux pumps and in a lesser amount, due to carbapenemase production.
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Affiliation(s)
- Răzvan Lucian Coșeriu
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania; (R.L.C.); (F.T.); (C.V.); (C.N.C.); (R.O.T.); (A.C.); (A.S.); (A.M.)
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania
| | - Anca Delia Mare
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania; (R.L.C.); (F.T.); (C.V.); (C.N.C.); (R.O.T.); (A.C.); (A.S.); (A.M.)
| | - Felicia Toma
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania; (R.L.C.); (F.T.); (C.V.); (C.N.C.); (R.O.T.); (A.C.); (A.S.); (A.M.)
| | - Camelia Vintilă
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania; (R.L.C.); (F.T.); (C.V.); (C.N.C.); (R.O.T.); (A.C.); (A.S.); (A.M.)
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania
| | - Cristina Nicoleta Ciurea
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania; (R.L.C.); (F.T.); (C.V.); (C.N.C.); (R.O.T.); (A.C.); (A.S.); (A.M.)
| | - Radu Ovidiu Togănel
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania; (R.L.C.); (F.T.); (C.V.); (C.N.C.); (R.O.T.); (A.C.); (A.S.); (A.M.)
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania
| | - Anca Cighir
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania; (R.L.C.); (F.T.); (C.V.); (C.N.C.); (R.O.T.); (A.C.); (A.S.); (A.M.)
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania
| | - Anastasia Simion
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania; (R.L.C.); (F.T.); (C.V.); (C.N.C.); (R.O.T.); (A.C.); (A.S.); (A.M.)
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania
| | - Adrian Man
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology Târgu Mureș, 540142 Târgu Mures, Romania; (R.L.C.); (F.T.); (C.V.); (C.N.C.); (R.O.T.); (A.C.); (A.S.); (A.M.)
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Tang Y, Duan F, Zhou A, Kanitthamniyom P, Luo S, Hu X, Jiang X, Vasoo S, Zhang X, Zhang Y. Image-based real-time feedback control of magnetic digital microfluidics by artificial intelligence-empowered rapid object detector for automated in vitro diagnostics. Bioeng Transl Med 2023; 8:e10428. [PMID: 37476053 PMCID: PMC10354763 DOI: 10.1002/btm2.10428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/19/2022] [Accepted: 10/03/2022] [Indexed: 11/12/2022] Open
Abstract
In vitro diagnostics (IVD) plays a critical role in healthcare and public health management. Magnetic digital microfluidics (MDM) perform IVD assays by manipulating droplets on an open substrate with magnetic particles. Automated IVD based on MDM could reduce the risk of accidental exposure to contagious pathogens among healthcare workers. However, it remains challenging to create a fully automated IVD platform based on the MDM technology because of a lack of effective feedback control system to ensure the successful execution of various droplet operations required for IVD. In this work, an artificial intelligence (AI)-empowered MDM platform with image-based real-time feedback control is presented. The AI is trained to recognize droplets and magnetic particles, measure their size, and determine their location and relationship in real time; it shows the ability to rectify failed droplet operations based on the feedback information, a function that is unattainable by conventional MDM platforms, thereby ensuring that the entire IVD process is not interrupted due to the failure of liquid handling. We demonstrate fundamental droplet operations, which include droplet transport, particle extraction, droplet merging and droplet mixing, on the MDM platform and show how the AI rectify failed droplet operations by acting upon the feedback information. Protein quantification and antibiotic resistance detection are performed on this AI-empowered MDM platform, and the results obtained agree well with the benchmarks. We envision that this AI-based feedback approach will be widely adopted not only by MDM but also by other types of digital microfluidic platforms to offer precise and error-free droplet operations for a wide range of automated IVD applications.
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Affiliation(s)
- Yuxuan Tang
- School of Mechanical and Aerospace EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Fei Duan
- School of Mechanical and Aerospace EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Aiwu Zhou
- Singapore Center for 3D Printing, School of Mechanical and Aerospace EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Pojchanun Kanitthamniyom
- School of Mechanical and Aerospace EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Shaobo Luo
- School of MicroelectronicsSouthern University of Science and TechnologyShenzhenChina
| | - Xuyang Hu
- China‐Singapore International Joint Research InstituteGuangzhouChina
| | - Xudong Jiang
- School of Electronic and Electrical EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Shawn Vasoo
- National Center for Infectious DiseaseTan Tock Seng HospitalSingaporeSingapore
| | - Xiaosheng Zhang
- School of Electronic Science and EngineeringUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Yi Zhang
- School of Electronic Science and EngineeringUniversity of Electronic Science and Technology of ChinaChengduChina
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8
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Ghasemian S, Karami‐Zarandi M, Heidari H, Khoshnood S, Kouhsari E, Ghafourian S, Maleki A, Kazemian H. Molecular characterizations of antibiotic resistance, biofilm formation, and virulence determinants of Pseudomonas aeruginosa isolated from burn wound infection. J Clin Lab Anal 2023; 37:e24850. [PMID: 36808649 PMCID: PMC10020843 DOI: 10.1002/jcla.24850] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/09/2023] [Accepted: 02/05/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Burn injuries result in disruption of the skin barrier against opportunistic infections. Pseudomonas aeruginosa is one of the main infectious agents colonizing burn wounds and making severe infections. Biofilm production and other virulence factors along with antibiotic resistance limit appropriate treatment options and time. MATERIALS AND METHODS Wound samples were collected from hospitalized burn patients. P. aeruginosa isolates and related virulence factors identified by the standard biochemical and molecular methods. Antibiotic resistance patterns were determined by the disc diffusion method and β-lactamase genes were detected by polymerase chain reaction (PCR) assay. To determine the genetic relatedness amongst the isolates, enterobacterial repetitive intergenic consensus (ERIC)-PCR was also performed. RESULTS Forty P. aeruginosa isolates were identified. All of these isolates were biofilm producers. Carbapenem resistance was detected in 40% of the isolates, and blaTEM (37/5%), blaVIM (30%), and blaCTX-M (20%) were the most common β-lactamase genes. The highest resistance was detected to cefotaxime, ceftazidime, meropenem, imipenem and piperacillin, and 16 (40%) isolates were resistant to these antibiotics. The minimum inhibitory concentrations (MIC) of colistin was lower than 2 μg/mL and no resistance was observed. Isolates were categorized to 17 MDR, 13 mono-drug resistance, and 10 susceptible isolates. High genetic diversity was also observed among the isolates (28 ERIC types) and most carbapenem-resistant isolates were classified into four main types. CONCLUSION Antibiotic resistance, particularly carbapenem resistance was considerable among the P. aeruginosa isolates colonizing burn wounds. Combining carbapenem resistance with biofilm production and virulence factors would result in severe and difficult-to-treat infections.
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Affiliation(s)
- Shirin Ghasemian
- Department of Microbiology, Faculty of MedicineIlam University of Medical SciencesIlamIran
| | - Morteza Karami‐Zarandi
- Department of Microbiology, Faculty of MedicineZanjan University of Medical SciencesZanjanIran
| | - Hamid Heidari
- Department of Microbiology, Faculty of MedicineShahid Sadoughi University of Medical SciencesYazdIran
| | - Saeed Khoshnood
- Clinical Microbiology Research CenterIlam University of Medical SciencesIlamIran
| | - Ebrahim Kouhsari
- Laboratory Sciences Research CenterGolestan University of Medical SciencesGorganIran
- Department of Laboratory Sciences, Faculty of ParamedicineGolestan University of Medical SciencesGorganIran
| | - Sobhan Ghafourian
- Department of Microbiology, Faculty of MedicineIlam University of Medical SciencesIlamIran
| | - Abbas Maleki
- Clinical Microbiology Research CenterIlam University of Medical SciencesIlamIran
| | - Hossein Kazemian
- Department of Microbiology, Faculty of MedicineIlam University of Medical SciencesIlamIran
- Clinical Microbiology Research CenterIlam University of Medical SciencesIlamIran
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9
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de Oliveira Santos IC, da Conceiçāo Neto OC, da Costa BS, Teixeira CBT, da Silva Pontes L, Silveira MC, Rocha-de-Souza CM, Carvalho-Assef APD. Evaluation of phenotypic detection of carbapenemase-producing Pseudomonas spp. from clinical isolates. Braz J Microbiol 2023; 54:135-141. [PMID: 36327041 PMCID: PMC9943810 DOI: 10.1007/s42770-022-00857-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
Carbapenems are considered last-resort antibiotics for the treatment of infections caused by multidrug-resistant Gram-negative bacteria. Although the main mechanism of carbapenem-resistance in Pseudomonas aeruginosa is the loss of OprD porin, carbapenemases continue to be a problem worldwide. The aim of this study was to evaluate the performance of phenotypic tests (Carba NP, Blue Carba, and mCIM/eCIM) for detection of carbapenemase-producing Pseudomonas spp. in Brazil. One hundred twenty-seven Pseudomonas spp. clinical isolates from different Brazilian states were submitted to phenotypic and molecular carbapenemase detection. A total of 90 carbapenemase-producing P. aeruginosa and 5 Pseudomonas putida (35, blaVIM-2; 17, blaSPM-1; 2, blaIMP-10; 1, blaVIM-24; 1, blaNDM-1; 39, blaKPC-2). The phenotypic Carba NP, Blue Carba, and mCIM/eCIM showed sensitivity of 94.7%, 93.6%, and 93.6%, and specificity of 90.6%, 100%, and 96.8%, respectively. However, only the Carba NP presented the highest sensitivity and showed the ability in differentiating the carbapenemases between class A and class B using EDTA. Blue Carba failed to detect most of the class B carbapenemases, having the worst performance using EDTA. Our results show changes in the epidemiology of the spread of carbapenemases and the importance of their detection by phenotypic and genotypic tests. Such, it is essential to use analytical tools that faithfully detect bacterial resistance in vitro in a simple, sensitive, rapid, and cost-effective way. Much effort must be done to improve the current tests and for the development of new ones.
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Affiliation(s)
- Ivson Cassiano de Oliveira Santos
- Laboratório de Pesquisa Em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz - FIOCRUZ, Fundação Oswaldo Cruz, Av. Brasil, 4365, Rio de Janeiro, RJ, 21045900, Brazil
| | - Orlando Carlos da Conceiçāo Neto
- Laboratório de Pesquisa Em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz - FIOCRUZ, Fundação Oswaldo Cruz, Av. Brasil, 4365, Rio de Janeiro, RJ, 21045900, Brazil
| | - Bianca Santos da Costa
- Laboratório de Pesquisa Em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz - FIOCRUZ, Fundação Oswaldo Cruz, Av. Brasil, 4365, Rio de Janeiro, RJ, 21045900, Brazil
| | - Camila Bastos Tavares Teixeira
- Laboratório de Pesquisa Em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz - FIOCRUZ, Fundação Oswaldo Cruz, Av. Brasil, 4365, Rio de Janeiro, RJ, 21045900, Brazil
| | - Leilane da Silva Pontes
- Laboratório de Pesquisa Em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz - FIOCRUZ, Fundação Oswaldo Cruz, Av. Brasil, 4365, Rio de Janeiro, RJ, 21045900, Brazil
| | - Melise Chaves Silveira
- Laboratório de Pesquisa Em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz - FIOCRUZ, Fundação Oswaldo Cruz, Av. Brasil, 4365, Rio de Janeiro, RJ, 21045900, Brazil
| | - Cláudio Marcos Rocha-de-Souza
- Laboratório de Pesquisa Em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz - FIOCRUZ, Fundação Oswaldo Cruz, Av. Brasil, 4365, Rio de Janeiro, RJ, 21045900, Brazil
| | - Ana Paula D'Alincourt Carvalho-Assef
- Laboratório de Pesquisa Em Infecção Hospitalar (LAPIH), Instituto Oswaldo Cruz - FIOCRUZ, Fundação Oswaldo Cruz, Av. Brasil, 4365, Rio de Janeiro, RJ, 21045900, Brazil.
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10
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Ihssane B, Fatima EO, Aboubakr K, Fatna B, Mohammed T, Pierre B, Te-Din H, Kaotar N. First report of Pseudomonas aeruginosa strains co-harboring bla NDM-bla VIM and bla VIM-bla IMP metallo‑β‑lactamase genes in Morocco. J Glob Antimicrob Resist 2023; 33:42-43. [PMID: 36842458 DOI: 10.1016/j.jgar.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/22/2023] [Accepted: 02/09/2023] [Indexed: 02/28/2023] Open
Affiliation(s)
- Benzaarate Ihssane
- Microbiology and Antimicrobial Agents Research Team, Department of Biology, Faculty of Sciences, Chouaib Doukkali University, El Jadida, Morocco; Molecular Bacteriology Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco.
| | - El Otmani Fatima
- Microbiology and Antimicrobial Agents Research Team, Department of Biology, Faculty of Sciences, Chouaib Doukkali University, El Jadida, Morocco
| | - Khazaz Aboubakr
- Microbiology and Antimicrobial Agents Research Team, Department of Biology, Faculty of Sciences, Chouaib Doukkali University, El Jadida, Morocco; Molecular Bacteriology Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Bourjilat Fatna
- Bacteriology Laboratory, Institut Pasteur du Maroc, Casablanca; Morocco
| | - Timinouni Mohammed
- Biotechnology and Bioinformatic Laboratory, School of Advanced Studies in Biotechnology and Health, Casablanca, Morocco
| | - Bogaerts Pierre
- National Center for Antimicrobial Resistance in Gram Negative Bacilli in CHU UCL Namur, Yvoir, Belgium
| | - Huang Te-Din
- National Center for Antimicrobial Resistance in Gram Negative Bacilli in CHU UCL Namur, Yvoir, Belgium
| | - Nayme Kaotar
- Molecular Bacteriology Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
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11
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Aguilar-Rodea P, Zúñiga G, Cerritos R, Rodríguez-Espino BA, Gomez-Ramirez U, Nolasco-Romero CG, López-Marceliano B, Rodea GE, Mendoza-Elizalde S, Reyes-López A, Olivares Clavijo H, Vigueras Galindo JC, Velázquez-Guadarrama N, Rosas-Pérez I. Nucleotide substitutions in the mexR, nalC and nalD regulator genes of the MexAB-OprM efflux pump are maintained in Pseudomonas aeruginosa genetic lineages. PLoS One 2022; 17:e0266742. [PMID: 35536836 PMCID: PMC9089866 DOI: 10.1371/journal.pone.0266742] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 03/25/2022] [Indexed: 12/20/2022] Open
Abstract
Pseudomonas aeruginosa has different resistant mechanisms including the constitutive MexAB-OprM efflux pump. Single nucleotide polymorphisms (SNPs) in the mexR, nalC, and nalD repressors of this efflux pump can contribute to antimicrobial resistance; however, it is unknown whether these changes are mainly related to genetic lineages or environmental pressure. This study identifies SNPs in the mexR, nalC, and nalD genes in clinical and environmental isolates of P. aeruginosa (including high-risk clones). Ninety-one P. aeruginosa strains were classified according to their resistance to antibiotics, typified by multilocus sequencing, and mexR, nalC, and nalD genes sequenced for SNPs identification. The mexAB-oprM transcript expression was determined. The 96.7% of the strains were classified as multidrug resistant. Eight strains produced serine carbapenemases, and 11 strains metallo-β-lactamases. Twenty-three new STs and high-risk clones ST111 and ST233 were identified. SNPs in the mexR, nalC, and nalD genes revealed 27 different haplotypes (patterns). Sixty-two mutational changes were identified, 13 non-synonymous. Haplotype 1 was the most frequent (n = 40), and mainly identified in strains ST1725 (33/40), with 57.5% pan drug resistant strains, 36.5% extensive drug resistant and two strains exhibiting serin-carbapenemases. Haplotype 12 (n = 9) was identified in ST233 and phylogenetically related STs, with 100% of the strains exhibiting XDR and 90% producing metallo-β-lactamases. Haplotype 5 was highly associated with XDR and related to dead when compared to ST1725 and ST233 (RRR 23.34; p = 0.009 and RRR 32.01; p = 0.025). A significant relationship between the mexR-nalC-nalD haplotypes and phylogenetically related STs was observed, suggesting mutational changes in these repressors are highly maintained within genetic lineages. In addition, phylogenetically related STs showed similar resistant profiles; however, the resistance was (likely or partly) attributed to the MexAB-OprM efflux pump in 56% of the strains (only 45.05% showed mexA overtranscription), in the remaining strains the resistance could be attributed to carbapenemases or mechanisms including other pumps, since same SNPs in the repressor genes gave rise to different resistance profiles.
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Affiliation(s)
- Pamela Aguilar-Rodea
- Posgrado en Ciencias de la Tierra, Centro de Ciencias de la Atmósfera, Universidad Nacional Autónoma de México, Ciudad de México, México
- Unidad de Investigación en Enfermedades Infecciosas Área de Genética Bacteriana, Hospital Infantil de México Federico Gómez, Ciudad de México, México
- Laboratorio de Aerobiología, Centro de Ciencias de la Atmósfera, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Gerardo Zúñiga
- Laboratorio de Variación Biológica y Evolución, Departamento de Zoología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | - René Cerritos
- Centro de Investigación en Políticas Población y Salud, Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Benjamín Antonio Rodríguez-Espino
- Laboratorio de Investigación y Diagnóstico en Nefrología y Metabolismo Mineral Óseo, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Uriel Gomez-Ramirez
- Unidad de Investigación en Enfermedades Infecciosas Área de Genética Bacteriana, Hospital Infantil de México Federico Gómez, Ciudad de México, México
- Programa de Posgrado en Ciencias Químicobiologicas, Escuela Nacional de Ciencias Biológicas. Instituto Politécnico Nacional, Ciudad de México, México
| | - Carolina G. Nolasco-Romero
- Unidad de Investigación en Enfermedades Infecciosas Área de Genética Bacteriana, Hospital Infantil de México Federico Gómez, Ciudad de México, México
- Programa de Posgrado en Ciencias Químicobiologicas, Escuela Nacional de Ciencias Biológicas. Instituto Politécnico Nacional, Ciudad de México, México
| | - Beatriz López-Marceliano
- Unidad de Investigación en Enfermedades Infecciosas Área de Genética Bacteriana, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Gerardo E. Rodea
- Unidad de Investigación en Enfermedades Infecciosas Área de Genética Bacteriana, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Sandra Mendoza-Elizalde
- Unidad de Investigación en Enfermedades Infecciosas Área de Genética Bacteriana, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Alfonso Reyes-López
- Centro de Estudios Económicos y Sociales en Salud, Dirección de Investigación, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | | | - Juan Carlos Vigueras Galindo
- Unidad de Investigación en Enfermedades Infecciosas Área de Genética Bacteriana, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Norma Velázquez-Guadarrama
- Unidad de Investigación en Enfermedades Infecciosas Área de Genética Bacteriana, Hospital Infantil de México Federico Gómez, Ciudad de México, México
- * E-mail: ,
| | - Irma Rosas-Pérez
- Laboratorio de Aerobiología, Centro de Ciencias de la Atmósfera, Universidad Nacional Autónoma de México, Ciudad de México, México
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12
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Chiș AA, Rus LL, Morgovan C, Arseniu AM, Frum A, Vonica-Țincu AL, Gligor FG, Mureșan ML, Dobrea CM. Microbial Resistance to Antibiotics and Effective Antibiotherapy. Biomedicines 2022; 10:biomedicines10051121. [PMID: 35625857 PMCID: PMC9138529 DOI: 10.3390/biomedicines10051121] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 12/24/2022] Open
Abstract
Currently, the efficacy of antibiotics is severely affected by the emergence of the antimicrobial resistance phenomenon, leading to increased morbidity and mortality worldwide. Multidrug-resistant pathogens are found not only in hospital settings, but also in the community, and are considered one of the biggest public health concerns. The main mechanisms by which bacteria develop resistance to antibiotics include changes in the drug target, prevention of entering the cell, elimination through efflux pumps or inactivation of drugs. A better understanding and prediction of resistance patterns of a pathogen will lead to a better selection of active antibiotics for the treatment of multidrug-resistant infections.
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13
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Ballash GA, Albers AL, Mollenkopf DF, Sechrist E, Adams RJ, Wittum TE. Antimicrobial resistant bacteria recovered from retail ground meat products in the US include a Raoultella ornithinolytica co-harboring bla KPC-2 and bla NDM-5. Sci Rep 2021; 11:14041. [PMID: 34234222 PMCID: PMC8263791 DOI: 10.1038/s41598-021-93362-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/23/2021] [Indexed: 01/03/2023] Open
Abstract
Retail beef and pork, including processed products, can serve as vehicles for the zoonotic foodborne transmission of pathogens and antimicrobial resistant bacteria. However, processed and seasoned products like sausages, are not often included in research and surveillance programs. The objective of this study was to investigate retail ground beef and pork, including processed products, for the presence of common foodborne pathogens and antimicrobial resistant bacteria. We purchased 763 packages of fresh and fully cooked retail meat products during 29 visits to 17 grocery stores representing seven major grocery chains located in west and central Ohio. Each package of meat was evaluated for contamination with methicillin-resistant Staphylococcus aureus (MRSA), Salmonella spp., Enterobacteriaceae expressing extended-spectrum cephalosporin resistance, and carbapenemase-producing organisms (CPO). Only 3 of the 144 (2.1%) packages of fully cooked meat products contained any of these organisms, 1 with an extended-spectrum β-lactamase-producing (ESBL) Enterobacteriaceae and 2 with CPO. Among the 619 fresh meat products, we found that 85 (13.7%) packages were contaminated with MRSA, 19 (3.1%) with Salmonella, 136 (22.0%) with Enterobacteriaceae expressing an AmpC (blaCMY) resistance genotype, 25 (4.0%) with Enterobacteriaceae expressing an ESBL (blaCTX-M) resistance genotype, and 31 (5.0%) with CPO, primarily environmental organisms expressing intrinsic carbapenem resistance. However, one CPO, a Raoultella ornithinolytica, isolated from pork sausage co-harbored both blaKPC-2 and blaNDM-5 on IncN and IncX3 plasmids, respectively. Our findings suggest that fresh retail meat, including processed products can be important vehicles for the transmission of foodborne pathogens and antimicrobial resistant bacteria, including those with epidemic carbapenemase-producing genotypes.
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Affiliation(s)
- Gregory A Ballash
- College of Veterinary Medicine, Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, USA
| | - Amy L Albers
- College of Veterinary Medicine, Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, USA
| | - Dixie F Mollenkopf
- College of Veterinary Medicine, Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, USA
| | - Emily Sechrist
- College of Veterinary Medicine, Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, USA
| | - Rachael J Adams
- College of Veterinary Medicine, Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, USA
| | - Thomas E Wittum
- College of Veterinary Medicine, Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH, USA.
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14
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Muntean MM, Muntean AA, Guerin F, Cattoir V, Creton E, Cotellon G, Oueslati S, Popa MI, Girlich D, Iorga BI, Bonnin RA, Naas T. Optimization of the rapid carbapenem inactivation method for use with AmpC hyperproducers. J Antimicrob Chemother 2021; 76:2294-2301. [PMID: 34143889 DOI: 10.1093/jac/dkab170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Detection of carbapenemase-producing Enterobacterales (CPEs) is sometimes difficult with AmpC-hyperproducing Enterobacterales (AHEs), as they may falsely be classified as CPEs. Here, we present a rapid Carbapenem Inactivation Method (rCIM) optimized for AmpC producers (rCIM-A) that allows rapid and easy discrimination between AHEs and CPEs. METHODS Enterobacterales (n = 249), including natural AmpC producers, AHEs, CPEs and non-carbapenemase-producing carbapenem-resistant control strains were evaluated, using Carba NP, rCIM and rCIM-A. The rCIM-A differs from the rCIM by the addition of cloxacillin (400 μg/mL) to the initial antibiotic incubation step. RESULTS The rCIM-A yielded a sensitivity and specificity of 84.26% (95% CI: 76.00%-90.55%) and 99.29% (95% CI: 96.11%-99.98%), respectively, while those of the rCIM were 86.11% (95% CI: 78.13%-92.01%) and 80.85% (95% CI: 73.38%-86.99%), respectively; those of Carba NP were lower at 84.04% (95% CI: 75.05%-90.78%) and 91.37% (95% CI: 85.41%-95.46%), respectively, due to indeterminate results. The rCIM-A was capable of discriminating between AHEs and true CPEs, but still failed to identify OXA-23-producing Proteus mirabilis isolates and remained only partially reliable for identifying IMI-like producers and a few MBL (2 NDM-1, 1 LMB-1, 1 TMB-1 and 1 IMP-13) producers. One chromosomally encoded AmpC variant, MIR-10, gave repeatedly positive results using all three tests and was thus considered a false positive. CONCLUSIONS Specificity for AHEs greatly improved with the rCIM-A without altering the test performance for the other resistance mechanisms. It may replace the rCIM as a cheap, easy, rapid and accurate CPE detection test.
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Affiliation(s)
- Mădălina Maria Muntean
- TeamRESIST, INSERM U1184, School of Medicine, Université Paris-Saclay, LabEx LERMIT, Le Kremlin-Bicêtre, France.,The "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,The "Cantacuzino" National Medico-Military Institute for Research and Development, Bucharest, Romania
| | - Andrei-Alexandru Muntean
- TeamRESIST, INSERM U1184, School of Medicine, Université Paris-Saclay, LabEx LERMIT, Le Kremlin-Bicêtre, France.,The "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,The "Cantacuzino" National Medico-Military Institute for Research and Development, Bucharest, Romania
| | - François Guerin
- CHU de Rennes, Service de Bactériologie-Hygiène Hospitalière, Rennes, France.,CNR de la Résistance aux Antibiotiques ("laboratoire associé Entérocoques"), Rennes, France
| | - Vincent Cattoir
- CHU de Rennes, Service de Bactériologie-Hygiène Hospitalière, Rennes, France.,CNR de la Résistance aux Antibiotiques ("laboratoire associé Entérocoques"), Rennes, France.,Université de Rennes 1, Inserm U1230, Rennes, France
| | - Elodie Creton
- TeamRESIST, INSERM U1184, School of Medicine, Université Paris-Saclay, LabEx LERMIT, Le Kremlin-Bicêtre, France.,Bacteriology-Hygiene unit, Assistance Publique/Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France.,French National Reference Center for Antibiotic Resistance: Carbapenem-resistant Enterobacterales, Le Kremlin-Bicêtre, France.,Joint research Unit EERA "Evolution and Ecology of Resistance to Antibiotics", Institut Pasteur-APHP-Université Paris Sud, Paris, France
| | - Garance Cotellon
- TeamRESIST, INSERM U1184, School of Medicine, Université Paris-Saclay, LabEx LERMIT, Le Kremlin-Bicêtre, France.,Bacteriology-Hygiene unit, Assistance Publique/Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France.,French National Reference Center for Antibiotic Resistance: Carbapenem-resistant Enterobacterales, Le Kremlin-Bicêtre, France.,Joint research Unit EERA "Evolution and Ecology of Resistance to Antibiotics", Institut Pasteur-APHP-Université Paris Sud, Paris, France
| | - Saoussen Oueslati
- TeamRESIST, INSERM U1184, School of Medicine, Université Paris-Saclay, LabEx LERMIT, Le Kremlin-Bicêtre, France.,Bacteriology-Hygiene unit, Assistance Publique/Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France.,French National Reference Center for Antibiotic Resistance: Carbapenem-resistant Enterobacterales, Le Kremlin-Bicêtre, France.,Joint research Unit EERA "Evolution and Ecology of Resistance to Antibiotics", Institut Pasteur-APHP-Université Paris Sud, Paris, France
| | - Mircea Ioan Popa
- The "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,The "Cantacuzino" National Medico-Military Institute for Research and Development, Bucharest, Romania
| | - Delphine Girlich
- TeamRESIST, INSERM U1184, School of Medicine, Université Paris-Saclay, LabEx LERMIT, Le Kremlin-Bicêtre, France.,French National Reference Center for Antibiotic Resistance: Carbapenem-resistant Enterobacterales, Le Kremlin-Bicêtre, France.,Joint research Unit EERA "Evolution and Ecology of Resistance to Antibiotics", Institut Pasteur-APHP-Université Paris Sud, Paris, France
| | - Bogdan I Iorga
- Université Paris-Saclay, CNRS, Institut de Chimie des Substances Naturelles, Gif-sur-Yvette, France
| | - Rémy A Bonnin
- TeamRESIST, INSERM U1184, School of Medicine, Université Paris-Saclay, LabEx LERMIT, Le Kremlin-Bicêtre, France.,French National Reference Center for Antibiotic Resistance: Carbapenem-resistant Enterobacterales, Le Kremlin-Bicêtre, France.,Joint research Unit EERA "Evolution and Ecology of Resistance to Antibiotics", Institut Pasteur-APHP-Université Paris Sud, Paris, France
| | - Thierry Naas
- TeamRESIST, INSERM U1184, School of Medicine, Université Paris-Saclay, LabEx LERMIT, Le Kremlin-Bicêtre, France.,Bacteriology-Hygiene unit, Assistance Publique/Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France.,French National Reference Center for Antibiotic Resistance: Carbapenem-resistant Enterobacterales, Le Kremlin-Bicêtre, France.,Joint research Unit EERA "Evolution and Ecology of Resistance to Antibiotics", Institut Pasteur-APHP-Université Paris Sud, Paris, France
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15
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Kanahashi T, Matsumura Y, Yamamoto M, Tanaka M, Nagao M. Comparison of the Xpert Carba-R and NG-Test CARBA5 for the detection of carbapenemases in an IMP-type carbapenemase endemic region in Japan. J Infect Chemother 2021; 27:503-506. [PMID: 33214070 DOI: 10.1016/j.jiac.2020.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/28/2020] [Accepted: 11/03/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The real-time PCR assay Xpert Carba-R and the lateral flow immunoassay NG-Test CARBA5 were developed to detect 5 types of carbapenemase genes (blaIMP, blaKPC, blaVIM, blaOXA-48, and blaNDM). METHODS We compared the diagnostic performance, turn-around time, and cost of these assays. Carbapenemase genes were defined using the Carba NP test, modified Carbapenem Inactivation Methods (mCIM), multiplex PCR, and whole-genome sequencing. We included clinical Enterobacterales isolates (n = 36) and nonfermenting gram-negative bacilli isolates (n = 17) collected from 16 acute-care hospitals in the Kinki region of Japan. RESULTS Twenty-six of these 53 isolates were positive according to both of the Carba NP test and mCIM and, contained the following carbapenemase genes: blaIMP-1 (n = 3), blaIMP-6 (n = 1), blaIMP-19 (n = 12), blaIMP-26 (n = 1), blaIMP-41 (n = 2), blaIMP-66 (n = 2), blaNDM-1 (n = 3), and blaVIM-2 (n = 2). All of the remaining 27 isolates were negative according to the Carba NP test, mCIM, and multiplex PCR. The specificities of both assays were 100%. The sensitivity of the Xpert Carba-R assay was as low as 53.8% and that of the NG-Test CARBA5 was 92.3% because the former failed to detect all isolates with blaIMP-19 (n = 12) and the latter failed to detect isolates with blaIMP-66 (n = 2). Both assays can easily be performed in less than 5 min. CONCLUSIONS The NG-Test CARBA5 assay was superior with regard to assay time and cost per sample. We propose the use of the NG-Test CARBA5 assay in clinical laboratories where IMP-type carbapenemases are endemic.
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Affiliation(s)
- Toru Kanahashi
- Department of Clinical Laboratory and Department of Infection Control and Prevention, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Yasufumi Matsumura
- Department of Clinical Laboratory and Department of Infection Control and Prevention, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan; Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Masaki Yamamoto
- Department of Clinical Laboratory and Department of Infection Control and Prevention, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan; Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Michio Tanaka
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Miki Nagao
- Department of Clinical Laboratory and Department of Infection Control and Prevention, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan; Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
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16
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Rentschler S, Kaiser L, Deigner HP. Emerging Options for the Diagnosis of Bacterial Infections and the Characterization of Antimicrobial Resistance. Int J Mol Sci 2021; 22:E456. [PMID: 33466437 PMCID: PMC7796476 DOI: 10.3390/ijms22010456] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
Precise and rapid identification and characterization of pathogens and antimicrobial resistance patterns are critical for the adequate treatment of infections, which represent an increasing problem in intensive care medicine. The current situation remains far from satisfactory in terms of turnaround times and overall efficacy. Application of an ineffective antimicrobial agent or the unnecessary use of broad-spectrum antibiotics worsens the patient prognosis and further accelerates the generation of resistant mutants. Here, we provide an overview that includes an evaluation and comparison of existing tools used to diagnose bacterial infections, together with a consideration of the underlying molecular principles and technologies. Special emphasis is placed on emerging developments that may lead to significant improvements in point of care detection and diagnosis of multi-resistant pathogens, and new directions that may be used to guide antibiotic therapy.
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Affiliation(s)
- Simone Rentschler
- Institute of Precision Medicine, Furtwangen University, Jakob-Kienzle-Straße 17, 78054 VS-Schwenningen, Germany; (S.R.); (L.K.)
- Department of Pharmaceutical and Medicinal Chemistry, Institute of Pharmaceutical Sciences, Eberhard Karls University Tübingen, Auf der Morgenstelle 8, 72076 Tübingen, Germany
| | - Lars Kaiser
- Institute of Precision Medicine, Furtwangen University, Jakob-Kienzle-Straße 17, 78054 VS-Schwenningen, Germany; (S.R.); (L.K.)
- Institute of Pharmaceutical Sciences, University of Freiburg, Albertstraße 25, 79104 Freiburg i. Br., Germany
| | - Hans-Peter Deigner
- Institute of Precision Medicine, Furtwangen University, Jakob-Kienzle-Straße 17, 78054 VS-Schwenningen, Germany; (S.R.); (L.K.)
- EXIM Department, Fraunhofer Institute IZI (Leipzig), Schillingallee 68, 18057 Rostock, Germany
- Faculty of Science, Tuebingen University, Auf der Morgenstelle 8, 72076 Tübingen, Germany
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17
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Edelstein MV, Skleenova EY, Trushin IV, Kuzmenkov AY, Martinovich AА, Shek EA, Shajdullina ER, Avramenko AA, Vinogradova AG, Ivanchik NV, Sukhorukova MV, Romanov AV, Mikotina AV, Azyzov IS, Dekhnich AV, Kozlov RS. Susceptibility of clinical Enterobacterales and Pseudomonas aeruginosa isolates to ceftazidimeavibactam in Russia: multicenter local laboratory databased surveillance. CLINICAL MICROBIOLOGY AND ANTIMICROBIAL CHEMOTHERAPY 2021. [DOI: 10.36488/cmac.2021.3.264-278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective.
To assess the in vitro activity of ceftazidime-avibactam against clinical Enterobacterales and Pseudomonas aeruginosa isolates in various regions of Russia based on results of local susceptibility testing by disk diffusion method.
Materials and Methods.
Overall, 160 laboratories located in 61 Russian cities participated in this surveillance during 2018-2020. All consecutive clinical isolates of Enterobacterales and Pseudomonas aeruginosa in each participating laboratory were included in the study. Ceftazidime-avibactam susceptibility testing was done by disc-diffusion method in accordance with current EUCAST recommendations. Susceptibility data for carbapenems and III-IV generation cephalosporins, as well as results of carbapenemases detection, were also reported, if available. All the data were recorded in electronic case report form developed on the OpenClinica online platform (www.openclinica.com). Data analysis and reporting were done using AMRcloud online platform (https://amrcloud.net/).
Results.
In total, we received information on antimicrobial susceptibility of 22,121 isolates, including 17,456 (78.9%) Enterobacterales and 4,665 (21.1%) P. aeruginosa. Less than 9% of Enterobacterales isolates were resistant to ceftazidime-avibactam. At the same time rates of resistance to ceftazidime, cefotaxime, cefepime, ertapenem, imipenem, and meropenem were 54.1%, 58.9%, 59.4%, 41.4%, 23.9%, and 21.3%. Among Enterobacterales the highest level of resistance to ceftazidime-avibactam was detected in K. pneumoniae (16.5%), lowest – in E. coli (2.1%). Some increase of resistance to ceftazidimeavibactam was noted during the study – from 7.8% in 2018-2019 to 9.6% in 2020 (p = 0.0001). Rate of resistance to ceftazidime-avibactam in P. aeruginosa was 33.1%. At the same time rates of resistance to ceftazidime, cefepime, imipenem, and meropenem were 51.1%, 54.5%, 50%, and 47.3%. During the study there was statistically significant decrease in resistance to ceftazidime-avibactam in P. aeruginosa (p = 0.0001). Resistance rates for all beta-lactams for both Enterobacterales and P. aeruginosa were higher in nosocomial isolates than in community-acquired isolates.
Conclusions.
Ceftazidime-avibactam demonstrated significantly higher in vitro activity against Enterobacterales and P. aeruginosa Russian clinical isolates comparing with commonly used carbapenems and extended spectrum cephalosporins. Access for all study data available at the AMRcloud online platform (https://amrcloud.net/ru/project/cazavi-1-2/).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ilya S. Azyzov
- Institute of Antimicrobial Chemotherapy (Smolensk, Russia)
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18
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Chen J, Li H, Xie H, Xu D. A novel method combining aptamer-Ag 10NPs based microfluidic biochip with bright field imaging for detection of KPC-2-expressing bacteria. Anal Chim Acta 2020; 1132:20-27. [PMID: 32980107 DOI: 10.1016/j.aca.2020.07.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 07/04/2020] [Accepted: 07/24/2020] [Indexed: 12/23/2022]
Abstract
The β-lactam drugs resistance poses a serious threat to human health throughout the world. Klebsiella pneumoniae carbapenemase 2 (KPC-2) is a carbapenemase that produced in bacteria can hydrolyze carbapenems, which typically considered as the antibiotics of last resort. Therefore, there is an urgent need to quickly and accurately detect whether bacteria express KPC-2. In this paper, a PDMS/glass microfluidic biochip integrated with aptamer-modified Ag10NPs nano-biosensors was developed for rapid, simple and specific pathogenic bacteria detection, more importantly, the biochip was combined with bright field imaging, then the captured bacteria could be observed and counted directly without using extra chemical labeling. KPC-2-expressing Escherichia coli (KPC-2 E.coli) was used as the target bacterium with a detected limit of 102 CFU and capture efficiency exceeded 90%. This method is remarkably specific towards KPC-2 E.coli over other non-resistant bacteria, and pathogen assay only takes ∼1 h to complete in a ready-to-use microfluidic biochip. Furthermore, the effective capture and fast counting of microfluidic biochip system demonstrates its potential for the rapid detection of antibiotic-resistant bacteria.
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Affiliation(s)
- Jing Chen
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry Engineering, Nanjing University, No 163, Xianlin Avenue, Nanjing, 210023, PR China
| | - Hui Li
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry Engineering, Nanjing University, No 163, Xianlin Avenue, Nanjing, 210023, PR China
| | - Hexin Xie
- State Key Laboratory of Bioreactor Engineering Shanghai Key Laboratory of New Drug Design School of Pharmacy, East China University of Science and Technology, Shanghai, 200237, PR China
| | - Danke Xu
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry Engineering, Nanjing University, No 163, Xianlin Avenue, Nanjing, 210023, PR China.
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19
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García-Betancur JC, Appel TM, Esparza G, Gales AC, Levy-Hara G, Cornistein W, Vega S, Nuñez D, Cuellar L, Bavestrello L, Castañeda-Méndez PF, Villalobos-Vindas JM, Villegas MV. Update on the epidemiology of carbapenemases in Latin America and the Caribbean. Expert Rev Anti Infect Ther 2020; 19:197-213. [PMID: 32813566 DOI: 10.1080/14787210.2020.1813023] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Carbapenemases are β-lactamases able to hydrolyze a wide range of β-lactam antibiotics, including carbapenems. Carbapenemase production in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter spp., with and without the co-expression of other β-lactamases is a serious public health threat. Carbapenemases belong to three main classes according to the Ambler classification: class A, class B, and class D. AREAS COVERED Carbapenemase-bearing pathogens are endemic in Latin America. In this review, we update the status of carbapenemases in Latin America and the Caribbean. EXPERT OPINION Understanding the current epidemiology of carbapenemases in Latin America and the Caribbean is of critical importance to improve infection control policies limiting the dissemination of multi-drug-resistant pathogens and in implementing appropriate antimicrobial therapy.
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Affiliation(s)
| | - Tobias Manuel Appel
- Grupo de Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque . Bogotá, Colombia
| | - German Esparza
- Programa de Aseguramiento de Calidad. PROASECAL SAS, Bogotá, Colombia
| | - Ana C Gales
- Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina/Universidade Federal de São Paulo - UNIFESP , São Paulo, Brazil
| | | | | | - Silvio Vega
- Complejo Hospitalario Metropolitano , Ciudad de Panamá, Panama
| | - Duilio Nuñez
- Infectious Diseases División, IPS Hospital Central , Asunción, Paraguay
| | - Luis Cuellar
- Servicio de Infectologia, Instituto Nacional de Enfermedades Neoplasicas , Lima, Peru
| | | | - Paulo F Castañeda-Méndez
- Department of Infectious Diseases, Hospital San Angel Inn Universidad , Ciudad de México, Mexico
| | | | - María Virginia Villegas
- Grupo de Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque . Bogotá, Colombia.,Centro Médico Imbanaco . Cali, Colombia
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20
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McCracken MG, Adam HJ, Blondeau JM, Walkty AJ, Karlowsky JA, Hoban DJ, Zhanel GG, Mulvey MR. Characterization of carbapenem-resistant and XDR Pseudomonas aeruginosa in Canada: results of the CANWARD 2007-16 study. J Antimicrob Chemother 2020; 74:iv32-iv38. [PMID: 31505643 DOI: 10.1093/jac/dkz285] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Carbapenem-resistant Pseudomonas aeruginosa are emerging worldwide with increasing reports of carbapenemase-producing isolates. Carbapenem-resistant isolates may also be XDR. This study characterized carbapenem-resistant and XDR P. aeruginosa isolated from patients receiving care at Canadian hospitals from 2007 to 2016. METHODS Antimicrobial susceptibility testing was performed using CLSI broth microdilution methods. PCR was used to detect carbapenemases (GES, KPC, NDM, IMP, VIM, OXA-48) and other resistance markers; specific carbapenemase gene variants were identified by DNA sequencing. Genetic relatedness was assessed by MLST and PFGE. RESULTS From 2007 to 2016, 3864 isolates of P. aeruginosa were collected; 466 (12.1%) isolates were carbapenem resistant. The prevalence of carbapenem-resistant P. aeruginosa reached a peak of 17.3% in 2014. Colistin (94% susceptible) and ceftolozane/tazobactam (92.5%) were the most active agents against carbapenem-resistant P. aeruginosa. XDR P. aeruginosa comprised 4.5% of isolates; they were found to be genetically diverse and remained susceptible to colistin and ceftolozane/tazobactam. Only 4.3% (n = 20) of carbapenem-resistant P. aeruginosa harboured a carbapenemase; most were blaGES-5 (35%, n = 7). Wide genetic diversity was observed among carbapenem-resistant P. aeruginosa with >200 different sequence types identified. CONCLUSIONS Although the prevalence of carbapenem-resistant P. aeruginosa in Canada spiked in 2014 and 2015, carbapenemase-producing P. aeruginosa remain rare with only 20 (4.3%) isolates identified over a 10 year period. Broad genetic diversity was observed among both carbapenem-resistant and XDR phenotypes of P. aeruginosa. Pan-drug-resistant P. aeruginosa have not yet been identified in Canada.
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Affiliation(s)
- Melissa G McCracken
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, Manitoba, Canada
| | - Heather J Adam
- Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Room 543-745 Bannatyne Avenue, Winnipeg, Manitoba, Canada.,Clinical Microbiology, Diagnostic Services Manitoba, MS673-820 Sherbrook Street, Winnipeg, Manitoba, Canada
| | - Joseph M Blondeau
- Division of Clinical Microbiology, Royal University Hospital and the Saskatoon Health Region and Departments of Microbiology and Immunology, Pathology, and Ophthalmology, University of Saskatchewan, Saskatoon, Canada
| | - Andrew J Walkty
- Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Room 543-745 Bannatyne Avenue, Winnipeg, Manitoba, Canada.,Clinical Microbiology, Diagnostic Services Manitoba, MS673-820 Sherbrook Street, Winnipeg, Manitoba, Canada
| | - James A Karlowsky
- Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Room 543-745 Bannatyne Avenue, Winnipeg, Manitoba, Canada.,Clinical Microbiology, Diagnostic Services Manitoba, MS673-820 Sherbrook Street, Winnipeg, Manitoba, Canada
| | - Daryl J Hoban
- Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Room 543-745 Bannatyne Avenue, Winnipeg, Manitoba, Canada.,Clinical Microbiology, Diagnostic Services Manitoba, MS673-820 Sherbrook Street, Winnipeg, Manitoba, Canada
| | - George G Zhanel
- Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Room 543-745 Bannatyne Avenue, Winnipeg, Manitoba, Canada
| | - Michael R Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, Manitoba, Canada
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21
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Dehbashi S, Tahmasebi H, Alikhani MY, Keramat F, Arabestani MR. Distribution of Class B and Class A β-Lactamases in Clinical Strains of Pseudomonas aeruginosa: Comparison of Phenotypic Methods and High-Resolution Melting Analysis (HRMA) Assay. Infect Drug Resist 2020; 13:2037-2052. [PMID: 32636657 PMCID: PMC7335274 DOI: 10.2147/idr.s255292] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/18/2020] [Indexed: 12/12/2022] Open
Abstract
Background There are various phenotypic methods for identifying class B and class A β-lactamase enzymes in Pseudomonas aeruginosa. The purpose of this study was to compare the sensitivity and specificity of different phenotypic methods with HRMA assay to detect β-lactamase-producing P. aeruginosa strains. Methods Eighty-eight of P. aeruginosa isolates were collected from different specimens. Conventional double-disk test (DDT) and EDTA-imipenem microbiological (EIM) were performed to detect ESBL and MBL-producing strains, respectively. Meanwhile, the Modified Hodge test and Carba-NP test were performed on all carbapenem-resistant strains. HRMA method and sensitivity and specificity of primers were determined based on the melt curve temperature range. In all comparisons, PCR was considered as the gold standard. Results Of the 402 isolates collected from different clinical specimens, 88 isolates of P. aeruginosa were identified. However, 43 strains were (48.88%) ESBL-producing, and 7 strains (7.95%) were MBL-producing. Also, using the Modified Hodge test and Carba-NP method, 11 (12.5%) and 19 (21.59%) strains were carbapenemase-producing, respectively. The results of the HRMA test revealed that genes coding for bla SHV, bla TEM, bla KPC, bla IMP, bla VIM, and bla GES were detected in 44.31%, 22.72%, 13.63%, 14.7%, 5.6%, and 2.27% of P. aeruginosa isolates. Nonetheless, for bla KPC and bla GES genes, sensitivity and specificity of the Carba-NP test were 90.47%, 94.87%, and 83.36%, 94.80%, respectively. However, sensitivity and specificity of MHT was 91.66%, 98.70%, and 77.77%, 96.42%, respectively. For bla SHV and bla TEM genes, sensitivity and specificity of DDT were 95.55%, 95.55%, and 86%, 83.50%, respectively. However, sensitivity and specificity of EMI were 77.77%, 97.59%, and 91.66%, 97.43% for bla VIM and bla IMP, respectively. Conclusion The HRMA is a powerful, accurate, closed-tube, rapid method for detecting β-lactamase genes in P. aeruginosa. The high sensitivity and specificity of this method, along with phenotypic tests, play a useful role in increasing the predictive value of clinical reports.
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Affiliation(s)
- Sanaz Dehbashi
- Microbiology Department, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hamed Tahmasebi
- Microbiology Department, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Yousef Alikhani
- Microbiology Department, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fariba Keramat
- Brucellosis Research Center, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Reza Arabestani
- Microbiology Department, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.,Nutrition Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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22
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Swathi C, Sudhaharan S, Lakshmi V, Suguna Ratnakar K, Sritharan V. Direct Detection and Discrimination of Carbapenemases of Acinetobacter baumannii from Uncultured Tracheal Aspirates. Microb Drug Resist 2020; 26:1153-1162. [PMID: 32364821 DOI: 10.1089/mdr.2019.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Carbapenemases play important roles in conferring resistance to beta-lactam antibiotics, including the carbapenems. Detection of carbapenemase activity helps to understand the possible mechanism(s) of carbapenem resistance. Identification of carbapenemases is currently being done by various phenotypic methods and molecular methods. However, innovative biochemical and spectrophotometric methods are desirable as they will be easy to perform, affordable, and rapid. A novel chromogenic method called Carba NP test was introduced recently to screen for carbapenemases in clinical isolates of gram-negative pathogens. We adopted this assay (1) to detect the total carbapenemase activity, (2) to discriminate Class A, B, and D carbapenemases with inhibitors, (3) to compare with carbapenemase genotype, and (4) for direct differential diagnosis of carbapenemases in uncultured clinical sample such as tracheal aspirate. The study included 132 purulent tracheal aspirates. All samples were processed and screened by a protocol optimized in our laboratory, which showed good sensitivity and correlation with genotyping and conventional phenotyping. Our protocol not only offers the fastest way to identify the pathogen but also its carbapenemase profile, directly from uncultured clinical samples in less than 4 hr. Our protocol is currently being validated on other types of clinical specimens in our laboratory.
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Affiliation(s)
- Cheguri Swathi
- Department of Molecular Diagnostics & Biomarkers, Global Medical Education and Research Foundation (GMERF), Hyderabad, India
| | - Sukanya Sudhaharan
- Department of Microbiology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, India
| | - Vemu Lakshmi
- Department of Microbiology, Nizam's Institute of Medical Sciences (NIMS), Hyderabad, India
| | - Kamaraju Suguna Ratnakar
- Department of Molecular Diagnostics & Biomarkers, Global Medical Education and Research Foundation (GMERF), Hyderabad, India
| | - Venkataraman Sritharan
- Department of Molecular Diagnostics & Biomarkers, Global Medical Education and Research Foundation (GMERF), Hyderabad, India
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23
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Reyes S, Nicolau DP. Precision medicine for the diagnosis and treatment of carbapenem-resistant Enterobacterales: time to think from a different perspective. Expert Rev Anti Infect Ther 2020; 18:721-740. [PMID: 32368940 DOI: 10.1080/14787210.2020.1760844] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Carbapenem-resistant Enterobacterales (CRE) represent a global public health problem. Precision medicine (PM) is a multicomponent medical approach that should be used to individualize the management of patients infected with CRE. AREAS COVERED Here, we differentiate carbapenem-producing CRE (CP-CRE) from non-CP-CRE and the importance of this distinction in clinical practice. The current phenotypic CRE-case definition and its implications are also discussed. Additionally, we summarize data regarding phenotypic and molecular diagnostic tools and available antibiotics. In order to review the most relevant data, a comprehensive literature search of peer-reviewed articles in PubMed and abstracts presented at high-impact conferences was performed. EXPERT OPINION PM in CRE infections entails a multi-step process that includes applying the current phenotypic definition, utilization of the right phenotypic or molecular testing methods, and thorough evaluation of risk factors, source of infection, and comorbidities. A powerful armamentarium is available to treat CRE infections, including recently approved agents. Randomized controlled trials targeting specific pathogens instead of site of infections may be appropriate to fill in the current gaps. In light of the diverse enzymology behind CP-CRE, PM should be employed to provide the best therapy based on the underlying resistance mechanism.
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Affiliation(s)
- Sergio Reyes
- Center for Anti-Infective Research and Development, Hartford Hospital , Hartford, CT, USA
| | - David P Nicolau
- Center for Anti-Infective Research and Development, Hartford Hospital , Hartford, CT, USA.,Division of Infectious Diseases, Hartford Hospital , Hartford, CT, USA
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24
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Lopez NV, Farsar CJ, Harmon DE, Ruiz C. Urban and agricultural soils in Southern California are a reservoir of carbapenem-resistant bacteria. Microbiologyopen 2020; 9:1247-1263. [PMID: 32246583 PMCID: PMC7294306 DOI: 10.1002/mbo3.1034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 01/01/2023] Open
Abstract
Carbapenems are last‐resort β‐lactam antibiotics used in healthcare facilities to treat multidrug‐resistant infections. Thus, most studies on identifying and characterizing carbapenem‐resistant bacteria (CRB) have focused on clinical settings. Relatively, little is still known about the distribution and characteristics of CRBs in the environment, and the role of soil as a potential reservoir of CRB in the United States remains unknown. Here, we have surveyed 11 soil samples from 9 different urban or agricultural locations in the Los Angeles–Southern California area to determine the prevalence and characteristics of CRB in these soils. All samples tested contained CRB with a frequency of <10 to 1.3 × 104 cfu per gram of soil, with most agricultural soil samples having a much higher relative frequency of CRB than urban soil samples. Identification and characterization of 40 CRB from these soil samples revealed that most of them were members of the genera Cupriavidus, Pseudomonas, and Stenotrophomonas. Other less prevalent genera identified among our isolated CRB, especially from agricultural soils, included the genera Enterococcus, Bradyrhizobium, Achromobacter, and Planomicrobium. Interestingly, all of these carbapenem‐resistant isolates were also intermediate or resistant to at least 1 noncarbapenem antibiotic. Further characterization of our isolated CRB revealed that 11 Stenotrophomonas, 3 Pseudomonas, 1 Enterococcus, and 1 Bradyrhizobium isolates were carbapenemase producers. Our findings show for the first time that both urban and agricultural soils in Southern California are an underappreciated reservoir of bacteria resistant to carbapenems and other antibiotics, including carbapenemase‐producing CRB.
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Affiliation(s)
- Nicolas V. Lopez
- Department of BiologyCalifornia State University NorthridgeNorthridgeCAUSA
| | - Cameron J. Farsar
- Department of BiologyCalifornia State University NorthridgeNorthridgeCAUSA
| | - Dana E. Harmon
- Department of BiologyCalifornia State University NorthridgeNorthridgeCAUSA
| | - Cristian Ruiz
- Department of BiologyCalifornia State University NorthridgeNorthridgeCAUSA
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25
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Das S, Ihssen J, Wick L, Spitz U, Shabat D. Chemiluminescent Carbapenem‐Based Molecular Probe for Detection of Carbapenemase Activity in Live Bacteria. Chemistry 2020; 26:3647-3652. [DOI: 10.1002/chem.202000217] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Sayantan Das
- School of Chemistry, Faculty of Exact SciencesTel Aviv University Tel Aviv 69978 Israel
| | - Julian Ihssen
- BIOSYNTH CARBOSYNTH Rietlistrasse 4, Postfach 125 9422 Staad Switzerland
| | - Lukas Wick
- BIOSYNTH CARBOSYNTH Rietlistrasse 4, Postfach 125 9422 Staad Switzerland
| | - Urs Spitz
- BIOSYNTH CARBOSYNTH Rietlistrasse 4, Postfach 125 9422 Staad Switzerland
| | - Doron Shabat
- School of Chemistry, Faculty of Exact SciencesTel Aviv University Tel Aviv 69978 Israel
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26
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Bouslah Z. Carba NP test for the detection of carbapenemase-producing Pseudomonas aeruginosa. Med Mal Infect 2020; 50:466-479. [PMID: 31899068 DOI: 10.1016/j.medmal.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/30/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The Carba NP test is a biochemical chromogenic assay developed to detect carbapenemase activity. Variable performance has been reported according to the type of carbapenemase and bacterial species involved. We aimed to describe the benefit of the Carba NP test and its commercial version, the RAPIDEC® CARBA NP, to detect carbapenemase-producing Pseudomonas aeruginosa. METHODS PubMed and ScienceDirect databases were searched. The following data was collected from each included study: research protocol, molecular profile of the tested strains, and sensitivity and specificity of the test used to detect carbapenemase-producing P. aeruginosa. RESULTS Thirty-four studies were included. The most frequently tested strains were metallo-beta-lactamase producers. The pooled sensitivity to detect carbapenemase-producing P. aeruginosa with the original Carba NP test, the Clinical and Laboratory Standards Institute (CLSI) Carba NP test, and the RAPIDEC® CARBA NP was 92%, 95%, and 96%, respectively. The pooled specificity was 99% with the original and the CLSI Carba NP tests, and 92% with the RAPIDEC® CARBA NP. Several studies evaluated modified versions of the Carba NP test to detect carbapenemase-producing P. aeruginosa, with reported sensitivity and specificity exceeding 90% in most cases. CONCLUSION The Carba NP test allows for fast screening and easy handling as well as optimal performance to detect carbapenemase-producing P. aeruginosa. These findings should be confirmed by further studies including a larger cohort of isolates and various types of carbapenemases, mainly non-metallo-beta-lactamases.
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Affiliation(s)
- Z Bouslah
- Faculté de médecine de Tunis, université de Tunis El Manar, 15, rue Djebel Lakhdhar, 1007 La Rabta, Tunis, Tunisie.
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27
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Petrova A, Feodorova Y, Miteva-Katrandzhieva T, Petrov M, Murdjeva M. First detected OXA-50 carbapenem-resistant clinical isolates Pseudomonas aeruginosa from Bulgaria and interplay between the expression of main efflux pumps, OprD and intrinsic AmpC. J Med Microbiol 2019; 68:1723-1731. [DOI: 10.1099/jmm.0.001106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Atanaska Petrova
- Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University-Plovdiv, Bulgaria
- Laboratory of Microbiology, University Hospital “St. George”-Plovdiv, Bulgaria
- Technology Center for Emergency Medicine, Plovdiv, Bulgaria
| | - Yana Feodorova
- Department of Medical Biology, Faculty of Medicine, Medical University-Plovdiv, Bulgaria
- Technology Center for Emergency Medicine, Plovdiv, Bulgaria
| | - Tsonka Miteva-Katrandzhieva
- Deparment of Social Medicine and Public Health, Faculty of Public Health, Medical University-Plovdiv, Bulgaria
| | - Michael Petrov
- Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University-Plovdiv, Bulgaria
| | - Mariana Murdjeva
- Technology Center for Emergency Medicine, Plovdiv, Bulgaria
- Laboratory of Microbiology, University Hospital “St. George”-Plovdiv, Bulgaria
- Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University-Plovdiv, Bulgaria
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28
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Croxatto A, Coste AT, Pillonel T, Bertelli C, Greub G, Prod'hom G. Evaluation of the BD Phoenix™ CPO Detect Test for the detection of carbapenemase producers. Clin Microbiol Infect 2019; 26:644.e9-644.e15. [PMID: 31634549 DOI: 10.1016/j.cmi.2019.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/29/2019] [Accepted: 10/01/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Becton-Dickinson recently developed the Phoenix™ CPO (carbapenemase-producing organism) Detect Test, a growth-based test embedded in Gram-negative (GN) panels for the detection and confirmation of bacteria producing class A, B and D carbapenemases. This study aimed to (a) determine the performance of the CPO test, and (b) assess its added value in routine diagnostic workflows. METHODS The performance of the BD Phoenix CPO test was analysed retrospectively on a collection of 185 molecularly characterized strains, including 92 CPOs, and prospectively on 135 and 160 routine isolates with and without CPO suspicion, respectively. RESULTS In the retrospective study the CPO test exhibited 92.4% accuracy (95%CI 87.6-95.8), 97.8% sensitivity (95%CI 92.4-99.7) and 87.1% specificity (95%CI 78.6-93.2) for carbapenemase detection. The CPO test provided a classification to class A, B, and D for 81.3% of detected carbapenemases with 94.6% accuracy (95%CI 86.7-98.5). In the prospective study the CPO test detection performance showed 77.8% accuracy (95%CI 68.8-84.5), 100% sensitivity (95%CI 91.2-100) and 67.8% specificity (95%CI 57.3-77.1) with 135 CPO-suspicious isolates and 98.8% accuracy and specificity (95%CI 95.6-99.9) with 160 non-CPO-suspicious isolates. Compared to routine testing, the implementation of the CPO test allowed a mean reduction of 21.3 h (95%CI 17.6-25) in turnaround time, 16.8 min (95%CI 13.4-20.2) in hands-on time, and 20.6 CHF (95%CI 16.5-24.8) in costs. CONCLUSIONS The CPO test is reliable for the detection of CPO with a high sensitivity. However, the relatively low detection specificity required the use of additional confirmatory methods. The carbapenemase classification accuracy is robust in providing preliminary results before molecular characterization. Finally, the implementation of the test in routine workflows allowed a significant reduction in turnaround time, hands-on time and cost compared to the conventional approach.
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Affiliation(s)
- A Croxatto
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - A T Coste
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - T Pillonel
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - C Bertelli
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - G Greub
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - G Prod'hom
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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29
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Rao MR, Chandrashaker P, Mahale RP, Shivappa SG, Gowda RS, Chitharagi VB. Detection of carbapenemase production in Enterobacteriaceae and Pseudomonas species by carbapenemase Nordmann-Poirel test. J Lab Physicians 2019; 11:107-110. [PMID: 31160847 PMCID: PMC6543936 DOI: 10.4103/jlp.jlp_132_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE: Multidrug-resistant organisms causing community-acquired and hospital-acquired infections are increasing at a dangerous rate. Carbapenemase-producing Enterobacteriaceae and Pseudomonas species are an important source of concern since these organisms are not only resistant to beta-lactam antibiotics but also show cross-resistance to other groups of antibiotics. In the present study, rapid detection of these carbapenemase-producing Enterobacteriaceae and Pseudomonas species by carbapenemase Nordmann–Poirel (Carba NP) test was evaluated by comparing with modified Hodge test (MHT). MATERIALS AND METHODS: Imipenem-resistant Enterobacteriaceae and Pseudomonas species isolated from various samples such as pus, blood, sputum, urine, and endotracheal aspirates were processed for carbapenemase detection by MHT and Carba NP test. Kappa analysis was done to evaluate the percentage agreement between the two tests. RESULTS: Seventy imipenem-resistant Enterobacteriaceae and Pseudomonas isolates were analyzed in the present study for carbapenemase production. 63.41% of Enterobacteriaceae and 34.48% of Pseudomonas species were carbapenemase producers considering both the methods. By MHT, 36 (51.42%) isolates and, by Carba NP test, 35 (50%) isolates were positive for carbapenemase production out of the 70 isolates. CONCLUSION: Carba NP test when compared to MHT is a simple, rapid, cost-effective biochemical test which can be used in all laboratories in the identification of life-threatening carbapenemase-producing Gram-negative bacteria.
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Affiliation(s)
- Morubagal R Rao
- Department of Microbiology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Pooja Chandrashaker
- Department of Microbiology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Rashmi P Mahale
- Department of Microbiology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Sowmya G Shivappa
- Department of Microbiology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Ranjitha S Gowda
- Department of Microbiology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Vidyavathi B Chitharagi
- Department of Microbiology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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30
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Mueller L, Ottiger C, Demord A, Poirel L, Nordmann P. Multiple colonization with carbapenem-resistant Gram-negative bacteria acquired in India and transferred to Switzerland. Infection 2019; 47:669-671. [PMID: 30972715 DOI: 10.1007/s15010-019-01307-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/04/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Linda Mueller
- Emerging Antibiotic Resistance Unit, Medical and Molecular Microbiology, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée 18, 1700, Fribourg, Switzerland.,Swiss National Reference Center for Emerging Antibiotic Resistance (NARA), University of Fribourg, Fribourg, Switzerland
| | - Cornelia Ottiger
- Institute for Laboratory Medicine, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Anthony Demord
- Emerging Antibiotic Resistance Unit, Medical and Molecular Microbiology, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée 18, 1700, Fribourg, Switzerland.,Swiss National Reference Center for Emerging Antibiotic Resistance (NARA), University of Fribourg, Fribourg, Switzerland
| | - Laurent Poirel
- Emerging Antibiotic Resistance Unit, Medical and Molecular Microbiology, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée 18, 1700, Fribourg, Switzerland. .,Swiss National Reference Center for Emerging Antibiotic Resistance (NARA), University of Fribourg, Fribourg, Switzerland. .,INSERM European Unit (IAME, France), University of Fribourg, Fribourg, Switzerland.
| | - Patrice Nordmann
- Emerging Antibiotic Resistance Unit, Medical and Molecular Microbiology, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée 18, 1700, Fribourg, Switzerland.,Swiss National Reference Center for Emerging Antibiotic Resistance (NARA), University of Fribourg, Fribourg, Switzerland.,INSERM European Unit (IAME, France), University of Fribourg, Fribourg, Switzerland.,University Hospital Center and University of Lausanne, Lausanne, Switzerland
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31
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Harmon DE, Miranda OA, McCarley A, Eshaghian M, Carlson N, Ruiz C. Prevalence and characterization of carbapenem-resistant bacteria in water bodies in the Los Angeles-Southern California area. Microbiologyopen 2019; 8:e00692. [PMID: 29987921 PMCID: PMC6460273 DOI: 10.1002/mbo3.692] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 01/15/2023] Open
Abstract
Carbapenems are β-lactam antibiotics used in healthcare settings as last resort drugs to treat infections caused by antibiotic-resistant bacteria. Carbapenem-resistant bacteria are increasingly being isolated from healthcare facilities; however, little is known about their distribution or prevalence in the environment, especially in the United States, where their distribution in water environments from the West Coast has not been studied before. The aim of this study was to determine the prevalence of carbapenem-resistant bacteria and carbapenemase genes in water bodies from the Los Angeles area (California, USA). All samples that were analyzed contained carbapenem-resistant bacteria with a frequency of between 0.1 and 324 carbapenem-resistant cfu per 100 mls of water. We identified 76 carbapenem-resistant or -intermediate isolates, most of which were also resistant to noncarbapenem antibiotics, as different strains of Enterobacter asburiae, Aeromonas veronii, Cupriavidus gilardii, Pseudomonas, and Stenotrophomonas species. Of them, 52 isolates were carbapenemase-producers. Furthermore, PCR and sequence analysis to identify the carbapenemase gene of these carbapenemase-producing isolates revealed that all Enterobacter asburiae isolates had a blaIMI-2 gene 100% identical to the reference sequence, and all Stenotrophomonas maltophlia isolates had a blaL1 gene 83%-99% identical to the reference blaL1 . Our findings indicate that water environments in Southern California are an important reservoir of bacteria-resistant to carbapenems and other antibiotics, including bacteria carrying intrinsic and acquired carbapenemase genes.
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Affiliation(s)
- Dana E. Harmon
- Department of BiologyCalifornia State University NorthridgeNorthridgeCalifornia
| | - Osvaldo A. Miranda
- Department of BiologyCalifornia State University NorthridgeNorthridgeCalifornia
| | - Ashley McCarley
- Department of BiologyCalifornia State University NorthridgeNorthridgeCalifornia
| | - Michelle Eshaghian
- Department of BiologyCalifornia State University NorthridgeNorthridgeCalifornia
| | - Natasha Carlson
- Department of BiologyCalifornia State University NorthridgeNorthridgeCalifornia
| | - Cristian Ruiz
- Department of BiologyCalifornia State University NorthridgeNorthridgeCalifornia
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NDM Metallo-β-Lactamases and Their Bacterial Producers in Health Care Settings. Clin Microbiol Rev 2019; 32:32/2/e00115-18. [PMID: 30700432 DOI: 10.1128/cmr.00115-18] [Citation(s) in RCA: 369] [Impact Index Per Article: 73.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
New Delhi metallo-β-lactamase (NDM) is a metallo-β-lactamase able to hydrolyze almost all β-lactams. Twenty-four NDM variants have been identified in >60 species of 11 bacterial families, and several variants have enhanced carbapenemase activity. Klebsiella pneumoniae and Escherichia coli are the predominant carriers of bla NDM, with certain sequence types (STs) (for K. pneumoniae, ST11, ST14, ST15, or ST147; for E. coli, ST167, ST410, or ST617) being the most prevalent. NDM-positive strains have been identified worldwide, with the highest prevalence in the Indian subcontinent, the Middle East, and the Balkans. Most bla NDM-carrying plasmids belong to limited replicon types (IncX3, IncFII, or IncC). Commonly used phenotypic tests cannot specifically identify NDM. Lateral flow immunoassays specifically detect NDM, and molecular approaches remain the reference methods for detecting bla NDM Polymyxins combined with other agents remain the mainstream options of antimicrobial treatment. Compounds able to inhibit NDM have been found, but none have been approved for clinical use. Outbreaks caused by NDM-positive strains have been reported worldwide, attributable to sources such as contaminated devices. Evidence-based guidelines on prevention and control of carbapenem-resistant Gram-negative bacteria are available, although none are specific for NDM-positive strains. NDM will remain a severe challenge in health care settings, and more studies on appropriate countermeasures are required.
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Acquisition of Extended-Spectrum β-Lactamase GES-6 Leading to Resistance to Ceftolozane-Tazobactam Combination in Pseudomonas aeruginosa. Antimicrob Agents Chemother 2018; 63:AAC.01809-18. [PMID: 30323045 DOI: 10.1128/aac.01809-18] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 10/11/2018] [Indexed: 12/21/2022] Open
Abstract
A clinical Pseudomonas aeruginosa isolate resistant to all β-lactams, including ceftolozane-tazobactam and carbapenems, was recovered. It belonged to sequence type 235 and produced the extended-spectrum β-lactamase (ESBL) GES-6 differing from GES-1 by two amino acid substitutions (E104K and G170S). GES-6 possessed an increased hydrolytic activity toward carbapenems and to ceftolozane and a decreased susceptibility to β-lactamase inhibitors compared to GES-1, except for avibactam. We show here that resistance to ceftolozane-tazobactam may occur through acquisition of a specific ESBL in P. aeruginosa but that ceftazidime-avibactam combination remains an effective alternative.
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34
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Within-a-Day Detection and Rapid Characterization of Carbapenemase by Use of a New Carbapenem Inactivation Method-Based Test, CIMplus. J Clin Microbiol 2018; 56:JCM.00137-18. [PMID: 29950336 DOI: 10.1128/jcm.00137-18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/30/2018] [Indexed: 11/20/2022] Open
Abstract
The dissemination of carbapenemase-producing Enterobacteriaceae (CPE) is a major threat to public health. Rapid and accurate detection of CPE is essential for initiating appropriate antimicrobial treatment and establishing infection control measures. The carbapenem inactivation method (CIM), which has good sensitivity and specificity but a detection time of 20 h, was recently described. In this study, we evaluated the performances of a new version, the CIMplus test, which allows detection of carbapenemases in 8 h and characterization of carbapenemase classes, according to the Ambler classification, in 20 h. A panel of 110 carbapenem-resistant Enterobacteriaceae strains, including 92 CPE strains (with NDM, VIM, IMP, KPC, GES, OXA-48, and OXA-48-like enzymes), was used to evaluate test performance. Carbapenemase activity was detected at 8 h and 20 h. Characterization of carbapenemase classes, using specific inhibitors, was possible in 20 h. The CIMplus test had sensitivities of 95.7% and 97.8% at 8 h and 20 h, respectively, and a specificity of 94.4%, independent of the culture duration. Using a decision algorithm, this test was successful in identifying the carbapenemase class for 98.9% of tested CPE isolates (87/88 isolates). In total, the characterization was correct for 100%, 96.9%, and 100% of Ambler class A, B, and D isolates, respectively. Therefore, this test allows detection of carbapenemase activity in 8 h and characterization of carbapenemase classes, according to the Ambler classification, in 20 h. The CIMplus test represents a simple, affordable, easy-to-read, and accurate tool that can be used without any specific equipment.
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Teethaisong Y, Hobbs G, Nakouti I, Evans K, Eumkeb G. A nitrocefin disc supplemented with ertapenem for rapid screening of carbapenemase-producing Enterobacteriaceae. Diagn Microbiol Infect Dis 2018; 91:85-88. [DOI: 10.1016/j.diagmicrobio.2017.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/29/2017] [Accepted: 12/31/2017] [Indexed: 11/15/2022]
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36
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Chandola P, Gupta RM, Lall M, Sen S, Shergill SPS, Dutta V. Molecular detection of blaNDM-1 (New Delhi metallobetalactamase-1) in nosocomial Enterobacteriaceae isolates by nested, multiplex polymerase chain reaction. Med J Armed Forces India 2018; 74:108-115. [PMID: 29692474 DOI: 10.1016/j.mjafi.2017.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/17/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Carbapenems are considered "drugs of last resort" in many life-threatening infections. Advent of carbapenemases like KPC, OXA-48, VIM, IMP, and NDM have greatly affected the efficacy of these drugs, posing serious threat to global health and infection control. NDM bears special significance to the India subcontinent, labeled as place of origin and reservoir. NDM tends to escape detection by routine phenotypic methods, requiring molecular confirmation. This study utilizes nested, multiplex polymerase chain reaction (PCR) for reliable detection of blaNDM-1 in nosocomial Enterobacteriaceae isolates. METHODS This study was conducted to detect prevalence of blaNDM-1, blaIMP, blaVIMand blaKPC genes by multiplex PCR among multidrug/carbapenem-resistant nosocomial Enterobacteriaceae isolates. From March 2013 to April 2014, 100 consecutive non-repeat isolates of Enterobacteriaceae from various inpatient clinical samples were analyzed. Imipenem-resistant isolates identified by Kirby Bauer disk diffusion method with Clinical and Laboratory Standards Institute guidelines were further subjected to nested, multiplex PCR to simultaneously detect blaNDM-1, blaIMP, blaVIMand blaKPC genes. RESULTS Out of 100 isolates, 17 (17%) were found to be imipenem-resistant. blaNDM-1 was detected in all 17 isolates by nested, multiplex PCR. blaVIM was co-carried in 4 isolates while one isolate co-harbored blaIMP with blaNDM-1. Imipenem resistance and NDM-1 carriage was predominant amongst Klebsiella isolates. Maximum NDM-1 producers were isolated from the intensive care unit (70.6%). CONCLUSION NDM-1 prevalence in nosocomial Enterobacteriaceae isolates in our hospital was found to be 17%. A nested, multiplex PCR was used for rapid detection of various carbapenemase genes with high sensitivity and specificity which is essential not only for favorable patient outcome but also for timely implementation of appropriate infection control practices to prevent further spread of such organisms.
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Affiliation(s)
- Parnika Chandola
- Assistant Professor (Microbiology and Molecular Medicine), Army Hospital (R&R), New Delhi 10, India
| | - R M Gupta
- Professor & Consultant (Pathology, Microbiology and Virology), Army Hospital (R&R), New Delhi 10, India
| | - Mahima Lall
- Study Leave (Microbiology), All India Institute of Medical Sciences, New Delhi, India
| | - Sourav Sen
- Professor & Head, Dept of Microbiology, Armed Forces Medical College, Pune 40, India
| | - S P S Shergill
- Assistant Professor (Microbiology and Molecular Medicine), Army Hospital (R&R), New Delhi 10, India
| | - Vibha Dutta
- Commandant, Command Hospital (Central Command), Lucknow, India
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37
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First detection of New Delhi metallo-β-lactamases variants (NDM-1, NDM-2) among Pseudomonas aeruginosa isolated from Iraqi hospitals. IRANIAN JOURNAL OF MICROBIOLOGY 2018; 10:98-103. [PMID: 29997749 PMCID: PMC6039455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Multidrug resistance and in particular, carbapenem resistant Gram-negative bacteria is spreading worldwide at an alarming rate. Among the clinically significant carbapenemases, the New Delhi Metallo-β-lactamase (NDM) is one of the most formidable. NDM efficiently hydrolyses β-lactams and is the last-resort among carbapenems. Hence, therapeutic options for NDM producer bacteria become restricted to a handful of antibiotics. The present study was undertaken to detect the prevalence of the blaNDM-variants Metallo β-lactamases (MBLs) among isolates of Pseudomonas aeruginosa recovered from various clinical samples of hospitalized patients in Baghdad, Iraq. MATERIALS AND METHODS A total of 100 isolates of Gram-negative bacteria obtained from various clinical samples were subjected to antibiotic susceptibility testing by the disc-diffusion method against meropenem (10 μg), imipenem (10 μg), doripenem (10 μg), polymyxin B (10 μg), colistin (10 μg), amikacin (30 μg), gentamicin (10 μg), aztreonam (30 μg), ciprofloxacin (5 μg), levofloxacin (5 μg), ofloxacin (5 μg), cefepime (30 μg), ceftazidime (30 μg), piperacillin-tazobactam (100\10 μg), tigecycline (15 μg) and tetracycline (10 μg). The results were interpreted according to the guidelines suggested by the Clinical Laboratory Standards Institute. Presence of blaNDM was detected by PCR and it was confirmed by DNA sequencing of the gene present in the isolates that exhibited carbapenem resistance. RESULTS In the present study, four isolates of P. aeruginosa carried the blaNDM, three isolates harboured blaNDM-1 and one isolate harboured blaNDM-2. All isolates were resistant to imipenem and meropenem. The blaNDM-1 carrying isolates remained susceptible to colistin and β-lactamase inhibitors piperacillin-tazobactam. CONCLUSION We are reporting emergence of the P. aeruginosa carrying the blaNDM-variant, which exhibited resistance to imipenem and meropenem for the first time in Iraq.
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Akyar I, Ayas M, Karatuna O, Besli Y. Evaluation of the Carba NP Test for the Detection of Carbapenemase Activity in Bacteroides Species. Pol J Microbiol 2018; 67:97-101. [PMID: 30015430 DOI: 10.5604/01.3001.0011.6148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 11/13/2022] Open
Abstract
We evaluated the usefulness of the Carba NP test for rapid detection of carbapenemase activity in Bacteroides spp. The minimum inhibitory concentration (MIC) for imipenem was determined with gradient test strips, and cfiA gene was investigated by polymerase chain reaction for 27 clinical Bacteroides spp. isolates. Carba NP test was performed according to recommendations of the Clinical and Laboratory Standards Institute. Among three cfiA gene harboring clinical isolates, two imipenem resistant isolates were Carba NP test positive, while the imipenem intermediate isolate was negative. Our preliminary results suggest that the Carba NP test can be useful as a rapid test to detect carbapenemases in Bacteroides species.
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Affiliation(s)
- Isin Akyar
- Department of Medical Microbiology, Acibadem University School of Medicine,Istanbul,Turkey.,Department of Microbiology, Acibadem Labmed Medical Laboratories,Istanbul,Turkey
| | - Meltem Ayas
- Department of Microbiology, Acibadem Labmed Medical Laboratories,Istanbul,Turkey
| | - Onur Karatuna
- Department of Medical Microbiology, Acibadem University School of Medicine,Istanbul,Turkey
| | - Yesim Besli
- Department of Medical Microbiology, Acibadem University School of Medicine,Istanbul,Turkey.,Department of Microbiology, Acibadem Labmed Medical Laboratories,Istanbul,Turkey
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Codjoe FS, Donkor ES. Carbapenem Resistance: A Review. Med Sci (Basel) 2017; 6:medsci6010001. [PMID: 29267233 PMCID: PMC5872158 DOI: 10.3390/medsci6010001] [Citation(s) in RCA: 262] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 11/25/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022] Open
Abstract
Carbapenem resistance is a major and an on-going public health problem globally. It occurs mainly among Gram-negative pathogens such as Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, and may be intrinsic or mediated by transferable carbapenemase-encoding genes. This type of resistance genes are already widespread in certain parts of the world, particularly Europe, Asia and South America, while the situation in other places such as sub-Saharan Africa is not well documented. In this paper, we provide an in-depth review of carbapenem resistance providing up-to-date information on the subject.
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Affiliation(s)
- Francis S Codjoe
- Department of Medical Laboratory Sciences (Microbiology Division), School of Biomedical & Allied Health Sciences, College of Health Sciences, University of Ghana, Korle Bu KB 143 Accra, Ghana.
- Biomolecular Science Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK.
| | - Eric S Donkor
- Department of Medical Microbiology, School of Biomedical & Allied Health Sciences, College of Health Sciences, University of Ghana, Korle Bu KB 143 Accra, Ghana.
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40
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Khorvash F, Yazdani M, Shabani S, Soudi A. Pseudomonas aeruginosa-producing Metallo-β-lactamases (VIM, IMP, SME, and AIM) in the Clinical Isolates of Intensive Care Units, a University Hospital in Isfahan, Iran. Adv Biomed Res 2017; 6:147. [PMID: 29285477 PMCID: PMC5735557 DOI: 10.4103/2277-9175.219412] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Pseudomonas aeruginosa is a severe challenge for antimicrobial therapy, due to the chromosomal mutations or exhibition of intrinsic resistance to various antimicrobial agents such as most β-lactams. We undertook this study to evaluate the existence of SME, IMP, AIM, and VIM metallo-β-lactamases (MBL) encoding genes among P. aeruginosa strains isolated from Intensive Care Unit (ICU) patients in Al-Zahra Hospital in Isfahan, Iran. Materials and Methods: In a retrospective cross-sectional study that was conducted between March 2012 and April 2013, a total of 48 strains of P. aeruginosa were collected from clinical specimens of bedridden patients in ICU wards. Susceptibility test was performed by disc diffusion method. All of the meropenem-resistant strains were subjected to modified Hodge test for detection of carbapenemases. Multiplex polymerase chain reaction was performed for detection of blaVIM, blaIMP, blaAIM, and blaSME genes. Results: In disk diffusion method, imipenem and meropenem showed the most and colistin the least resistant antimicrobial agents against P. aeruginosa strains. Of the 48 isolates, 36 (75%) were multidrug resistant (MDR). Amplification of β-lactamase genes showed the presence of blaVIM genes in 7 (%14.6) strains and blaIMP genes in 15 (31.3%) strains. All of the isolates were negative for blaSME and blaAIM genes. We could not find any statistically significant difference among the presence of this gene and MDR positive, age, or source of the specimen. Conclusion: As patients with infections caused by MBL-producing bacteria are at an intensified risk of treatment failure, fast determination of these organisms is necessary. Our findings may provide useful insights in replace of the appropriate antibiotics and may also prevent MBLs mediated resistance problem.
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Affiliation(s)
- Farzin Khorvash
- Department of Infectious Diseases, Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadreza Yazdani
- Department of Infectious Diseases, Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shiva Shabani
- Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aliasghar Soudi
- Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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41
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Shalom O, Adler A. Comparative study of 3 carbapenem-hydrolysis methods for the confirmation of carbapenemase production in Enterobacteriaceae. Diagn Microbiol Infect Dis 2017; 90:73-76. [PMID: 29174735 DOI: 10.1016/j.diagmicrobio.2017.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/03/2017] [Accepted: 10/13/2017] [Indexed: 12/01/2022]
Abstract
The goals of the study were to examine the analytic and performance parameters of 2 commercial rapid carbapenem-hydrolysis assays, the β-CARBA test (Bio-Rad) and the Rapid CARB Blue Kit (ROSCO) in comparison with an in-house CARBA NP assay for the detection of Carbapenemase-Producing Enterobacteriaceae (CPE). Their performance was evaluated following growth on 2 chromogenic CPE screening media. The sensitivity was highest (91%) in the β-CARBA test when used from the mSuperCARBA™ plates and was lowest when the same test was used from the chromID™ CARBA plates (75%). The specificity was highest in the NP CARBA test in both media (96%), followed by the β CARBA/mSuperCARBA™ combination (92%). The specificity of the Rapid CARB Blue Kit was as low as 36% when used with the chromID™ CARBA plates. The β-CARBA test was simple to use and had the shortest turn-around time and hand-on time.
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Affiliation(s)
- Ohad Shalom
- Clinical Microbiology Laboratory, Tel Aviv Sourasky Medical Center, Israel
| | - Amos Adler
- Clinical Microbiology Laboratory, Tel Aviv Sourasky Medical Center, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel.
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Hirabayashi A, Kato D, Tomita Y, Iguchi M, Yamada K, Kouyama Y, Morioka H, Tetsuka N, Yagi T. Risk factors for and role of OprD protein in increasing minimal inhibitory concentrations of carbapenems in clinical isolates of Pseudomonas aeruginosa. J Med Microbiol 2017; 66:1562-1572. [PMID: 28984565 DOI: 10.1099/jmm.0.000601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study examined the risk factors for, and molecular mechanisms underlying, the increase in carbapenem minimum inhibitory concentrations (MICs) in clinical isolates of Pseudomonas aeruginosa. METHODOLOGY Consecutive clinical isolates of P. aeruginosa were collected. The MicroScan WalkAway system detected more than fourfold increases in the MICs of carbapenems in P. aeruginosa isolates serially recovered from some patients during their clinical course. The clinical risk factors associated with this increase were examined by multiple logistic regression analysis. Western blot analysis and nucleotide sequencing of the oprD gene of 19 clonally related and paired P. aeruginosa isolates from the same patients were undertaken to examine the mechanisms underlying the increase in MICs. RESULTS The results showed that prior use of carbapenems (OR, 2.799; 95 % CI, 1.088-7.200; P=0.033) and the use of ventilators or tracheostomies (OR, 2.648; 95 % CI, 1.051-6.671; P=0.039) were risk factors for increased carbapenem MICs. Analysis of the underlying mechanisms revealed that loss of functional OprD protein due to mutation of the oprD gene tended to occur in P. aeruginosa isolates with imipenem MICs of more than 8 µg ml-1; a reduction in OprD expression was observed in P. aeruginosa isolates with imipenem MICs of 4 or 8 µg ml-1. This difference in the resistance mechanism was not correlated with the MICs of meropenem. CONCLUSION This difference in the resistance mechanism of P. aeruginosa indicates a critical breakpoint at an imipenem MIC of 8 µg ml-1, in accordance with EUCAST criteria. Reducing carbapenem use will prevent P. aeruginosa clinical isolates from developing resistance to carbapenems.
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Affiliation(s)
- Aki Hirabayashi
- Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Aichi, Japan.,Department of Infectious Diseases, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Daizo Kato
- Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Yuka Tomita
- Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Mitsutaka Iguchi
- Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Keiko Yamada
- Department of Bacteriology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yuichi Kouyama
- Department of Hospital Pharmacy, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Hiroshi Morioka
- Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Aichi, Japan.,Department of Infectious Diseases, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Nobuyuki Tetsuka
- Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Aichi, Japan.,Department of Infectious Diseases, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tetsuya Yagi
- Department of Infectious Diseases, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Aichi, Japan
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Comparison of MALDI-ToF MS with the Rapidec Carba NP test for the detection of carbapenemase-producing Enterobacteriaceae. Eur J Clin Microbiol Infect Dis 2017; 37:149-155. [PMID: 28980084 DOI: 10.1007/s10096-017-3115-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
Abstract
Although carbapenemase-producing Enterobacteriaceae (CPE) have become a serious public health issue, their detection remains challenging. The aim of this study was to implement a test based on imipenem hydrolysis by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-ToF MS), using 65 strains producing or not a carbapenemase. Then, we compared its performance to that of the Rapidec Carba NP test using 20 additional strains. The MS-based test effectively discriminated between CPE and other non-carbapenem-susceptible strains compared to the Rapidec Carba NP test (sensitivity 100% and 92%, specificity 94% and 92%, respectively). The MS-based test gave less difficulty in interpretation than the colorimetric Rapidec Carba NP test. MALDI-ToF gave a result in less than one hour and limited the use of expensive molecular assays. In conclusion, the hydrolysis test based on MALDI-ToF MS can detect clinically relevant CPE isolates in routine practice. This technology, also described to screen for carbapenem resistance in Pseudomonas aeruginosa and Acinetobacter baumannii complex strains, also seems to be interesting in routine practice for these pathogens.
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Li Y, Yang X, Zhao W. Emerging Microtechnologies and Automated Systems for Rapid Bacterial Identification and Antibiotic Susceptibility Testing. SLAS Technol 2017; 22:585-608. [PMID: 28850804 DOI: 10.1177/2472630317727519] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Rapid bacterial identification (ID) and antibiotic susceptibility testing (AST) are in great demand due to the rise of drug-resistant bacteria. Conventional culture-based AST methods suffer from a long turnaround time. By necessity, physicians often have to treat patients empirically with antibiotics, which has led to an inappropriate use of antibiotics, an elevated mortality rate and healthcare costs, and antibiotic resistance. Recent advances in miniaturization and automation provide promising solutions for rapid bacterial ID/AST profiling, which will potentially make a significant impact in the clinical management of infectious diseases and antibiotic stewardship in the coming years. In this review, we summarize and analyze representative emerging micro- and nanotechnologies, as well as automated systems for bacterial ID/AST, including both phenotypic (e.g., microfluidic-based bacterial culture, and digital imaging of single cells) and molecular (e.g., multiplex PCR, hybridization probes, nanoparticles, synthetic biology tools, mass spectrometry, and sequencing technologies) methods. We also discuss representative point-of-care (POC) systems that integrate sample processing, fluid handling, and detection for rapid bacterial ID/AST. Finally, we highlight major remaining challenges and discuss potential future endeavors toward improving clinical outcomes with rapid bacterial ID/AST technologies.
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Affiliation(s)
- Yiyan Li
- 1 Sue and Bill Gross Stem Cell Research Center, University of California-Irvine, Irvine, CA, USA.,7 Department of Physics and Engineering, Fort Lewis College, Durango, Colorado, USA
| | | | - Weian Zhao
- 1 Sue and Bill Gross Stem Cell Research Center, University of California-Irvine, Irvine, CA, USA.,6 Department of Biological Chemistry, University of California-Irvine, Irvine, CA, USA
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The Changing Role of the Clinical Microbiology Laboratory in Defining Resistance in Gram-negatives. Infect Dis Clin North Am 2017; 30:323-345. [PMID: 27208762 DOI: 10.1016/j.idc.2016.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The evolution of resistance in Gram-negatives has challenged the clinical microbiology laboratory to implement new methods for their detection. Multidrug-resistant strains present major challenges to conventional and new detection methods. More rapid pathogen identification and antimicrobial susceptibility testing have been developed for use directly on specimens, including fluorescence in situ hybridization tests, automated polymerase chain reaction systems, microarrays, mass spectroscopy, next-generation sequencing, and microfluidics. Review of these methods shows the advances that have been made in rapid detection of resistance in cultures, but limited progress in direct detection from specimens.
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Evaluation of the Carba NP test for carbapenemase detection in Enterobacteriaceae, Pseudomonas spp. and Acinetobacter spp., and its practical use in the routine work of a national reference laboratory for susceptibility testing. Eur J Clin Microbiol Infect Dis 2017; 36:2281-2287. [PMID: 28744664 PMCID: PMC5653713 DOI: 10.1007/s10096-017-3062-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/04/2017] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate the Carba NP test (and CarbAcineto) for the detection of carbapenemases in Enterobacteriaceae, Pseudomonas spp. and Acinetobacter spp., and to assess its usefulness in the routine work of the National Reference Centre for Susceptibility Testing (NRCST) in Poland. The evaluation of the Carba NP/CarbAcineto tests was carried out on a group of 81 Enterobacteriaceae, Pseudomonas spp. and Acinetobacter spp. isolates producing KPC-, NDM-, VIM-, IMP- or OXA-48, -23, -24/40, -58-type carbapenemases, and on 26 carbapenemase-negative strains cultivated on a broad panel of microbiological media. Subsequently, the performance of the Carba NP/CarbAcineto tests was assessed on 1282 isolates of Enterobacteriaceae, Pseudomonas spp. and Acinetobacter spp. from Polish hospitals, submitted to the NRCST during a 9-month period in 2014. The Carba NP/CarbAcineto results were compared with other phenotypic tests and/or polymerase chain reaction (PCR). The impact of the media on the results of the Carba NP/CarbAcineto tests was observed, with the Columbia blood agar yielding the highest sensitivity and clarity of the results. Furthermore, the Carba NP/CarbAcineto tests were included in the NRCST routine procedure for carbapenemase identification. The sensitivity and specificity of the Carba NP test were 95.8% and 93.3%, respectively, for Enterobacteriaceae, and 97.5% and 99.0%, respectively, for Pseudomonas spp. The sensitivity of the CarbAcineto test for Acinetobacter spp. was 88.9%. This study confirmed the usefulness of the Carba NP/CarbAcineto tests for the rapid detection of various types of carbapenemases.
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Anandan S, Gopi R, Devanga Ragupathi NK, Muthuirulandi Sethuvel DP, Gunasekaran P, Walia K, Veeraraghavan B. First report of bla OXA-181-mediated carbapenem resistance in Aeromonas caviae in association with pKP3-A: Threat for rapid dissemination. J Glob Antimicrob Resist 2017; 10:310-314. [PMID: 28743649 DOI: 10.1016/j.jgar.2017.07.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Carbapenemase-producing Aeromonas spp. are of great concern in healthcare settings and are also known to acquire clinically relevant resistance genes. In this study, carbapenem-non-susceptible Aeromonas isolates were characterised for their molecular mechanisms of resistance. METHODS Among 180 Aeromonas isolates, 10 carbapenem-non-susceptible isolates were selected based on their antimicrobial susceptibility profile. Carbapenemase production was investigated by the CarbaNP test. ESBL-, AmpC- and carbapenemase-encoding genes were screened by PCR. Isolates VBF557 and VBF856 with high MICs for imipenem were selected for whole-genome sequencing (WGS). Conjugation experiments were performed to determine the transmissibility of resistance. RESULTS WGS remarkably revealed the presence of class D β-lactamases (AmpS/AmpH), class C β-lactamases and class B2 metallo-β-lactamase (cphA3) in VBF557. In contrast, VBF856 had multiple resistance genes coding for aminoglycoside, sulphonamide, carbapenem (blaOXA-181 class D β-lactamase), macrolide, fluoroquinolone, rifampicin, phenicol, tetracycline and trimethoprim resistance. This is the first global report of blaOXA-181 in Aeromonas spp. Interestingly, blaOXA-181 was identified in association with transposon Tn2013 in plasmid pKP3-A. Additionally, an IncQ2 plasmid with qnrS2 was identified. Among the tested isolates, VBF1116 and VBF888 possessed blaNDM and blaVEB, respectively, by PCR. None of the other isolates harboured any tested β-lactamase genes. The resistance gene was transmissible in the presence of imipenem. CONCLUSIONS Presence of such resistance genes in plasmids further adds complexity for control of spread of carbapenem resistance. This study reveals the emergence of carbapenem resistance among Aeromonas spp. and the importance of mobile genetic elements such as plasmids in interchanging resistance determinants between species.
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Affiliation(s)
- Shalini Anandan
- Department of Clinical Microbiology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Radha Gopi
- Department of Clinical Microbiology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | | | | | - Priya Gunasekaran
- Department of Clinical Microbiology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Kamini Walia
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi 110 029, India
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore 632004, Tamil Nadu, India.
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Aktaş E, Malkoçoğlu G, Otlu B, Çopur Çiçek A, Külah C, Cömert F, Sandallı C, Gürsoy NC, Erdemir D, Bulut ME. Evaluation of the Carbapenem Inactivation Method for Detection of Carbapenemase-Producing Gram-Negative Bacteria in Comparison with the RAPIDEC CARBA NP. Microb Drug Resist 2017; 23:457-461. [DOI: 10.1089/mdr.2016.0092] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Elif Aktaş
- Clinical Microbiology Laboratory, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Barış Otlu
- Department of Medical Microbiology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Ayşegül Çopur Çiçek
- Department of Medical Microbiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Canan Külah
- Department of Medical Microbiology, Faculty of Medicine, Bülent Ecevit University Zonguldak, Turkey
| | - Füsun Cömert
- Department of Medical Microbiology, Faculty of Medicine, Bülent Ecevit University Zonguldak, Turkey
| | - Cemal Sandallı
- Department of Biology, Faculty of Arts and Sciences, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Nafia Canan Gürsoy
- Department of Medical Microbiology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Duygu Erdemir
- Clinical Microbiology Laboratory, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Emin Bulut
- Clinical Microbiology Laboratory, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Multicenter Performance Assessment of Carba NP Test. J Clin Microbiol 2017; 55:1954-1960. [PMID: 28404676 DOI: 10.1128/jcm.00244-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/05/2017] [Indexed: 01/04/2023] Open
Abstract
Eighty Gram-negative bacilli (54 Enterobacteriaceae and 26 nonfermenting Gram-negative bacilli) obtained from multiple institutions in the United States were distributed in a blinded manner to seven testing laboratories to compare their performance of a test for detection of carbapenemase production, the Carba NP test. The Carba NP test was performed by all laboratories, following the Clinical and Laboratory Standards Institute (CLSI) procedure. Site-versus-site comparisons demonstrated a high level of consistency for the Carba NP assay, with just 3/21 site comparisons yielding a difference in sensitivity (P < 0.05). Previously described limitations with blaOXA-48-like carbapenemases and blaOXA carbapenemases associated with Acinetobacter baumannii were noted. Based on these data, we demonstrate that the Carba NP test, when implemented with the standardized CLSI methodology, provides reproducible results across multiple sites for detection of carbapenemases.
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Mao W, Xia L, Xie H. Detection of Carbapenemase-Producing Organisms with a Carbapenem-Based Fluorogenic Probe. Angew Chem Int Ed Engl 2017; 56:4468-4472. [DOI: 10.1002/anie.201612495] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 01/27/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Wuyu Mao
- State Key Laboratory of Bioreactor Engineering; Shanghai Key Laboratory of New Drug Design; School of Pharmacy; East China University of Science and Technology; Shanghai 200237 P.R. China
| | - Lingying Xia
- State Key Laboratory of Bioreactor Engineering; Shanghai Key Laboratory of New Drug Design; School of Pharmacy; East China University of Science and Technology; Shanghai 200237 P.R. China
| | - Hexin Xie
- State Key Laboratory of Bioreactor Engineering; Shanghai Key Laboratory of New Drug Design; School of Pharmacy; East China University of Science and Technology; Shanghai 200237 P.R. China
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