Molecular typing of Campylobacter jejuni isolates involved in a neonatal outbreak indicates nosocomial transmission

Significant contribution of the CmeABC Efflux pump in high-level resistance to ciprofloxacin and tetracycline in Campylobacter jejuni and Campylobacter coli clinical isolates

Background

Campylobacter resistance to antimicrobial agents is regarded as a major concern worldwide. The aim of this study was to investigate the expression of the CmeABC efflux pump and the RAPD-PCR pattern in drug-resistant Campylobacter isolates.

Methods

A total of 283 stool specimens were collected from children under the age of five with diarrhea. The minimum inhibitory concentration (MIC) of tetracycline and ciprofloxacin was determined by broth microdilution method and E-test, respectively. Detection of tetracycline and ciprofloxacin determinants was done by amplification of tetO gene and PCR-sequencing of the gyrA gene. The cmeABC transcriptional expression was analyzed by Real-time (RT)-PCR. Clonal correlation of resistant strains was determined by RAPD-PCR genotyping.

Results

Out of 283 fecal samples, 20 (7.02%) samples were positive for Campylobacter spp. Analysis of duplex PCR assay of the cadF gene showed that 737 and 461 bp amplicons were corresponding to Campylobacter jejuni and Campylobacter coli, respectively. All of the 17 phenotypically tetracycline-resistant Campylobacter isolates harbored the tetO gene. Also, four phenotypically ciprofloxacin-resistant Campylobacter isolates had a point mutation at codon 257 of the gyrA gene (ACA to ATA; Thr > Ile). High-level expression of the cmeA gene was observed in ciprofloxacin-resistant and high-level tetracycline-resistant Campylobacter isolates, suggesting a positive correlation between the cmeA gene expression level and tetracycline resistance level. Moreover, a statistically significant difference was observed in the cmeA gene expression between ciprofloxacin-resistant and ciprofloxacin-susceptible strains, which signifies the crucial contribution of the efflux pump in conferring multiple drug resistance phenotype among Campylobacter spp. RAPD analysis of Campylobacter isolates exhibited 16 different patterns. Simpsone`s diversity index of RAPD-PCR was calculated as 0.85, showing a high level of homogeneity among the population; however, no clear correlation was detected among tetracycline and/or ciprofloxacin resistant isolates.

Conclusion

Significant contribution of the CmeABC efflux pump in conferring high-level resistance to tetracycline and ciprofloxacin was observed in C. jejuni and C. coli clinical isolates. The resistant phenotype is suggested to be mediated by CmeABC efflux pumps, the tetO gene, and point mutation of the gyrA gene. Genotyping revealed no clonal correlation among resistant strains, indicating distinct evolution of tetracycline and ciprofloxacin resistant genotypes among the isolates.

SISTEMA API CAMPY PARA CARACTERIZAÇÃO DE AMOSTRAS DE CAMPYLOBACTER ISOLADAS DE DESCARGA CECAL, FEZES, SWABS CLOACAIS E CARCAÇAS DE FRANGOS DE CORTE

RESUMO O presente estudo verificou a aplicação do sistema API Campy para identificação de bactérias do gênero Campylobacter. Foram utilizadas 48 amostras, sendo 15 oriundas de descarga cecal, cinco de fezes, três de swabs cloacais e 21 de carcaças, isoladas de 22 lotes de frangos de corte com três semanas de idade. As amostras caracterizadas presuntivamente por microscopia em contraste de fase, coloração de Gram, catalase/oxidase e aglutinação em látex foram inoculadas no sistema API Campy, que consta de testes enzimáticos e convencionais em aerobiose e testes de assimilação ou inibição em microaerofilia, ambos incubados a 37º C por 24-48 horas, sendo a leitura realizada em sistema informatizado. Foi possível identificar 43 amostras (89,58%), enquanto cinco (10,41%) tiveram perfil inaceitável. Identificou-se as espécies C. jejuni subsp. jejuni (68,8%); C. coli (8,3%); C. jejuni subsp. doylei (6,3%); C. upsaliensis (4,2%) e C. fetus subsp. fetus (2,1%). A ocorrência de Campylobacter nos lotes de frango de corte estudados foi de 81,8% e as espécies identificadas principalmente como Campylobacter jejuni subesp. jejuni pelo sistema API Campy, apresentando um maior número de espécies, subespécies e biotipos deCampylobacter dentre as amostras isoladas de carcaças de frango do que dentre as amostras clínicas isoladas nas granjas.

Antimicrobial resistance in Campylobacter spp isolated from broiler flocks

The aim of this study was to assess the antimicrobial susceptibility of 62 Campylobacter spp. strains obtained from broiler flocks using the agar diffusion method. The Campylobacter spp strains were isolated from 22 flocks aged between 3 and 5 weeks of life, isolated from cloacae swabs, stools and cecal droppings in the farm and from the carcass rinsing in the slaughterhouse. Campylobacter spp strains were tested on Mueller-Hilton (MH) agar (27 samples) and MH plus TTC agar (35 samples). The antimicrobial susceptibility test revealed a 62.5% resistance to at least one drug, especially to enrofloxacin (71%), neomycin (50%), lincomycin (50%), tetracycline (43%), penicillin (42%), ceftiofur (33%) amoxicillin (27%), spiramycin (20%), ampicillin (18%) and norfloxacin (14%), whereas a lower percentage of strains was resistant to erythromycin (10%) and doxycycline (10%). All strains were sensitive to gentamicin and lincomycin-spectinomycin and 80% of them to colistin. These results indicate that it is necessary to reduce the use of antimicrobials in veterinary and human medicine.

Descripción de un brote de gastroenteritis por Campylobacter jejuni y caracterización molecular de la cepa implicada

INTRODUCTION

The aim of this study is to describe an outbreak of diarrhea caused by Campylobacter jejuni in a primary school.

METHODS

Stool samples from five patients were cultured. Molecular typing of the isolated strains was performed using PCR-RFLP-flaA, PFGE and MLST.

RESULTS

Campylobacter jejuni was isolated from all five patients. Two of the five strains were available for typing. The DNA patterns of the two isolates were indistinguishable.

CONCLUSION

The results suggest that the causal strain had a common identity.

Linking healthcare associated norovirus outbreaks: a molecular epidemiologic method for investigating transmission

BACKGROUND

Noroviruses are highly infectious pathogens that cause gastroenteritis in the community and in semi-closed institutions such as hospitals. During outbreaks, multiple units within a hospital are often affected, and a major question for control programs is: are the affected units part of the same outbreak or are they unrelated transmission events? In practice, investigators often assume a transmission link based on epidemiological observations, rather than a systematic approach to tracing transmission.Here, we present a combined molecular and statistical method for assessing:1) whether observed clusters provide evidence of local transmission and2) the probability that anecdotally|linked outbreaks truly shared a transmission event.

METHODS

76 healthcare associated outbreaks were observed in an active and prospective surveillance scheme of 15 hospitals in the county of Avon, England from April 2002 to March 2003. Viral RNA from 64 out of 76 specimens from distinct outbreaks was amplified by reverse transcription-PCR and was sequenced in the polymerase (ORF 1) and capsid (ORF 2) regions. The genetic diversity, at the nucleotide level, was analysed in relation to the epidemiological patterns.

RESULTS

Two out of four genetic and epidemiological clusters of outbreaks were unlikely to have occurred by chance alone, thus suggesting local transmission. There was anecdotal epidemiological evidence of a transmission link among 5 outbreaks pairs. By combining this epidemiological observation with viral sequence data, the evidence of a link remained convincing in 3 of these pairs. These results are sensitive to prior beliefs of the strength of epidemiological evidence especially when the outbreak strains are common in the background population.

CONCLUSION

The evidence suggests that transmission between hospitals units does occur. Using the proposed criteria, certain hypothesized transmission links between outbreaks were supported while others were refuted. The combined molecular/epidemiologic approach presented here could be applied to other viral populations and potentially to other pathogens for a more thorough view of transmission.

PCR-restriction fragment length polymorphism assay for detection of gyrA mutations associated with fluoroquinolone resistance in Campylobacter coli

A fragment of the gyrA gene was sequenced from 34 isolates of Campylobacter coli, including 23 isolates resistant to ciprofloxacin. All ciprofloxacin-resistant isolates examined by DNA sequencing carried a point mutation at position Thr-86 on the gyrA gene product, involving the replacement of Thr-86 by Ile. A combined PCR-restriction fragment length polymorphism technique using RsaI was developed to detect this mutation.