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Muzembo BA, Kitahara K, Ohno A, Okamoto K, Miyoshi SI. Colonization with extended-spectrum beta-lactamase-producing Escherichia coli and traveler's diarrhea attack rates among travelers to India: a systematic review and meta-analysis. Trop Dis Travel Med Vaccines 2022; 8:22. [PMID: 36180932 PMCID: PMC9525155 DOI: 10.1186/s40794-022-00179-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/14/2022] [Indexed: 11/07/2022] Open
Abstract
Background India is an attractive destination for travelers. Unfortunately, numerous reports exist on traveler’s diarrhea (TD) and fecal colonization with extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) among international travelers visiting India. Here, we systematically reviewed studies published on the acquisition of ESBL-EC and TD attack rates among international visitors to India. Methods Design: Systematic review and meta-analysis. A systematic search was performed using Google Scholar, PubMed, EMBASE, Web of Science, and gray literature from 2000 to December 2021, for studies containing data for ESBL-EC acquisition or TD experience related to a trip to India. Random effects models were used to compute the prevalence of ESBL-EC acquisition and TD attack. Results The literature search yielded a total of 5023 records. Of these, 31 met our inclusion criteria for systematic review and only 17 could be meta-analyzed (9 for TD, and 8 for ESBL-EC). The overall pooled attack rate of TD was 39% (95% confidence interval, CI: 25–53%). In studies where travelers' memory was used to diagnose TD, the pooled attack rate of TD was slightly higher (42%, 95% CI: 21–64%) compared to those where TD was objectively documented (33%, 95% CI: 17–49%). There were significant risks to be colonized with ESBL-EC among the travelers who experienced TD. The pooled rate of ESBL-EC colonization was 72% (CI: 67–78%). Most ESBL-EC produced CTX-M-15 enzyme. Furthermore, most of the travelers who acquired ESBL-EC were from highly industrialized countries recruited from travel clinics: Canada (n = 80), Germany (n = 69), Netherlands (n = 20), Sweden (n = 18), Japan (n = 10), Finland (n = 8), USA (n = 7), Spain (n = 5), and Denmark (n = 3). Conclusions TD pooled attack rate and ESBL-EC acquisition among international travelers visiting India were high in this study. However, we cannot make generalizations based upon this TD pooled attack rate for the current situation, due to a lack of current data. Our study highlights that travelers should be advised on TD to ensure that they do not disregard the risk of contracting TD and be better prepared as a result. It also illustrates the importance of international travel in acquiring antibiotic-resistant Escherichia coli. Supplementary Information The online version contains supplementary material available at 10.1186/s40794-022-00179-1.
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Affiliation(s)
- Basilua Andre Muzembo
- grid.261356.50000 0001 1302 4472Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushimanaka, Kita Ward, Okayama, 700-8530 Japan
| | - Kei Kitahara
- grid.261356.50000 0001 1302 4472Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushimanaka, Kita Ward, Okayama, 700-8530 Japan ,Collaborative Research Centre of Okayama University for Infectious Diseases in India, Kolkata 700010, India
| | - Ayumu Ohno
- grid.261356.50000 0001 1302 4472Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushimanaka, Kita Ward, Okayama, 700-8530 Japan ,Collaborative Research Centre of Okayama University for Infectious Diseases in India, Kolkata 700010, India
| | - Keinosuke Okamoto
- grid.261356.50000 0001 1302 4472Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushimanaka, Kita Ward, Okayama, 700-8530 Japan
| | - Shin-Ichi Miyoshi
- grid.261356.50000 0001 1302 4472Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushimanaka, Kita Ward, Okayama, 700-8530 Japan
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Yusof NY, Norazzman NII, Zaidi NFM, Azlan MM, Ghazali B, Najib MA, Malik AHA, Halim MAHA, Sanusi MNSM, Zainal AA, Aziah I. Prevalence of Antimicrobial Resistance Genes in Salmonella Typhi: A Systematic Review and Meta-Analysis. Trop Med Infect Dis 2022; 7:tropicalmed7100271. [PMID: 36288012 PMCID: PMC9611315 DOI: 10.3390/tropicalmed7100271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/23/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Salmonella enterica serovar Typhi (S. Typhi) that has developed resistance to many antimicrobials poses a serious challenge to public health. Hence, this study aimed to systematically determine the prevalence of antimicrobial resistance (AMR) in S. Typhi isolated from the environment and humans as well as to ascertain the spread of the selected AMR genes in S. Typhi. This systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, and the study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). A total of 2353 studies were retrieved from three databases, of which 42 studies fulfilled the selection criteria. The pooled prevalence of AMR S. Typhi (using a random-effect model) was estimated at 84.8% (95% CI; 77.3−90.2), with high heterogeneity (I2: 95.35%, p-value < 0.001). The high estimated prevalence indicates that control methods should be improved immediately to prevent the spread of AMR among S. Typhi internationally.
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Affiliation(s)
- Nik Yusnoraini Yusof
- Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: (N.Y.Y.); (I.A.)
| | - Nur Iffah Izzati Norazzman
- Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Nur Fatihah Mohd Zaidi
- Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Mawaddah Mohd Azlan
- Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Basyirah Ghazali
- Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Mohamad Ahmad Najib
- Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Abdul Hafiz Abdul Malik
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | | | | | - Annur Ashyqin Zainal
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Ismail Aziah
- Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: (N.Y.Y.); (I.A.)
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3
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Khadka S, Shrestha B, Pokhrel A, Khadka S, Joshi RD, Banjara MR. Antimicrobial Resistance in Salmonella Typhi Isolated From a Referral Hospital of Kathmandu, Nepal. Microbiol Insights 2021; 14:11786361211056350. [PMID: 34916803 PMCID: PMC8669115 DOI: 10.1177/11786361211056350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/09/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: The morbidity and mortality due to typhoid fever can be significantly reduced with the use of effective antibiotics. At present, fluoroquinolones, third generation cephalosporins, and azithromycin are widely used to treat typhoid fever. However, changing antibiotic susceptibility among Salmonella Typhi and Salmonella Paratyphi poses a particular challenge to the therapeutic management of enteric fever. The objective of this study was to assess the antibiotic susceptibility pattern of Salmonella Typhi isolates. Patients and Methods: A total of 706 blood specimens were collected from febrile patients attending the outpatient department of Kathmandu Model Hospital during June to September, 2018. The antibiotic susceptibility testing for 11 different antibiotics (nalidixic acid, ciprofloxacin, ofloxacin, levofloxacin, cefixime, ceftriaxone, cefotaxime, azithromycin, cotrimoxazole, chloramphenicol, and amoxicillin) was performed by disk diffusion method. Furthermore, minimum inhibitory concentration (MIC) values of ciprofloxacin, ofloxacin, and azithromycin were determined by agar dilution method. Mutation at gyrA ser83 associated with reduced susceptibility to fluoroquinolones was determined by PCR-RFLP. Results: Out of 706 blood samples, 6.94% (n = 49) were culture positive for Salmonella enterica (S. Typhi, n = 46). It was revealed that 97.8% S. Typhi isolates were susceptible to conventional first-line antibiotics (ampicillin, chloramphenicol, and cotrimoxazole), 97.3% to cephalosporins and 95.7% to azithromycin. S. Typhi were either resistant or intermediately susceptible to fluoroquinolones: 97.8% to ciprofloxacin, 91.3% to ofloxacin, and 89.1% to levofloxacin. The MIC of ciprofloxacin, ofloxacin, and azithromycin for S. Typhi ranged from 0.008 to 32, 0.03 to 16, and 2 to 8 μg/mL, respectively. Out of 46 S. Typhi isolates, 44 (95.65%) had gyrA ser83 mutation. Conclusion: Fluoroquinolones have poor activity against Salmonella Typhi. The trends of increasing azithromycin MIC value among S. Typhi might limit its use for the treatment of typhoid fever. Effectiveness of conventional first-line antibiotics in vitro suggests considering their clinical use after large-scale studies.
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Affiliation(s)
- Saroj Khadka
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Nepal
| | - Basudha Shrestha
- Department of Microbiology, Kathmandu Model Hospital, Kathmandu, Nepal
| | - Anil Pokhrel
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Nepal
| | - Sachin Khadka
- Department of Medicine, Kathmandu Model Hospital, Kathmandu, Nepal
| | | | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Nepal
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4
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Sah R, Donovan S, Seth-Smith HMB, Bloemberg G, Wüthrich D, Stephan R, Kataria S, Kumar M, Singla S, Deswal V, Kaur A, Neumayr A, Hinic V, Egli A, Kuenzli E. A Novel Lineage of Ceftriaxone-resistant Salmonella Typhi From India That Is Closely Related to XDR S. Typhi Found in Pakistan. Clin Infect Dis 2021; 71:1327-1330. [PMID: 31872221 DOI: 10.1093/cid/ciz1204] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/18/2019] [Indexed: 11/13/2022] Open
Abstract
Two MDR Salmonella Typhi isolates from India were found by whole genome sequencing to be closely related to the 2016 XDR S. Typhi outbreak strain from Pakistan. The Indian isolates have no chromosomal antimicrobial resistance cassette but carry the IncY plasmid p60006. Both isolates are susceptible to chloramphenicol, azithromycin, and carbapenems.
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Affiliation(s)
- Ranjit Sah
- Medanta The Medicity, Gurgaon, Haryana, India.,Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | - Helena M B Seth-Smith
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland.,Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland.,Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Guido Bloemberg
- National Reference Center for Enteropathogenic Bacteria and Listeria, Institute for Food Safety and Hygiene, University of Zurich, Zurich, Switzerland
| | - Daniel Wüthrich
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland.,Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland.,Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Roger Stephan
- National Reference Center for Enteropathogenic Bacteria and Listeria, Institute for Food Safety and Hygiene, University of Zurich, Zurich, Switzerland
| | | | | | | | | | | | - Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Vladimira Hinic
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland.,Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Adrian Egli
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland.,Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Esther Kuenzli
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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5
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Popa GL, Papa MI. Salmonella spp. infection - a continuous threat worldwide. Germs 2021; 11:88-96. [PMID: 33898345 DOI: 10.18683/germs.2021.1244] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 11/08/2022]
Abstract
Acute diarrheal disease remains a major public health issue. Salmonella spp. infection is one of the leading causes of acute diarrheal disease despite the preventive measures implemented. The clinical picture of salmonellosis varies from a common gastroenteritis to enteric fevers which are life-threatening diseases requiring a prompt and correct antibiotic treatment. In this review we present recent salmonellosis outbreaks and point out that Salmonella infections continue to be an important health issue. Numerous outbreaks of Salmonella spp. have been reported worldwide in recent years, indicating that prevention and control programs need to be improved as well as the infectious diseases surveillance, all over the world.
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Affiliation(s)
- Gabriela Loredana Popa
- MD, PhD, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania, Colentina Clinical Hospital, 020125, Bucharest, Romania
| | - Mircea Ioan Papa
- MD, PhD, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania, "Cantacuzino" National Medico-Military Institute for Research and Development, 011233 Bucharest, Romania
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6
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Shin E, Park J, Jeong HJ, Park AK, Na K, Lee H, Chun JH, Hwang KJ, Kim CJ, Kim J. Emerging high-level ciprofloxacin-resistant Salmonella enterica serovar typhi haplotype H58 in travelers returning to the Republic of Korea from India. PLoS Negl Trop Dis 2021; 15:e0009170. [PMID: 33651791 PMCID: PMC7987170 DOI: 10.1371/journal.pntd.0009170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 03/23/2021] [Accepted: 01/22/2021] [Indexed: 11/19/2022] Open
Abstract
In Korea, typhoid fever is a rare disease due to improved living standards. However, typhoid fever remains a major burden in developing countries and regions, such as India and Southeast Asia. In this study, we isolated Salmonella Typhi (S. Typhi) from eight patients with typhoid fever who were travelers returning from India. The strains isolated were characterized by antimicrobial susceptibility profiling and whole-genome sequencing (WGS) analysis. All strains were resistant to nalidixic acid and azithromycin. Among them, four isolates were highly resistant to ciprofloxacin (MIC ≥32 μg/ml); these strains have not been confirmed in Korea PulseNet DB. According to WGS, the ciprofloxacin-resistant strains belong to the global dominant multidrug-resistant (MDR) haplotype H58 (SNP glpA C1047T, SptP protein Q185* (premature stop codon)) and do not harbor the MDR plasmid. H58-associated SNPs in membrane and metabolism genes, including yhdA, yajI, hyaE, tryE, rlpB and metH, are present. Additionally, phylogenetic analysis assigned the H58 strains to sublineage II, whereas the non-H58 strains are closely related to haplotype H50. The presence of high-level ciprofloxacin-resistant S. Typhi haplotype H58 in Korea was first confirmed as due to influx from overseas via travelers. This study provides information about intercontinental drug-resistant transmission between countries and suggests that travelers need to be careful about personal hygiene. Typhoid fever is a systemic human disease that involves gastroenteritis, fever, and severe diarrhea caused by Salmonella enterica serotype Typhi (S. Typhi) and requires prompt antibiotic treatment. Due to improved living standards, it has become a rare disease but is still prevalent in developing countries such as India and Southeast Asia. Most reported cases are related to travelers or immigrants from these regions. Because of treatment failure, serious morbidity, and economic loss, there is a global health issue with the emergence of antimicrobial-resistant strains associated with fluoroquinolones and third-generation cephalosporins. Of antimicrobial-resistant S. Typhi, haplotype H58 is a dominant multidrug-resistant lineage that has been reported in endemic regions over the past two decades. We identified fluoroquinolone resistance in cases of S. Typhi infection after travel to India. Among them, some strains highly resistant to ciprofloxacin were confirmed to have characteristics of haplotype H58. In Korea, S. Typhi haplotype H58 from travelers has not been confirmed before. This study provides information about intercontinental drug-resistant transmission between countries and suggests that travelers need to be careful about personal hygiene.
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Affiliation(s)
- Eunkyung Shin
- Division of Bacterial Diseases, Korea Centers for Diseases Control and Prevention, Cheongju, Republic of Korea
- College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jungsun Park
- Division of Bacterial Diseases, Korea Centers for Diseases Control and Prevention, Cheongju, Republic of Korea
| | - Hyun Ju Jeong
- Division of Bacterial Diseases, Korea Centers for Diseases Control and Prevention, Cheongju, Republic of Korea
| | - Ae Kyung Park
- Division of Bacterial Diseases, Korea Centers for Diseases Control and Prevention, Cheongju, Republic of Korea
| | - Kyoungin Na
- Division of Infectious Diseases Control, Korea Centers for Diseases Control and Prevention, Cheongju, Republic of Korea
| | - Hyerim Lee
- Division of Infectious Diseases Control, Korea Centers for Diseases Control and Prevention, Cheongju, Republic of Korea
| | - Jeong-hoon Chun
- Division of Bacterial Diseases, Korea Centers for Diseases Control and Prevention, Cheongju, Republic of Korea
| | - Kyu Jam Hwang
- Division of Bacterial Diseases, Korea Centers for Diseases Control and Prevention, Cheongju, Republic of Korea
| | - Chul-Joong Kim
- College of Veterinary Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Junyoung Kim
- Division of Bacterial Diseases, Korea Centers for Diseases Control and Prevention, Cheongju, Republic of Korea
- * E-mail:
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7
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Ayobola EHWARIEMED, Oscar WHILIKIO, Ejovwokoghene EJUKONEMUF. Occurrence of plasmid mediated fluoroquinolone resistance genes amongst enteric bacteria isolated from human and animal sources in Delta State, Nigeria. AIMS Microbiol 2021; 7:75-95. [PMID: 33659770 PMCID: PMC7921378 DOI: 10.3934/microbiol.2021006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/07/2021] [Indexed: 12/04/2022] Open
Abstract
Plasmid mediated quinolone resistance (PMQR) is a public health challenge arising among other things, from indiscriminate use of the floroquinolones (FQr) prophylactically in animal husbandry. This study examines the occurrence of PMQR genes amongst enteric bacteria isolated from human and animal sources. A total of 720 (360 stool and 360 fish pond water/poultry litter) samples were examined for fluoroquinolone resistant (FQr) bacteria. Percentage FQr was generally higher among human isolates than isolates from animals. Proportion of PMQR amongst FQr isolates were (1.05 and 4.32) % for E. coli from human and animal sources. For Salmonella spp., Shigella spp., Klebsiella spp. and Aeromonas spp., percentages PMQR were 0.00 & 6.93, 0.00 & 6.38, 4.26 & 5.26 and 0.00 &3.03 for human and animal sources respectively, for the isolates. The PMQR genes: qnrA, qnr B, qnr S and qep A were 11, 15, 7 and 1 amongst a total of 1018 FQr and 29 PMQR isolates respectively. The aac (6')-Ib-cr gene was not detected in this study. Approximate Plasmid bands of PCR amplicon for qnr A, qnr B, qnr S and qep A respectively were established. The proportion of PMQR genes especially among isolates from animal sources is of public health concern due to the higher possibility of a horizontal FQ resistance transfer to humans.
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Bokhary H, Pangesti KNA, Rashid H, Abd El Ghany M, Hill-Cawthorne GA. Travel-Related Antimicrobial Resistance: A Systematic Review. Trop Med Infect Dis 2021; 6:11. [PMID: 33467065 PMCID: PMC7838817 DOI: 10.3390/tropicalmed6010011] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 12/26/2022] Open
Abstract
There is increasing evidence that human movement facilitates the global spread of resistant bacteria and antimicrobial resistance (AMR) genes. We systematically reviewed the literature on the impact of travel on the dissemination of AMR. We searched the databases Medline, EMBASE and SCOPUS from database inception until the end of June 2019. Of the 3052 titles identified, 2253 articles passed the initial screening, of which 238 met the inclusion criteria. The studies covered 30,060 drug-resistant isolates from 26 identified bacterial species. Most were enteric, accounting for 65% of the identified species and 92% of all documented isolates. High-income countries were more likely to be recipient nations for AMR originating from middle- and low-income countries. The most common origin of travellers with resistant bacteria was Asia, covering 36% of the total isolates. Beta-lactams and quinolones were the most documented drug-resistant organisms, accounting for 35% and 31% of the overall drug resistance, respectively. Medical tourism was twice as likely to be associated with multidrug-resistant organisms than general travel. International travel is a vehicle for the transmission of antimicrobial resistance globally. Health systems should identify recent travellers to ensure that adequate precautions are taken.
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Affiliation(s)
- Hamid Bokhary
- School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (K.N.A.P.); (G.A.H.-C.)
- University Medical Center, Umm Al-Qura University, Al Jamiah, Makkah, Makkah Region 24243, Saudi Arabia
- The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead, NSW 2145, Australia; (H.R.); or (M.A.E.G.)
- The Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Krisna N. A. Pangesti
- School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (K.N.A.P.); (G.A.H.-C.)
- The Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
| | - Harunor Rashid
- The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead, NSW 2145, Australia; (H.R.); or (M.A.E.G.)
- National Centre for Immunisation Research and Surveillance (NCIRS), Kids Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Moataz Abd El Ghany
- The Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead, NSW 2145, Australia; (H.R.); or (M.A.E.G.)
- The Westmead Institute for Medical Research, Westmead, NSW 2145, Australia
- The Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Grant A. Hill-Cawthorne
- School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia; (K.N.A.P.); (G.A.H.-C.)
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9
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Travel-Related Typhoid Fever: Narrative Review of the Scientific Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020615. [PMID: 31963643 PMCID: PMC7013505 DOI: 10.3390/ijerph17020615] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 12/13/2022]
Abstract
Enteric fever is a foodborne infectious disease caused by Salmonella enterica serotypes Typhi and Paratyphi A, B and C. The high incidence in low income countries can increase the risk of disease in travelers coming from high income countries. Pre-travel health advice on hygiene and sanitation practices and vaccines can significantly reduce the risk of acquiring infections. Although the majority of the cases are self-limiting, life-threatening complications can occur. Delayed diagnosis and cases of infections caused by multi-drug resistant strains can complicate the clinical management and affect the prognosis. More international efforts are needed to reduce the burden of disease in low income countries, indirectly reducing the risk of travelers in endemic settings. Surveillance activities can help monitor the epidemiology of cases caused by drug-susceptible and resistant strains.
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10
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Meyer Sauteur PM, Stevens MJA, Paioni P, Wüthrich D, Egli A, Stephan R, Berger C, Bloemberg GV. Siblings with typhoid fever: An investigation of intrafamilial transmission, clonality, and antibiotic susceptibility. Travel Med Infect Dis 2019; 34:101498. [PMID: 31580900 DOI: 10.1016/j.tmaid.2019.101498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Typhoid fever usually manifests as an acute disease. However, asymptomatic carriage with Salmonella Typhi may occur. This study investigated a family setting of severe typhoid fever in Switzerland months after return from Bangladesh. METHOD Standard microbiological procedures were performed. Testing for S. Typhi IgM antibodies was done using a novel immunochromographic lateral flow assay. Whole genome sequencing (WGS) followed by comparative core genome multilocus sequence typing (cgMLST) was performed on the S. Typhi isolates. RESULTS Four months after returning from a visit to Bangladesh sibling 1 (9 months) was diagnosed with a S. Typhi meningitis and sibling 3 (8 years) was identified as asymptomatic S. Typhi carrier. Sibling 2 (2 years) was retrospectively diagnosed with typhoid fever by IgM serology at the time point of admission to the hospital. Parents were asymptomatic and culture-negative. WGS analysis of family S. Typhi isolates showed clonality and strongest homology with S. Typhi strains occurring in Bangladesh. The S. Typhi strain showed resistance against fluoroquinolones. A 4-week course of ceftriaxone resulted in full recovery of sibling 1. S. Typhi was eradicated from sibling 3 following azithromycin treatment for 14 days. CONCLUSION S. Typhi, acquired from a visit to Bangladesh, was most likely transmitted within the family from one brother as asymptomatic shedder to his 9-month-old brother who manifested S. Typhi meningitis as a very rare and life-threatening presentation of typhoid fever. S. Typhi infection should be considered even in case of uncommon manifestations and irrespective of the interval between disease presentation and travel to an endemic area.
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Affiliation(s)
- Patrick M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Switzerland
| | - Marc J A Stevens
- Institute for Food Safety and Hygiene, University of Zurich, Switzerland
| | - Paolo Paioni
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Switzerland
| | - Daniel Wüthrich
- Clinical Bacteriology & Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland; Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Adrian Egli
- Clinical Bacteriology & Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Roger Stephan
- Swiss National Center for Enteropathogenic Bacteria and Listeria (NENT), Institute for Food Safety and Hygiene, University of Zurich, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Switzerland
| | - Guido V Bloemberg
- Swiss National Center for Enteropathogenic Bacteria and Listeria (NENT), Institute for Food Safety and Hygiene, University of Zurich, Switzerland.
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Chen K, Dong N, Chan EWC, Chen S. Transmission of ciprofloxacin resistance in Salmonella mediated by a novel type of conjugative helper plasmids. Emerg Microbes Infect 2019; 8:857-865. [PMID: 31169081 PMCID: PMC6566993 DOI: 10.1080/22221751.2019.1626197] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Ciprofloxacin resistance in Salmonella has been increasingly reported due to the emergence and dissemination of multiple Plasmid-Mediated Quinolone Resistance (PMQR) determinants, which are mainly located in non-conjugative plasmids or chromosome. In this study, we aimed to depict the molecular mechanisms underlying the rare phenomenon of horizontal transfer of ciprofloxacin resistance phenotype in Salmonella by conjugation experiments, S1-PFGE and complete plasmid sequencing. Two types of non-conjugative plasmids, namely an IncX1 type carrying a qnrS1 gene, and an IncH1 plasmid carrying the oqxAB-qnrS gene, both ciprofloxacin resistance determinants in Salmonella, were recovered from two Salmonella strains. Importantly, these non-conjugative plasmids could be fused with a novel Incl1 type conjugative helper plasmid, which could target insertion sequence (IS) elements located in the non-conjugative, ciprofloxacin-resistance-encoding plasmid through replicative transcription, eventually forming a hybrid conjugative plasmid transmissible among members of Enterobacteriaceae. Since our data showed that such conjugative helper plasmids are commonly detectable among clinical Salmonella strains, particularly S. Typhimurium, fusion events leading to generation and enhanced dissemination of conjugative ciprofloxacin resistance-encoding plasmids in Salmonella are expected to result in a sharp increase in the incidence of resistance to fluoroquinolone, the key choice for treating life-threatening Salmonella infections, thereby posing a serious public health threat.
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Affiliation(s)
- Kaichao Chen
- a Shenzhen Key lab for Food Biological Safety Control, Food Safety and Technology Research Center , Hong Kong PolyU Shen Zhen Research Institute , Shenzhen , People's Republic of China.,b State Key Lab of Chirosciences, Department of Applied Biology and Chemical Technology , The Hong Kong Polytechnic University , Kowloon , Hong Kong
| | - Ning Dong
- a Shenzhen Key lab for Food Biological Safety Control, Food Safety and Technology Research Center , Hong Kong PolyU Shen Zhen Research Institute , Shenzhen , People's Republic of China.,b State Key Lab of Chirosciences, Department of Applied Biology and Chemical Technology , The Hong Kong Polytechnic University , Kowloon , Hong Kong
| | - Edward Wai-Chi Chan
- a Shenzhen Key lab for Food Biological Safety Control, Food Safety and Technology Research Center , Hong Kong PolyU Shen Zhen Research Institute , Shenzhen , People's Republic of China.,b State Key Lab of Chirosciences, Department of Applied Biology and Chemical Technology , The Hong Kong Polytechnic University , Kowloon , Hong Kong
| | - Sheng Chen
- a Shenzhen Key lab for Food Biological Safety Control, Food Safety and Technology Research Center , Hong Kong PolyU Shen Zhen Research Institute , Shenzhen , People's Republic of China.,b State Key Lab of Chirosciences, Department of Applied Biology and Chemical Technology , The Hong Kong Polytechnic University , Kowloon , Hong Kong
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12
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Cui M, Zhang P, Li J, Sun C, Song L, Zhang C, Zhao Q, Wu C. Prevalence and Characterization of Fluoroquinolone Resistant Salmonella Isolated From an Integrated Broiler Chicken Supply Chain. Front Microbiol 2019; 10:1865. [PMID: 31456779 PMCID: PMC6700324 DOI: 10.3389/fmicb.2019.01865] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 07/29/2019] [Indexed: 11/23/2022] Open
Abstract
The objectives of this study were to investigate the prevalence and fluoroquinolone resistant Salmonella isolated from an integrated broiler chicken supply chain and their molecular characterization. In total, 73 Salmonella isolates were recovered from a broiler chicken supply chain in Shanghai. Salmonella isolates were tested for susceptibility to 11 antimicrobial agents using the broth dilution method and were characterized using pulsed-field gel electrophoresis (PFGE). Then, the Salmonella isolates were examined for mutations in quinolone resistance-determining region (QRDR) of gyrA, gyrB, parC, and parE, and were screened for plasmid-mediated quinolone resistance (PMQR) genes. Lastly, we sequenced the plasmids carrying qnrS1 in six Salmonella isolates from three sources (two isolated per source). Among 73 Salmonella isolates, 45 isolates were identified as S. Indiana, 24 were S. Schwarzengrund, 2 were S. Enteritidis, and 2 were S. Stanleyville. In addition, high rates of resistance were detected for nalidixic acid (41.1%) and ciprofloxacin (37.0%), while resistance to other test agents was diverse (2.0-100%). S. Indiana and S. Schwarzengrund isolates from different sources exhibited the same PFGE pattern, suggesting that the Salmonella isolates possessed high potential to spread along the broiler chicken supply chain. gyrA and parC exhibited frequent missense mutations. Moreover, qnrS1 was the most prevalent PMQR gene in the 73 Salmonella isolates, and it was found about a new hybrid plasmid. This study concludes a high prevalence of fluoroquinolone resistant Salmonella in chicken supply chain, threatening the treatment of Salmonella foodborne diseases. In particular, the emergence of a new hybrid plasmid carrying qnrS1 indicates that the recombination of plasmid carrying resistance gene might be a potential risk factor for the prevention and control strategies of drug resistance.
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Affiliation(s)
- Mingquan Cui
- China Institute of Veterinary Drug Control, Beijing, China
| | - Peng Zhang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing, China
- Key Laboratory of Detection for Veterinary Drug Residue and Illegal Additive, MOA, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Jiyun Li
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing, China
- Key Laboratory of Detection for Veterinary Drug Residue and Illegal Additive, MOA, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Chengtao Sun
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing, China
- Key Laboratory of Detection for Veterinary Drug Residue and Illegal Additive, MOA, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Li Song
- China Institute of Veterinary Drug Control, Beijing, China
| | - Chunping Zhang
- China Institute of Veterinary Drug Control, Beijing, China
| | - Qi Zhao
- China Institute of Veterinary Drug Control, Beijing, China
| | - Congming Wu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing, China
- Key Laboratory of Detection for Veterinary Drug Residue and Illegal Additive, MOA, College of Veterinary Medicine, China Agricultural University, Beijing, China
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13
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Chen K, Chan EWC, Chen S. Evolution and transmission of a conjugative plasmid encoding both ciprofloxacin and ceftriaxone resistance in Salmonella. Emerg Microbes Infect 2019; 8:396-403. [PMID: 30896347 PMCID: PMC6455229 DOI: 10.1080/22221751.2019.1585965] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Ceftriaxone and ciprofloxacin are the drugs of choice in treatment of invasive Salmonella infections. This study discovered a novel type of plasmid, pSa44-CIP-CRO, which was recovered from a S. London strain isolated from meat product and comprised genetic determinants that encoded resistance to both ciprofloxacin and ceftriaxone. This plasmid could be resolved into two daughter plasmids and co-exist with such daughter plasmids in a dynamic form in Salmonella; yet it was only present as a single plasmid in Escherichia coli. One daughter plasmid, pSa44-CRO, was found to carry the blaCTX-M-130 gene, which encodes resistance to ceftriaxone, whereas the other plasmid, pSa44-CIP, carried multiple PMQR genes such as qnrB6-aac(6')-Ib-cr, which mediated resistance to ciprofloxacin. These two daughter plasmids could be integrated into one single plasmid through ISPa40 mediated homologous recombination. Mouse infection and treatment experiments showed that carriage of plasmid, pSa44-CIP-CRO by S. typhimurium led to the impairment of treatment by ciprofloxacin or cefitiofur, a veterinary drug with similar properties as ceftriaxone. In conclusion, dissemination of such conjugative plasmids impairs current choices of treatment for life-threatening Salmonella infection and hence constitutes a serious public health threat.
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Affiliation(s)
- Kaichao Chen
- a Shenzhen Key Lab for Food Biological Safety Control, Food Safety and Technology Research Center, Hong Kong PolyU Shen Zhen Research Institute , Shenzhen , People's Republic of China.,b Department of Applied Biology and Chemical Technology , State Key Lab of Chirosciences, The Hong Kong Polytechnic University , Kowloon , Hong Kong
| | - Edward Wai Chi Chan
- a Shenzhen Key Lab for Food Biological Safety Control, Food Safety and Technology Research Center, Hong Kong PolyU Shen Zhen Research Institute , Shenzhen , People's Republic of China.,b Department of Applied Biology and Chemical Technology , State Key Lab of Chirosciences, The Hong Kong Polytechnic University , Kowloon , Hong Kong
| | - Sheng Chen
- a Shenzhen Key Lab for Food Biological Safety Control, Food Safety and Technology Research Center, Hong Kong PolyU Shen Zhen Research Institute , Shenzhen , People's Republic of China.,b Department of Applied Biology and Chemical Technology , State Key Lab of Chirosciences, The Hong Kong Polytechnic University , Kowloon , Hong Kong
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14
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Tiba-Casas MR, Sacchi CT, Gonçalves CR, Almeida EA, Soares FB, de Jesus Bertani AM, Fernandes SA, de Paula Eduardo MB, Camargo CH. Molecular analysis of clonally related Salmonella Typhi recovered from epidemiologically unrelated cases of typhoid fever, Brazil. Int J Infect Dis 2019; 81:191-195. [PMID: 30849581 DOI: 10.1016/j.ijid.2019.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/08/2019] [Accepted: 02/09/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The primary method of molecular subtyping for the identification and investigation of outbreaks has been pulsed-field gel electrophoresis (PFGE). In some cases, this technique has not been able to show discrimination between the unrelated strains that can be achieved by whole genome sequencing (WGS). METHODS The aim of this study was to determine the strengths and drawbacks of WGS using different analytic approaches compared to traditional typing method, PFGE, for retrospectively typing clusters cases of 28 S. Typhi. RESULTS We evaluated three analytical approaches on the WGS data set (Nucleotide Difference (ND), (SNPs) and Whole genome multi locus sequence typing (wgMLST) that identically classified the clusters-related strains into two clusters, cluster A (with strains from 2017), and Cluster B (with strains from 2007). CONCLUSIONS In this study WGS based typing, was able to compete with PFGE for differentiation of the clusters of S. Typhi strains.
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15
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Day MR, Doumith M, Do Nascimento V, Nair S, Ashton PM, Jenkins C, Dallman TJ, Stevens FJ, Freedman J, Hopkins KL, Woodford N, De Pinna EM, Godbole G. Comparison of phenotypic and WGS-derived antimicrobial resistance profiles of Salmonella enterica serovars Typhi and Paratyphi. J Antimicrob Chemother 2019; 73:365-372. [PMID: 29216342 DOI: 10.1093/jac/dkx379] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/19/2017] [Indexed: 01/12/2023] Open
Abstract
Objectives Surveillance of antimicrobial resistance (AMR) in Salmonella enterica serovars Typhi and Paratyphi is essential to provide an evidence base for empirical treatment protocols and to monitor emerging AMR. We sought to compare phenotypic and WGS-based genotypic methods for the detection of AMR in Salmonella Typhi and Salmonella Paratyphi. Methods WGS data from 603 isolates of Salmonella Typhi (n = 332) and Salmonella Paratyphi (n = 271) were mapped to genes or chromosomal mutations known to be associated with phenotypic AMR and compared with phenotypic susceptibility data interpreted using breakpoints recommended by EUCAST. Results There were two (0.03%) discordant interpretations out of a possible 6030 isolate/antimicrobial class combinations. MDR (resistant to three or more classes of antimicrobial) was detected in 83/332 (25.0%) Salmonella Typhi isolates, but was not detected in Salmonella Paratyphi. Thirty-six (10.8%) isolates of Salmonella Typhi were resistant to ciprofloxacin (MIC >0.5 mg/L), with 33 (9.9%) of 332 exhibiting mutations in gyrA and parC, and 244 (73.5%) isolates had reduced susceptibility to ciprofloxacin (MIC 0.06-0.25 mg/L). In comparison, 209/227 (92.1%) isolates of Salmonella Paratyphi A exhibited resistance to ciprofloxacin (MIC >0.5 mg/L). No resistance to azithromycin or the third-generation cephalosporins was detected. Conclusions WGS data provided a robust and informative approach for monitoring MDR and emerging resistance to ciprofloxacin in Salmonella Typhi and Salmonella Paratyphi. Phenotypic antimicrobial susceptibility testing continues to be performed to guide targeted individual patient treatment, but inferred AMR profiles from WGS data may be used for surveillance and to guide empirical therapy.
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Affiliation(s)
- Martin R Day
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Michel Doumith
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Vivienne Do Nascimento
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Satheesh Nair
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Philip M Ashton
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Claire Jenkins
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Timothy J Dallman
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Flora J Stevens
- Travel and Migrant Health Section, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Joanne Freedman
- Travel and Migrant Health Section, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Katie L Hopkins
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Neil Woodford
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Elizabeth M De Pinna
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Gauri Godbole
- Bacteriology Reference Department, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
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16
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Identification and Characterization of Conjugative Plasmids That Encode Ciprofloxacin Resistance in Salmonella. Antimicrob Agents Chemother 2018; 62:AAC.00575-18. [PMID: 29760137 DOI: 10.1128/aac.00575-18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/23/2018] [Indexed: 11/20/2022] Open
Abstract
This study aimed to characterize novel conjugative plasmids that encode transferable ciprofloxacin resistance in Salmonella In this study, 157 nonduplicated Salmonella isolates were recovered from food products, of which 55 were found to be resistant to ciprofloxacin. Interestingly, 37 of the 55 CiprSalmonella isolates (67%) did not harbor any mutations in the quinolone resistance-determining regions (QRDR). Six Salmonella isolates were shown to carry two novel types of conjugative plasmids that could transfer the ciprofloxacin resistance phenotype to Escherichia coli J53 (azithromycin resistant [Azir]). The first type of conjugative plasmid belonged to the ∼110-kb IncFIB-type conjugative plasmids carrying qnrB-bearing and aac(6')-Ib-cr-bearing mobile elements. Transfer of the plasmid between E. coli and Salmonella could confer a ciprofloxacin MIC of 1 to 2 μg/ml. The second type of conjugative plasmid belonged to ∼240-kb IncH1/IncF plasmids carrying a single PMQR gene, qnrS Importantly, this type of conjugative ciprofloxacin resistance plasmid could be detected in clinical Salmonella isolates. The dissemination of these conjugative plasmids that confer ciprofloxacin resistance poses serious challenges to public health and Salmonella infection control.
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17
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Abstract
PURPOSE OF REVIEW The rise in antimicrobial resistance is an urgent public health threat which, in the absence of intervention, may result in a post-antibiotic era limiting the effectiveness of antibiotics to treat both common and serious infections. Globalization and human migration have profoundly contributed to the spread of drug-resistant bacteria. In this review, we summarize the recent literature on the importance of travelers in the spread of drug-resistant bacterial organisms. Our goal was to describe the importance of travel on a variety of clinically relevant drug-resistant bacterial organisms including extended-spectrum β-lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, methicillin-resistant Staphylococcus aureus, Salmonella species, as well as other enteric infections. RECENT FINDINGS Travelers from high income countries, visiting low and middle income countries, frequently acquire drug-resistant bacteria, particularly extended-spectrum β-lactamase-producing Enterobacteriaceae. The highest risk is associated with travel to the Indian subcontinent. Multidrug-resistant enteric infections in travelers from Salmonella spp., Campylobacter spp., and Shigella spp. are increasing. Refugees, pilgrimages, and medical tourists are associated with considerable risk of multiple forms of drug resistance. This review highlights the importance of antimicrobial stewardship, infection control, and surveillance; particularly in low and middle income countries. International leadership with global coordination is vital in the battle against antimicrobial resistance.
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Affiliation(s)
- Kevin L Schwartz
- Public Health Ontario, 480 University Ave, suite 300, Toronto, Ontario, M5G 1V2, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. .,St. Joseph's Health Centre, Toronto, Ontario, Canada.
| | - Shaun K Morris
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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18
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Okanda T, Haque A, Ehara T, Huda Q, Ohkusu K, Miah RA, Matsumoto T. Characteristics of Resistance Mechanisms and Molecular Epidemiology of Fluoroquinolone-Nonsusceptible Salmonella enterica Serovar Typhi and Paratyphi A Isolates from a Tertiary Hospital in Dhaka, Bangladesh. Microb Drug Resist 2018; 24:1460-1465. [PMID: 29894282 DOI: 10.1089/mdr.2018.0039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to characterize the fluoroquinolone (FQ) resistance mechanism of Salmonella enterica serovar Typhi and Paratyphi A in Bangladesh. Salmonella Typhi isolates were classified into sequence type (ST) 1, ST2, and ST2209 and Salmonella Paratyphi A isolates were classified into ST85 and ST129. The most common STs of the FQ-nonsusceptible strain were ST1 (44.4%) and ST129 (66.6%). Thirty-nine percent of Salmonella Typhi isolates were multidrug resistant, and these were all ST1, which is the type prevalent in the Indian subcontinent. Although plasmid-mediated quinolone resistance genes were not detected in any of the tested strains, single and double mutations were identified in the quinolone resistance-determining region (QRDR). The most common QRDR mutation was GyrA_Ser83Phe (66.7% for Salmonella Typhi and 100% for Salmonella Paratyphi A). Treatment with an efflux pump inhibitor resulted in susceptibility of the strains to levofloxacin. All isolates demonstrated 100% susceptibility to ceftriaxone, azithromycin, and carbapenem. Our results suggest that mutations in gyrase A and enhancement of efflux pump activity are responsible for the resistance to FQs; in particular, the AcrAB-TolC efflux pump may be an important resistance factor for levofloxacin. To control the spread of FQ-nonsusceptible Salmonella Typhi, intensive surveillance in endemic areas, including Bangladesh, and effective infection control are necessary.
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Affiliation(s)
- Takashi Okanda
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | - Anwarul Haque
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | - Tomoko Ehara
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | - Qumrul Huda
- Department of Anesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Kiyofumi Ohkusu
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | - Ruhul Amin Miah
- Department of Microbiology and Immunology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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19
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Cao TT, Deng GH, Fang LX, Yang RS, Sun J, Liu YH, Liao XP. Characterization of Quinolone Resistance in Salmonella enterica from Farm Animals in China. J Food Prot 2017; 80:1742-1748. [PMID: 28922026 DOI: 10.4315/0362-028x.jfp-17-068] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study was focused on the prevalence and antimicrobial susceptibilities of Salmonella directly isolated at animal clinics in Guangdong, People's Republic of China. The isolation rates from chickens, ducks, and pigs were 11.3% (11 of 97 samples), 15.4% (53 of 344 samples), and 3.0% (13 of 434 samples), respectively. Among the 77 Salmonella enterica isolates, the most predominant serovar was Typhimurium (81.8%, 63 isolates), followed by serovars Meleagridis (2.6%, 2 isolates) and Abaetetuba (1.3%, 1 isolate). Salmonella isolates were resistant to ciprofloxacin (16.9% of isolates) and nalidixic acid (66.2% of isolates), and 68 isolates (88.3%) were multidrug resistant, displaying resistance to three or more classes of antimicrobial agents. Eighteen isolates (23.4%) had at least one plasmid-mediated quinolone resistance gene, which was identified using PCR and DNA sequencing. The most prevalent plasmid-mediated quinolone resistance gene was aac(6')-Ib-cr, found in 14 isolates (18.2%), followed by oqxAB (9.1%) and qnrS (7.8%). Alterations in the gyrA gene were detected in 24 (57.1%) of 42 strains with a ciprofloxacin MIC of ≥0.25 μg/mL; the same level of susceptibility was found for enrofloxacin. Six types of mutations were found in the quinolone resistance determining regions of gyrA, and the predominant one (S83Y) was found singly in 15 (62.5%) of 24 isolates. We also found 22 different pulsed-field gel electrophoresis types among the Salmonella isolates. The Salmonella serovars and MICs of ciprofloxacin were similar within clusters, although individual differences were noted. This finding suggests that resistance plasmids were horizontally transmitted but also clonally spread.
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Affiliation(s)
- Ting-Ting Cao
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria and Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, South China Agricultural University, Guangzhou, 510642, People's Republic of China (ORCID: http://orcid.org/0000-0002-4654-5837 [X.-p.L.])
| | - Guo-Hui Deng
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria and Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, South China Agricultural University, Guangzhou, 510642, People's Republic of China (ORCID: http://orcid.org/0000-0002-4654-5837 [X.-p.L.])
| | - Liang-Xing Fang
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria and Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, South China Agricultural University, Guangzhou, 510642, People's Republic of China (ORCID: http://orcid.org/0000-0002-4654-5837 [X.-p.L.])
| | - Run-Shi Yang
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria and Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, South China Agricultural University, Guangzhou, 510642, People's Republic of China (ORCID: http://orcid.org/0000-0002-4654-5837 [X.-p.L.])
| | - Jian Sun
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria and Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, South China Agricultural University, Guangzhou, 510642, People's Republic of China (ORCID: http://orcid.org/0000-0002-4654-5837 [X.-p.L.])
| | - Ya-Hong Liu
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria and Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, South China Agricultural University, Guangzhou, 510642, People's Republic of China (ORCID: http://orcid.org/0000-0002-4654-5837 [X.-p.L.])
| | - Xiao-Ping Liao
- National Risk Assessment Laboratory for Antimicrobial Resistance of Animal Original Bacteria and Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, South China Agricultural University, Guangzhou, 510642, People's Republic of China (ORCID: http://orcid.org/0000-0002-4654-5837 [X.-p.L.])
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20
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Renaissance of Conventional First-Line Antibiotics in Salmonella enterica Clinical Isolates: Assessment of MICs for Therapeutic Antimicrobials in Enteric Fever Cases from Nepal. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2868143. [PMID: 29018810 PMCID: PMC5605800 DOI: 10.1155/2017/2868143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/02/2017] [Indexed: 11/18/2022]
Abstract
Enteric fever caused by Salmonella enterica is a life-threatening systemic illness of gastrointestinal tract especially in tropical countries. Antimicrobial therapy is generally indicated but resistance towards commonly used antibiotics has limited their therapeutic usefulness. Therefore, we aimed to determine the antimicrobial susceptibility pattern by minimum inhibitory concentration method of common therapeutic regimens against Salmonella enterica from enteric fever clinical cases. Salmonella enterica clinical isolates recovered from the patients with suspected enteric fever whose blood samples were submitted to microbiology laboratory of Manmohan Memorial Community Hospital, Kathmandu, from March 2016 to August 2016, were studied. These isolates were subjected to antimicrobial susceptibility testing against common therapeutic antimicrobials by Kirby-Bauer disk diffusion method. The minimum inhibitory concentration of ciprofloxacin, azithromycin, chloramphenicol, and cefixime was determined by Agar dilution method based on the latest CLSI protocol. A total of 88 isolates of Salmonella enterica were recovered from blood samples of enteric fever cases. Out of them, 74 (84.09%) were Salmonella Typhi and 14 (15.91%) were Salmonella Paratyphi A. On Kirby-Bauer disk diffusion antimicrobial susceptibility testing, entire isolates were susceptible to cotrimoxazole, cefixime, ceftriaxone, azithromycin, and chloramphenicol. Sixty-four (72.7%) Salmonella enterica isolates were nalidixic acid resistant and nonsusceptible to ciprofloxacin and levofloxacin. On MIC determination, four Salmonella isolates were ciprofloxacin resistant with MIC 1 µg/ml and two isolates were ciprofloxacin intermediate with MIC 0.5 µg/ml. The MIC range of azithromycin was from 0.125 µg/ml to 2.0 µg/ml, whereas that for chloramphenicol was 2.0 µg/ml–8.0 µg/ml and for cefixime was 0.0075–0.5 µg/ml, respectively. Despite global surge of antimicrobial resistance among Salmonella enterica clinical isolates, the level of drug resistance in our study was not so high. However, higher level of NARST strains limits therapeutic use of fluoroquinolones and necessitates the routine monitoring of such resistance determinants in order to effectively and rationally manage enteric fever cases.
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21
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Affiliation(s)
- Guy E Thwaites
- From the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (G.E.T., N.P.J.D.); Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (G.E.T.); and the Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (N.P.J.D.)
| | - Nicholas P J Day
- From the Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom (G.E.T., N.P.J.D.); Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (G.E.T.); and the Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (N.P.J.D.)
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22
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Bacterial plasmid-mediated quinolone resistance genes in aquatic environments in China. Sci Rep 2017; 7:40610. [PMID: 28094345 PMCID: PMC5240147 DOI: 10.1038/srep40610] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/07/2016] [Indexed: 02/07/2023] Open
Abstract
Emerging antimicrobial resistance is a major threat to human’s health in the 21st century. Understanding and combating this issue requires a full and unbiased assessment of the current status on the prevalence of antimicrobial resistance genes and their correlation with each other and bacterial groups. In aquatic environments that are known reservoirs for antimicrobial resistance genes, we were able to reach this goal on plasmid-mediated quinolone resistance (PMQR) genes that lead to resistance to quinolones and possibly also to the co-emergence of resistance to β-lactams. Novel findings were made that qepA and aac-(6′)-Ib genes that were previously regarded as similarly abundant with qnr genes are now dominant among PMQR genes in aquatic environments. Further statistical analysis suggested that the correlation between PMQR and β-lactam resistance genes in the environment is still weak, that the correlations between antimicrobial resistance genes could be weakened by sufficient wastewater treatment, and that the prevalence of PMQR has been implicated in environmental, pathogenic, predatory, anaerobic, and more importantly, human symbiotic bacteria. This work provides a comprehensive analysis of PMQR genes in aquatic environments in Jinan, China, and provides information with which combat with the antimicrobial resistance problem may be fought.
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Sharma P, Dahiya S, Balaji V, Kanga A, Panda P, Das R, Dhanraju A, Mendiratta DK, Sood S, Das BK, Kapil A. Typhoidal Salmonellae: Use of Multi-Locus Sequence Typing to Determine Population Structure. PLoS One 2016; 11:e0162530. [PMID: 27618626 PMCID: PMC5019401 DOI: 10.1371/journal.pone.0162530] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 08/24/2016] [Indexed: 01/26/2023] Open
Abstract
Enteric fever is an invasive infection predominantly caused by Salmonella enterica serovars Typhi and Paratyphi A. The pathogens have evolved from other nontyphoidal salmonellaeto become invasive and host restricted. Emergence of antimicrobial resistance in typhoidal salmonellae in some countries is a major therapeutic concern as the travelers returning from endemic countries carry resistant strains to non endemic areas. In order to understand the epidemiology and to design disease control strategies molecular typing of the pathogen is very important. We performed Multilocus Sequence Typing (MLST) of 251 S. Typhi and 18 S. Paratyphi strains isolated from enteric fever patients from seven centers across India during 2010-2013to determine the population structure and prevalence of MLST sequence types in India. MLST analysis revealed the presence of five sequence types (STs) of typhoidal salmonellae in India namely ST1, ST2 and ST3 for S. Typhi and ST85 and ST129 for S. Paratyphi A.S. Typhi strains showed monophyletic lineage and clustered in to 3 Sequence Types—ST1, ST2 and ST3 and S. Paratyphi A isolates segregated in two sequence types ST85 and ST129 respectively. No association was found between antimicrobial susceptibility and sequence types. This study found ST1 as the most prevalent sequence type of S. Typhi in India followed by ST2, which is in concordance with previous studies and MLST database. In addition a rare sequence type ST3 has been found which is reported for the first time from the Indian subcontinent. Amongst S. Paratyphi A, the most common sequence type is ST129 as also reported from other parts of world. This distribution and prevalence suggest the common spread of the sequence types across the globe and these findings can help in understanding the disease distribution.
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Affiliation(s)
| | - Sushila Dahiya
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Anil Kanga
- Indira Gandhi Medical College, Shimla, India
| | - Preetilata Panda
- Maharaja Krishna Chandra Gajapati Medical College, Orissa, India
| | - Rashna Das
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Anbumani Dhanraju
- Sri Ramachandra Medical College and Research Institute, Chennai, India
| | | | - Seema Sood
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Arti Kapil
- All India Institute of Medical Sciences, New Delhi, India
- * E-mail:
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Tian L, Zhu X, Chen Z, Liu W, Li S, Yu W, Zhang W, Xiang X, Sun Z. Characteristics of bacterial pathogens associated with acute diarrhea in children under 5 years of age: a hospital-based cross-sectional study. BMC Infect Dis 2016; 16:253. [PMID: 27267601 PMCID: PMC4897805 DOI: 10.1186/s12879-016-1603-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/27/2016] [Indexed: 11/24/2022] Open
Abstract
Background Acute diarrhea is a leading cause of morbidity and mortality in children, particularly in those under the age of 5 years. Rotavirus is recognized as the leading cause of acute diarrhea in children, however, the contribution of bacterial pathogens as causative agents varies throughout the world. Here we report a hospital-based prospective study to analyze the characteristics of bacterial pathogens associated with acute diarrhea in children under 5 years of age. Methods Stool samples were collected from 508 patients with acute diarrhea under 5 years of age who presented at our hospital. Nine pathogens were isolated and identified by culturing, serology or PCR, these included Salmonella spp., Shigella spp., Vibrio cholerae, diarrheagenic Escherichia coli (DEC), Aeromonas spp., Plesiomonas spp., Vibrio parahaemolyticus, Campylobacter spp. and Yersinia enterocolitica. Antimicrobial sensitivity tests of these pathogens were conducted. The most commonly detected pathogen, Salmonella spp., was further investigated by PCR and sequencing of antibiotic resistance-related genes. Results Pathogens were identified in 20.1 % of the 508 samples. The most commonly detected pathogens were Salmonella spp. (8.5 %), followed by DEC (4.7 %), Campylobacter jejuni (3.0 %) and Aeromonas spp. (2.0 %). The resistance rates to ampicillin and tetracycline in Salmonella spp. were >60 %, but were <30 % to cephalosporins and quinolones. More than 50 % of DEC strains displayed resistance to ampicillin, cefotaxime and tetracycline, and 60 % of C. jejuni strains were resistant to ciprofloxacin but highly sensitive to the other antibiotics. Among 12 cephalosporin-resistant Salmonella isolates, TEM-1 and CTX-M-14 determinants were present in two (16.7 %) isolates. PCR screening for plasmid-mediated quinolone resistance genes revealed gyrA mutations in one of three highly quinolone resistant isolates. Conclusions Salmonella spp., DEC, Campylobacter spp. and Aeromonas spp. were the most commonly detected bacterial pathogens in children under the age of 5 years with acute diarrhea. Our findings indicate that ampicillin and tetracycline are not suitable as first line therapeutic drugs against Salmonella spp. Resistance to third generation cephalosporins and quinolones was also detected. TEM-1 and CTX-M-14 genetic determinants, and gyrA mutations, were the major mechanisms associated with high levels of cephalosporin and quinolone resistance, respectively, in Salmonella isolates.
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Affiliation(s)
- Lei Tian
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuhui Zhu
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhongju Chen
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiyong Liu
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Song Li
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiting Yu
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenqian Zhang
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xu Xiang
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziyong Sun
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Qin TT, Kang HQ, Ma P, Li PP, Huang LY, Gu B. SOS response and its regulation on the fluoroquinolone resistance. ANNALS OF TRANSLATIONAL MEDICINE 2016; 3:358. [PMID: 26807413 DOI: 10.3978/j.issn.2305-5839.2015.12.09] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Bacteria can survive fluoroquinolone antibiotics (FQs) treatment by becoming resistant through a genetic change-mutation or gene acquisition. The SOS response is widespread among bacteria and exhibits considerable variation in its composition and regulation, which is repressed by LexA protein and derepressed by RecA protein. Here, we take a comprehensive review of the SOS gene network and its regulation on the fluoroquinolone resistance. As a unique survival mechanism, SOS may be an important factor influencing the outcome of antibiotic therapy in vivo.
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Affiliation(s)
- Ting-Ting Qin
- 1 Medical Technology Institute of Xuzhou Medical College, Xuzhou 221004, China ; 2 Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical College, Xuzhou 221006, China
| | - Hai-Quan Kang
- 1 Medical Technology Institute of Xuzhou Medical College, Xuzhou 221004, China ; 2 Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical College, Xuzhou 221006, China
| | - Ping Ma
- 1 Medical Technology Institute of Xuzhou Medical College, Xuzhou 221004, China ; 2 Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical College, Xuzhou 221006, China
| | - Peng-Peng Li
- 1 Medical Technology Institute of Xuzhou Medical College, Xuzhou 221004, China ; 2 Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical College, Xuzhou 221006, China
| | - Lin-Yan Huang
- 1 Medical Technology Institute of Xuzhou Medical College, Xuzhou 221004, China ; 2 Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical College, Xuzhou 221006, China
| | - Bing Gu
- 1 Medical Technology Institute of Xuzhou Medical College, Xuzhou 221004, China ; 2 Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical College, Xuzhou 221006, China
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Lin D, Chen K, Wai-Chi Chan E, Chen S. Increasing prevalence of ciprofloxacin-resistant food-borne Salmonella strains harboring multiple PMQR elements but not target gene mutations. Sci Rep 2015; 5:14754. [PMID: 26435519 PMCID: PMC4648336 DOI: 10.1038/srep14754] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/01/2015] [Indexed: 11/12/2022] Open
Abstract
Fluoroquinolone resistance in Salmonella has become increasingly prevalent in recent years. To probe the molecular basis of this phenomenon, the genetic and phenotypic features of fluoroquinolone resistant Salmonella strains isolated from food samples were characterized. Among the 82 Salmonella strains tested, resistance rate of the three front line antibiotics of ceftriaxone, ciprofloxacin and azithromycin was 10%, 39% and 25% respectively, which is significantly higher than that reported in other countries. Ciprofloxacin resistant strains typically exhibited cross-resistance to multiple antibiotics including ceftriaxone, primarily due to the presence of multiple PMQR genes and the blaCTX-M-65, blaCTX-M-55blaCMY-2 and blaCMY-72 elements. The prevalence rate of the oqxAB and aac(6’)-Ib-cr genes were 91% and 75% respectively, followed by qnrS (66%), qnrB (16%) and qnrD (3%). The most common PMQR combination observable was aac(6’)-Ib-cr-oqxAB-qnrS2, which accounted for 50% of the ciprofloxacin resistant strains. Interestingly, such isolates contained either no target mutations or only a single gyrA mutation. Conjugation and hybridization experiments suggested that most PMQR genes were located either in the chromosome or a non-transferrable plasmid. To summarize, findings in this work suggested that PMQRs greatly facilitate development of fluoroquinolone resistance in Salmonella by abolishing the requirement of target gene mutations.
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Affiliation(s)
- Dachuan Lin
- Food Safety and Technology Research Center, Hong Kong PolyU Shenzhen Research Institute, Shenzhen, P. R. China.,State Key Lab of Chirosciences, Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | - Kaichao Chen
- Food Safety and Technology Research Center, Hong Kong PolyU Shenzhen Research Institute, Shenzhen, P. R. China.,State Key Lab of Chirosciences, Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | - Edward Wai-Chi Chan
- Food Safety and Technology Research Center, Hong Kong PolyU Shenzhen Research Institute, Shenzhen, P. R. China.,State Key Lab of Chirosciences, Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | - Sheng Chen
- Food Safety and Technology Research Center, Hong Kong PolyU Shenzhen Research Institute, Shenzhen, P. R. China.,State Key Lab of Chirosciences, Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
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