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Mauritz MD, Claus B, Forster J, Petzold M, Schneitler S, Halfmann A, Hauswaldt S, Nurjadi D, Toepfner N. The EC-COMPASS: Long-term, multi-centre surveillance of Enterobacter cloacae complex - a clinical perspective. J Hosp Infect 2024; 148:11-19. [PMID: 38554809 DOI: 10.1016/j.jhin.2024.03.010] [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: 01/08/2024] [Revised: 03/02/2024] [Accepted: 03/13/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Enterobacter cloacae complex (ECCO) comprises closely related Enterobacterales, causing a variety of infections ranging from mild urinary tract infections to severe bloodstream infections. ECCO has emerged as a significant cause of healthcare-associated infections, particularly in neonatal and adult intensive care. AIM The Enterobacter Cloacae COMplex PASsive Surveillance (EC-COMPASS) aims to provide a detailed multi-centre overview of ECCO epidemiology and resistance patterns detected in routine microbiological diagnostics in four German tertiary-care hospitals. METHODS In a sentinel cluster of four German tertiary-care hospitals, all culture-positive ECCO results between 1st January 2020 and 31st December 2022, were analysed based on Hybase® laboratory data. FINDINGS Analysis of 31,193 ECCO datasets from 14,311 patients revealed a higher incidence in male patients (P<0.05), although no significant differences were observed in ECCO infection phenotypes. The most common sources of ECCO were swabs (42.7%), urine (17.5%), respiratory secretions (16.1%), blood cultures (8.9%) and tissue samples (5.6%). The annual bacteraemia rate remained steady at approximately 33 cases per hospital. Invasive ECCO infections were predominantly found in oncology and intensive care units. Incidences of nosocomial outbreaks were infrequent and limited in scope. Notably, resistance to carbapenems was consistently low. CONCLUSION EC-COMPASS offers a profound clinical perspective on ECCO infections in German tertiary-healthcare settings, highlighting elderly men in oncology and intensive care units as especially vulnerable to ECCO infections. Early detection strategies targeting at-risk patients could improve ECCO infection management.
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Affiliation(s)
- M D Mauritz
- Department of General Pediatrics and Adolescent Medicine, Children's and Adolescents' Hospital, Datteln, Germany; Department of Children's Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.
| | - B Claus
- Department of Children's Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany; PedScience Research Institute, Datteln, Germany
| | - J Forster
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - M Petzold
- Institute for Medical Microbiology and Virology, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
| | - S Schneitler
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - A Halfmann
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - S Hauswaldt
- Department of Infectious Diseases and Microbiology, University of Luebeck, Luebeck, Germany
| | - D Nurjadi
- Department of Infectious Diseases and Microbiology, University of Luebeck, Luebeck, Germany
| | - N Toepfner
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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2
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Klein Klouwenberg PMC, Altorf–van der Kuil W, van Griethuysen AJ, Hendriks M, Kuijper EJ, Notermans DW, Schoffelen AF. False aminoglycoside resistance in Enterobacterales and non-fermenters by an automated testing system: a descriptive study. Microbiol Spectr 2023; 11:e0309323. [PMID: 38194628 PMCID: PMC10790582 DOI: 10.1128/spectrum.03093-23] [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: 08/13/2023] [Accepted: 10/03/2023] [Indexed: 01/11/2024] Open
Abstract
IMPORTANCE Antimicrobial sensitivity data are important to guide antimicrobial therapy. In microbiological laboratories, routine sensitivity measurements are typically performed with automated testing systems such as VITEK2 and Phoenix. Using data from the Dutch national surveillance system for antimicrobial resistance over a 6-year period, we found that the measured minimum inhibitory concentrations for aminoglycosides in Enterobacterales and non-fermenters were too high for the Phoenix system. In addition, we observed a yearly increase in resistance for several species measured by Phoenix. These findings might have consequences for clinical treatment of patients with sepsis.
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Affiliation(s)
| | - W. Altorf–van der Kuil
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - M. Hendriks
- Department of Medical Microbiology, Gelderse Vallei Hospital, Ede, the Netherlands
| | - E. J. Kuijper
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - D. W. Notermans
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - A. F. Schoffelen
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - on behalf of the ISIS-AR study groupCohen StuartJ.W.T.1MellesD.C.2van DijkK.3AlzubaidyA.4ScholingM.5KuilS.D.6BlaauwG.J.7Altorf–van der KuilW.8BiermanS.M.8de GreeffS.C.8GroenendijkS.R.8HertroysR.8MarchalN.8MonenJ.C.M.8PolmanJ.8van den ReekW.J.8Schneeberger–van der LindenC.8SchoffelenA.F.8WieldersC.C.H.8de WitB.J.8ZoetigheidR.E.8van den BijllaardtW.9KraanE.M.10HaesekerM.B.11da SilvaJ.M.12de JongE.13MarahaB.14van GriethuysenA.J.15WintermansB.B.16van TrijpM.J.C.A.17MullerA.E.18WongM.19OttA.20BathoornE.21LokateM.21SinnigeJ.22MellesD.C.23RendersN.H.24Dorigo–ZetsmaJ.W.25BakkerL.J.25WaarK.26van der BeekM.T.27Leversteijn–van HallM.A.28van MensS.P.29SchaftenaarE.30Nabuurs–FranssenM.H.31MaatI.32SturmP.D.J.33DiederenB.M.W.34BodeL.G.M.35OngD.S.Y.36van RijnM.37PontesilliO.37DinantS.38van DamD.W.39de BrauwerE.I.G.B.39BentvelsenR.G.4041BuitingA.G.M.42VlekA.L.M.43de GraafM.44TroelstraA.45JanszA.R.46van MeerM.P.A.47de VriesJ.48MachielsJ.49Department of Medical Microbiology, Noordwest Ziekenhuisgroep, Alkmaar, the NetherlandsDepartment of Medical Microbiology, Meander Medical Center, Amersfoort, the NetherlandsDepartment of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity Institute, Amsterdam, the NetherlandsDepartment of Medical Microbiology, Atalmedial, Amsterdam, the NetherlandsDepartment of Medical Microbiology, OLVG Lab BV, Amsterdam, the NetherlandsPublic Health Service, Public Health Laboratory, Amsterdam, the NetherlandsDepartment of Medical Microbiology and Infection Prevention, Gelre Hospitals, Apeldoorn, the NetherlandsCentre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the NetherlandsMicrovida Amphia, Laboratory for Microbiology and Infection Control, Breda, the NetherlandsDepartment of Medical Microbiology, IJsselland Hospital, Capelle aan den IJssel, the NetherlandsDepartment of Medical Microbiology, Haeseker, Reinier de Graaf Group, Delft, the NetherlandsDepartment of Medical Microbiology, Deventer Hospital, Deventer, the NetherlandsDepartment of Medical Microbiology, Slingeland Hospital, Doetinchem, the NetherlandsDepartment of Medical Microbiology, Albert Schweitzer Hospital, Dordrecht, the NetherlandsDepartment of Medical Microbiology, Gelderse Vallei Hospital, Ede, the NetherlandsDepartment of Medical Microbiology, Admiraal De Ruyter Hospital, Goes, the NetherlandsDepartment of Medical Microbiology and Infection Prevention, Groene Hart Hospital, Gouda, the NetherlandsDepartment of Medical Microbiology, Haaglanden MC, 's-Gravenhage, the NetherlandsDepartment of Medical Microbiology, Haga Hospital, 's-Gravenhage, the NetherlandsCerte, Medical Microbiology Groningen|Drenthe, Groningen, the NetherlandsDepartment of Medical Microbiology, University of Groningen, University Medical Center, Groningen, the NetherlandsRegional Public Health Laboratory Haarlem, Haarlem, the NetherlandsDepartment of Medical Microbiology, St Jansdal Hospital, Harderwijk, the NetherlandsDepartment of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, the NetherlandsDepartment of Medical Microbiology, CBSL, Tergooi MC, Hilversum, the NetherlandsCerte, Medical Microbiology Friesland|NOP, Leeuwarden, the NetherlandsDepartment of Medical Microbiology, Leiden University Medical Center, Leiden, the NetherlandsDepartment of Medical Microbiology, Eurofins Clinical Diagnostics, Leiden-Leiderdorp, the NetherlandsDepartment of Medical Microbiology, Maastricht University Medical Centre, Maastricht, the NetherlandsDepartment of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein, the NetherlandsDepartment of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, the NetherlandsDepartment of Medical Microbiology, Radboud University Medical Center, Nijmegen, the NetherlandsLaurentius Hospital, Roermond, the NetherlandsDepartment of Medical Microbiology, Bravis Hospital, Roosendaal, the NetherlandsDepartment of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, the NetherlandsDepartment of Medical Microbiology and Infection Control, Franciscus Gasthuis and Vlietland, Rotterdam, the NetherlandsDepartment of Medical Microbiology, Ikazia Hospital, Rotterdam, the NetherlandsStar-SHL, Rotterdam, the NetherlandsDepartment of Medical Microbiology and Infection Control, Zuyderland Medical Centre, Sittard-Geleen, the NetherlandsDepartment of Medical Microbiology, Microvida ZorgSaam, Terneuzen, the NetherlandsDepartment of Medical Microbiology, Microvida ZorgSaam, Terneuzen, the NetherlandsDepartment of Medical Microbiology, St. Elisabeth Hospital, Tilburg, the NetherlandsDepartment of Medical Microbiology and Immunology, Diakonessenhuis, Utrecht, the NetherlandsDepartment of Medical Microbiology, Saltro Diagnostic Centre, Utrecht, the NetherlandsDepartment of Medical Microbiology, University Medical Center Utrecht, Utrecht, the NetherlandsDepartment of Medical Microbiology, Eurofins-PAMM, Veldhoven, the NetherlandsRijnstate Hospital, Laboratory for Medical Microbiology and Immunology, Velp, the NetherlandsDepartment of Medical Microbiology, VieCuri Medical Center, Venlo, the NetherlandsIsala Hospital, Laboratory of Medical Microbiology and Infectious Diseases, Zwolle, the Netherlands
- Department of pharmacy, Fundashon Mariadal, Kralendijk, Bonaire, the Netherlands
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Department of Medical Microbiology, Gelderse Vallei Hospital, Ede, the Netherlands
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Wang J, Dong X, Wang F, Jiang J, Zhao Y, Gu J, Xu J, Mao X, Tu B. Molecular Characteristics and Genetic Analysis of Extensively Drug-Resistant Isolates with different Tn3 Mobile Genetic Elements. Curr Microbiol 2023; 80:246. [PMID: 37335402 DOI: 10.1007/s00284-023-03340-x] [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: 02/23/2023] [Accepted: 05/22/2023] [Indexed: 06/21/2023]
Abstract
Extensively drug-resistant (XDR) bacteria are the main caues for causing clinical infectious diseases. Our aim was to distinguish the present molecular epidemiological situation of XDR Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli isolates recovered from local hospitals in Changzhou. Antibiotic susceptibility and phenotypic analysis, multilocus sequence typing and Pulsed Field Gel Electrophoresis were performed to trace these isolates. Resistant phenotype and gene analysis from 29 XDR strains demonstrated that they mainly included TEM, CTX-M-1/2, OXA-48, and KPC products. A. baumannii strains belonged to sequence type (ST) ST224, and carrying the blaCTX-M-2/TEM gene. The quinolone genes aac(6')-ib-cr and qnrB were carrying only in A. baumannii and E.coli. Three (2.3%) of these strains were found to contain the blaNDM-1 or blaNDM-5 gene. A new genotype of K. pneumoniae was found as ST2639. Epidemic characteristics of the XDR clones showed that antibiotic resistance genes distributed unevenly in different wards in Changzhou's local hospitals. With the sequencing of blaNDM carrying isolates, the plasmids often carrying a highly conservative Tn3-relavent mobile genetic element. The especially coupled insert sequence ISKox3 may be a distinctive resistance gene transfer loci. The genotypic diversity variation of XDRs suggested that tracking and isolating the sources of antibiotic resistance especially MBL-encoding genes such as blaNDM-will help manage the risk of infection by these XDRs.
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Affiliation(s)
- Jiazhen Wang
- School of Public Health, Xuzhou Medical University, Xuzhou, 221004, China
| | - Xin Dong
- Pathogenic Biological Laboratory, Changzhou Disease Control and Prevention Centre, Changzhou Medical Centre, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Fengming Wang
- School of Public Health, Xuzhou Medical University, Xuzhou, 221004, China
- Pathogenic Biological Laboratory, Changzhou Disease Control and Prevention Centre, Changzhou Medical Centre, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Jinyi Jiang
- Pathogenic Biological Laboratory, Changzhou Disease Control and Prevention Centre, Changzhou Medical Centre, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Ying Zhao
- Pathogenic Biological Laboratory, Changzhou Disease Control and Prevention Centre, Changzhou Medical Centre, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Jingyue Gu
- School of Public Health, Xuzhou Medical University, Xuzhou, 221004, China
| | - Jian Xu
- Pathogenic Biological Laboratory, Changzhou Disease Control and Prevention Centre, Changzhou Medical Centre, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Xujian Mao
- Pathogenic Biological Laboratory, Changzhou Disease Control and Prevention Centre, Changzhou Medical Centre, Nanjing Medical University, Changzhou, 213000, Jiangsu, China
| | - Bowen Tu
- School of Public Health, Xuzhou Medical University, Xuzhou, 221004, China.
- Pathogenic Biological Laboratory, Changzhou Disease Control and Prevention Centre, Changzhou Medical Centre, Nanjing Medical University, Changzhou, 213000, Jiangsu, China.
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Ranjan R, Iyer RN, Jangam RR, Arora N. Evaluation of in-vitro colistin susceptibility and clinical profile of carbapenem resistant Enterobacteriaceae related invasive infections. Indian J Med Microbiol 2023; 41:40-44. [PMID: 36870748 DOI: 10.1016/j.ijmmb.2022.12.008] [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: 07/03/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To determine the colistin susceptibility. To compare E-test vs broth-microdilution (BMD) method for invasive carbapenem resistant Enterobacteriaceae (CRE) infections. To study treatment options for the CRE. To analyze the clinical profile and outcome of CRE infections. METHODS Antimicrobial susceptibility testing was performed for 100 invasive CRE isolates. Gradient diffusion and BMD methods were performed to determine colistin MICs. Essential agreement (EA), categorical agreement (CA), very major error (VME), and major error (ME) were worked out between BMD method and E-test. The clinical profile of patients was analyzed. RESULTS The majority of the patients suffered from bacteremia [47(47%)]. Klebsiella pneumoniae was the most common organism isolated overall as well as among bacteremic isolates. 9(9%) CRE isolates were colistin resistant by BMD of which six were Klebsiella pneumoniae. There was 97% CA between E-test and BMD. EA was 68%. VME was found in three out of nine colistin resistant isolates. No ME was found. Among the other antibiotics tested for CRE isolates, the highest susceptibility was seen to tigecycline [43(43%)] followed by amikacin [19 (19%)]. The most common underlying condition was post solid organ transplantation [36(36%)]. A higher survival rate was seen among non-bacteremic CRE infections (58.49%) than bacteremic CRE infections (42.6%). Four out of nine patients with colistin resistant CRE infections survived and had a satisfactory outcome. CONCLUSION Klebsiella pneumoniae was the most common organism causing invasive infection. Survival rates were higher in non-bacteremic CRE infections than bacteremic infections. Good CA was seen between E-test and BMD for colistin susceptibility, but the EA was poor. VME was more common than ME when E-tests were used for colistin susceptibility testing resulting in false susceptibility. Tigecycline and aminoglycosides are possible adjunct drugs for the treatment of invasive CRE infections.
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Affiliation(s)
- Rahul Ranjan
- Global Hospital, Lakdi-ka Pool, Hyderabad, India.
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5
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Research Updates of Plasmid-Mediated Aminoglycoside Resistance 16S rRNA Methyltransferase. Antibiotics (Basel) 2022; 11:antibiotics11070906. [PMID: 35884160 PMCID: PMC9311965 DOI: 10.3390/antibiotics11070906] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 01/27/2023] Open
Abstract
With the wide spread of multidrug-resistant bacteria, a variety of aminoglycosides have been used in clinical practice as one of the effective options for antimicrobial combinations. However, in recent years, the emergence of high-level resistance against pan-aminoglycosides has worsened the status of antimicrobial resistance, so the production of 16S rRNA methyltransferase (16S-RMTase) should not be ignored as one of the most important resistance mechanisms. What is more, on account of transferable plasmids, the horizontal transfer of resistance genes between pathogens becomes easier and more widespread, which brings challenges to the treatment of infectious diseases and infection control of drug-resistant bacteria. In this review, we will make a presentation on the prevalence and genetic environment of 16S-RMTase encoding genes that lead to high-level resistance to aminoglycosides.
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Distribution of fluoroquinolone resistance determinants in Carbapenem-resistant Klebsiella pneumoniae clinical isolates associated with bloodstream infections in China. BMC Microbiol 2021; 21:164. [PMID: 34078263 PMCID: PMC8173869 DOI: 10.1186/s12866-021-02238-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/21/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The rate of fluoroquinolone (FQ) resistance among carbapenem-resistant Klebsiella pneumoniae (CRKP) is high. The present study aimed to investigate the distribution of fluoroquinolone resistance determinants in clinical CRKP isolates associated with bloodstream infections (BSIs). RESULTS A total of 149 BSI-associated clinical CRKP isolates collected from 11 Chinese teaching hospitals from 2015 to 2018 were investigated for the prevalence of fluoroquinolone resistance determinants, including plasmid-mediated quinolone resistance (PMQR) genes and spontaneous mutations in the quinolone resistance-determining regions (QRDRs) of the gyrA and parC genes. Among these 149 clinical CRKP isolates, 117 (78.5%) exhibited resistance to ciprofloxacin. The GyrA substitutions (Ser83 → IIe/Phe) and (Asp87 → Gly/Ala) were found among 112 (75.2%) of 149 isolates, while the substitution (Ser80 → IIe) of ParC was found in 111 (74.5%) of the 149 isolates. In total, 70.5% (105/149) of the CRKP isolates had at least two mutations within gyrA as well as a third mutation in parC. No mutations in the QRDRs were found in 31 ciprofloxacin susceptible CRKP isolates. Eighty-nine (56.9%) of 149 were found to carry PMQR genes including qnrS1 (43.0%), aac(6')-Ib-cr (16.1%), qnrB4 (6.0%), qnrB2 (2.7%), and qnrB1 (1.3%). Nine isolates contained two or more PMQR genes, with one carrying four [aac(6')-Ib-cr, qnr-S1, qnrB2, and qnrB4]. The co-existence rate of PMQR determinants and mutations in the QRDRs of gyrA and parC reached 68.5% (61/89). Seventy-four (83.1%, 74/89) PMQR-positive isolates harbored extended-spectrum beta-lactamase (ESBL)-encoding genes. Multilocus sequence typing (MLST) analysis demonstrated that the ST11 was the most prevalent STs in our study. CONCLUSIONS Mutations in the QRDRs of gyrA and parC were the key factors leading to the high prevalence of fluoroquinolone resistance among BSI-associated CRKP. The co-existence of PMQR genes and mutations in the QRDRs can increase the resistance level of CRKP to fluoroquinolones in clinical settings. ST11 CRKP isolates with identical QRDR substitution patterns were found throughout hospitals in China.
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Azargun R, Gholizadeh P, Sadeghi V, Hosainzadegan H, Tarhriz V, Memar MY, Pormohammad A, Eyvazi S. Molecular mechanisms associated with quinolone resistance in Enterobacteriaceae: review and update. Trans R Soc Trop Med Hyg 2021; 114:770-781. [PMID: 32609840 DOI: 10.1093/trstmh/traa041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/09/2020] [Accepted: 05/20/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Quinolones are broad-spectrum antibiotics, which are used for the treatment of different infectious diseases associated with Enterobacteriaceae. During recent decades, the wide use as well as overuse of quinolones against diverse infections has led to the emergence of quinolone-resistant bacterial strains. Herein, we present the development of quinolone antibiotics, their function and also the different quinolone resistance mechanisms in Enterobacteriaceae by reviewing recent literature. METHODS All data were extracted from Google Scholar search engine and PubMed site, using keywords; quinolone resistance, Enterobacteriaceae, plasmid-mediated quinolone resistance, etc. RESULTS AND CONCLUSION The acquisition of resistance to quinolones is a complex and multifactorial process. The main resistance mechanisms consist of one or a combination of target-site gene mutations altering the drug-binding affinity of target enzymes. Other mechanisms of quinolone resistance are overexpression of AcrAB-tolC multidrug-resistant efflux pumps and downexpression of porins as well as plasmid-encoded resistance proteins including Qnr protection proteins, aminoglycoside acetyltransferase (AAC(6')-Ib-cr) and plasmid-encoded active efflux pumps such as OqxAB and QepA. The elucidation of resistance mechanisms will help researchers to explore new drugs against the resistant strains.
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Affiliation(s)
- Robab Azargun
- Department of Microbiology, Faculty of Medicine, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Pourya Gholizadeh
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Sadeghi
- Faculty of Veterinary Medicine, Islamic Azad University, Urmia, Iran
| | - Hasan Hosainzadegan
- Department of Microbiology, Faculty of Medicine, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Vahideh Tarhriz
- Molecular Medicine Research Center, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Yousef Memar
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Pormohammad
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shirin Eyvazi
- Department of Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Wachino JI, Doi Y, Arakawa Y. Aminoglycoside Resistance: Updates with a Focus on Acquired 16S Ribosomal RNA Methyltransferases. Infect Dis Clin North Am 2020; 34:887-902. [PMID: 33011054 PMCID: PMC10927307 DOI: 10.1016/j.idc.2020.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The clinical usefulness of aminoglycosides has been revisited as an effective choice against β-lactam-resistant and fluoroquinolone-resistant gram-negative bacterial infections. Plazomicin, a next-generation aminoglycoside, was introduced for the treatment of complicated urinary tract infections and acute pyelonephritis. In contrast, bacteria have resisted aminoglycosides, including plazomicin, by producing 16S ribosomal RNA (rRNA) methyltransferases (MTases) that confer high-level and broad-range aminoglycoside resistance. Aminoglycoside-resistant 16S rRNA MTase-producing gram-negative pathogens are widespread in various settings and are becoming a grave concern. This article provides up-to-date information with a focus on aminoglycoside-resistant 16S rRNA MTases.
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Affiliation(s)
- Jun-Ichi Wachino
- Department of Bacteriology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan.
| | - Yohei Doi
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, S829 Scaife Hall, 3350 Terrace Street, Pittsburgh, PA 15261, USA; Department of Microbiology, Fujita Health University School of Medicine, Toyoake, Japan; Department of Infectious Diseases, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yoshichika Arakawa
- Department of Bacteriology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan; Department of Medical Technology, Shubun University, Japan
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9
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Gajdács M, Ábrók M, Lázár A, Jánvári L, Tóth Á, Terhes G, Burián K. Detection of VIM, NDM and OXA-48 producing carbapenem resistant Enterobacterales among clinical isolates in Southern Hungary. Acta Microbiol Immunol Hung 2020; 67:209-215. [PMID: 33258795 DOI: 10.1556/030.2020.01181] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 04/04/2020] [Indexed: 02/06/2023]
Abstract
Infections caused by carbapenem-resistant Enterobacterales (CRE) present an important therapeutic problem, as there are limited number of effective therapeutic alternatives available. In this study, phenotypic and genotypic methods were used to characterize carbapenemase-production and other resistance-determinants (AmpC and ESBL-production, efflux pump-overexpression) in 50 isolates (Klebsiella spp. n = 35, Escherichia coli n = 12 and Enterobacter cloacae complex n = 3) collected at the Albert Szent-Györgyi Clinical Center (University of Szeged) between 2014 and 2017. Minimum inhibitory concentrations of meropenem, sulfamethoxazole/trimethoprim, tigecycline, amikacin, moxifloxacin, colistin and fosfomycin were also determined. 24% of isolates were AmpC-producers, while 30% carried blaCTX-M ESBL-genes. Carbapenemase-genes were detected in 18 (36%) of the tested isolates: in 2 isolates blaNDM, in 6 isolates blaOXA-48-like and in 12 isolates, blaVIM was detected by PCR. The species-distribution for isolates positive for carbapenemase-genes was the following: Klebsiella pneumoniae n = 11, Klebsiella oxytoca n = 1, E. coli n = 5, E. cloacae complex n = 1. Efflux pump-overexpression based on the PAβN-screening agar was shown in n = 3 of the tested strains. In nine isolates (18%), carbapenemase and ESBL-genes were detected simultaneously. Highest levels of resistance were noted for fosfomycin (74%) and moxifloxacin (70%), while all isolates were susceptible to colistin. Among applied phenotypic tests in this study the modified carbapenem inactivation method (mCIM) proved to be the most accurate one compared to that of PCR results.
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Affiliation(s)
- Márió Gajdács
- 1Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Eötvös utca 6., 6720 Szeged, Hungary
| | - Marianna Ábrók
- 2Institute of Clinical Microbiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis utca 6., 6725 Szeged, Hungary
| | - Andrea Lázár
- 2Institute of Clinical Microbiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis utca 6., 6725 Szeged, Hungary
| | - Laura Jánvári
- 3Department of Bacteriology, Mycology and Parasitology, National Public Health Centre, Albert Flórián út 2-6., 1097 Budapest, Hungary
| | - Ákos Tóth
- 3Department of Bacteriology, Mycology and Parasitology, National Public Health Centre, Albert Flórián út 2-6., 1097 Budapest, Hungary
| | - Gabriella Terhes
- 3Department of Bacteriology, Mycology and Parasitology, National Public Health Centre, Albert Flórián út 2-6., 1097 Budapest, Hungary
| | - Katalin Burián
- 2Institute of Clinical Microbiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis utca 6., 6725 Szeged, Hungary
- 4Department of Medical Microbiology and Immunobiology, Faculty of Medicine, University of Szeged, Dóm tér 10., 6720 Szeged, Hungary
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10
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Yang Y, Xiao T, Li J, Cheng P, Li F, Yu H, Liu R, Muhammad I, Zhang X. Wild-type cutoff for Apramycin against Escherichia coli. BMC Vet Res 2020; 16:309. [PMID: 32847547 PMCID: PMC7448428 DOI: 10.1186/s12917-020-02522-0] [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: 03/30/2020] [Accepted: 08/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background Apramycin is used exclusively for the treatment of Escherichia coli (E.coli) infections in swine around the world since the early 1980s. Recently, many research papers have demonstrated that apramycin has significant in vitro activity against multidrug-resistant E.coli isolated in hospitals. Therefore, ensuring the proper use of apramycin in veterinary clinics is of great significance of public health. The objectives of this study were to develop a wild-type cutoff for apramycin against E.coli using a statistical method recommended by Clinical and Laboratory Standards Institute (CLSI) and to investigate the prevalence of resistance genes that confer resistance to apramycin in E. coli. Results Apramycin susceptibility testing of 1230 E.coli clinical isolates from swine were determinded by broth microdilution testing according to the CLSI document M07-A9. A total number of 310 E.coli strains from different minimum inhibitory concentration (MIC) subsets (0.5–256 μg/mL) were selected for the detection of resistance genes (aac(3)-IV; npmA; apmA) in E. coli by PCR. The percentage of E. coli isolates at each MIC (0.5, 1, 2, 4, 8, 16, 32, 64, 128, and 256 μg/mL) was 0.08, 0.08, 0.16, 2.93, 31.14, 38.86, 12.85, 2.03, 1.46, and 10.41%. The MIC50 and MIC90 were 16 and 64 μg/mL. All the 310 E.coli isolates were negative for npmA and apmA gene, and only the aac(3)-IV gene was detected in this study. Conclusions The wild-type cutoff for apramycin against E.coli was defined as 32 μg/mL. The prevelance of aac(3)-IV gene mainly concentrated in these MIC subsets ‘MIC ≥ 64 μg/ mL’, which indicates that the wild-type cutoff established in our study is reliable. The wild-type cutoff offers interpretion criteria of apramycin susceptibility testing of E.coli.
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Affiliation(s)
- Yuqi Yang
- Pharmacology Teaching and Research Department, School of Basic Medicine, Guizhou University of Traditional Chinese Medicine, Dongqing Road, University Town, Huaxi District, Guiyang, People's Republic of China
| | - Tianshi Xiao
- Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development. Faculty of Basic Veterinary Science, College of Veterinary Medicine, Northeast Agricultural University, 600 Changjiang Road, Xiangfang District, Harbin, Heilongjiang, 150030, People's Republic of China
| | - Jiarui Li
- Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development. Faculty of Basic Veterinary Science, College of Veterinary Medicine, Northeast Agricultural University, 600 Changjiang Road, Xiangfang District, Harbin, Heilongjiang, 150030, People's Republic of China
| | - Ping Cheng
- Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development. Faculty of Basic Veterinary Science, College of Veterinary Medicine, Northeast Agricultural University, 600 Changjiang Road, Xiangfang District, Harbin, Heilongjiang, 150030, People's Republic of China
| | - Fulei Li
- Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development. Faculty of Basic Veterinary Science, College of Veterinary Medicine, Northeast Agricultural University, 600 Changjiang Road, Xiangfang District, Harbin, Heilongjiang, 150030, People's Republic of China
| | - Hongxiao Yu
- Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development. Faculty of Basic Veterinary Science, College of Veterinary Medicine, Northeast Agricultural University, 600 Changjiang Road, Xiangfang District, Harbin, Heilongjiang, 150030, People's Republic of China
| | - Ruimeng Liu
- Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development. Faculty of Basic Veterinary Science, College of Veterinary Medicine, Northeast Agricultural University, 600 Changjiang Road, Xiangfang District, Harbin, Heilongjiang, 150030, People's Republic of China
| | - Ishfaq Muhammad
- Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development. Faculty of Basic Veterinary Science, College of Veterinary Medicine, Northeast Agricultural University, 600 Changjiang Road, Xiangfang District, Harbin, Heilongjiang, 150030, People's Republic of China
| | - Xiuying Zhang
- Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development. Faculty of Basic Veterinary Science, College of Veterinary Medicine, Northeast Agricultural University, 600 Changjiang Road, Xiangfang District, Harbin, Heilongjiang, 150030, People's Republic of China.
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11
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Hong JS, Kim D, Kang DY, Park BY, Yang S, Yoon EJ, Lee H, Jeong SH. Evaluation of the BD Phoenix M50 Automated Microbiology System for Antimicrobial Susceptibility Testing with Clinical Isolates in Korea. Microb Drug Resist 2019; 25:1142-1148. [DOI: 10.1089/mdr.2018.0370] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Jun Sung Hong
- Department of Laboratory Medicine, Research Institute of Bacterial Resistance, College of Medicine, Yonsei University, Seoul, Korea
| | - Dokyun Kim
- Department of Laboratory Medicine, Research Institute of Bacterial Resistance, College of Medicine, Yonsei University, Seoul, Korea
| | - Da Young Kang
- Department of Laboratory Medicine, Research Institute of Bacterial Resistance, College of Medicine, Yonsei University, Seoul, Korea
| | - Byeol Yi Park
- Department of Laboratory Medicine, Research Institute of Bacterial Resistance, College of Medicine, Yonsei University, Seoul, Korea
| | - SunMi Yang
- Division of Diagnostic Systems, BD Life Science, Seoul, Korea
| | - Eun-Jung Yoon
- Department of Laboratory Medicine, Research Institute of Bacterial Resistance, College of Medicine, Yonsei University, Seoul, Korea
| | - Hyukmin Lee
- Department of Laboratory Medicine, Research Institute of Bacterial Resistance, College of Medicine, Yonsei University, Seoul, Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine, Research Institute of Bacterial Resistance, College of Medicine, Yonsei University, Seoul, Korea
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12
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Abstract
While the description of resistance to quinolones is almost as old as these antimicrobial agents themselves, transferable mechanisms of quinolone resistance (TMQR) remained absent from the scenario for more than 36 years, appearing first as sporadic events and afterward as epidemics. In 1998, the first TMQR was soundly described, that is, QnrA. The presence of QnrA was almost anecdotal for years, but in the middle of the first decade of the 21st century, there was an explosion of TMQR descriptions, which definitively changed the epidemiology of quinolone resistance. Currently, 3 different clinically relevant mechanisms of quinolone resistance are encoded within mobile elements: (i) target protection, which is mediated by 7 different families of Qnr (QnrA, QnrB, QnrC, QnrD, QnrE, QnrS, and QnrVC), which overall account for more than 100 recognized alleles; (ii) antibiotic efflux, which is mediated by 2 main transferable efflux pumps (QepA and OqxAB), which together account for more than 30 alleles, and a series of other efflux pumps (e.g., QacBIII), which at present have been sporadically described; and (iii) antibiotic modification, which is mediated by the enzymes AAC(6')Ib-cr, from which different alleles have been claimed, as well as CrpP, a newly described phosphorylase.
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13
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Haffler ZJ, Kulengowski B, Ribes JA, Burgess DS. Evaluation of the BD Phoenix automated system for determining antimicrobial susceptibility against carbapenem-resistant Enterobacteriaceae compared with broth microdilution. Int J Antimicrob Agents 2019; 54:249-254. [DOI: 10.1016/j.ijantimicag.2019.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/30/2019] [Accepted: 05/01/2019] [Indexed: 01/28/2023]
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14
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Prosthetic Joint Infection from Carbapenemase-Resistant Klebsiella pneumoniae Successfully Treated with Ceftazidime-Avibactam. Case Rep Infect Dis 2018; 2018:1854805. [PMID: 30186645 PMCID: PMC6112089 DOI: 10.1155/2018/1854805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/03/2018] [Accepted: 06/19/2018] [Indexed: 11/18/2022] Open
Abstract
Antimicrobial resistance in Gram-negative bacteria, particularly Enterobacteriaceae, has become a leading cause of morbidity and mortality and a serious public health concern. Gram-negative bacteria carrying extended-spectrum beta-lactamase (ESBL) enzymes now represent a significant proportion of all bacteria isolated from different countries worldwide. Furthermore, the increasing number of isolates carrying carbapenemases in recent years includes multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) bacteria. Here, we describe what, to our knowledge, is the first case of a patient with a prosthetic joint infection from carbapenemase-resistant Klebsiella pneumoniae (CRKP) successfully treated with ceftazidime-avibactam in Italy.
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15
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Ishizaki Y, Shibuya Y, Hayashi C, Inoue K, Kirikae T, Tada T, Miyoshi-Akiyama T, Igarashi M. Instability of the 16S rRNA methyltransferase-encoding npmA gene: why have bacterial cells possessing npmA not spread despite their high and broad resistance to aminoglycosides? J Antibiot (Tokyo) 2018; 71:798-807. [PMID: 29884863 DOI: 10.1038/s41429-018-0070-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/05/2018] [Accepted: 04/26/2018] [Indexed: 11/09/2022]
Abstract
The NpmA bacterial 16S rRNA methyltransferase, which is identified from Escherichia coli strains, confers high resistance to many types of aminoglycoside upon its host cells. But despite its resistance-conferring ability, only two cases of its isolation from E. coli (14 years apart) have been reported to date. Here, we investigated the effect of the npmA gene on aminoglycoside resistance in Pseudomonas aeruginosa and Klebsiella pneumoniae and its stability in E. coli cells by comparing it with armA, another 16S rRNA methyltransferase gene currently spreading globally. As a result, we found that npmA conferred resistance to all types of aminoglycoside antibiotics we tested (except streptomycin) in both P. aeruginosa and K. pneumoniae, as well in E. coli. In addition, co-expression of armA and npmA resulted in an additive effect for the resistance. However, in return for the resistance, we also observed that the growth rates and the cell survivability of the strains transformed with the npmA-harboring plasmids were inferior than those of the control strains and that these plasmids were easily disrupted by IS10, IS1, and IS5 insertion sequences. We discuss these data in the context of the threat posed by pathogenic strains possessing npmA.
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Affiliation(s)
- Yoshimasa Ishizaki
- Laboratory of Microbiology, Institute of Microbial Chemistry, Tokyo, Japan.
| | - Yuko Shibuya
- Laboratory of Microbiology, Institute of Microbial Chemistry, Tokyo, Japan
| | - Chigusa Hayashi
- Laboratory of Microbiology, Institute of Microbial Chemistry, Tokyo, Japan
| | - Kunio Inoue
- Laboratory of Microbiology, Institute of Microbial Chemistry, Tokyo, Japan
| | - Teruo Kirikae
- Department of Microbiology, Juntendo University School of Medicine, Tokyo, Japan.,Department of Infectious Diseases, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tatsuya Tada
- Department of Microbiology, Juntendo University School of Medicine, Tokyo, Japan.,Department of Infectious Diseases, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tohru Miyoshi-Akiyama
- Pathogenic Microbe Laboratory, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masayuki Igarashi
- Laboratory of Microbiology, Institute of Microbial Chemistry, Tokyo, Japan
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