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Biedrzycka M, Izdebski R, Gniadkowski M, Żabicka D. Several epidemic and multiple sporadic genotypes of OXA-244-producing Escherichia coli in Poland; predominance of the ST38 clone. Eur J Clin Microbiol Infect Dis 2024:10.1007/s10096-024-04954-0. [PMID: 39373812 DOI: 10.1007/s10096-024-04954-0] [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: 08/07/2024] [Accepted: 09/24/2024] [Indexed: 10/08/2024]
Abstract
OXA-244-producing Escherichia coli (OXA-244-Ec) has disseminated in Europe, mostly in the community. In Poland it has spread since 2017, especially in 2023, but in contrast to other countries, all isolates have been identified in hospitals so far. The isolates (n = 101) represented one large and two limited outbreaks in different regions, and multiple epidemiologically and genetically non-related organisms. The OXA-244-Ec population consisted of 14 STs, with ST38 dominating. The ST38 isolates belonged to two major lineages, Clusters A and B, responsible for two of the hospital outbreaks. Enhanced concern and vigilance are necessary in the OXA-244-Ec surveillance.
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Affiliation(s)
- Marta Biedrzycka
- Department of Molecular Microbiology, National Medicines Institute, Chełmska 30/34, Warsaw, 00-725, Poland
| | - Radosław Izdebski
- Department of Molecular Microbiology, National Medicines Institute, Chełmska 30/34, Warsaw, 00-725, Poland
| | - Marek Gniadkowski
- Department of Molecular Microbiology, National Medicines Institute, Chełmska 30/34, Warsaw, 00-725, Poland
| | - Dorota Żabicka
- Department of Epidemiology and Clinical Microbiology, National Reference Centre for Susceptibility Testing, National Medicines Institute, Chełmska 30/34, Warsaw, 00-725, Poland.
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2
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Bonnin RA, Jeannot K, Henriksen AS, Quevedo J, Dortet L. In vitro activity of cefepime-enmetazobactam on carbapenem resistant Gram negatives. Clin Microbiol Infect 2024:S1198-743X(24)00478-6. [PMID: 39374655 DOI: 10.1016/j.cmi.2024.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 09/12/2024] [Accepted: 09/28/2024] [Indexed: 10/09/2024]
Abstract
OBJECTIVES Cefepime-enmetazobactam is a new β-lactam-β-lactamase inhibitor (BL/BLI) combination with broad-spectrum activity against multidrug-resistant Enterobacterales including ESBL producers. This study evaluated the in vitro activity of cefepime-enmetazobactam towards a collection of carbapenem-resistant Enterobacterales (CRE), Pseudomonas aeruginosa and Acinetobacter baumannii compared to the other BL/BLI combinations. METHODS MIC of cefepime, cefepime-enmetazobactam, ceftazidime, ceftazidime-avibactam, meropenem, meropenem-vaborbactam, imipenem, imipenem-relebactam and ertapenem were determined by broth microdilution on 2,212 CRE including 2,089 carbapenemase producers (1000 OXA-48-like, 49 KPC, 697 NDM, 180 VIM, 1 IMP, 9 IMI, 158 multiple carbapenemases) and 123 non-carbapenemase producers (CRE non-CPE) received at the French National Reference Center (1st March to 31th August 2023), 50 P. aeruginosa and 30 A. baumannii. All strains were fully sequenced. RESULTS We confirmed the absence of inhibitory activity of enmetazobactam towards metallo-β-lactamases. Cefepime-enmetazobactam and ceftazidime-avibactam exhibited a similar susceptibility (96.7% vs 99.5%, respectively) on OXA-48-producers. Cefepime-enmetazobactam exhibited 66.9% and 63.3% susceptibility for CRE non-EPC and KPC while those rates rose to 96.7%/95.9%, 93.4%/95.9%, 95.9%/98.0% for ceftazidime-avibactam, imipenem-relebactam and meropenem-vaborbactam, respectively. Low MICs (≤0.25 mg/L) were obtained for ceftazidime-avibactam resistant KPC variants. Cefepime-enmetazobactam did not display a significant added value compared to cefepime alone on P. aeruginosa and A. baumannii. CONCLUSION OXA-48 producers displayed high susceptibility to cefepime-enmetazobactam which is similar to ceftazidime-avibactam, including for OXA-48 producers that co-produce a ceftazidime hydrolyzing enzyme (ESBL or AmpC). In vivo experiments have to be implemented to confim if cefepime-enmetazobactam might be a relevant alternative to ceftazidime-avibactam for the treatment of infections caused by OXA-48 producers.
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Affiliation(s)
- Rémy A Bonnin
- Team "Resist" UMR1184 "Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France; Bacteriology-Hygiene Unit, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
| | - Katy Jeannot
- Bacteriology Unit, University hospital of Besançon, Besançon, France; Associated French National Reference Center for Antibiotic Resistance in Pseudomonas and Acinetobacter, Besançon, France
| | | | | | - Laurent Dortet
- Team "Resist" UMR1184 "Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France; Bacteriology-Hygiene Unit, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France.
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3
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Martin MJ, Luo TL, Kovalchuk V, Kondratiuk V, Dao HD, Kovalenko I, Plaza BJ, Kettlewell JM, Anderson CP, Smedberg JR, Ong AC, Kwak YI, Hawley-Molloy JS, Bennett JW, McGann PT, Lebreton F. Detection of cefiderocol and aztreonam/avibactam resistance in epidemic Escherichia coli ST-361 carrying blaNDM-5 and blaKPC-3 from foreign fighters evacuated from Ukraine. Antimicrob Agents Chemother 2024:e0109024. [PMID: 39302119 DOI: 10.1128/aac.01090-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 09/07/2024] [Indexed: 09/22/2024] Open
Abstract
Genomic surveillance detected clonal Escherichia coli sequence type-361 isolates carrying blaNDM-5, blaKPC-3, blaCTX-M-15, and rmtB1 from a patient in Ukraine and four wounded foreign soldiers evacuated to Germany. Isolates were non-susceptible to carbapenems, aminoglycosides, and cefiderocol and aztreonam/avibactam due to a PBP3 YRIN insertion and the blaCMY-145 AmpC β-lactamase. Coordinated surveillance efforts across civilian, military, and veteran healthcare systems are essential to prevent further spread as international volunteers return home after medical evacuation from Ukraine.
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Affiliation(s)
- Melissa J Martin
- Multidrug-Resistant Organism Repository and Surveillance Network (MRSN), Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Ting L Luo
- Multidrug-Resistant Organism Repository and Surveillance Network (MRSN), Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Valentyn Kovalchuk
- Department of Microbiology, National Pirogov Memorial Medical University, Vinnytsia, Ukraine
| | - Viacheslav Kondratiuk
- Department of Emergency and Military Medicine, National Pirogov Memorial Medical University, Vinnytsia, Ukraine
| | - Henry D Dao
- Multidrug-Resistant Organism Repository and Surveillance Network (MRSN), Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
- Department of Pathology, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Iryna Kovalenko
- Department of Microbiology, National Pirogov Memorial Medical University, Vinnytsia, Ukraine
| | - Brandon J Plaza
- Department of Pathology, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Joanna M Kettlewell
- Department of Pathology, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Cole P Anderson
- Department of Pathology, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Jason R Smedberg
- Department of Pathology, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Ana C Ong
- Multidrug-Resistant Organism Repository and Surveillance Network (MRSN), Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Yoon I Kwak
- Multidrug-Resistant Organism Repository and Surveillance Network (MRSN), Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | | | - Jason W Bennett
- Multidrug-Resistant Organism Repository and Surveillance Network (MRSN), Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Patrick T McGann
- Multidrug-Resistant Organism Repository and Surveillance Network (MRSN), Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Francois Lebreton
- Multidrug-Resistant Organism Repository and Surveillance Network (MRSN), Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
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Jaidane N, Vanparis O, Mansour W, Volland H, Oueslati S, Naas T. Evaluation of a novel lateral flow immunochromatographic assay for the rapid detection of KPC, NDM, IMP, VIM and OXA-48 carbapenemases in Gram-negatives. J Antimicrob Chemother 2024; 79:2396-2399. [PMID: 39001779 DOI: 10.1093/jac/dkae239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2024] Open
Affiliation(s)
- Nadia Jaidane
- Laboratoire de Biophysique métabolique et Pharmacologie Appliquée (LR12ES02), Faculté de Médecine Ibn Al Jazzar Sousse, Sousse, Tunisia
| | - Océane Vanparis
- Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
- Team Resist, INSERM UMR 1184, Faculty of Medicine, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Wejdene Mansour
- Laboratoire de Biophysique métabolique et Pharmacologie Appliquée (LR12ES02), Faculté de Médecine Ibn Al Jazzar Sousse, Sousse, Tunisia
| | - Hervé Volland
- Service de Pharmacologie et Immunoanalyse, Médicaments et Technologies pour la Santé (MTS), CEA, INRA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Saoussen Oueslati
- Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
- Team Resist, INSERM UMR 1184, Faculty of Medicine, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Thierry Naas
- Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
- Team Resist, INSERM UMR 1184, Faculty of Medicine, Paris-Saclay University, Le Kremlin-Bicêtre, France
- French National Reference Center for Carbapenem-resistant Enterobacterales, Le Kremlin-Bicêtre, France
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5
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Gonzalez C, Oueslati S, Rima M, Nermont R, Dortet L, Hopkins KL, Iorga BI, Bonnin RA, Naas T. Molecular, Genetic, and Biochemical Characterization of OXA-484 Carbapenemase, a Difficult-to-Detect R214G Variant of OXA-181. Microorganisms 2024; 12:1391. [PMID: 39065158 PMCID: PMC11278660 DOI: 10.3390/microorganisms12071391] [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: 06/07/2024] [Revised: 07/04/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
OXA-244, an R214G variant of OXA-48, is silently spreading worldwide likely because of difficulties in detection using classical screening media. Here, we characterized two clinical isolates of Escherichia coli and Citrobacter youngae that displayed reduced susceptibility to carbapenems but were lacking significant carbapenemase activity as revealed by negative Carba NP test results. However, positive test results were seen for OXA-48-like enzymes by lateral flow immunoassays. WGS revealed the presence of a blaOXA-181-like gene that codes for OXA-484, an R214G variant of OXA-181. BlaOXA-484 gene was located on a 58.4-kb IncP1-like plasmid (pN-OXA-484), that upon transfer into E. coli HB4 with impaired permeability, conferred carbapenem and temocillin resistance (MICs > 32 mg/L). E. coli TOP10 (pTOPO-OXA-484) revealed reduced MICs in most substrates as compared to E. coli TOP10 (pTOPO-OXA-181), especially for imipenem (0.25 mg/L versus 0.75 mg/L) and temocillin (16 mg/L versus 1028 mg/L). Catalytic efficiencies of OXA-484 were reduced as compared to OXA-181 for most ß-lactams including imipenem and temocillin with 27.5- and 21.7-fold reduction, respectively. Molecular modeling confirmed that the salt bridges between R214, D159, and the R1 substituent's carboxylate group of temocillin were not possible with G214 in OXA-484, explaining the reduced affinity for temocillin. In addition, changes in active site's water network may explain the decrease in hydrolysis rate of carbapenems. OXA-484 has weak imipenem and temocillin hydrolytic activities, which may lead to silent spread due to underdetection using selective screening media or biochemical imipenem hydrolysis confirmatory tests.
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Affiliation(s)
- Camille Gonzalez
- Team “Resist” UMR1184 “Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB)”, Faculty of Medicine, University Paris-Saclay, INSERM, CEA, 94270 Le Kremlin-Bicêtre, France; (C.G.); (S.O.); (M.R.); (R.N.); (L.D.); (R.A.B.)
- Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France
| | - Saoussen Oueslati
- Team “Resist” UMR1184 “Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB)”, Faculty of Medicine, University Paris-Saclay, INSERM, CEA, 94270 Le Kremlin-Bicêtre, France; (C.G.); (S.O.); (M.R.); (R.N.); (L.D.); (R.A.B.)
- Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France
| | - Mariam Rima
- Team “Resist” UMR1184 “Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB)”, Faculty of Medicine, University Paris-Saclay, INSERM, CEA, 94270 Le Kremlin-Bicêtre, France; (C.G.); (S.O.); (M.R.); (R.N.); (L.D.); (R.A.B.)
| | - Réva Nermont
- Team “Resist” UMR1184 “Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB)”, Faculty of Medicine, University Paris-Saclay, INSERM, CEA, 94270 Le Kremlin-Bicêtre, France; (C.G.); (S.O.); (M.R.); (R.N.); (L.D.); (R.A.B.)
| | - Laurent Dortet
- Team “Resist” UMR1184 “Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB)”, Faculty of Medicine, University Paris-Saclay, INSERM, CEA, 94270 Le Kremlin-Bicêtre, France; (C.G.); (S.O.); (M.R.); (R.N.); (L.D.); (R.A.B.)
- Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France
- French National Reference Center for Antibiotic Resistance, Carbapenemase-Producing Enterobacteriaceae, 94270 Le Kremlin-Bicêtre, France
| | - Katie L. Hopkins
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, HCAI, Fungal, AMR, AMU and Sepsis Division, UK Health Security Agency, London NW9 5EQ, UK;
| | - Bogdan I. Iorga
- Institut de Chimie des Substances Naturelles, Université Paris-Saclay, CNRS, 91190 Gif-sur-Yvette, France;
| | - Rémy A. Bonnin
- Team “Resist” UMR1184 “Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB)”, Faculty of Medicine, University Paris-Saclay, INSERM, CEA, 94270 Le Kremlin-Bicêtre, France; (C.G.); (S.O.); (M.R.); (R.N.); (L.D.); (R.A.B.)
- Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France
- French National Reference Center for Antibiotic Resistance, Carbapenemase-Producing Enterobacteriaceae, 94270 Le Kremlin-Bicêtre, France
| | - Thierry Naas
- Team “Resist” UMR1184 “Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB)”, Faculty of Medicine, University Paris-Saclay, INSERM, CEA, 94270 Le Kremlin-Bicêtre, France; (C.G.); (S.O.); (M.R.); (R.N.); (L.D.); (R.A.B.)
- Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, 94270 Le Kremlin-Bicêtre, France
- French National Reference Center for Antibiotic Resistance, Carbapenemase-Producing Enterobacteriaceae, 94270 Le Kremlin-Bicêtre, France
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Lerminiaux N, Mitchell R, Katz K, Fakharuddin K, McGill E, Mataseje L. Plasmid genomic epidemiology of carbapenem-hydrolysing class D β-lactamase (CDHL)-producing Enterobacterales in Canada, 2010-2021. Microb Genom 2024; 10:001257. [PMID: 38896471 PMCID: PMC11261825 DOI: 10.1099/mgen.0.001257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
Carbapenems are last-resort antibiotics for treatment of infections caused by multidrug-resistant Enterobacterales, but carbapenem resistance is a rising global threat due to the acquisition of carbapenemase genes. Oxacillinase-48 (bla OXA-48)-type carbapenemases are increasing in abundance in Canada and elsewhere; these genes are frequently found on mobile genetic elements and are associated with specific transposons. This means that alongside clonal dissemination, bla OXA-48-type genes can spread through plasmid-mediated horizontal gene transfer. We applied whole genome sequencing to characterize 249 bla OXA-48-type-producing Enterobacterales isolates collected by the Canadian Nosocomial Infection Surveillance Program from 2010 to 2021. Using a combination of short- and long-read sequencing, we obtained 70 complete and circular bla OXA-48-type-encoding plasmids. Using MOB-suite, four major plasmids clustered were identified, and we further estimated a plasmid cluster for 91.9 % (147/160) of incomplete bla OXA-48-type-encoding contigs. We identified different patterns of carbapenemase mobilization across Canada, including horizontal transmission of bla OXA-181/IncX3 plasmids (75/249, 30.1 %) and bla OXA-48/IncL/M plasmids (47/249, 18.9 %), and both horizontal transmission and clonal transmission of bla OXA-232 for Klebsiella pneumoniae ST231 on ColE2-type/ColKP3 plasmids (25/249, 10.0 %). Our findings highlight the diversity of OXA-48-type plasmids and indicate that multiple plasmid clusters and clonal transmission have contributed to bla OXA-48-type spread and persistence in Canada.
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Affiliation(s)
- Nicole Lerminiaux
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | | | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
| | - Ken Fakharuddin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Erin McGill
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Laura Mataseje
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
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7
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Zongo PD, Cabanel N, Royer G, Depardieu F, Hartmann A, Naas T, Glaser P, Rosinski-Chupin I. An antiplasmid system drives antibiotic resistance gene integration in carbapenemase-producing Escherichia coli lineages. Nat Commun 2024; 15:4093. [PMID: 38750030 PMCID: PMC11096173 DOI: 10.1038/s41467-024-48219-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/24/2024] [Indexed: 05/18/2024] Open
Abstract
Plasmids carrying antibiotic resistance genes (ARG) are the main mechanism of resistance dissemination in Enterobacterales. However, the fitness-resistance trade-off may result in their elimination. Chromosomal integration of ARGs preserves resistance advantage while relieving the selective pressure for keeping costly plasmids. In some bacterial lineages, such as carbapenemase producing sequence type ST38 Escherichia coli, most ARGs are chromosomally integrated. Here we reproduce by experimental evolution the mobilisation of the carbapenemase blaOXA-48 gene from the pOXA-48 plasmid into the chromosome. We demonstrate that this integration depends on a plasmid-induced fitness cost, a mobile genetic structure embedding the ARG and a novel antiplasmid system ApsAB actively involved in pOXA-48 destabilization. We show that ApsAB targets high and low-copy number plasmids. ApsAB combines a nuclease/helicase protein and a novel type of Argonaute-like protein. It belongs to a family of defense systems broadly distributed among bacteria, which might have a strong ecological impact on plasmid diffusion.
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Affiliation(s)
- Pengdbamba Dieudonné Zongo
- Ecology and Evolution of Antibiotic Resistance Unit, Institut Pasteur, Paris, France
- Sorbonne Université, Paris, France
- Université Paris Cité, Paris, France
| | - Nicolas Cabanel
- Ecology and Evolution of Antibiotic Resistance Unit, Institut Pasteur, Paris, France
- Université Paris Cité, Paris, France
| | - Guilhem Royer
- Ecology and Evolution of Antibiotic Resistance Unit, Institut Pasteur, Paris, France
- Université Paris Cité, Paris, France
| | - Florence Depardieu
- Université Paris Cité, Paris, France
- Synthetic Biology Unit, Institut Pasteur, Paris, France
| | - Alain Hartmann
- UMR AgroEcologie 1347, INRAe, Université Bourgogne Franche-Comté, Dijon, France
| | - Thierry Naas
- Team ReSIST, INSERM UMR 1184, Paris-Saclay University, Le Kremlin-Bicêtre, France
- Department of Bacteriology-Hygiene, Bicêtre Hospital, APHP, Le Kremlin-Bicêtre, France
- Associated French National Reference Center for Antibiotic Resistance, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Philippe Glaser
- Ecology and Evolution of Antibiotic Resistance Unit, Institut Pasteur, Paris, France
- Université Paris Cité, Paris, France
| | - Isabelle Rosinski-Chupin
- Ecology and Evolution of Antibiotic Resistance Unit, Institut Pasteur, Paris, France.
- Université Paris Cité, Paris, France.
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8
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Duque M, Bonnin RA, Dortet L. Comparison of the French novel disc diffusion-based algorithm and the current EUCAST guidelines for the screening of carbapenemase-producing Enterobacterales. J Antimicrob Chemother 2024; 79:1194-1196. [PMID: 38412338 DOI: 10.1093/jac/dkae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Affiliation(s)
- Mathilde Duque
- Team Resist UMR1184 Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB), INSERM, Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Rémy A Bonnin
- Team Resist UMR1184 Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB), INSERM, Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriales, Le Kremlin-Bicêtre, France
| | - Laurent Dortet
- Team Resist UMR1184 Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB), INSERM, Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriales, Le Kremlin-Bicêtre, France
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9
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Izdebski R, Biedrzycka M, Urbanowicz P, Żabicka D, Błauciak T, Lechowicz D, Gałecka-Ziółkowska B, Gniadkowski M. Large hospital outbreak caused by OXA-244-producing Escherichia coli sequence type 38, Poland, 2023. Euro Surveill 2024; 29:2300666. [PMID: 38818748 PMCID: PMC11141128 DOI: 10.2807/1560-7917.es.2024.29.22.2300666] [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: 11/23/2023] [Accepted: 04/04/2024] [Indexed: 06/01/2024] Open
Abstract
In February 2023, Escherichia coli sequence type (ST) 38 producing oxacillinase 244 (OXA-244-Ec ST38) was detected from three patients in a hospital in western Poland. Overall, OXA-244-Ec ST38 was detected from 38 colonised patients in 13 wards between February and June 2023. The outbreak was investigated on site by an infection control team, and the bacterial isolates were characterised microbiologically and by whole genome sequencing. We could not identify the primary source of the outbreak or reconstruct the transmission sequence. In some of the 13 affected wards or their groups linked by the patients' movement, local outbreaks occurred. The tested outbreak isolates were resistant to β-lactams (penicillins, cephalosporins, aztreonam and ertapenem) and to trimethoprim-sulfamethoxazole. Consistently, apart from bla OXA-244, all isolates contained also the bla CMY-2 and bla CTX-M-14 genes, coding for an AmpC-like cephalosporinase and extended-spectrum β-lactamase, respectively, and genes conferring resistance to trimethoprim-sulfamethoxazole, sul2 and dfrA1. Genomes of the isolates formed a tight cluster, not of the major recent European Cluster A but of the older Cluster B, with related isolates identified in Germany. This outbreak clearly demonstrates that OXA-244-Ec ST38 has a potential to cause hospital outbreaks which are difficult to detect, investigate and control.
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Affiliation(s)
- Radosław Izdebski
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - Marta Biedrzycka
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - Paweł Urbanowicz
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - Dorota Żabicka
- National Reference Centre for Susceptibility Testing, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Teresa Błauciak
- Bacteriological and Serological Laboratory, Multispecialist Hospital, Nowa Sól, Poland
| | - Dorota Lechowicz
- Hospital Infection Control and Prevention Team, Multispecialist Hospital, Nowa Sól, Poland
| | | | - Marek Gniadkowski
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
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10
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Duque M, Bonnin RA, Dortet L. Evaluation of the French novel disc diffusion-based algorithm for the phenotypic screening of carbapenemase-producing Enterobacterales. Clin Microbiol Infect 2024; 30:397.e1-397.e4. [PMID: 38065362 DOI: 10.1016/j.cmi.2023.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/07/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES The early identification of carbapenemase-producing Enterobacterales (CPE) is required to prevent their spread and initiate proper therapy. Accordingly, it is crucial to develop efficient algorithms using susceptibility testing results to discriminate non-carbapenemase producers (non-CPE) from those that require complementary tests. In 2022, to adapt its recommendations to the evolution of CPE epidemiology (increased prevalence of OXA-244 producers), the Antibiogram Committee of the French Society of Microbiology (CA-SFM) proposed a new algorithm for the screening of CPE. We compared this algorithm to the former algorithm (2015-2021). METHODS From July 2022 to January 2023, all nonduplicate enterobacterial isolates referred to French National Reference Centre for carbapenemase detection (n = 518) were subjected to the former CA-SFM algorithm (2015 to 2021) using inhibition diameters of ertapenem, ticarcillin-clavulanate, temocillin and meropenem or imipenem, and the novel CA-SFM algorithm (since 2022) using inhibition diameters of ceftazidime-avibactam, temocillin, and meropenem or imipenem. RESULTS Sensitivity, specificity, negative predictive value, and positive predictive value were of 80.8% (CI95 76.3%-84.6%), 66.2% (58.1%-73.5%), 59.3% (51.5%-66.6%), and 85.0% (80.7% - 88.5%) for the old CA-SFM algorithm and 97.8% (95.5%-99.0%), 45.5% (37.5%-53.7%), 89.7% (80.3%-95.2%), and 80.9% (76.9%-84.4%) for the novel CA-SFM algorithm. DISCUSSION The novel CA-SFM algorithm possesses the best performance for the screening of CPE particularly in countries with a high prevalence of OXA-48-like producers.
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Affiliation(s)
- Mathilde Duque
- Team Resist UMR1184 Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB), INSERM, Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France; Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Rémy A Bonnin
- Team Resist UMR1184 Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB), INSERM, Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriales, Le Kremlin-Bicêtre, France; Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Laurent Dortet
- Team Resist UMR1184 Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB), INSERM, Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriales, Le Kremlin-Bicêtre, France; Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
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11
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Reichert F, Brinkwirth S, Pfennigwerth N, Haller S, Fritsch LS, Eckmanns T, Werner G, Gatermann S, Hans JB. Prolonged carriage of OXA-244-carbapenemase-producing Escherichia coli complicates epidemiological investigations. Int J Med Microbiol 2024; 314:151595. [PMID: 38159514 DOI: 10.1016/j.ijmm.2023.151595] [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: 10/20/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
The rapid increase of OXA-244-producing Escherichia coli, predominantly driven by genetically clustered isolates of sequence type (ST)38, has been observed in at least nine European countries, including Germany. However, the reasons for the spread of OXA-244-producing E. coli remain unclear. Here, we aim to evaluate the possibility of prolonged carriage. We identified a total of six different patients with repeated detection of OXA-244-producing E. coli isolates, which were subjected to both short and long-read whole-genome sequencing (WGS). Besides allelic differences using core genome multilocus sequence typing (cgMLST) analyses, we obtained numbers of single-nucleotide polymorphisms (SNPs) to calculate individual base-pair substitution (BPS) rates. To assess possible re-exposure and risk factors for prolonged carriage, case interviews were conducted. The time between detections ranged from eleven months to more than three years. Initial isolates originated in three+ out of six cases from clinical samples, whereas remaining samples were from screening, mostly in the inpatient setting. As expected, cgMLST analyses showed low numbers of allelic differences between isolates of each case ranging from 1 to 4, whereas numbers of SNPs were between 2 and 99 (mean = 36), thus clearly highlighting the discrepancy between these different bacterial typing approaches. For five out of six cases, observed BPS rates suggest that patients can be colonized with OXA-244-producing E. coli, including ST38 cluster isolates, for extensively long times. Thus, we may have previously missed the epidemiological link between cases because exposure to OXA-244-producing E. coli could have occurred in a time frame, which has not been evaluated in previous investigations. Our results may help to guide future epidemiological investigations as well as to support the interpretation of genetic diversity of OXA-244-producing E. coli, particularly among ST38 cluster isolates.
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Affiliation(s)
- Felix Reichert
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Unit 37: Healthcare-Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Berlin, Germany
| | - Simon Brinkwirth
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Unit 37: Healthcare-Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Berlin, Germany; Postgraduate Training for Applied Epidemiology (PAE), Robert Koch-Institute, Berlin, Germany; ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Niels Pfennigwerth
- National Reference Centre for multidrug-resistant Gram-negative bacteria, Department of Medical Microbiology, Ruhr-University Bochum, Bochum, Germany
| | - Sebastian Haller
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Unit 37: Healthcare-Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Berlin, Germany
| | - Lena Sophie Fritsch
- National Reference Centre for multidrug-resistant Gram-negative bacteria, Department of Medical Microbiology, Ruhr-University Bochum, Bochum, Germany
| | - Tim Eckmanns
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Unit 37: Healthcare-Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Berlin, Germany
| | - Guido Werner
- Robert Koch Institute, Division of Nosocomial Pathogens and Antibiotic Resistances, Wernigerode Branch, Germany
| | - Sören Gatermann
- National Reference Centre for multidrug-resistant Gram-negative bacteria, Department of Medical Microbiology, Ruhr-University Bochum, Bochum, Germany
| | - Jörg B Hans
- National Reference Centre for multidrug-resistant Gram-negative bacteria, Department of Medical Microbiology, Ruhr-University Bochum, Bochum, Germany.
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12
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Grevskott DH, Radisic V, Salvà-Serra F, Moore ERB, Akervold KS, Victor MP, Marathe NP. Emergence and dissemination of epidemic-causing OXA-244 carbapenemase-producing Escherichia coli ST38 through hospital sewage in Norway, 2020-2022. J Hosp Infect 2024; 145:165-173. [PMID: 38286237 DOI: 10.1016/j.jhin.2023.12.020] [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: 08/29/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Population-based sewage surveillance has emerged as a promising approach for studying the prevalence of antibiotic resistance in pathogens. AIM To determine the temporal prevalence of cefotaxime-resistant Escherichia coli in sewage from five sewage treatment plants located in Bergen city, to determine whether ESBL- and carbapenemase-producing E. coli are consistently disseminated in the receiving environment through sewage. METHOD A total of 569 cefotaxime-resistant E. coli were isolated over a period of 19 months (August 2020 to February 2022) using ECC CHROMagar™ plates from 82 samples, antibiotic sensitivity profiles were determined, using Sensititre™ plates. The draft genome sequences were determined, using Illumina MiSeq-based sequencing. Complete genome sequences were determined, using Oxford Nanopore-based sequencing. FINDINGS All 569 strains obtained from influent (N=461) and effluent (N=108) were multi-drug resistant. Most of the sequenced strains (52 of 61) carried blaCTX-M-15 (38.5%) and blaCTX-M-27 (34.6%). The most prevalent sequence types (STs) for ESBL-carrying strains were ST131 (32.8%) and ST38 (21.3%). All CTX-M-27-carrying ST131 strains belonged to clade A or C1, while CTX-M-15-harbouring strains were present in all the clades. Five OXA-244-producing ST38 strains, genetically similar to epidemic-causing strains from Western Norway, France and the Netherlands, were isolated only from raw and treated sewage of the treatment plant receiving hospital sewage. CONCLUSION This is the first study showing persistent dissemination of OXA-244-producing ST38 clones through sewage in Norway, demonstrating that hospital sewage is the likely source of OXA-244-producing ST38 clones reaching the receiving environment.
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Affiliation(s)
- D H Grevskott
- Department of Contaminants and Biohazards, Institute of Marine Research (IMR), Bergen, Norway
| | - V Radisic
- Department of Contaminants and Biohazards, Institute of Marine Research (IMR), Bergen, Norway; Department of Biological Sciences, University of Bergen, Bergen, Norway
| | - F Salvà-Serra
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Culture Collection University of Gothenburg (CCUG), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden; Microbiology, Department of Biology, University of the Balearic Islands, Palma de Mallorca, Spain
| | - E R B Moore
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Culture Collection University of Gothenburg (CCUG), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - K S Akervold
- Water and Sewage Agency, Bergen Municipality, Bergen, Norway
| | - M P Victor
- Department of Contaminants and Biohazards, Institute of Marine Research (IMR), Bergen, Norway
| | - N P Marathe
- Department of Contaminants and Biohazards, Institute of Marine Research (IMR), Bergen, Norway.
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13
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Biez L, Bonnin RA, Emeraud C, Birer A, Jousset AB, Naas T, Dortet L. Nationwide molecular epidemiology of carbapenemase-producing Citrobacter spp. in France in 2019 and 2020. mSphere 2023; 8:e0036623. [PMID: 37815363 PMCID: PMC10732076 DOI: 10.1128/msphere.00366-23] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/25/2023] [Indexed: 10/11/2023] Open
Abstract
IMPORTANCE The emergence of carbapenemase producers in Enterobacterales mostly involves Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae complex species. However, in France, we observed the emergence and the rapid dissemination of carbapenemase in Citrobacter spp. In this study, we demonstrated that a wide variety of carbapenemases is produced by many different species of Citrobacter spp. However, we clearly identify three high-risk clones of Citrobacter freundii, ST8, ST22, and ST91 that drive the spread of carbapenemase in France. This epidemiological study paves the way of further analysis that would aim to identify the virulence factors involved in this pellicular ability of these three clones to disseminate at the hospital.
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Affiliation(s)
- Laura Biez
- Team "Resist" UMR1184 "Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France
| | - Rémy A. Bonnin
- Team "Resist" UMR1184 "Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
| | - Cecile Emeraud
- Team "Resist" UMR1184 "Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
- Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, AP-HP Paris Saclay, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Aurélien Birer
- Centre National de Référence de la Résistance aux Antibiotiques, Clermont-Ferrand, France
| | - Agnès B. Jousset
- Team "Resist" UMR1184 "Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
- Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, AP-HP Paris Saclay, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Thierry Naas
- Team "Resist" UMR1184 "Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
- Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, AP-HP Paris Saclay, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Laurent Dortet
- Team "Resist" UMR1184 "Immunology of Viral, Auto-Immune, Hematological and Bacterial diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
- Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, AP-HP Paris Saclay, Bicêtre Hospital, Le Kremlin-Bicêtre, France
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14
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Daaboul D, Oueslati S, Rima M, Kassem II, Mallat H, Birer A, Girlich D, Hamze M, Dabboussi F, Osman M, Naas T. The emergence of carbapenemase-producing Enterobacterales in hospitals: a major challenge for a debilitated healthcare system in Lebanon. Front Public Health 2023; 11:1290912. [PMID: 38074718 PMCID: PMC10699444 DOI: 10.3389/fpubh.2023.1290912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
Background Carbapenem- and extended-spectrum cephalosporin-resistant Enterobacterales (CR-E and ESCR-E, respectively) are increasingly isolated worldwide. Information about these bacteria is sporadic in Lebanon and generally relies on conventional diagnostic methods, which is detrimental for a country that is struggling with an unprecedented economic crisis and a collapsing public health system. Here, CR-E isolates from different Lebanese hospitals were characterized. Materials and methods Non-duplicate clinical ESCR-E or CR-E isolates (N = 188) were collected from three hospitals from June 2019 to December 2020. Isolates were identified by MALDI-TOF, and their antibiotic susceptibility by Kirby-Bauer disk diffusion assay. CR-E isolates (n = 33/188) were further analyzed using Illumina-based WGS to identify resistome, MLST, and plasmid types. Additionally, the genetic relatedness of the CR-E isolates was evaluated using an Infrared Biotyper system and compared to WGS. Results Using the Kirby-Bauer disk diffusion assay, only 90 isolates out of the 188 isolates that were collected based on their initial routine susceptibility profile by the three participating hospitals could be confirmed as ESCR-E or CR-E isolates and were included in this study. This collection comprised E. coli (n = 70; 77.8%), K. pneumoniae (n = 13; 14.4%), Enterobacter spp. (n = 6; 6.7%), and Proteus mirabilis (n = 1; 1.1%). While 57 were only ESBL producers the remaining 33 isolates (i.e., 26 E. coli, five K. pneumoniae, one E. cloacae, and one Enterobacter hormaechei) were resistant to at least one carbapenem, of which 20 were also ESBL-producers. Among the 33 CR-E, five different carbapenemase determinants were identified: blaNDM-5 (14/33), blaOXA-244 (10/33), blaOXA-48 (5/33), blaNDM-1 (3/33), and blaOXA-181 (1/33) genes. Notably, 20 CR-E isolates were also ESBL-producers. The analysis of the genetic relatedness revealed a substantial genetic diversity among CR-E isolates, suggesting evolution and transmission from various sources. Conclusion This study highlighted the emergence and broad dissemination of blaNDM-5 and blaOXA-244 genes in Lebanese clinical settings. The weak AMR awareness in the Lebanese community and the ongoing economic and healthcare challenges have spurred self-medication practices. Our findings highlight an urgent need for transformative approaches to combat antimicrobial resistance in both community and hospital settings.
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Affiliation(s)
- Dina Daaboul
- Faculty of Medicine, Team "Resist" UMR1184, "Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, Health and Therapeutic Innovation (HEALTHI), Le Kremlin-Bicêtre, France
- Laboratoire Microbiologie Santé et Environment (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Saoussen Oueslati
- Faculty of Medicine, Team "Resist" UMR1184, "Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, Health and Therapeutic Innovation (HEALTHI), Le Kremlin-Bicêtre, France
- Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, AP-HP Paris-Saclay, Bicêtre Hospital Le Kremlin-Bicêtre, Paris, France
| | - Mariam Rima
- Faculty of Medicine, Team "Resist" UMR1184, "Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, Health and Therapeutic Innovation (HEALTHI), Le Kremlin-Bicêtre, France
| | - Issmat I. Kassem
- Center for Food Safety and Department of Food Science and Technology, University of Georgia, Griffin, GA, United States
| | - Hassan Mallat
- Laboratoire Microbiologie Santé et Environment (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Aurélien Birer
- French National Reference Center for Antibiotic Resistance, Clermont-Ferrand, France
| | - Delphine Girlich
- Faculty of Medicine, Team "Resist" UMR1184, "Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, Health and Therapeutic Innovation (HEALTHI), Le Kremlin-Bicêtre, France
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environment (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environment (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Marwan Osman
- Cornell Atkinson Center for Sustainability, Cornell University, Ithaca, NY, United States
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States
| | - Thierry Naas
- Faculty of Medicine, Team "Resist" UMR1184, "Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB)," INSERM, Université Paris-Saclay, CEA, Health and Therapeutic Innovation (HEALTHI), Le Kremlin-Bicêtre, France
- Bacteriology-Hygiene Unit, Assistance Publique-Hôpitaux de Paris, AP-HP Paris-Saclay, Bicêtre Hospital Le Kremlin-Bicêtre, Paris, France
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15
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Lindemann PC, Pedersen T, Oma DH, Janice J, Grøvan F, Chedid GM, Hafne LJ, Josefsen EH, Kacelnik O, Sundsfjord A, Samuelsen Ø. Intraregional hospital outbreak of OXA-244-producing Escherichia coli ST38 in Norway, 2020. Euro Surveill 2023; 28:2200773. [PMID: 37410380 PMCID: PMC10370041 DOI: 10.2807/1560-7917.es.2023.28.27.2200773] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 05/09/2023] [Indexed: 07/07/2023] Open
Abstract
Infections with OXA-244-carbapenemase-producing Escherichia coli with sequence type (ST)38 have recently increased in Europe. Due to its low-level activity against carbapenems, OXA-244 can be difficult to detect. Previous assessments have not revealed a clear source and route of transmission for OXA-244-producing E. coli, but there are indications of non-healthcare related sources and community spread. Here we report a hospital-associated outbreak of OXA-244-producing E. coli ST38 involving three hospitals in Western Norway in 2020. The outbreak occurred over a 5-month period and included 12 cases identified through clinical (n = 6) and screening (n = 6) samples. The transmission chain was unclear; cases were identified in several wards and there was no clear overlap of patient stay. However, all patients had been admitted to the same tertiary hospital in the region, where screening revealed an outbreak in one ward (one clinical case and five screening cases). Outbreak control measures were instigated including contact tracing, isolation, and screening; no further cases were identified in 2021. This outbreak adds another dimension to the spread of OXA-244-producing E. coli ST38, illustrating this clone's ability to establish itself in the healthcare setting. Awareness of challenges concerning OXA-244-producing E. coli diagnostic is important to prevent further spread.
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Affiliation(s)
| | - Torunn Pedersen
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Dorthea Hagen Oma
- Division of Patient Safety, Haukeland University Hospital, Bergen, Norway
| | - Jessin Janice
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | | | | | - Liv Jorunn Hafne
- Department of Microbiology, Haugesund Hospital, Haugesund, Norway
| | - Ellen H Josefsen
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Oliver Kacelnik
- Department of Antibiotic Resistance and Infection Prevention, Norwegian Institute of Public Health, Oslo, Norway
| | - Arnfinn Sundsfjord
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Department of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ørjan Samuelsen
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway
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16
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Hans JB, Pfennigwerth N, Neumann B, Pfeifer Y, Fischer MA, Eisfeld J, Schauer J, Haller S, Eckmanns T, Gatermann S, Werner G. Molecular surveillance reveals the emergence and dissemination of NDM-5-producing Escherichia coli high-risk clones in Germany, 2013 to 2019. Euro Surveill 2023; 28:2200509. [PMID: 36892470 PMCID: PMC9999457 DOI: 10.2807/1560-7917.es.2023.28.10.2200509] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
BackgroundCarbapenemase-producing Enterobacterales (CPE) are rapidly increasing worldwide, also in Europe. Although prevalence of CPE in Germany is comparatively low, the National Reference Centre for Multidrug-resistant Gram-negative Bacteria noted annually increasing numbers of NDM-5-producing Escherichia coli isolates.AimAs part of our ongoing surveillance programme, we characterised NDM-5-producing E. coli isolates received between 2013 and 2019 using whole genome sequencing (WGS).MethodsFrom 329 identified NDM-5-producing E. coli, 224 isolates from known geographical locations were subjected to Illumina WGS. Analyses of 222 sequenced isolates included multilocus sequence typing (MLST), core genome (cg)MLST and single-nucleotide polymorphism (SNP)-based analyses.ResultsResults of cgMLST revealed genetically distinct clusters for many of the 43 detected sequence types (ST), of which ST167, ST410, ST405 and ST361 predominated. The SNP-based phylogenetic analyses combined with geographical information identified sporadic cases of nosocomial transmission on a small spatial scale. However, we identified large clusters corresponding to clonal dissemination of ST167, ST410, ST405 and ST361 strains in consecutive years in different regions in Germany.ConclusionOccurrence of NDM-5-producing E. coli rose in Germany, which was to a large extent due to the increased prevalence of isolates belonging to the international high-risk clones ST167, ST410, ST405 and ST361. Of particular concern is the supra-regional dissemination of these epidemic clones. Available information suggest community spread of NDM-5-producing E. coli in Germany, highlighting the importance of epidemiological investigation and an integrated surveillance system in the One Health framework.
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Affiliation(s)
- Jörg B Hans
- National Reference Centre for Multidrug-resistant Gram-negative Bacteria, Department for Medical Microbiology, Ruhr University Bochum, Bochum, Germany
| | - Niels Pfennigwerth
- National Reference Centre for Multidrug-resistant Gram-negative Bacteria, Department for Medical Microbiology, Ruhr University Bochum, Bochum, Germany
| | - Bernd Neumann
- Institute for Hospital Hygiene, Medical Microbiology and Clinical Infectiology, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany.,Division of Nosocomial Pathogens and Antibiotic Resistance, Department of Infectious Diseases, Robert Koch-Institute, Wernigerode Branch, Wernigerode, Germany
| | - Yvonne Pfeifer
- Division of Nosocomial Pathogens and Antibiotic Resistance, Department of Infectious Diseases, Robert Koch-Institute, Wernigerode Branch, Wernigerode, Germany
| | - Martin A Fischer
- Division of Nosocomial Pathogens and Antibiotic Resistance, Department of Infectious Diseases, Robert Koch-Institute, Wernigerode Branch, Wernigerode, Germany
| | - Jessica Eisfeld
- National Reference Centre for Multidrug-resistant Gram-negative Bacteria, Department for Medical Microbiology, Ruhr University Bochum, Bochum, Germany
| | - Jennifer Schauer
- Landeszentrum Gesundheit Nordrhein-Westfalen, Fachgruppe Infektionsepidemiologie, Bochum, Germany.,National Reference Centre for Multidrug-resistant Gram-negative Bacteria, Department for Medical Microbiology, Ruhr University Bochum, Bochum, Germany
| | - Sebastian Haller
- Department for Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Tim Eckmanns
- Department for Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Sören Gatermann
- National Reference Centre for Multidrug-resistant Gram-negative Bacteria, Department for Medical Microbiology, Ruhr University Bochum, Bochum, Germany
| | - Guido Werner
- Division of Nosocomial Pathogens and Antibiotic Resistance, Department of Infectious Diseases, Robert Koch-Institute, Wernigerode Branch, Wernigerode, Germany
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17
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Zhao X, Zhao H, Zhou Z, Miao Y, Li R, Yang B, Cao C, Xiao S, Wang X, Liu H, Wang J, Yang Z. Characterization of Extended-Spectrum β-Lactamase-Producing Escherichia coli Isolates That Cause Diarrhea in Sheep in Northwest China. Microbiol Spectr 2022; 10:e0159522. [PMID: 35943154 PMCID: PMC9431196 DOI: 10.1128/spectrum.01595-22] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/13/2022] [Indexed: 11/20/2022] Open
Abstract
Development of extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli is one the greatest threats faced by mankind. Among animals, chickens, pigs, and cattle are reservoirs of these pathogens worldwide. Nevertheless, there is a knowledge gap on ESBL-producing E. coli from small ruminants (i.e., sheep and goats) in China. The aim of this study was to identify and characterize the resistance profiles, resistomes, and sequence features of 67 ESBL-producing E. coli isolates from sheep in northwest China. The findings showed that blaCTX-M and blaTEM were the most prevalent. Interestingly, we found that the resistance gene mcr-1 was widespread in sheep merely from Shaanxi areas, accounting for 19.2% (5/26). The highly prevalent serotypes and FumC-FimH (CH) typing isolates were O8 and C4H32, respectively. High-risk E. coli clones, such as sequence type 10 (ST10), ST23, ST44, and ST58, were also found in China's sheep population. A total of 67 ESBL-producing isolates were divided into five phylogenetic groups, namely, B1 (n = 47, 70.1%), B2 (n = 1, 1.5%), C (n = 14, 20.9%), E (n = 1, 1.5%), and F (n = 1, 1.5%), with the phylogenetic groups for 3 isolates (4.5%) remaining unknown. Moreover, ESBL-producing E. coli isolates were also characterized by the abundance and diversity of biocide/metal resistance genes and insert sequences. We found that in ESBL-producing E. coli isolates, there were two different types of isolates, those containing ESBL genes or not, which led to large discrepancies between resistance phenotypes and resistomes. In summary, our study provides a comprehensive overview of resistance profiles and genome sequence features in ESBL-producing E. coli and highlights the possible role of sheep as antibiotic resistance gene disseminators into humans. IMPORTANCE Antimicrobial resistance (AMR), especially the simultaneous resistance to several antibiotics (multidrug resistance [MDR]), is one of the greatest threats to global public health in the 21st century. Among animals, chickens, pigs, and cattle are reservoirs of these pathogens worldwide. Nevertheless, there is a knowledge gap on ESBL-producing E. coli from small ruminants in China. This study is the largest and most comprehensive analysis of ESBL-producing E. coli isolates from sheep, including antibiotic resistance profiles, phylogenetic groups, serotypes, multilocus sequence types (MLST), insert sequences (IS), antibiotic resistance genes, disinfectant resistance genes, and heavy metal resistance genes. We recommend extending the surveillance of AMR of sheep-origin E. coli to prevent future public health risks.
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Affiliation(s)
- Xueliang Zhao
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China
| | - Haoyu Zhao
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China
| | - Zilian Zhou
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China
| | - Yongqiang Miao
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China
| | - Ruichao Li
- College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, China
| | - Baowei Yang
- College of Food Science and Engineering, Northwest A&F University, Yangling, Shaanxi, China
| | - Chenyang Cao
- College of Food Science and Engineering, Northwest A&F University, Yangling, Shaanxi, China
| | - Sa Xiao
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China
| | - Xinglong Wang
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China
| | - Haijin Liu
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China
| | - Juan Wang
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China
| | - Zengqi Yang
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China
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18
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Specificities and Commonalities of Carbapenemase-Producing Escherichia coli Isolated in France from 2012 to 2015. mSystems 2022; 7:e0116921. [PMID: 35014866 PMCID: PMC8751382 DOI: 10.1128/msystems.01169-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Carbapenemase-producing Escherichia coli (CP-Ec) represents a major public health threat with a risk of dissemination in the community as has occurred for lineages producing extended-spectrum β-lactamases. To characterize the extent of CP-Ec spread in France, isolates from screening and infection samples received at the French National Reference Center (F-NRC) laboratory for carbapenemase-producing Enterobacterales were investigated. A total of 691 CP-Ec isolates collected between 2012 and 2015 and 22 isolates collected before 2012 were fully sequenced. Analysis of their genome sequences revealed some disseminating multidrug-resistant (MDR) lineages frequently acquiring diverse carbapenemase genes mainly belonging to clonal complex 23 (CC23) (sequence type 410 [ST410]) and CC10 (ST10 and ST167) and sporadic isolates, including rare ST131 isolates (n = 17). However, the most represented sequence type (ST) was ST38 (n = 92) with four disseminated lineages carrying blaOXA-48-like genes inserted in the chromosome. Globally, the most frequent carbapenemase gene (n = 457) was blaOXA-48. It was also less frequently associated with MDR isolates being the only resistance gene in 119 isolates. Thus, outside the ST38 clades, its acquisition was frequently sporadic with no sign of dissemination, reflecting the circulation of the IncL plasmid pOXA-48 in France and its high frequency of conjugation. In contrast, blaOXA-181 and blaNDM genes were often associated with the evolution of MDR E. coli lineages characterized by mutations in ftsI and ompC. IMPORTANCE Carbapenemase-producing Escherichia coli (CP-Ec) might be difficult to detect, as MICs can be very low. However, their absolute number and their proportion among carbapenem-resistant Enterobacterales have been increasing, as reported by WHO and national surveillance programs. This suggests a still largely uncharacterized community spread of these isolates. Here, we have characterized the diversity and evolution of CP-Ec isolated in France before 2016. We show that carbapenemase genes are associated with a wide variety of E. coli genomic backgrounds and a small number of dominant phylogenetic lineages. In a significant proportion of CP-Ec, the most frequent carbapenemase gene blaOXA-48, was detected in isolates lacking any other resistance gene, reflecting the dissemination of pOXA-48 plasmids, likely in the absence of any antibiotic pressure. In contrast, carbapenemase gene transfer may also occur in multidrug-resistant E. coli, ultimately giving rise to at-risk lineages encoding carbapenemases with a high potential of dissemination.
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19
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Rima M, Emeraud C, Bonnin RA, Gonzalez C, Dortet L, Iorga BI, Oueslati S, Naas T. Biochemical characterization of OXA-244, an emerging OXA-48 variant with reduced β-lactam hydrolytic activity. J Antimicrob Chemother 2021; 76:2024-2028. [PMID: 33993262 DOI: 10.1093/jac/dkab142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND OXA-48-producing Enterobacterales have widely disseminated globally with an increasing number of variants identified. Among them, OXA-244 is increasingly reported, despite detection difficulties. OBJECTIVES To determine the steady-state kinetic parameters of OXA-244. METHODS The blaOXA-244 gene was amplified, cloned into plasmids p-TOPO and pET41b+, and transformed into Escherichia coli TOP10 for MIC determination and E. coli BL21 DE3 for purification. Steady-state kinetic parameters and IC50s of clavulanic acid, tazobactam and NaCl were determined using purified OXA-244. Molecular modelling was also performed. RESULTS A reduction in MICs of temocillin and carbapenems was observed in E. coli expressing OXA-244 as compared with OXA-48. The kinetic parameters revealed a reduced carbapenemase activity of OXA-244 as compared with OXA-48, especially for imipenem, which was 10-fold lower. Similarly, catalytic efficiency (kcat/Km) was reduced by 4-fold and 20-fold for ampicillin and temocillin, respectively. Kinetic parameters for cephalosporins were, however, similar. Molecular modelling studies evidenced the key role of R214 in OXA-48, establishing salt bridges with D159 and with the carboxylate group of the R1 substituent of temocillin. These interactions are not possible with G214 in OXA-244, explaining the reduced affinity of temocillin for this enzyme. The R214G mutation in OXA-244 is also likely to induce changes in the active site's water network that would explain the decrease in the hydrolysis rate of carbapenems. CONCLUSIONS Our data confirm that the R214G mutation (present in OXA-244) results in reduced carbapenem- and temocillin-hydrolysing activity, confirming the crucial role of residue 214 in the hydrolysis of these substrates by OXA-48-like β-lactamases.
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Affiliation(s)
- Mariam Rima
- Team ReSIST, INSERM U1184, School of Medicine Université Paris-Saclay, LabEx LERMIT, and Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Saclay, Le Kremlin-Bicêtre, France
| | - Cecile Emeraud
- Team ReSIST, INSERM U1184, School of Medicine Université Paris-Saclay, LabEx LERMIT, and Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Saclay, Le Kremlin-Bicêtre, France.,Bacteriology-Hygiene Unit, Assistance Publique/Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France.,French National Reference Centre for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
| | - Rémy A Bonnin
- Team ReSIST, INSERM U1184, School of Medicine Université Paris-Saclay, LabEx LERMIT, and Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Saclay, Le Kremlin-Bicêtre, France.,French National Reference Centre for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
| | - Camille Gonzalez
- Team ReSIST, INSERM U1184, School of Medicine Université Paris-Saclay, LabEx LERMIT, and Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Saclay, Le Kremlin-Bicêtre, France.,Bacteriology-Hygiene Unit, Assistance Publique/Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Laurent Dortet
- Team ReSIST, INSERM U1184, School of Medicine Université Paris-Saclay, LabEx LERMIT, and Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Saclay, Le Kremlin-Bicêtre, France.,Bacteriology-Hygiene Unit, Assistance Publique/Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France.,French National Reference Centre for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
| | - Bogdan I Iorga
- Université Paris-Saclay, CNRS, Institut de Chimie des Substances Naturelles, Gif-sur-Yvette, France
| | - Saoussen Oueslati
- Team ReSIST, INSERM U1184, School of Medicine Université Paris-Saclay, LabEx LERMIT, and Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Saclay, Le Kremlin-Bicêtre, France.,Bacteriology-Hygiene Unit, Assistance Publique/Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Thierry Naas
- Team ReSIST, INSERM U1184, School of Medicine Université Paris-Saclay, LabEx LERMIT, and Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Saclay, Le Kremlin-Bicêtre, France.,Bacteriology-Hygiene Unit, Assistance Publique/Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France.,French National Reference Centre for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriaceae, Le Kremlin-Bicêtre, France
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