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Khan UB, Portal EAR, Sands K, Lo S, Chalker VJ, Jauneikaite E, Spiller OB. Genomic Analysis Reveals New Integrative Conjugal Elements and Transposons in GBS Conferring Antimicrobial Resistance. Antibiotics (Basel) 2023; 12:544. [PMID: 36978411 PMCID: PMC10044541 DOI: 10.3390/antibiotics12030544] [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: 02/02/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023] Open
Abstract
Streptococcus agalactiae or group B streptococcus (GBS) is a leading cause of neonatal sepsis and increasingly found as an invasive pathogen in older patient populations. Beta-lactam antibiotics remain the most effective therapeutic with resistance rarely reported, while the majority of GBS isolates carry the tetracycline resistance gene tet(M) in fixed genomic positions amongst five predominant clonal clades. In the UK, GBS resistance to clindamycin and erythromycin has increased from 3% in 1991 to 11.9% (clindamycin) and 20.2% (erythromycin), as reported in this study. Here, a systematic investigation of antimicrobial resistance genomic content sought to fully characterise the associated mobile genetic elements within phenotypically resistant GBS isolates from 193 invasive and non-invasive infections of UK adult patients collected during 2014 and 2015. Resistance to erythromycin and clindamycin was mediated by erm(A) (16/193, 8.2%), erm(B) (16/193, 8.2%), mef(A)/msr(D) (10/193, 5.1%), lsa(C) (3/193, 1.5%), lnu(C) (1/193, 0.5%), and erm(T) (1/193, 0.5%) genes. The integrative conjugative elements (ICEs) carrying these genes were occasionally found in combination with high gentamicin resistance mediating genes aac(6')-aph(2″), aminoglycoside resistance genes (ant(6-Ia), aph(3'-III), and/or aad(E)), alternative tetracycline resistance genes (tet(O) and tet(S)), and/or chloramphenicol resistance gene cat(Q), mediating resistance to multiple classes of antibiotics. This study provides evidence of the retention of previously reported ICESag37 (n = 4), ICESag236 (n = 2), and ICESpy009 (n = 3), as well as the definition of sixteen novel ICEs and three novel transposons within the GBS lineage, with no evidence of horizontal transfer.
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Affiliation(s)
- Uzma Basit Khan
- Department of Medical Microbiology, Division of Infection and Immunity, Cardiff University, 6th Floor University Hospital of Wales, Cardiff CF14 4XN, UK
- Parasites and Microbes Programme, The Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Edward A. R. Portal
- Department of Medical Microbiology, Division of Infection and Immunity, Cardiff University, 6th Floor University Hospital of Wales, Cardiff CF14 4XN, UK
- Bacterial Reference Department, UK Health Security Agency, London NW9 5DF, UK
- Department of Biology, Ineos Oxford Institute, University of Oxford, Oxford OX1 3RE, UK
| | - Kirsty Sands
- Department of Medical Microbiology, Division of Infection and Immunity, Cardiff University, 6th Floor University Hospital of Wales, Cardiff CF14 4XN, UK
- Department of Biology, Ineos Oxford Institute, University of Oxford, Oxford OX1 3RE, UK
| | - Stephanie Lo
- Parasites and Microbes Programme, The Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK
| | - Victoria J. Chalker
- Bacterial Reference Department, UK Health Security Agency, London NW9 5DF, UK
| | - Elita Jauneikaite
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London W12 0NN, UK
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Owen B. Spiller
- Department of Medical Microbiology, Division of Infection and Immunity, Cardiff University, 6th Floor University Hospital of Wales, Cardiff CF14 4XN, UK
- Bacterial Reference Department, UK Health Security Agency, London NW9 5DF, UK
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Wang J, Zhang Y, Lin M, Bao J, Wang G, Dong R, Zou P, Chen Y, Li N, Zhang T, Su Z, Pan X. Maternal colonization with group B Streptococcus and antibiotic resistance in China: systematic review and meta-analyses. Ann Clin Microbiol Antimicrob 2023; 22:5. [PMID: 36639677 PMCID: PMC9837753 DOI: 10.1186/s12941-023-00553-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Maternal rectovaginal colonization with group B Streptococcus (GBS) or Streptococcus agalactiae is the most common pathway for this disease during the perinatal period. This meta-analysis aimed to summarize existing data regarding maternal colonization, serotype profiles, and antibiotic resistance in China. METHODS Systematic literature reviews were conducted after searching 6 databases. Meta-analysis was applied to analyze colonization rate, serotype, and antimicrobial susceptibility of GBS clinical isolates in different regions of China. Summary estimates are presented using tables, funnel plots, forest plots, histograms, violin plots, and line plots. RESULTS The dataset regarding colonization included 52 articles and 195 303 pregnant women. Our estimate for maternal GBS colonization in China was 8.1% (95% confidence interval [CI] 7.2%-8.9%). Serotypes Ia, Ib, III, and V account for 95.9% of identified isolates. Serotype III, which is frequently associated with the hypervirulent clonal complex, accounts for 46.4%. Among the maternal GBS isolates using multilocus sequence typing (MLST), ST19 (25.7%, 289/1126) and ST10 (25.1%, 283/1126) were most common, followed by ST12 (12.4%, 140/1126), ST17 (4.8%, 54/1126), and ST651 (3.7%, 42/1126). GBS was highly resistant to tetracycline (75.1% [95% CI 74.0-76.3%]) and erythromycin (65.4% [95% CI 64.5-66.3%]) and generally susceptible to penicillin, ampicillin, vancomycin, ceftriaxone, and linezolid. Resistance rates of GBS to clindamycin and levofloxacin varied greatly (1.0-99.2% and 10.3-72.9%, respectively). A summary analysis of the bacterial drug resistance reports released by the China Antimicrobial Resistance Surveillance System (CARSS) in the past 5 years showed that the drug resistance rate of GBS to erythromycin, clindamycin, and levofloxacin decreased slowly from 2018 to 2020. However, the resistance rates of GBS to all 3 antibiotics increased slightly in 2021. CONCLUSIONS The overall colonization rate in China was much lower than the global colonization rate (17.4%). Consistent with many original and review reports in other parts of the world, GBS was highly resistant to tetracycline. However, the resistance of GBS isolates in China to erythromycin and clindamycin was greater than in other countries. This paper provides important epidemiological information, to assist with prevention and treatment of GBS colonization in these women.
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Affiliation(s)
- Jing Wang
- grid.258151.a0000 0001 0708 1323Women’s Hospital of Jiangnan University, No. 48, Huaishu Lane, Wuxi, Jiangsu China
| | - Yan Zhang
- Baoding No. 1 Hospital of TCM, Baoding, Hebei China
| | - Miao Lin
- grid.260474.30000 0001 0089 5711College of Life Sciences, Nanjing Normal University, Nanjing, Jiangsu China ,Department of Microbiology, Hua Dong Research Institute for Medicine and Biotechnics, No. 293 Zhongshan East Road, Nanjing, Jiangsu China
| | - Junfeng Bao
- grid.258151.a0000 0001 0708 1323Women’s Hospital of Jiangnan University, No. 48, Huaishu Lane, Wuxi, Jiangsu China
| | - Gaoying Wang
- grid.258151.a0000 0001 0708 1323Women’s Hospital of Jiangnan University, No. 48, Huaishu Lane, Wuxi, Jiangsu China
| | - Ruirui Dong
- grid.258151.a0000 0001 0708 1323Women’s Hospital of Jiangnan University, No. 48, Huaishu Lane, Wuxi, Jiangsu China
| | - Ping Zou
- grid.258151.a0000 0001 0708 1323Women’s Hospital of Jiangnan University, No. 48, Huaishu Lane, Wuxi, Jiangsu China
| | - Yuejuan Chen
- grid.258151.a0000 0001 0708 1323Women’s Hospital of Jiangnan University, No. 48, Huaishu Lane, Wuxi, Jiangsu China
| | - Na Li
- grid.258151.a0000 0001 0708 1323Women’s Hospital of Jiangnan University, No. 48, Huaishu Lane, Wuxi, Jiangsu China
| | - Ting Zhang
- Women's Hospital of Jiangnan University, No. 48, Huaishu Lane, Wuxi, Jiangsu, China.
| | - Zhaoliang Su
- School of Medicine, Jiangsu University, No. 301 Xuefu Road, Zhenjiang, Jiangsu, China.
| | - Xiuzhen Pan
- Department of Microbiology, Hua Dong Research Institute for Medicine and Biotechnics, No. 293 Zhongshan East Road, Nanjing, Jiangsu, China.
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Abstract
PURPOSE OF REVIEW Neonatal bloodstream infections (BSI) are a major contributor to morbidity and mortality within neonatal intensive care units. BSI, including central line-associated BSI, have decreased over the past 15 years but remain common in extremely preterm infants. The purpose of this review is to highlight recent advances in the causes, diagnosis, management, and prevention of neonatal BSI. RECENT FINDINGS Continued quality improvement efforts and bundles have reduced BSI incidence, and novel approaches are highlighted. An update of emerging pathogens as well as traditional pathogens with novel antimicrobial resistance, which are an increasingly common cause of neonatal BSI, is included. Finally, current and future investigations into serum or noninvasive biomarkers for neonatal BSI are reviewed. SUMMARY Neonatal BSIs continue to decrease due to enhanced infection control and prevention techniques. However, many challenges remain, including emerging bacterial and fungal resistance and the continued need for novel diagnostics that hasten time to pathogen identification and effective treatment. This review of the past 18 months highlights the rapid changes in this area. Ongoing efforts to reduce the morbidity and mortality caused by neonatal BSI must remain a priority.
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Affiliation(s)
| | - Joseph B Cantey
- Department of Pediatrics, Division of Neonatology
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Texas Health San Antonio, San Antonio, Texas, USA
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