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Mattioni Marchetti V, Hrabak J, Bitar I. Fosfomycin resistance mechanisms in Enterobacterales: an increasing threat. Front Cell Infect Microbiol 2023; 13:1178547. [PMID: 37469601 PMCID: PMC10352792 DOI: 10.3389/fcimb.2023.1178547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/31/2023] [Indexed: 07/21/2023] Open
Abstract
Antimicrobial resistance is well-known to be a global health and development threat. Due to the decrease of effective antimicrobials, re-evaluation in clinical practice of old antibiotics, as fosfomycin (FOS), have been necessary. FOS is a phosphonic acid derivate that regained interest in clinical practice for the treatment of complicated infection by multi-drug resistant (MDR) bacteria. Globally, FOS resistant Gram-negative pathogens are raising, affecting the public health, and compromising the use of the antibiotic. In particular, the increased prevalence of FOS resistance (FOSR) profiles among Enterobacterales family is concerning. Decrease in FOS effectiveness can be caused by i) alteration of FOS influx inside bacterial cell or ii) acquiring antimicrobial resistance genes. In this review, we investigate the main components implicated in FOS flow and report specific mutations that affect FOS influx inside bacterial cell and, thus, its effectiveness. FosA enzymes were identified in 1980 from Serratia marcescens but only in recent years the scientific community has started studying their spread. We summarize the global epidemiology of FosA/C2/L1-2 enzymes among Enterobacterales family. To date, 11 different variants of FosA have been reported globally. Among acquired mechanisms, FosA3 is the most spread variant in Enterobacterales, followed by FosA7 and FosA5. Based on recently published studies, we clarify and represent the molecular and genetic composition of fosA/C2 genes enviroment, analyzing the mechanisms by which such genes are slowly transmitting in emerging and high-risk clones, such as E. coli ST69 and ST131, and K. pneumoniae ST11. FOS is indicated as first line option against uncomplicated urinary tract infections and shows remarkable qualities in combination with other antibiotics. A rapid and accurate identification of FOSR type in Enterobacterales is difficult to achieve due to the lack of commercial phenotypic susceptibility tests and of rapid systems for MIC detection.
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Affiliation(s)
- Vittoria Mattioni Marchetti
- Department of Microbiology, Faculty of Medicine, University Hospital in Pilsen, Charles University, Pilsen, Czechia
- Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czechia
- Unit of Microbiology and Clinical Microbiology, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Jaroslav Hrabak
- Department of Microbiology, Faculty of Medicine, University Hospital in Pilsen, Charles University, Pilsen, Czechia
- Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czechia
| | - Ibrahim Bitar
- Department of Microbiology, Faculty of Medicine, University Hospital in Pilsen, Charles University, Pilsen, Czechia
- Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czechia
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Rong F, Liu Z, Yang P, Wu F, Sun Y, Sun X, Zhou J. Epidemiological and Molecular Characteristics of bla NDM-1 and bla KPC-2 Co-Occurrence Carbapenem-Resistant Klebsiella pneumoniae. Infect Drug Resist 2023; 16:2247-2258. [PMID: 37090038 PMCID: PMC10120834 DOI: 10.2147/idr.s400138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/01/2023] [Indexed: 04/25/2023] Open
Abstract
Objective Carbapenem-resistant Klebsiella pneumoniae (CRKP) has emerged and spread worldwide. It can usually cause a serious threat complicating treatment options in clinical settings. However, treatment options are limited. The present study investigates the prevalence and genetic characteristics of bla NDM-1 and bla KPC-2 co-harboring clinical isolates of Klebsiella pneumoniae. Methods In this study, Multiplex polymerase chain reaction (PCR) was performed to detect the carbapenem-resistant genes, and the broth microdilution method was used to determine the minimum inhibitory concentrations (MICs) of antibacterial drugs. The transferability of carbapenem-resistant phenotypes was examined using filter mating assays. Overall, we used Illumina sequencing to evaluate the epidemiological and molecular characteristics of bla NDM-1 and bla KPC-2 (genes encoding carbapenemase) co-occurrence in CRKP strains. Results All strains exhibited resistance to carbapenems and other antibiotics. However, they were still susceptible to polymyxin E. Among them, 18 isolates were positive for bla KPC-2, bla NDM-1, and multiple virulence determinants, such as genes encoding the virulence factor aerobactin, yersiniabactin, and the regulator of the mucoid phenotype (rmpA and rmpA2). Whole genome sequencing revealed that the 18 CRKP strains belonged to ST11 and capsular serotype KL64, and could be grouped into two evolutionary branches. Furthermore, these strains displayed hypervirulence potential since all of them carried pLVPK-like plasmid. Conclusion These findings suggested that ST11-KL64 CRKP strains are major threats in terms of nosocomial infections in this hospital. Hence, new strategies should be urgently developed to monitor, diagnose, and treat this high-risk CRKP clone.
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Affiliation(s)
- Fang Rong
- Department of General Practice, The Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
- Graduate School Department of Dalian Medical University, Dalian, Liaoning, People’s Republic of China
| | - Ziyi Liu
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
- Institute of Comparative Medicine, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
| | - Pengbin Yang
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, College of Veterinary Medicine, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
- Institute of Comparative Medicine, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
| | - Feng Wu
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
| | - Yu Sun
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
| | - Xuewei Sun
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
| | - Jun Zhou
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
- Correspondence: Jun Zhou, Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, Jiangsu, 225009, People’s Republic of China, Email
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Abou-assy RS, Aly MM, Amasha RH, Jastaniah S, Alammari F, Shamrani M. Carbapenem Resistance Mechanisms, Carbapenemase Genes Dissemination , and Laboratory Detection Methods: A Review. INTERNATIONAL JOURNAL OF PHARMACEUTICAL RESEARCH AND ALLIED SCIENCES 2023. [DOI: 10.51847/wqutf4vfuo] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Nishida S, Ihashi Y, Yoshino Y, Ono Y. Evaluation of an immunological assay for the identification of multiple carbapenemase-producing Gram-negative bacteria. Pathology 2022; 54:917-921. [PMID: 35934532 DOI: 10.1016/j.pathol.2022.05.007] [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: 11/10/2021] [Revised: 04/24/2022] [Accepted: 05/08/2022] [Indexed: 12/31/2022]
Abstract
Carbapenemase-producing Gram-negative organisms (CPOs) frequently gain multidrug-resistant phenotypes and thereby limit the therapeutic options available. Colonisation and infection with CPOs are critical risks for mortality in clinical settings, especially in critical care medicine. Carbapenemase genes on plasmids have transferred to many Gram-negative species, and these species have spread, leading to global concern regarding antimicrobial resistance. A molecular rapid diagnostic test (mRDT) for CPOs is urgently required in critical care medicine. Here, we evaluated a rapid lateral flow immunoassay (LFIA) for CPOs isolated from patients at university hospitals, including intensive care units, and compared the results with those obtained using the multiplex polymerase chain reaction (PCR) method. NG-test CARBA 5 detected multiple carbapenemases, KPC, OXA-48, NDM, VIM, and IMP variants expressed in clinical isolates. Quick Chaser IMP detected IMP variants. The LFIAs exhibited 100% sensitivity and specificity relative to clinical isolates on agar plates. By contrast, the multiplex PCR method exhibited a limited ability to detect IMP-7-producing isolates not belonging to the IMP1 group, which resulted in 97% sensitivity and 100% specificity for IMP-producing isolates. Our results demonstrate that the LFIA is a useful mRDT to identify CPOs and has an advantage over the PCR method for both detection time and sensitivity to the IMP groups. LFIA could complement the nucleic acid amplification test used to identify CPOs. In conclusion, we evaluated sensitive and specific LFIAs capable of detecting carbapenemase production in Gram-negative bacteria. We anticipate that LFIAs will become a point-of-care test enabling rapid detection of carbapenemases in hospital settings, particularly in intensive care units.
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Affiliation(s)
- Satoshi Nishida
- Department of Microbiology and Immunology, Teikyo University School of Medicine, Itabashi, Tokyo, Japan.
| | - Yusuke Ihashi
- Department of Microbiology and Immunology, Teikyo University School of Medicine, Itabashi, Tokyo, Japan
| | - Yusuke Yoshino
- Department of Microbiology and Immunology, Teikyo University School of Medicine, Itabashi, Tokyo, Japan
| | - Yasuo Ono
- Department of Microbiology and Immunology, Teikyo University School of Medicine, Itabashi, Tokyo, Japan; Faculty of Health and Medical Science, Teikyo Heisei University, Toshima, Tokyo, Japan
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Štefánek M, Wenner S, Borges V, Pinto M, Gomes JP, Rodrigues J, Faria I, Pessanha MA, Martins F, Sabino R, Veríssimo C, Nogueira ID, Carvalho PA, Bujdáková H, Jordao L. Antimicrobial Resistance and Biofilms Underlying Catheter-Related Bloodstream Coinfection by Enterobacter cloacae Complex and Candida parapsilosis. Antibiotics (Basel) 2022; 11:antibiotics11091245. [PMID: 36140024 PMCID: PMC9495738 DOI: 10.3390/antibiotics11091245] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022] Open
Abstract
Biofilm-associated infections are a public health concern especially in the context of healthcare-associated infections such as catheter-related bloodstream infections (CRBSIs). We evaluated the biofilm formation and antimicrobials resistance (AMR) of Enterobacter cloacae complex and Candida parapsilosis co-isolated from a CRBSI patient. Antimicrobial susceptibility of central venous catheters (CVCs) and hemoculture (HC) isolates was evaluated, including whole genome sequencing (WGS) resistome analysis and evaluation of gene expression to obtain insight into their AMR determinants. Crystal violet assay was used to assess dual biofilm biomass and microscopy was used to elucidate a microorganism’s distribution within biofilms assembled on different materials. Bacteria were multidrug-resistant including resistance to colistin and beta-lactams, likely linked to the mcr-9-like phosphoethanolamine transferase and to an ACT family cephalosporin-hydrolyzing class C beta-lactamase, respectively. The R398I and Y132F mutations in the ERG11 gene and its differential expression might account for C. parapsilosis resistance to fluconazole. The phenotype of dual biofilms assembled on glass, polystyrene and polyurethane depends on the material and how biofilms were initiated by one or both pathogens. Biofilms assembled on polyurethane were denser and richer in the extracellular polymeric matrix, and microorganisms were differently distributed on the inner/outer surface of the CVC.
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Affiliation(s)
- Matúš Štefánek
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 842 15 Bratislava, Slovakia
| | | | - Vítor Borges
- Genomics and Bioinformatic Unit, Department of Infectious Diseases (DDI), National Institute of Health Dr. Ricardo Jorge (INSA), 1649-016 Lisbon, Portugal
| | - Miguel Pinto
- Genomics and Bioinformatic Unit, Department of Infectious Diseases (DDI), National Institute of Health Dr. Ricardo Jorge (INSA), 1649-016 Lisbon, Portugal
| | - João Paulo Gomes
- Genomics and Bioinformatic Unit, Department of Infectious Diseases (DDI), National Institute of Health Dr. Ricardo Jorge (INSA), 1649-016 Lisbon, Portugal
| | - João Rodrigues
- Unidade Laboratorial Integrada de Microbiologia, Department of Infectious Diseases (DDI), National Institute of Health Dr. Ricardo Jorge (INSA), 1649-016 Lisboa, Portugal
| | - Isabel Faria
- Laboratório de Microbiologia e Biologia Molecular do Serviço de Patologia Clínica, Centro Hospitalar de lisboa Ocidental (CHLO), 1349-019 Lisboa, Portugal
| | - Maria Ana Pessanha
- Laboratório de Microbiologia e Biologia Molecular do Serviço de Patologia Clínica, Centro Hospitalar de lisboa Ocidental (CHLO), 1349-019 Lisboa, Portugal
| | - Filomena Martins
- Direção do Programa de Prevenção e Controlo de Infeção e Resistência aos Antimicrobianos, Centro Hospitalar de lisboa Ocidental (CHLO), 1349-019 Lisboa, Portugal
| | - Raquel Sabino
- Reference Unit for Parasitic and Fungal Infections, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge (INSA), 1649-016 Lisboa, Portugal
- Institute of Environmental Health, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal
| | - Cristina Veríssimo
- Reference Unit for Parasitic and Fungal Infections, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge (INSA), 1649-016 Lisboa, Portugal
| | | | | | - Helena Bujdáková
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 842 15 Bratislava, Slovakia
| | - Luisa Jordao
- Unidade de Investigação & Desenvolvimento, Departamento de Saúde Ambiental, Instituto Nacional de Saude Dr. Ricardo Jorge (INSA),1649-016 Lisboa, Portugal
- Correspondence:
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Mutai IJ, Juma AA, Inyimili MI, Nyachieo A, Nyamache AK. Efficacy of diversely isolated lytic phages against multi-drug resistant Enterobacter cloacae isolates in Kenya. Afr J Lab Med 2022; 11:1673. [PMID: 36091354 PMCID: PMC9453119 DOI: 10.4102/ajlm.v11i1.1673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 05/04/2022] [Indexed: 11/07/2022] Open
Abstract
Background Enterobacter cloacae causes nosocomial infections in 15% of patients in low- and middle-income countries with emergence of carbapenem resistance. The utilisation of bacteriophages for therapeutic purposes is crucial for eradicating these resistant bacterial strains. Objective This study evaluated the efficacy of lytic phages on bacterial isolates of E. cloacae and determined their stability in various physicochemical conditions. Methods Twenty-nine lytic phages were isolated from the waste water of six informal settlements in Nairobi County, Kenya, from July 2019 to December 2020 and cross-reacted with 30 anonymised clinical isolates of E. cloacae. Six phages were then selected for physicochemical property studies. Phages were described as potent upon lysing any bacterial strain in the panel. Results Selected phages were stable at 4 °C – 50 °C with a 5.1% decrease in titre in four of six phages and a 1.8% increase in titre in two of six phages at 50 °C. The phages were efficient following two weeks incubation at 4 °C with optimal activity at human body temperature (37 °C) and an optimal pH of 7.5. Phages were active at 0.002 M and 0.015 M concentrations of Ca2+ ions. The efficiency of all phages decreased with increased exposure to ultraviolet light. All phages (n = 29) showed cross-reactivity against anonymised clinical isolates of E. cloacae strains (n = 30). The most potent phage lysed 67.0% of bacterial strains; the least potent phage lysed 27.0%. Conclusion This study reveals the existence of therapeutic phages in Kenya that are potent enough for treatment of multi-drug resistant E. cloacae.
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Affiliation(s)
- Ivy J Mutai
- Phage Biology Laboratory, Institute of Primate Research, Nairobi, Kenya
- Department of Biochemistry, Biotechnology and Microbiology, Faculty of Pure and Applied Sciences, Kenyatta University, Nairobi, Kenya
| | - Angela A Juma
- Phage Biology Laboratory, Institute of Primate Research, Nairobi, Kenya
| | | | - Atunga Nyachieo
- Phage Biology Laboratory, Institute of Primate Research, Nairobi, Kenya
| | - Anthony K Nyamache
- Department of Biochemistry, Biotechnology and Microbiology, Faculty of Pure and Applied Sciences, Kenyatta University, Nairobi, Kenya
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Alzaidi JR, Mohammed AS. First Record of Dissemination of BLBLI-Resistant Enterobacter cloacae from Public Hospitals in Baghdad, Iraq. Open Microbiol J 2022. [DOI: 10.2174/18742858-v16-e2201310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Enterobacter cloacae are most frequently isolated from human clinical specimens.
Objective:
This cross-sectional study aimed to investigate the dissemination of E. cloacae clinical isolates resistant to β-lactam-β-lactamase inhibitor (BLBLI) combinations from different clinical specimens of hospitalized patients.
Methods:
E. cloacae isolates were recovered from different clinical samples of hospitalized patients in three main hospitals in Baghdad city. E. cloacae isolates were identified based on their morphology and biochemical tests, and the identification was confirmed using Vitek-2 system. The antibiotic susceptibility testing of E. cloacae isolates to a variety of antibiotics was achieved using disc diffusion test (DDT) and Vitek-2 system.
Results:
Results found that among 335 culture-positive samples, 30 isolates (8.9%) belonged to E. cloacae. A high rate of isolation was observed in urine isolates (46.6%), followed by wounds (burns) isolates (26.6%). Out of 30 E. cloacae strains isolated during this study, 18 (60%) showed reduced susceptibility to BLBLI combinations. TEM genes (TEM-1 and TEM-2) were successfully amplified from 7/18 isolates (38.8%) and high rate of BLBLI genes was detected (CTX-M, bla-SHV, SHV-2, and OXA-1). However, no BLBLI genes of bla-AmpC, bla- OXA-2, and bla- OXA-10 were found in E. cloacae isolates when tested using specific primers for bla-AmpC and bla-OXA genes.
Conclusion:
From this study, we can conclude that the production of inhibitor-resistant β-lactamases by E. cloacae isolates could be increasingly common in nosocomial pathogens other than E. coli or K. pneumoniae in public hospitals in Baghdad, Iraq.
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Feng W, Lv J, Wang H, Yao P, Xiong L, Xia P, Yuan Q, Sun F. The first report of the bla IMP-10 gene and complete sequence of the IMP-10-encoding plasmid p12NE515 from Pseudomonas aeruginosa in China. Acta Trop 2022; 228:106326. [PMID: 35077675 DOI: 10.1016/j.actatropica.2022.106326] [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: 12/21/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate a detailed genomic characterization of the blaIMP-10-carrying plasmid p12NE515 from a Pseudomonas aeruginosa isolate in China. METHODS Plasmid p12NE515 was subjected to whole-genome sequencing and the complete sequence was compared with related plasmid sequences. Transferability of plasmid, carbapenemase activity and bacterial susceptibility profiles were determined to assess p12NE515-mediated resistance phenotypes. RESULTS P. aeruginosa 12NE515 was identified as a less common sequence type of ST1976. p12NE515 harboring blaIMP-10 possessed a backbone identical to plasmid p60512-IMP (carrying blaIMP-1), but the accessory resistance regions differed. Only one accessory module, Tn7339, was carried in p12NE515, and this transposon was an insertion sequence-mediated transposition unit generated by the insertion of a novel class 1 integron, In1814, at the downstream end of ISPa17. Here, blaIMP-10 together with aacA7 was located in In1814, being at evolution stage III of Tn402-associated integron due to truncation of the tni module. CONCLUSION This study is the first to determine the complete sequence of a blaIMP-10-carrying plasmid, and this is also the first report of a blaIMP-10-producing strain in China. The prevalence of the blaIMP-10 gene and the genetic characterization of the blaIMP-10-carrying plasmid should be analyzed to provide deeper insight into the transmission mechanism of antimicrobial resistance genes.
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Affiliation(s)
- Wei Feng
- Department of Pharmacy, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Jun Lv
- Department of Pharmacy, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Hongping Wang
- Department of Pharmacy, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Pu Yao
- Department of Pharmacy, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Lirong Xiong
- Department of Pharmacy, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Peiyuan Xia
- Department of Pharmacy, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Qian Yuan
- Department of Pharmacy, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.
| | - Fengjun Sun
- Department of Pharmacy, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.
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Polyclonal emergence of MDR Enterobacter cloacae complex isolates producing multiple extended spectrum beta-lactamases at Maputo Central Hospital, Mozambique. RENDICONTI LINCEI. SCIENZE FISICHE E NATURALI 2022. [DOI: 10.1007/s12210-021-01039-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AbstractEnterobacter spp. are important nosocomial pathogens responsible of a wide variety of infections, mainly due to Extended Spectrum β-Lactamase (ESBL) producing isolates, constituting a global public health issue in terms of clinical treatment and infection control, especially in low-income countries, where last-line treatment is often unavailable and there is weak nosocomial surveillance. In this study, we conducted a phenotypic and molecular characterization of 8 clinical Enterobacter spp. strains, isolated from patient’s blood in three hospitals in Mozambique. Isolates were identified by MALDI-TOF and antimicrobial Susceptibility Testing was performed by VITEK 2 system. Half of isolates were analyzed by PCR for β-lactamases genes, other isolates by Whole Genome Sequencing. We identified all isolates as Enterobacter cloacae complex (ECC), those from Maputo Central Hospital were polyclonal, multidrug resistant (5/8), and ESBL producers (50%), carrying blaCTX-M-15 and different assortment of blaSHV-12, blaTEM-1B and blaOXA-1, and AmpCs blaCMH-3, blaACT-7 and blaACT-9 genes. Resistance determinants linked to fluoroquinolone (aac(6')Ib-cr and qnrB1) and others antimicrobials were also found. Notably, one isolate showed phenotypically resistance to colistin, while another colistin susceptible isolate carried a silent mcr-9 gene. ECC nosocomial surveillance is urgently needed to contain and prevent the dissemination of ESBLs producing clones, and mcr-9 spread to other Enterobacteriaceae.
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Kong Y, Sun Q, Chen H, Draz MS, Xie X, Zhang J, Ruan Z. Transmission Dynamics of Carbapenem-Resistant Klebsiella pneumoniae Sequence Type 11 Strains Carrying Capsular Loci KL64 and rmpA/ rmpA2 Genes. Front Microbiol 2021; 12:736896. [PMID: 34690977 PMCID: PMC8529244 DOI: 10.3389/fmicb.2021.736896] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
The presence and dissemination of carbapenem-resistant Klebsiella pneumoniae (CRKP) often cause life-threatening infections worldwide, but the therapeutic option is limited. In this study, whole-genome sequencing (WGS) was applied to assess the epidemiological characteristics and transmission dynamics of CRKP isolates recovered from two fetal outbreaks of nosocomial infections. Between April 2016 and March 2018, a total of 70 isolates of K. pneumoniae were collected from sterile samples in a tertiary hospital in Hangzhou, China. The minimal inhibitory concentrations (MICs) of 21 antimicrobial agents were determined using the broth microdilution methods. Pulsed-field gel electrophoresis (PFGE) was performed on 47 CRKP isolates, and 16 clonally related isolates were further characterized by Illumina sequencing. In addition, the complete genome sequences of three representative isolates (KP12, KP36, and KP37) were determined by Oxford Nanopore sequencing. The K. pneumoniae isolates were recovered from patients diagnosed with pulmonary infection, cancer, or encephalopathy. For all CRKP isolates, PFGE separated three clusters among all strains. The most predominant PFGE cluster contained 16 isolates collected from patients who shared close hospital units and represented a potential outbreak. All 16 isolates showed an extremely high resistance level (≥87.5%) to 18 antimicrobials tested but remain susceptible to colistin (CST). Multiple antimicrobial resistance and virulence determinants, such as the carbapenem resistance gene blaKPC-2, and genes encoding the virulence factor aerobactin and the regulator of the mucoid phenotype (rmpA and rmpA2), were observed in the 16 CRKP isolates. These isolates belonged to sequence type 11 (ST11) and capsular serotype KL64. A core genome single nucleotide polymorphism (cgSNP)-based phylogenetic analysis indicated that the 16 CRKP isolates could be partitioned into two separate clades (≤15 SNPs), suggesting the two independent transmission scenarios co-occurred. Moreover, a high prevalence of IncFIB/IncHI1B type virulence plasmid with the iroBCDN locus deleted, and an IncFII/IncR type blaKPC-2-bearing plasmid was co-harbored in ST11-KL64 CRKP isolates. In conclusion, our data indicated that the nosocomial dissemination of ST11-KL64 CRKP clone is a potential threat to anti-infective therapy. The development of novel strategies for surveillance, diagnosis, and treatment of this high-risk CRKP clone is urgently needed.
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Affiliation(s)
- Yingying Kong
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qingyang Sun
- Department of Clinical Laboratory, No. 903 Hospital of PLA Joint Logistic Support Force, Hangzhou, China
| | - Hangfei Chen
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mohamed S Draz
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Xinyou Xie
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Zhang
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhi Ruan
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Nishida S, Nakagawa M, Ouchi Y, Sakuma C, Nakajima Y, Shimizu H, Shibata T, Kurosawa Y, Maruyama T, Okumura CJ, Hatayama N, Sato Y, Asahara M, Ishigaki S, Furukawa T, Akuta T, Ono Y. A rabbit monoclonal antibody-mediated lateral flow immunoassay for rapid detection of CTX-M extended-spectrum β-lactamase-producing Enterobacterales. Int J Biol Macromol 2021; 185:317-323. [PMID: 34129888 DOI: 10.1016/j.ijbiomac.2021.06.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/04/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
Infections of CTX-M extended-spectrum β-lactamase-producing Enterobacterales are a severe threat in clinical settings. CTX-M genes on plasmids have been transferred to many Enterobacterales species, and these species have spread, leading to the global problem of antimicrobial resistance. Here, we developed a lateral flow immunoassay (LFIA) based on an anti-CTX-M rabbit monoclonal antibody. This antibody detected CTX-M variants from the CTX-M-9, CTX-M-2, and CTX-M-1 groups expressed in clinical isolates. The LFIA showed 100% sensitivity and specificity with clinical isolates on agar plates, and its limit of detection was 0.8 ng/mL recombinant CTX-M-14. The rabbit monoclonal antibody did not cross-react with bacteria producing other class A β-lactamases, including SHV. In conclusion, we developed a highly sensitive and specific LFIA capable of detecting CTX-M enzyme production in Enterobacterales. We anticipate that our LFIA will become a point-of-care test enabling rapid detection of CTX-M in hospital and community settings as well as a rapid environmental test.
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Affiliation(s)
- Satoshi Nishida
- Department of Microbiology and Immunology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
| | - Masataka Nakagawa
- Department of Microbiology and Immunology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan; Kyokuto Pharmaceutical Industrial Co., Ltd., 7-8 Nihonbashi Kobunacho, Chuo-ku, Tokyo, 103-0024, Japan
| | - Yuki Ouchi
- Kyokuto Pharmaceutical Industrial Co., Ltd., 7-8 Nihonbashi Kobunacho, Chuo-ku, Tokyo, 103-0024, Japan
| | - Chiaki Sakuma
- Kyokuto Pharmaceutical Industrial Co., Ltd., 7-8 Nihonbashi Kobunacho, Chuo-ku, Tokyo, 103-0024, Japan
| | - Yu Nakajima
- Kyokuto Pharmaceutical Industrial Co., Ltd., 7-8 Nihonbashi Kobunacho, Chuo-ku, Tokyo, 103-0024, Japan
| | - Hisayo Shimizu
- Kyokuto Pharmaceutical Industrial Co., Ltd., 7-8 Nihonbashi Kobunacho, Chuo-ku, Tokyo, 103-0024, Japan
| | - Takashi Shibata
- Kyokuto Pharmaceutical Industrial Co., Ltd., 7-8 Nihonbashi Kobunacho, Chuo-ku, Tokyo, 103-0024, Japan
| | - Yasunori Kurosawa
- Kyokuto Pharmaceutical Industrial Co., Ltd., 7-8 Nihonbashi Kobunacho, Chuo-ku, Tokyo, 103-0024, Japan
| | - Toshiaki Maruyama
- Abwiz Bio, Inc., 9823 Pacific Heights BLVD, Suite J, San Diego, CA, 92121, USA
| | - C J Okumura
- Abwiz Bio, Inc., 9823 Pacific Heights BLVD, Suite J, San Diego, CA, 92121, USA
| | - Nami Hatayama
- Department of Microbiology and Immunology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Yoshinori Sato
- Department of Microbiology and Immunology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Miwa Asahara
- Department of Laboratory Medicine, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Shinobu Ishigaki
- Department of Laboratory Medicine, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Taiji Furukawa
- Department of Laboratory Medicine, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Teruo Akuta
- Department of Microbiology and Immunology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan; Kyokuto Pharmaceutical Industrial Co., Ltd., 7-8 Nihonbashi Kobunacho, Chuo-ku, Tokyo, 103-0024, Japan
| | - Yasuo Ono
- Department of Microbiology and Immunology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
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