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Moghnia OH, Al-Sweih NA. Whole Genome Sequence Analysis of Multidrug Resistant Escherichia coli and Klebsiella pneumoniae Strains in Kuwait. Microorganisms 2022; 10:microorganisms10030507. [PMID: 35336083 PMCID: PMC8949579 DOI: 10.3390/microorganisms10030507] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
The spread of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae is a global concern. The management of infections caused by multidrug resistance (MDR) isolates poses substantial clinical challenges in both hospitals and communities. This study aimed to investigate the genetic characteristics and variations of MDR E. coli and K. pneumoniae isolates. Bacterial identification and antibiotic susceptibility testing against 19 antibiotics were performed by standard methods. Whole genome sequencing (WGS) was carried out on eight carbapenem-resistant isolates using an Illumina MiSeq platform. The assembled draft genomes were annotated, then sequences were blasted against antimicrobial resistance (AMR) genes database. WGS detected several resistance genes mediating the production of β-lactamases, including carbapenems and extended-spectrum β-lactamase genes as (blaOXA-1/-48, blaKPC-2/-29, blaCMY-4/-6, blaSHV-11/-12, blaTEM-1, blaCTX-M-15, blaOKP-B, blaACT and blaEC). Furthermore quinolone resistance including oqxA/oqxB, aac(6′)-Ib-cr5, gyrA_D87N, gyrA_S83F, gyrA_S83L, parC_S80I, parE_S458A, parE_I355T, parC_S80I, and qnrB1. In addition to aminoglycoside modifying enzymes genes (aph(6)-Id, aph(3″)-Ib, aac(3)-IIa, aac(6′)-Ib, aadA1, aadA2 and aadA5), trimethoprim-sulfamethoxazole (dfrA12/A14/A17 and sul1/sul2), tetracycline (tetA and tetB), fosfomycin (fosA and uhpT_E350Q) resistance genes, while other genes were detected conferring chloramphenicol (floR, catA2, and efflux pump cmIA5), macrolides resistance (mph(A) and erm(B), and quaternary ammonium efflux pump qacEdelta. Bleomycin and colistin resistance genes were detected as ble and pmrB_R256G, respectively. Comprehensive analysis of MDR strains provided by WGS detected variable antimicrobial resistance genes and their precise resistance mechanism. WGS is essential for control and prevention strategies to combat the growing threat of AMR and the implementation of multifaceted interventions are needed.
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Girijan SK, Paul R, V J RK, Pillai D. Investigating the impact of hospital antibiotic usage on aquatic environment and aquaculture systems: A molecular study of quinolone resistance in Escherichia coli. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 748:141538. [PMID: 32805571 DOI: 10.1016/j.scitotenv.2020.141538] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 05/26/2023]
Abstract
Quinolones are one of the most important classes of antibacterials available for the treatment of infectious diseases in humans. However, there is a growing concern about bacterial resistance to antimicrobials including quinolones. The spread of antibiotic-resistant bacteria in the aquatic environment has been recognized as a growing threat to public health and hospitals appear to be a major contributor to this. The objective of this study was to investigate the prevalence of quinolone resistance in Escherichia coli from selected water bodies receiving direct hospital effluents in Kerala, India. Standard disc diffusion and E-test were used for antibiotic susceptibility testing. As antibiotic resistance can develop in bacterial isolates by different means, EtBr Agar Cartwheel method was used to detect the efflux pump activity and presence of resistant genes was detected by PCR. The mechanism of transfer of plasmid mediated resistance was confirmed by conjugation experiments. A total of 209 multidrug-resistant Escherichia coli were isolated from different hospital effluent discharge sites and aquaculture farms located in their vicinity. Among them, qnrB was found to be most prevalent followed by qnrS, OqxAB, qnrA and aac (6')-Ib-cr. The results suggested that the antibiotics present at sub-inhibitory concentrations in direct hospital effluents increases the selection pressure impacting the cell function of even normal microorganisms in the aquatic environment to change the genetic expression of virulence factors or acquire resistance genes by different transfer mechanisms, posing a serious threat to public health.
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Affiliation(s)
- Sneha Kalasseril Girijan
- Department of Aquatic Animal Health Management, Kerala University of Fisheries and Ocean Studies, Kochi, Kerala, India
| | - Robin Paul
- State Laboratory for Livestock, Marine & Agri Products (SLMAP), Department of Animal Husbandry, Government of Kerala, India
| | - Rejish Kumar V J
- Department of Aquatic Animal Health Management, Kerala University of Fisheries and Ocean Studies, Kochi, Kerala, India; Department of Aquaculture, Kerala University of Fisheries and Ocean Studies, Kochi, Kerala, India
| | - Devika Pillai
- Department of Aquatic Animal Health Management, Kerala University of Fisheries and Ocean Studies, Kochi, Kerala, India.
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Geetha PV, Aishwarya KVL, Mariappan S, Sekar U. Fluoroquinolone Resistance in Clinical Isolates of Klebsiella Pneumonia e. J Lab Physicians 2020; 12:121-125. [PMID: 32905353 PMCID: PMC7467831 DOI: 10.1055/s-0040-1716478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction
Fluoroquinolones are widely used broad-spectrum antibiotics. Recently, increased rate of resistance to this antibiotic has been observed in Klebsiella pneumoniae. The aim of the present study was to determine the presence of quinolone resistance determining regions (QRDR) mutation genes and plasmid-mediated quinolone resistance (PMQR) determinants in clinical isolates of ciprofloxacin-resistant K. pneumoniae.
Material and Methods
The study included 110 nonduplicate ciprofloxacin-resistant K. pneumoniae clinical isolates. Antibiotic susceptibility testing by disk diffusion method and minimum inhibitory concentration (MIC) by agar dilution methods for ciprofloxacin was performed according to the recommendations of Clinical Laboratory Standards Institute. The presence of QRDR genes and PMQR genes was screened by polymerase chain reaction (PCR) amplification.
Result
All 110 isolates were resistance to ciprofloxacin, levofloxacin, and ofloxacin. As much as 88% of the isolates exhibited high-level of MIC to ciprofloxacin. Among the 110 isolates, 94(85%) harbored gyrA and 85 (77%) gyrB. The parC and parE genes were detected in 88 (80%) and 64 (58%) isolates. qnrB was detected in 13 (12%) isolates and qnrS in 5 (4.5%) isolates. Two (1.8%) isolates carried both qnrB and qnrS genes. The acc (6')-Ib-cr gene was found in 98 (89%) isolates and oqxAB was detected in 7 (6.3%) isolates. One (0.9%) isolate carried qnrB, acc(6')-Ib-cr and oqxAB genes.
Conclusion
The prevalence of acc (6')-Ib-cr gene is high among PMQR determinants, followed by qnrB, oqxAB and qnrS.
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Affiliation(s)
- Pacha Venkataramana Geetha
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | | | - Shanthi Mariappan
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - Uma Sekar
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
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4
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Basu S, Mukherjee M. Incidence and risk of co-transmission of plasmid-mediated quinolone resistance and extended-spectrum β-lactamase genes in fluoroquinolone-resistant uropathogenic Escherichia coli: a first study from Kolkata, India. J Glob Antimicrob Resist 2018; 14:217-223. [DOI: 10.1016/j.jgar.2018.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 02/15/2018] [Accepted: 03/24/2018] [Indexed: 10/17/2022] Open
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5
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Dasgupta N, Paul D, Dhar(Chanda) D, Ingti B, Bhattacharjee D, Chakravarty A, Bhattacharjee A. An insight into selection specificity of quinolone resistance determinants within Enterobacteriaceae family. J Glob Antimicrob Resist 2017; 10:40-46. [DOI: 10.1016/j.jgar.2017.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 01/17/2017] [Accepted: 03/08/2017] [Indexed: 11/30/2022] Open
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Singh SK, Mishra M, Sahoo M, Patole S, Sahu S, Misra SR, Mohapatra H. Antibiotic resistance determinants and clonal relationships among multidrug-resistant isolates of Klebsiella pneumoniae. Microb Pathog 2017. [PMID: 28629728 DOI: 10.1016/j.micpath.2017.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In the present study, we performed PCR based screening to determine the presence of antibiotic resistance genes and sequencing to find mutation in QRDR region among fourteen isolates of K. pneumoniae. Association analysis was conducted to detect the co-resistance among the isolates. Multi-locus sequence analysis was carried out to determine the clonal relationship among them. All the K. pneumoniae isolates showed resistance to multiple antibiotics and exhibited cross-resistance to antibiotics. Although few isolates co-harbored variants of β-lactamase genes, others carried qnrB on plasmid and mutations in Quinolone-Resistant Determining Region (QRDR). This study thus indicates that clonally unrelated K. pneumoniae isolates exhibited co-resistance, harboured multiple antibiotic resistance genes present on the chromosome, plasmids and/or integron Therefore, the data from this study can provide guidelines for the prudent use of antibiotics to avert the impending danger of losing out on the available antibiotics for therapeutic use.
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Affiliation(s)
- Santosh Kumar Singh
- Room No. 320, 3rd Floor, School of Biological Sciences, National Institute of Science Education and Research, HBNI, Jatni, District:-Khurda, 752050, India
| | - Mitali Mishra
- Room No. 320, 3rd Floor, School of Biological Sciences, National Institute of Science Education and Research, HBNI, Jatni, District:-Khurda, 752050, India
| | - Minu Sahoo
- Room No. 320, 3rd Floor, School of Biological Sciences, National Institute of Science Education and Research, HBNI, Jatni, District:-Khurda, 752050, India
| | - Shashank Patole
- Room No. 320, 3rd Floor, School of Biological Sciences, National Institute of Science Education and Research, HBNI, Jatni, District:-Khurda, 752050, India
| | - Suneeta Sahu
- Apollo Hospital, Sainik School Road, Bhubaneswar 751005, Odisha, India
| | | | - Harapriya Mohapatra
- Room No. 320, 3rd Floor, School of Biological Sciences, National Institute of Science Education and Research, HBNI, Jatni, District:-Khurda, 752050, India.
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7
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Tayh G, Ben Sallem R, Ben Yahia H, Gharsa H, Klibi N, Boudabous A, Ben Slama K. First Report of Extended-Spectrum β-Lactamases Among Clinical Isolates ofKlebsiella pneumoniaein Gaza Strip, Palestine. Microb Drug Resist 2017; 23:169-176. [DOI: 10.1089/mdr.2016.0089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ghassan Tayh
- Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences de Tunis, Université de Tunis-El Manar, Tunis, Tunisie
| | - Rym Ben Sallem
- Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences de Tunis, Université de Tunis-El Manar, Tunis, Tunisie
| | - Houssem Ben Yahia
- Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences de Tunis, Université de Tunis-El Manar, Tunis, Tunisie
| | - Haythem Gharsa
- Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences de Tunis, Université de Tunis-El Manar, Tunis, Tunisie
- Institut Supérieur des Sciences Biologiques Appliquées de Tunis, Université de Tunis El-Manar, Tunis, Tunisie
| | - Naouel Klibi
- Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences de Tunis, Université de Tunis-El Manar, Tunis, Tunisie
| | - Abdellatif Boudabous
- Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences de Tunis, Université de Tunis-El Manar, Tunis, Tunisie
| | - Karim Ben Slama
- Laboratoire des Microorganismes et Biomolécules Actives, Faculté des Sciences de Tunis, Université de Tunis-El Manar, Tunis, Tunisie
- Institut Supérieur des Sciences Biologiques Appliquées de Tunis, Université de Tunis El-Manar, Tunis, Tunisie
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Subramanian GK, Soundari PG, Ramanathan V, Krishnan P. Endemic Indian clones of Klebsiella pneumoniae-harbouring New Delhi metallo-beta-lactamase-1 on a hybrid plasmid replicon type: A case of changing New Delhi metallo-beta-lactamase plasmid landscapes in India? Indian J Med Microbiol 2017; 34:286-92. [PMID: 27514948 DOI: 10.4103/0255-0857.188314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE blaNDM genes are MBL genes that confer resistance to carbapenems. Globally, they are associated with diverse clones and plasmids. In this study, we characterised three isolates of Klebsiella pneumoniae-harbouring blaNDM1 from patients undergoing chronic haemodialysis and renal transplantation. MATERIALS AND METHODS 3 blaNDM1 -producing K. pneumoniae were isolated from end-stage renal disease patients undergoing haemodialysis and renal transplantation from a nephrology unit. All the three isolates were screened for clinically relevant resistant genes. Plasmid replicon content was analysed by polymerase chain reaction based replicon typing. Conjugation assays were done using azide-resistant Escherichia coli J53 as the recipient strain. Multilocus sequence typing and variable number tandem repeat typing were done to find the clonality. Replicon sequence based typing was attempted to find the diversity of replicon-associated sequences in IncHI3 plasmids. RESULTS All the 3 blaNDM positive isolates possessed the New Delhi metallo-beta-lactamase-1 (NDM-1) allele with an IncHI3 plasmid which was not transferable in one isolate. The isolates were found to be sequence type 14 (ST14; 2 nos) and ST38 both of which were previously reported to be the NDM-producing K. pneumoniae STs prevalent in India. Replicon sequence analysis revealed limited sequence diversity within the repHI3 and repFIB locus. CONCLUSION To the best of our knowledge, this is the first report of IncHI3, a newly assigned enterobacterial plasmid incompatibility group from India. This could either be a case of importation or a widely circulating NDM plasmid type in India.
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Affiliation(s)
- G K Subramanian
- Department of Microbiology, Dr. ALM PGIBMS, University of Madras, Chennai, Tamil Nadu, India
| | - P G Soundari
- Department of Microbiology, Dr. ALM PGIBMS, University of Madras, Chennai, Tamil Nadu, India
| | - V Ramanathan
- Nephrology Unit, Billroth Hospitals, Chennai - 600 028, Tamil Nadu, India
| | - P Krishnan
- Department of Microbiology, Dr. ALM PGIBMS, University of Madras, Chennai, Tamil Nadu, India
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9
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Rafiq Z, Sam N, Vaidyanathan R. Whole genome sequence of Klebsiella pneumoniae U25, a hypermucoviscous, multidrug resistant, biofilm producing isolate from India. Mem Inst Oswaldo Cruz 2016; 111:144-6. [PMID: 26872343 PMCID: PMC4750456 DOI: 10.1590/0074-02760150423] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/25/2016] [Indexed: 01/31/2023] Open
Abstract
Klebsiella pneumoniae U25 is a multidrug resistant strain isolated
from a tertiary care hospital in Chennai, India. Here, we report the complete
annotated genome sequence of strain U25 obtained using PacBio RSII. This is the first
report of the whole genome of K. pneumoniaespecies from Chennai. It
consists of a single circular chromosome of size 5,491,870-bp and two plasmids of
size 211,813 and 172,619-bp. The genes associated with multidrug resistance were
identified. The chromosome of U25 was found to have eight antibiotic resistant genes
[blaOXA-1,blaSHV-28,
aac(6’)1b-cr,catB3, oqxAB,
dfrA1]. The plasmid pMGRU25-001 was found to have only one
resistant gene (catA1) while plasmid pMGRU25-002 had 20 resistant
genes [strAB, aadA1,aac(6’)-Ib,
aac(3)-IId,sul1,2,
blaTEM-1A,1B,blaOXA-9,
blaCTX-M-15,blaSHV-11, cmlA1,
erm(B),mph(A)]. A mutation in the porin OmpK36
was identified which is likely to be associated with the intermediate resistance to
carbapenems in the absence of carbapenemase genes. U25 is one of the few K.
pneumoniaestrains to harbour clustered regularly interspaced short
palindromic repeats (CRISPR) systems. Two CRISPR arrays corresponding to Cas3 family
helicase were identified in the genome. When compared to K.
pneumoniaeNTUHK2044, a transposase gene InsH of IS5-13
was found inserted.
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Affiliation(s)
- Zumaana Rafiq
- Department of Biotechnology, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu, India
| | - Nithin Sam
- Department of Biotechnology, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu, India
| | - Rama Vaidyanathan
- Department of Biotechnology, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu, India
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10
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Yugendran T, Harish BN. High incidence of plasmid-mediated quinolone resistance genes among ciprofloxacin-resistant clinical isolates of Enterobacteriaceae at a tertiary care hospital in Puducherry, India. PeerJ 2016; 4:e1995. [PMID: 27168994 PMCID: PMC4860338 DOI: 10.7717/peerj.1995] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/10/2016] [Indexed: 11/20/2022] Open
Abstract
Background. Plasmid-mediated quinolone resistance (PMQR) has received considerable attention recently. Data analysis in Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) revealed 75% of the Enterobacteriaceae isolates to be ciprofloxacin-resistant in 2012. Few reports regarding the prevalence of PMQR are available from India. Hence, the present study was carried out to ascertain the prevalence of PMQR genes among clinical isolates of ciprofloxacin-resistant Enterobacteriaceae in JIPMER. Methods. The study included 642 ciprofloxacin-resistant clinical Enterobacteriaceae isolates. JIPMER hospital's annual consumption data for fluoroquinolones were retrieved from the Department of Pharmacy. The test isolates were screened for the presence of qnr A, B, D, S and aac(6')-Ib-cr genes. PMQR-positive isolates alone were tested for the presence of class I (intI1) and class II (intI2) integrons. Randomly selected PCR amplicons were sequenced and analysed using MEGA software. A total of 30 PMQR strains chosen at random were assessed for the transferability of the PMQR genes. Results. A majority of the strains exhibited high MIC values with 106 strains exhibiting MIC values >256 µg/mL. The aac(6')-Ib-cr gene had the highest prevalence at 64% (414) while, qnrB and qnrS genes were present in 15% (97) and 10% (64) of the isolates respectively. None of the strains were positive for qnrA and qnrD. All PMQR-positive isolates were screened for class I (intI1) and class II (intI2) integrons. Class I integron was found to be predominant among the test isolates with a few of them carrying both the classes of integrons. Transferability of PMQR genes to transconjugants was identified. Conclusion. The incidence of PMQR genes in the tertiary-care setup of the JIPMER hospital was found to be high which could be probably due to the increased prescription of fluoroquinolones. Thus, there is a need for rational usage of fluoroquinolones.
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Affiliation(s)
- Thiyagarajan Yugendran
- Department of Microbiology, Jawaharlal Institute for Post-graduate Medical Education and Research , Puducherry , India
| | - Belgode Narasimha Harish
- Department of Microbiology, Jawaharlal Institute for Post-graduate Medical Education and Research , Puducherry , India
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11
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Successful international clones of blaCTX-M-15–producing Klebsiella pneumoniae with coexpression of plasmid-mediated quinolone resistance (PMQR) determinants in Tehran hospitals. Diagn Microbiol Infect Dis 2015; 83:371-4. [DOI: 10.1016/j.diagmicrobio.2015.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/06/2015] [Accepted: 09/09/2015] [Indexed: 11/22/2022]
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Chandran S, Diwan V, Tamhankar A, Joseph B, Rosales-Klintz S, Mundayoor S, Lundborg C, Macaden R. Detection of carbapenem resistance genes and cephalosporin, and quinolone resistance genes along with oqxAB
gene in Escherichia coli
in hospital wastewater: a matter of concern. J Appl Microbiol 2014; 117:984-95. [DOI: 10.1111/jam.12591] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/07/2014] [Accepted: 06/25/2014] [Indexed: 01/22/2023]
Affiliation(s)
- S.P. Chandran
- Division of Infectious Diseases; St. John's Research Institute; Bangalore India
- Department of Microbiology; St. John's Medical College; Bangalore India
| | - V. Diwan
- Department of Public Health Sciences; Global Health/IHCAR; Karolinska Institutet; Stockholm Sweden
- Department of Public Health and Environment; R.D. Gardi Medical College; Ujjain India
- International Center for Health Research; R.D. Gardi Medical College; Ujjain India
| | - A.J. Tamhankar
- Department of Public Health Sciences; Global Health/IHCAR; Karolinska Institutet; Stockholm Sweden
- Department of Environmental Medicine; Indian Initiative for Management of Antibiotic Resistance (IIMAR); R D Gardi Medical College; Ujjain India
| | - B.V. Joseph
- Departments of Biotechnology; Christ University; Bangalore India
| | - S. Rosales-Klintz
- Department of Public Health Sciences; Global Health/IHCAR; Karolinska Institutet; Stockholm Sweden
| | - S. Mundayoor
- Mycobacterial Research Group; Department of Molecular Microbiology; Rajiv Gandhi Centre for Biotechnology; Thiruvananthapuram India
| | - C.S. Lundborg
- Department of Public Health Sciences; Global Health/IHCAR; Karolinska Institutet; Stockholm Sweden
| | - R. Macaden
- Division of Infectious Diseases; St. John's Research Institute; Bangalore India
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Raei F, Eftekhar F, Feizabadi MM. Prevalence of Quinolone Resistance Among Extended-Spectrum β -Lactamase Producing Uropathogenic Klebsiella pneumoniae. Jundishapur J Microbiol 2014; 7:e10887. [PMID: 25371807 PMCID: PMC4217673 DOI: 10.5812/jjm.10887] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 07/20/2013] [Accepted: 07/28/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Extended-spectrum β-lactamase (ESBL) production is the major resistance mechanism to β-lactam antibiotics in Enterobacteriaceae. In addition, emergence of plasmid-mediated quinolone resistance (PMQR) in ESBL-producing isolates has become a global threat for treatment of these infections. OBJECTIVES We investigated the association between ESBL production and quinolone resistance in urinary isolates of K. pneumoniae. PATIENTS AND METHODS A total of 196 urinary isolates of K. pneumoniae were collected from Imam Hussein Hospital in Tehran during a four year period (2008-2012). Antibiotic susceptibility was determined by disc diffusion and ESBL production was screened using the phenotypic confirmatory test (PCT). RESULTS All isolates were susceptible to imipenem. Resistance to piperacillin and cefotaxime were 66.3% and 50.5%, respectively. Resistance to ceftazidime, amoxiclave, aztreonam, ceftriaxone, cefepime, nitrofurantoin, gentamicin, ciprofloxacin, nalidixic acid, ofloxacin, norfloxacin, levofloxacin, amikacin and pipracilin/tazobactam were less than 50%. ESBL production was detected in 92 isolates (46.9%) of which, 61.9% were resistant to nalidixic acid and 65.2% to ciprofloxacin. Multidrug-resistance was observed in 96.7% of ESBL producers. CONCLUSIONS Our results showed coexistence of ESBL and quinolone resistance in the majority of the uropathogenic K. pneumoniae test isolates suggesting that care should be taken for the choice of antibiotic therapy.
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Affiliation(s)
- Fereshteh Raei
- Department of Microbiology, Faculty of Biological Sciences, Shahid Beheshti University, General Campus, Tehran, IR Iran
| | - Fereshteh Eftekhar
- Department of Microbiology, Faculty of Biological Sciences, Shahid Beheshti University, General Campus, Tehran, IR Iran
- Corresponding author: Fereshteh Eftekhar, Department of Microbiology, Faculty of Biological Sciences, Shahid Beheshti University, General Campus, Tehran, IR Iran. Tel: +98-2129903208, Fax: +98-2122431664, E-mail:
| | - Mohammad Mehdi Feizabadi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
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Jlili NEH, Réjiba S, Smaoui H, Guillard T, Chau F, Kechrid A, Cambau E. Trend of plasmid-mediated quinolone resistance genes at the Children's Hospital in Tunisia. J Med Microbiol 2013; 63:195-202. [PMID: 24194556 DOI: 10.1099/jmm.0.062216-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The prevalence of plasmid-mediated quinolone resistance genes [qnr, aac(6')-Ib-cr and qepA] was sought among Enterobacteriaceae strains obtained from the Children's Hospital of Tunis (Tunisia). Non-duplicate isolates (n = 278) with resistance to extended-spectrum cephalosporins and collected in 2003, 2007, 2008 and 2009 were screened for qnr genes. Forty (14.4 %) isolates were qnr positive and were screened for the presence of the aac(6')-Ib-cr and qepA genes. qnrB was detected in 21 Klebsiella pneumoniae, 11 Escherichia coli and 6 Enterobacter cloacae isolates. Sequence analysis of the qnrB amplicons revealed variants including 24 qnrB1, 11 qnrB2 and 3 qnrB6. qnrS (qnrS1 allele) was detected only in K. pneumoniae isolates, either alone (two isolates) or with the qnrB gene (one isolate). The qnrA, qnrC and qnrD genes were not found in any of the 278 isolates. No qnr-positive isolates carried the qepA gene. Pyrosequencing results showed that aac(6')-Ib-cr, a variant of the aac(6')-Ib gene, was present in 31 qnr-positive isolates (21 K. pneumoniae isolates, seven Escherichia coli isolates and three Enterobacter cloacae isolates). aac(6')-Ib was also found either alone (two isolates) or in association with aac(6')-Ib-cr (one isolate). Of the 40 qnr-positive isolates, 92.5, 82.5, 57.5, 85 and 82.5 % were non-susceptible to nalidixic acid, ciprofloxacin, levofloxacin, ofloxacin and norfloxacin, respectively, and all were extended-spectrum β-lactamase producers. Random amplified polymorphic DNA-PCR typing of these isolates showed 16, 8 and 5 different genotypes in K. pneumoniae, Escherichia coli and Enterobacter cloacae isolates, respectively. Our study highlights the high prevalence of qnr in association with aac(6')-Ib-cr among Enterobacteriaceae isolates, even from children, who are patients not overtreated with quinolones.
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Affiliation(s)
- Nour El-Houda Jlili
- EA3964, Université Paris Diderot, Paris, France.,Unité de Recherche UR12ES01, Faculté de Médecine de Tunis, Université de Tunis El Manar; Laboratoire de Microbiologie, Hôpital d'Enfants Béchir Hamza, Bab Saadoun 1068, Tunis, Tunisia
| | - Samia Réjiba
- Département des Sciences Biologiques, Faculté des Sciences de Tunis, Université Tunis El Manar, 2092, Tunis, Tunisia.,Unité de Recherche UR12ES01, Faculté de Médecine de Tunis, Université de Tunis El Manar; Laboratoire de Microbiologie, Hôpital d'Enfants Béchir Hamza, Bab Saadoun 1068, Tunis, Tunisia
| | - Hanen Smaoui
- Unité de Recherche UR12ES01, Faculté de Médecine de Tunis, Université de Tunis El Manar; Laboratoire de Microbiologie, Hôpital d'Enfants Béchir Hamza, Bab Saadoun 1068, Tunis, Tunisia
| | - Thomas Guillard
- Laboratoire de Bactériologie-Virologie-Hygiène, Hôpital Robert Debré, CHU Reims, F-51092 Reims, France.,EA3964, Université Paris Diderot, Paris, France
| | | | - Amel Kechrid
- Unité de Recherche UR12ES01, Faculté de Médecine de Tunis, Université de Tunis El Manar; Laboratoire de Microbiologie, Hôpital d'Enfants Béchir Hamza, Bab Saadoun 1068, Tunis, Tunisia
| | - Emmanuelle Cambau
- Laboratoire de Bactériologie, APHP, Hôpital Lariboisière, Paris, France.,EA3964, Université Paris Diderot, Paris, France
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