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Messaoudene M, Saint-Lu N, Sablier-Gallis F, Ferreira S, Ponce M, Bescop CL, Loppinet T, Corbel T, Féger C, Vitry F, Andremont A, de Gunzburg J, Routy B. Abstract 5882: Prevention of antibiotic-induced dysbiosis in human volunteers by DAV132 and preservation of responsiveness to anti-PD-1 demonstrated by transplantation of human feces into tumor-bearing mice. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-5882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background: Over the last decade, studies unraveled the cancer-immune dialogue in the setting of immune checkpoint inhibitors (ICI) and influenced by the gut microbiota. The first evidence of the key role of the microbiota in ICI modulation was observed during antibiotics (ATB) treatment, where altering the microbiota composition by ATB inhibited ICI responses. DAV132 (DAV) is an orally administered colon-targeted ATB adsorbent capsules designed to prevent ATB-induced dysbiosis. We investigated whether DAV co-administered with ATB could prevent ATB-related dysbiosis and ICI response.
Methods: 72 human healthy volunteers (HV) were randomized to receive either IV ceftazidime-avibactam (CZA) or Piperacillin tazobactam (PTZ) alone or in combination with oral DAV. CZA and PTZ plasmatic and fecal pharmacodynamic levels were measured using HPLC-MS/MS. Microbiome was profiled with metagenomics at different timepoints. FMT experiments in germ-free mice were performed using fecal samples from HV from the trial, before (D1) or after 6 days (D6) of CZA or PTZ+/-DAV; subsequently mice were inoculated with MCA205 or B16 tumors and treated with anti-PD-1. Tumor infiltrating lymphocytes (TILs) were analyzed by flow cytometry.
Results: DAV did not impact plasmatic CZA or PTZ concentrations, but significantly reduced ceftazidime and piperacillin concentrations in feces compared to ATB groups alone. DAV significantly prevented the reduction in microbiota alpha-diversity at D6 and was associated with a rapid return to baseline microbiota. 50 and 43 metagenomics species were preserved in the CZA+DAV vs CZA, or PTZ-DAV vs PTZ such as Faecalibacterium praunistzii, Alistipes Spp and Blautia obeum. FMT in germ-free mice using feces collected at D1 exhibited a significant anti-PD-1 activity. This anti-tumor response was inhibited in two tumors models in mice transplanted with D6 feces from patients in the CZA or PTZ alone groups. Conversely, the anti-tumor response was maintained in mice transplanted with D6 feces from HV treated with CZA+DAV or PTZ+DAV groups. Flow cytometry on TILs demonstrated that CZA decreased CD8+T cell and CD8+/Treg ratio compared to CZA+DAV.
Conclusions: DAV prevented ATB-induced dysbiosis in HV treated with CZA or PTZ without influencing plasmatic concentrations. In avatar mice FMT from HV treated with CZA+DAV was able to preserve anti-PD-1 efficacy. These results provide rationale to launch clinical trials combining DAV in patients on ATB amenable to ICI.
Citation Format: Meriem Messaoudene, Nathalie Saint-Lu, Frédérique Sablier-Gallis, Stéphanie Ferreira, Mayra Ponce, Clément Le Bescop, Thomas Loppinet, Tanguy Corbel, Céline Féger, Fabien Vitry, Antoine Andremont, Jean de Gunzburg, Bertrand Routy. Prevention of antibiotic-induced dysbiosis in human volunteers by DAV132 and preservation of responsiveness to anti-PD-1 demonstrated by transplantation of human feces into tumor-bearing mice [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5882.
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Affiliation(s)
| | | | | | | | - Mayra Ponce
- 1University of Montreal, Montreal, Quebec, Canada
| | | | | | | | - Céline Féger
- 1University of Montreal, Montreal, Quebec, Canada
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Rondinaud E, Clermont O, Petitjean M, Ruppé E, Esposito-Farèse M, Nazimoudine A, Coignard B, Matheron S, Andremont A, Denamur E, Armand-Lefevre L. Acquisition of Enterobacterales carrying the colistin resistance gene mcr following travel to the tropics. J Travel Med 2023; 30:6851135. [PMID: 36444951 DOI: 10.1093/jtm/taac141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/04/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Colistin is an antibiotic of last resort in the management of highly drug-resistant Enterobacterales infections. Travel to some destinations presents a high risk of acquiring multidrug-resistant Enterobacterales, but little data are available on the risk of acquiring colistin-resistant strains. Here, we use the VOYAG-R sample collection (2012-2013) in order to evaluate the rate of acquisition of colistin-resistant Enterobacterales, excluding species with intrinsic resistance (CRE), following travel to tropical regions. METHODS A total of 574 frozen stool samples of travellers returning from tropical regions were screened for colistin-resistant strains using ChromID Colistin R agar (bioMerieux®) after pre-enrichment culture with 1 mg/L of colistin. Genomes were obtained by Illumina sequencing and genetic determinants of colistin resistance (mutational events and mcr genes) were searched. RESULTS A total of 22 travellers (3.8%) acquired colistin-resistant Enterobacterales carrying an mcr gene. Acquisition rates varied between visited regions: 9.2% (18/195) for Asia (southeast Asia: 17/18), 2.2% (4/184) for Latin America (Peru: 4/4) and 0% from Africa (0/195). Acquired strains were predominantly Escherichia coli (92%) and carried mostly the mcr-1 variant (83%). Escherichia coli strains belonged mainly to commensal phylogroups A and B1, and were genetically highly diverse (5 non-clonal sequence type (ST)10 and 17 ST singletons). Only four non mcr colistin-resistant strains (two E. coli and two Enterobacter cloacae complex) were identified. Among all the strains, two also carried extended-spectrum beta-lactamase genes. CONCLUSIONS Travel to tropical regions, and particularly to Southeast Asia, is a risk factor for the acquisition of mcr-carrying Enterobacterales. This study highlights the community dissemination of mcr in humans as early as 2012, 4 years prior to its first published description.
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Affiliation(s)
- Emilie Rondinaud
- Bacteriology Laboratory, Bichat-Claude Bernard Hospital, AP-HP Nord-Université Paris Cité, F-75018 Paris, France
- University of Paris Cité, INSERM UMR 1137 IAME, F-75018 Paris, France
| | - Olivier Clermont
- University of Paris Cité, INSERM UMR 1137 IAME, F-75018 Paris, France
| | - Marie Petitjean
- University of Paris Cité, INSERM UMR 1137 IAME, F-75018 Paris, France
| | - Etienne Ruppé
- Bacteriology Laboratory, Bichat-Claude Bernard Hospital, AP-HP Nord-Université Paris Cité, F-75018 Paris, France
- University of Paris Cité, INSERM UMR 1137 IAME, F-75018 Paris, France
| | - Marina Esposito-Farèse
- URC HUPNVS, Paris, France; INSERM CIC 1425-EC, UMR1123, Clinical Investigation Center, Bichat-Claude Bernard Hospital, AP-HP Nord-Université Paris Cité, F-75018 Paris, France
| | - Anissa Nazimoudine
- Bacteriology Laboratory, Bichat-Claude Bernard Hospital, AP-HP Nord-Université Paris Cité, F-75018 Paris, France
| | | | | | - Sophie Matheron
- University of Paris Cité, INSERM UMR 1137 IAME, F-75018 Paris, France
- Department of Infectious and Tropical Diseases, Bichat-Claude Bernard Hospital, AP-HP Nord-Paris Cité University, F-75018 Paris, France
| | - Antoine Andremont
- University of Paris Cité, INSERM UMR 1137 IAME, F-75018 Paris, France
| | - Erick Denamur
- University of Paris Cité, INSERM UMR 1137 IAME, F-75018 Paris, France
- Molecular Genetics Laboratory, Bichat-Claude Bernard Hospital, AP-HP Nord-Université Paris Cité, F-75018 Paris, France
| | - Laurence Armand-Lefevre
- Bacteriology Laboratory, Bichat-Claude Bernard Hospital, AP-HP Nord-Université Paris Cité, F-75018 Paris, France
- University of Paris Cité, INSERM UMR 1137 IAME, F-75018 Paris, France
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Messaoudene M, Saint-Lu N, Sablier-Gallis F, Ferreira S, Le Bescop C, Ponce M, Féger C, Andremont A, de Gunzburg J, Routy B. 1663MO DAV132 prevents antibiotic-induced intestinal microbiota dysbiosis and maintains anti-PD-1 efficacy: A proof-of-concept in tumor-bearing mice transplanted with human feces. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Vehreschild MJGT, Ducher A, Louie T, Cornely OA, Feger C, Dane A, Varastet M, Vitry F, de Gunzburg J, Andremont A, Mentré F, Wilcox MH. An open randomized multicentre Phase 2 trial to assess the safety of DAV132 and its efficacy to protect gut microbiota diversity in hospitalized patients treated with fluoroquinolones. J Antimicrob Chemother 2022; 77:1155-1165. [PMID: 35016205 PMCID: PMC8969469 DOI: 10.1093/jac/dkab474] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/19/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND DAV132 (colon-targeted adsorbent) has prevented antibiotic-induced effects on microbiota in healthy volunteers. OBJECTIVES To assess DAV132 safety and biological efficacy in patients. PATIENTS AND METHODS An open-label, randomized [stratification: fluoroquinolone (FQ) indication] multicentre trial comparing DAV132 (7.5 g, 3 times a day, orally) with No-DAV132 in hospitalized patients requiring 5-21 day treatment with FQs and at risk of Clostridioides difficile infection (CDI). FQ and DAV132 were started simultaneously, DAV132 was administered for 48 h more, and patients were followed up for 51 days. The primary endpoint was the rate of adverse events (AEs) independently adjudicated as related to DAV132 and/or FQ. The planned sample size of 260 patients would provide a 95% CI of ±11.4%, assuming a 33% treatment-related AE rate. Plasma and faecal FQ concentrations, intestinal microbiota diversity, intestinal colonization with C. difficile, MDR bacteria and yeasts, and ex vivo resistance to C. difficile faecal colonization were assessed. RESULTS Two hundred and forty-three patients (median age 71 years; 96% with chronic comorbidity) were included (No-DAV132, n = 120; DAV132, n = 123). DAV132- and/or FQ-related AEs did not differ significantly: 18 (14.8%) versus 13 (10.8%) in DAV132 versus No-DAV132 patients (difference 3.9%; 95% CI: -4.7 to 12.6). Day 4 FQ plasma levels were unaffected. DAV132 was associated with a >98% reduction in faecal FQ levels (Day 4 to end of treatment; P < 0.001), less impaired microbiota diversity (Shannon index; P = 0.003), increased ex vivo resistance to C. difficile colonization (P = 0.0003) and less frequent FQ-induced VRE acquisition (P = 0.01). CONCLUSIONS In FQ-treated hospitalized patients, DAV132 was well tolerated, and FQ plasma concentrations unaffected. DAV132 preserved intestinal microbiota diversity and C. difficile colonization resistance.
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Affiliation(s)
- Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Thomas Louie
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Oliver A Cornely
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Celine Feger
- Da Volterra, Paris, France.,EMIBiotech, Paris, France
| | | | | | | | | | - Antoine Andremont
- Da Volterra, Paris, France.,Université de Paris, IAME, INSERM U1137, Paris, France
| | - France Mentré
- Université de Paris, IAME, INSERM U1137, Paris, France
| | - Mark H Wilcox
- Leeds Institute of Medical Research, University of Leeds and Leeds Teaching Hospitals, Leeds, UK
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Milenkov M, Rasoanandrasana S, Rahajamanana LV, Rakotomalala RS, Razafindrakoto CA, Rafalimanana C, Ravelomandranto E, Ravaoarisaina Z, Westeel E, Petitjean M, Mullaert J, Clermont O, Raskine L, Samison LH, Endtz H, Andremont A, Denamur E, Komurian-Pradel F, Armand-Lefevre L. Prevalence, Risk Factors, and Genetic Characterization of Extended-Spectrum Beta-Lactamase Escherichia coli Isolated From Healthy Pregnant Women in Madagascar. Front Microbiol 2021; 12:786146. [PMID: 35003019 PMCID: PMC8740230 DOI: 10.3389/fmicb.2021.786146] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/17/2021] [Indexed: 12/14/2022] Open
Abstract
Antimicrobial resistance is a major public health concern worldwide affecting humans, animals and the environment. However, data is lacking especially in developing countries. Thus, the World Health Organization developed a One-Health surveillance project called Tricycle focusing on the prevalence of ESBL-producing Escherichia coli in humans, animals, and the environment. Here we present the first results of the human community component of Tricycle in Madagascar. From July 2018 to April 2019, rectal swabs from 492 pregnant women from Antananarivo, Mahajanga, Ambatondrazaka, and Toamasina were tested for ESBL-E. coli carriage. Demographic, sociological and environmental risk factors were investigated, and E. coli isolates were characterized (antibiotic susceptibility, resistance and virulence genes, plasmids, and genomic diversity). ESBL-E. coli prevalence carriage in pregnant women was 34% varying from 12% (Toamasina) to 65% (Ambatondrazaka). The main risk factor associated with ESBL-E. coli carriage was the rainy season (OR = 2.9, 95% CI 1.3-5.6, p = 0.009). Whole genome sequencing was performed on 168 isolates from 144 participants. bla CTX-M-15 was the most frequent ESBL gene (86%). One isolate was resistant to carbapenems and carried the bla NDM-5 gene. Most isolates belonged to commensalism associated phylogenetic groups A, B1, and C (90%) and marginally to extra-intestinal virulence associated phylogenetic groups B2, D and F (10%). Multi locus sequence typing showed 67 different sequence types gathered in 17 clonal complexes (STc), the most frequent being STc10/phylogroup A (35%), followed distantly by the emerging STc155/phylogroup B1 (7%), STc38/phylogroup D (4%) and STc131/phylogroup B2 (3%). While a wide diversity of clones has been observed, SNP analysis revealed several genetically close isolates (n = 34/168) which suggests human-to-human transmissions. IncY plasmids were found with an unusual prevalence (23%), all carrying a bla CTX-M-15. Most of them (85%) showed substantial homology (≥85%) suggesting a dissemination of IncY ESBL plasmids in Madagascar. This large-scale study reveals a high prevalence of ESBL-E. coli among pregnant women in four cities in Madagascar associated with warmth and rainfall. It shows the great diversity of E. coli disseminating throughout the country but also transmission of specific clones and spread of plasmids. This highlights the urgent need of public-health interventions to control antibiotic resistance in the country.
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Affiliation(s)
- Milen Milenkov
- Fondation Mérieux, Lyon, France
- Université de Paris, IAME, INSERM UMR 1137, Paris, France
| | - Saida Rasoanandrasana
- Laboratoire de Bactériologie, CHU Joseph Raseta Befelatanana, RESAMAD Network, Antananarivo, Madagascar
| | | | | | | | - Christian Rafalimanana
- Laboratoire de Bactériologie, CHU Joseph Ravoahangy Andrianavalona, RESAMAD Network, Antananarivo, Madagascar
| | - Emile Ravelomandranto
- Laboratoire de Bactériologie, CHRR Alaotra Mangoro, RESAMAD Network, Ambatondrazaka, Madagascar
| | | | | | | | - Jimmy Mullaert
- Université de Paris, IAME, INSERM UMR 1137, Paris, France
| | | | | | - Luc Hervé Samison
- Centre d’Infectiologie Charles Mérieux, University of Antananarivo, Antananarivo, Madagascar
| | - Hubert Endtz
- Fondation Mérieux, Lyon, France
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, Netherlands
| | | | - Erick Denamur
- Université de Paris, IAME, INSERM UMR 1137, Paris, France
- Laboratoire de Génétique Moléculaire, Hôpital Bichat-Claude Bernard, AP-HP Nord-Université de Paris, Paris, France
| | | | - Laurence Armand-Lefevre
- Université de Paris, IAME, INSERM UMR 1137, Paris, France
- Laboratoire de Bactériologie, Hôpital Bichat-Claude Bernard, AP-HP Nord-Université de Paris, Paris, France
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Feldman SF, Temkin E, Wullfhart L, Nutman A, Schechner V, Shitrit P, Shvartz R, Schwaber MJ, Andremont A, Carmeli Y. A nationwide population-based study of Escherichia coli bloodstream infections: incidence, antimicrobial resistance and mortality. Clin Microbiol Infect 2021; 28:879.e1-879.e7. [PMID: 34922002 DOI: 10.1016/j.cmi.2021.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/16/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Escherichia coli is the leading cause of bloodstream infection (BSI). The incidence of E. coli BSI caused by antibiotic-resistant strains is increasing. We aimed to describe the nationwide incidence and resistance profile of E. coli BSI in Israel and its impact on mortality, to compare E. coli BSI mortality to all-cause mortality, and community-onset to hospital-onset E. coli BSI. METHODS We used mandatory BSI surveillance reports submitted by all Israeli hospitals to the Ministry of Health and the national death registry. All E. coli BSI from January 1, 2018, to December 31, 2019 in patients ages 18 and over were included. RESULTS A total of 11 113 E. coli BSI occurred in 10 218 patients; 85% (9012/10 583) were community onset. Median age was 76 (IQR 65-85), and 57% (6304/11 113) of cases occurred in women. The annual incidence was 92.5 per 100,000 population. Antibiotic resistance was frequent and significantly more common in hospital-onset than in community-onset BSI; 65% (1021/1571) vs 45% (4049/9012) were multidrug-resistant (MDR) (p<0.001). The case-fatality rate (CFR) was higher following hospital-onset BSI than community-onset: 23% (276/1214) vs 12% (926/7620) at 14 days, 31% (378/1214) vs 16% (1244/7620) at 30 days, and 55% (418/766) vs 34% (1645/4903) at 1 year (p<0.001 for all comparisons). The 1-year-CFR was 47% (1258/2707) for MDR vs 28% (928/3281) for non-MDR (p<0.001). The annual mortality rate was 31.0 per 100,000 population, comprising 4.2% (31.0/734.8) of all causes of deaths. CONCLUSIONS E. coli BSI carries a high burden, with a large proportion of MDR isolates, which are associated with increased incidence and CFR.
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Affiliation(s)
- Sarah F Feldman
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel.
| | - Elizabeth Temkin
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel
| | - Liat Wullfhart
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel
| | - Amir Nutman
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Vered Schechner
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Pnina Shitrit
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Infection Control Unit, Meir Medical Center, Kfar Saba, Israel
| | - Racheli Shvartz
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel
| | - Mitchell J Schwaber
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | - Yehuda Carmeli
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
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Harpet C, Andremont A. L’épopée des antibiotiques dans le monde publicitaire. Infect Dis Now 2021. [DOI: 10.1016/j.idnow.2021.06.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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8
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Armand-Lefèvre L, Rondinaud E, Desvillechabrol D, Mullaert J, Clermont O, Petitjean M, Ruppe E, Cokelaer T, Bouchier C, Tenaillon O, Ma L, Nooroya Y, Matheron S, The Voyag-R Study Group, Andremont A, Denamur E, Kennedy SP. Dynamics of extended-spectrum beta-lactamase-producing Enterobacterales colonization in long-term carriers following travel abroad. Microb Genom 2021; 7. [PMID: 34279212 PMCID: PMC8477403 DOI: 10.1099/mgen.0.000576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Travel to tropical regions is associated with high risk of acquiring extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) that are typically cleared in less than 3 months following return. The conditions leading to persistent carriage that exceeds 3 months in some travellers require investigation. Whole-genome sequencing (Illumina MiSeq) was performed on the 82 ESBL-E isolates detected upon return and 1, 2, 3, 6 and 12 months later from the stools of 11 long-term (>3 months) ESBL-E carriers following travel abroad. One to five different ESBL Escherichia coli strains were detected per traveller upon return, and this diminished to one after 3 months. Long-term carriage was due to the presence of the same ESBL E. coli strain, for more than 3 months, in 9 out of 11 travellers, belonging to epidemic sequence type complexes (STc 10, 14, 38, 69, 131 and 648). The mean carriage duration of strains belonging to phylogroups B2/D/F, associated with extra-intestinal virulence, was higher than that for commensal-associated A/B1/E phylogroups (3.5 vs 0.5 months, P=0.021). Genes encoding iron capture systems (fyuA, irp), toxins (senB, sat), adhesins (flu, daaF, afa/nfaE, pap, ecpA) and colicin (cjrA) were more often present in persistent strains than in transient ones. Single-nucleotide polymorphism (SNP) analysis in persistent strains showed a maximum divergence of eight SNPs over 12 months without signs of adaptation. Genomic plasticity was observed during the follow-up with the loss or gain of mobile genetic elements such as plasmids, integrons and/or transposons that may contain resistance genes at different points in the follow-up. Long-term colonization of ESBL-E following travel is primarily due to the acquisition of E. coli strains belonging to epidemic clones and harbouring ‘virulence genes’, allowing good adaptation to the intestinal microbiota.
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Affiliation(s)
- Laurence Armand-Lefèvre
- Laboratoire de Bactériologie, Hôpital Bichat-Claude Bernard, AP-HP Nord-Université de Paris, F-75018 Paris, France.,Université de Paris, IAME, INSERM UMR 1137, F-75018 Paris, France
| | - Emilie Rondinaud
- Laboratoire de Bactériologie, Hôpital Bichat-Claude Bernard, AP-HP Nord-Université de Paris, F-75018 Paris, France.,Université de Paris, IAME, INSERM UMR 1137, F-75018 Paris, France
| | - Dimitri Desvillechabrol
- Plate-forme Technologique Biomics - Centre de Ressources et Recherches Technologiques (C2RT), Institut Pasteur, F-75015 Paris, France
| | - Jimmy Mullaert
- Université de Paris, IAME, INSERM UMR 1137, F-75018 Paris, France
| | - Olivier Clermont
- Université de Paris, IAME, INSERM UMR 1137, F-75018 Paris, France
| | - Marie Petitjean
- Université de Paris, IAME, INSERM UMR 1137, F-75018 Paris, France
| | - Etienne Ruppe
- Laboratoire de Bactériologie, Hôpital Bichat-Claude Bernard, AP-HP Nord-Université de Paris, F-75018 Paris, France.,Université de Paris, IAME, INSERM UMR 1137, F-75018 Paris, France
| | - Thomas Cokelaer
- Plate-forme Technologique Biomics - Centre de Ressources et Recherches Technologiques (C2RT), Institut Pasteur, F-75015 Paris, France.,Hub de Bioinformatique et Biostatistique - Département Biologie Computationnelle, Institut Pasteur, USR 3756 CNRS, F-75015 Paris, France
| | - Christiane Bouchier
- Plate-forme Technologique Biomics - Centre de Ressources et Recherches Technologiques (C2RT), Institut Pasteur, F-75015 Paris, France
| | | | - Laurence Ma
- Plate-forme Technologique Biomics - Centre de Ressources et Recherches Technologiques (C2RT), Institut Pasteur, F-75015 Paris, France
| | - Yasmine Nooroya
- Université de Paris, IAME, INSERM UMR 1137, F-75018 Paris, France
| | - Sophie Matheron
- Université de Paris, IAME, INSERM UMR 1137, F-75018 Paris, France.,Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, AP-HP Nord-Université de Paris, F-75018 Paris, France
| | | | - Antoine Andremont
- Laboratoire de Bactériologie, Hôpital Bichat-Claude Bernard, AP-HP Nord-Université de Paris, F-75018 Paris, France.,Université de Paris, IAME, INSERM UMR 1137, F-75018 Paris, France
| | - Erick Denamur
- Université de Paris, IAME, INSERM UMR 1137, F-75018 Paris, France.,Laboratoire de Génétique Moléculaire, Hôpital Bichat-Claude Bernard, AP-HP Nord-Université de Paris, F-75018 Paris, France
| | - Sean P Kennedy
- Département Biologie Computationnelle, Institut Pasteur, USR 3756 CNRS, F-75015 Paris, France
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Maataoui N, Langendorf C, Berthe F, Bayjanov JR, van Schaik W, Isanaka S, Grais RF, Clermont O, Andremont A, Armand-Lefèvre L, Woerther PL. Increased risk of acquisition and transmission of ESBL-producing Enterobacteriaceae in malnourished children exposed to amoxicillin. J Antimicrob Chemother 2021; 75:709-717. [PMID: 31821452 DOI: 10.1093/jac/dkz487] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/05/2019] [Accepted: 10/23/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Routine amoxicillin for children with uncomplicated severe acute malnutrition raises concerns of increasing antibiotic resistance. We performed an ancillary study nested within a double-blind, placebo-controlled trial in Niger testing the role of routine 7 day amoxicillin therapy in nutritional recovery of children 6 to 59 months of age with uncomplicated severe acute malnutrition. METHODS We screened 472 children for rectal carriage of ESBL-producing Enterobacteriaceae (ESBL-E) as well as their household siblings under 5 years old, at baseline and Week 1 (W1) and Week 4 (W4) after start of therapy, and characterized strains by WGS. ClinicalTrials.gov: NCT01613547. RESULTS Carriage in index children at baseline was similar in the amoxicillin and the placebo groups (33.8% versus 27.9%, P = 0.17). However, acquisition of ESBL-E in index children at W1 was higher in the amoxicillin group than in the placebo group (53.7% versus 32.2%, adjusted risk ratio = 2.29, P = 0.001). Among 209 index and sibling households possibly exposed to ESBL-E transmission, 16 (7.7%) had paired strains differing by ≤10 SNPs, suggesting a high probability of transmission. This was more frequent in households from the amoxicillin group than from the placebo group [11.5% (12/104) versus 3.8% (4/105), P = 0.04]. CONCLUSIONS Among children exposed to amoxicillin, ESBL-E colonization was more frequent and the risk of transmission to siblings higher. Routine amoxicillin should be carefully balanced with the risks associated with ESBL-E colonization.
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Affiliation(s)
- Naouale Maataoui
- Laboratoire de Bactériologie, Hôpital Bichat-Claude-Bernard, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France.,Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Paris, France.,Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
| | | | - Fatou Berthe
- Department of Research, Epicentre, Paris, France and Maradi, Niger
| | - Jumamurat R Bayjanov
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Willem van Schaik
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Sheila Isanaka
- Department of Research, Epicentre, Paris, France and Maradi, Niger
| | - Rebecca F Grais
- Department of Research, Epicentre, Paris, France and Maradi, Niger
| | - Olivier Clermont
- Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Paris, France
| | - Antoine Andremont
- Laboratoire de Bactériologie, Hôpital Bichat-Claude-Bernard, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France.,Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Paris, France.,Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
| | - Laurence Armand-Lefèvre
- Laboratoire de Bactériologie, Hôpital Bichat-Claude-Bernard, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France.,Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Paris, France.,Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
| | - Paul-Louis Woerther
- Department of Microbiology and Infection Control, Henri-Mondor Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France.,EA 7380 Dynamyc, EnvA, UPEC, Paris-Est University, Créteil, France
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10
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Ronat JB, Natale A, Kesteman T, Andremont A, Elamin W, Hardy L, Kanapathipillai R, Michel J, Langendorf C, Vandenberg O, Naas T, Kouassi F. AMR in low-resource settings: Médecins Sans Frontières bridges surveillance gaps by developing a turnkey solution, the Mini-Lab. Clin Microbiol Infect 2021; 27:1414-1421. [PMID: 33932617 DOI: 10.1016/j.cmi.2021.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/26/2021] [Accepted: 04/13/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND In low- and middle-income countries (LMICs), data related to antimicrobial resistance (AMR) are often inconsistently collected. Humanitarian, private and non-governmental medical organizations (NGOs), working with or in parallel to public medical systems, are sometimes present in these contexts. Yet, what is the role of NGOs in the fight against AMR, and how can they contribute to AMR data collection in contexts where reporting is scarce? How can context-adapted, high-quality clinical bacteriology be implemented in remote, challenging and underserved areas of the world? OBJECTIVES The aim was to provide an overview of AMR data collection challenges in LMICs and describe one initiative, the Mini-Lab project developed by Médecins Sans Frontières (MSF), that attempts to partially address them. SOURCES We conducted a literature review using PubMed and Google scholar databases to identify peer-reviewed research and grey literature from publicly available reports and websites. CONTENT We address the necessity of and difficulties related to obtaining AMR data in LMICs, as well as the role that actors outside of public medical systems can play in the collection of this information. We then describe how the Mini-Lab can provide simplified bacteriological diagnosis and AMR surveillance in challenging settings. IMPLICATIONS NGOs are responsible for a large amount of healthcare provision in some very low-resourced contexts. As a result, they also have a role in AMR control, including bacteriological diagnosis and the collection of AMR-related data. Actors outside the public medical system can actively contribute to implementing and adapting clinical bacteriology in LMICs and can help improve AMR surveillance and data collection.
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Affiliation(s)
- Jean-Baptiste Ronat
- Médecins Sans Frontières, Paris, France; Team ReSIST, INSERM U1184, School of Medicine University Paris-Saclay, France; Bacteriology-Hygiene Unit, Assistance Publique - Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France.
| | | | | | | | - Wael Elamin
- Clinical Microbiology Department, Queen Mary University, London, UK; Clinical Microbiology Department, Elrazi University, Khartoum, Sudan
| | - Liselotte Hardy
- Unit Tropical Bacteriology, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | | - Olivier Vandenberg
- Center for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium; Innovation and Business Development Unit, Laboratoire Hospitalier Universitaire de Bruxelles, Brussels, Belgium; Division of Infection and Immunity, University College London, London, UK
| | - Thierry Naas
- Team ReSIST, INSERM U1184, School of Medicine University Paris-Saclay, France; Bacteriology-Hygiene Unit, Assistance Publique - Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
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11
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Andremont A, Cervesi J, Bandinelli PA, Vitry F, de Gunzburg J. Spare and repair the gut microbiota from antibiotic-induced dysbiosis: state-of-the-art. Drug Discov Today 2021; 26:2159-2163. [PMID: 33639249 DOI: 10.1016/j.drudis.2021.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 02/08/2023]
Abstract
Homeostasis of the intestinal microbiota is currently recognized as a major contributor to human health. Furthermore, intestinal dysbiosis is associated with a multitude of consequences, including intestinal colonization by antibiotic-resistant or pathogenic bacteria, such as Clostridioides difficile, and reduced efficacy of promising anticancer immunotherapies. By far, the most immediate and drastic exposure leading to dysbiosis is antibiotic treatment. Many attempts have been made to prevent or repair antibiotic-associated dysbiosis. Here, we review these innovations and the difficulties associated with their development.
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Affiliation(s)
- Antoine Andremont
- Da Volterra, Paris, France; Université de Paris, IAME, INSERM, Paris, France.
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12
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Ducher A, Vehreschild MJGT, Vehreschild MJGT, Louie TJ, Cornely OA, Féger C, Dane A, Dane A, Varastet M, de Gunzburg J, Andremont A, Mentré F. LB-5. DAV132 Protects Intestinal Microbiota of Patients Treated with Quinolones, a European Phase II Randomized Controlled Trial (SHIELD). Open Forum Infect Dis 2020. [PMCID: PMC7776914 DOI: 10.1093/ofid/ofaa515.1902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Antibiotics elicit intestinal dysbiosis with short and long-term deleterious effects. A colon-targeted adsorbent, DAV132, prevents dysbiosis in healthy humans and may protect antibiotic-treated patients. Methods Hospitalized patients receiving oral/iv fluoroquinolones (FQ) for the treatment of or prophylaxis of febrile neutropenia were randomized to receive DAV132 (7.5g tid orally), or not, during FQ receipt and followed up 51d. Plasma FQ levels were assessed at D4 (LC-MS/MS). Feces were collected during and up to 30d after FQ receipt for assessment of free fecal FQ levels (LC-MS/MS), gut microbiome α/β diversity (16S rRNA), resistance to colonization by C. difficile (Cd; ex-vivo proliferation). Relatedness of adverse events (AEs) to drugs was adjudicated by blinded independent experts. Results 243 patients from 23 sites, median age 71y, ≥1 chronic comorbidity 95%, received levofloxacin (43%), ciprofloxacin (40%) or moxifloxacin (18%) for (79% iv). During receipt, fecal FQ levels were lowered by >97% with DAV132 vs. No DAV132 (p< 0.0001), whilst plasma levels did not change significantly. Microbiome diversity was significantly protected with DAV132 using all metrics, e.g. the change from D1 of Shannon index at End-of-FQ (difference of means at End-of-FQ 0.42, 95% CI: 0.085; 0.752). The proportions of patients with DAV132- and/or FQ-related AEs (primary endpoint) did not differ significantly (14.8 vs. 10.8%, difference of proportions: 3.9%; 95% CI: -4.7; 12.6). No Cd infection occurred. Resistance to colonization by Cd was reduced in stools of patients receiving FQ only, but was maintained in those of patients who also received DAV132 (p=0.035). The acquisition of fecal carriage of vancomycin-resistant enterococci (VRE) was reduced with DAV132 (p=0.019). Figure 1: a. Free fluoroquinolones fecal concentration (mean ± SEM, µg/g) over time per FQ treatment group; b. Change of Shannon Index from baseline (mean ± SEM) over time ![]()
Conclusion DAV132 was well tolerated in elderly hospitalized patients with comorbidities. It neither altered antibiotic plasma levels nor elicited changes in concomitant drugs regimens. Intestinal microbiota diversity was protected and resistance to colonization by Cd was preserved. DAV132 is a promising, novel product to prevent antibiotic-induced intestinal dysbiosis. Disclosures Annie Ducher, MD, Da Volterra (Employee, Shareholder) Maria J.G.T. Vehreschild, n/a, 3M (Grant/Research Support)Astellas Pharma (Grant/Research Support)Astellas Pharma (Consultant)Astellas Pharma (Speaker's Bureau)Basilea (Speaker's Bureau)Berlin Chemie (Consultant)Da Volterra (Grant/Research Support)Da Volterra (Grant/Research Support)Gilead (Grant/Research Support)Gilead (Speaker's Bureau)Merck/MSD (Speaker's Bureau)Merck/MSD (Grant/Research Support)MSD/Merck (Consultant)Organobalance (Grant/Research Support)Organobalance (Speaker's Bureau)Pfizer (Speaker's Bureau)Seres Therapeutics (Grant/Research Support) Thomas J. Louie, MD, Da Volterra (Consultant) Oliver A. Cornely, MD, Actelion (Consultant, Grant/Research Support, Speaker's Bureau)Al Jazeera Pharmaceuticals (Consultant)Allecra Therapeutics (Consultant, Grant/Research Support, Speaker's Bureau)Amplyx (Consultant, Grant/Research Support, Speaker's Bureau)Astellas (Consultant, Grant/Research Support, Speaker's Bureau)Basilea (Consultant, Grant/Research Support, Speaker's Bureau)Biosys UK Limited (Consultant, Grant/Research Support, Speaker's Bureau)Cidara (Consultant, Grant/Research Support, Speaker's Bureau)Da Volterra (Consultant, Grant/Research Support, Speaker's Bureau)Entasis (Consultant, Grant/Research Support, Speaker's Bureau)European Commission (Grant/Research Support)F2G (Consultant, Grant/Research Support, Speaker's Bureau)German Federal Ministry of Research andEducation (Grant/Research Support)Gilead (Consultant, Grant/Research Support, Speaker's Bureau)Grupo Biotoscana (Consultant, Grant/Research Support, Speaker's Bureau)Janssen Pharmaceuticals (Consultant, Grant/Research Support, Speaker's Bureau)Matinas (Consultant, Grant/Research Support, Speaker's Bureau)MedicinesCompany (Consultant, Grant/Research Support, Speaker's Bureau)MedPace (Consultant, Grant/Research Support, Speaker's Bureau)Melinta Therapeutics (Consultant, Grant/Research Support, Speaker's Bureau)Menarini Ricerche (Consultant, Grant/Research Support, Speaker's Bureau)Merck/MSD (Consultant, Grant/Research Support, Speaker's Bureau)Mylan Pharmaceuticals (Consultant)Nabriva (Consultant)Noxxon (Consultant)Octapharma (Consultant, Grant/Research Support, Speaker's Bureau)Paratek Pharmaceuticals (Consultant, Grant/Research Support, Speaker's Bureau)Pfizer (Consultant, Grant/Research Support, Speaker's Bureau)PSI (Consultant, Grant/Research Support, Speaker's Bureau)Roche Diagnostics (Consultant)Scynexis (Consultant, Grant/Research Support, Speaker's Bureau)Shionogi (Consultant) Céline Féger, PhD, Da Volterra (Consultant) Aaron Dane, MSc, Da Volterra (Consultant)Spero theraputics (Consultant) Aaron Dane, MSc, Spero theraputics (Consultant) Marina Varastet, PhD, Da Volterra (Employee) Jean de Gunzburg, PhD, Da Volterra (Board Member, Consultant, Shareholder) Antoine Andremont, PhD, Bioaster (Consultant)Da Volterra (Board Member, Consultant, Shareholder) France Mentré, MD, Da Volterra (Consultant)
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Affiliation(s)
- Annie Ducher
- Da Volterra, Paris, France, Paris, Ile-de-France, France
| | - Maria J G T Vehreschild
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Niedersachsen, Germany
| | - Maria J G T Vehreschild
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Niedersachsen, Germany
| | - Thomas J Louie
- Cumming School of Medicine, University of Calgary, Calgary, Canada, Calgary, Alberta, Canada
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine, Department I of Internal Medicine; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD); Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany, Cologne, Nordrhein-Westfalen, Germany
| | - Céline Féger
- Da Volterra, Paris, France, Paris, Ile-de-France, France
| | - Aaron Dane
- DaneStat Consulting, Macclesfield, Cheshire, England, United Kingdom
| | - Aaron Dane
- DaneStat Consulting, Macclesfield, Cheshire, England, United Kingdom
| | | | | | - Antoine Andremont
- Da Volterra, Paris, France & 6. Paris University, IAME, INSERM U1137, Paris, France, Paris, Ile-de-France, France
| | - France Mentré
- Paris University, IAME, INSERM U1137, Paris, France, Paris, Ile-de-France, France
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13
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Djuikoue IC, Tambo E, Tazemda G, Njajou O, Makoudjou D, Sokeng V, Wandji M, Tomi C, Nanfack A, Dayomo A, Lacmago S, Tassadjo F, Sipowo RT, Kakam C, Djoko AB, Assob CN, Andremont A, Barbut F. Evaluation of inpatients Clostridium difficile prevalence and risk factors in Cameroon. Infect Dis Poverty 2020; 9:122. [PMID: 32867842 PMCID: PMC7457802 DOI: 10.1186/s40249-020-00738-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 08/11/2020] [Indexed: 12/18/2022] Open
Abstract
Background Clostridium difficile, rarely found in hospitals, is a bacterium responsible for post-antibiotic diarrhea and Pseudomembranous Colitis (CPM). C. difficile selective pressure represents potential public health problem due to the production of toxins A and B serious pathologies effects/consequences. A transversal and analytic study was to assess the risk factors of C. difficile infection and to determine the prevalence of C. difficile in patients received in randomly selected five hospitals in Yaoundé, Cameroon. Methods A total of 300 stool samples were collected from consented patients using a transversal and analytic study conducted from 10th July to 10th November 2018 in five hospitals in Cameroon. The detection or diagnostic kit was CerTest C. difficile Glutamate Dehydrogenase + Toxin A + Toxin B based on immuno-chromatographic assay. A univariate and multivariate analysis allowed us to highlight the associated factors. Results The results showed a prevalence of C. difficile of 27.33% (82/300 stool patients’samples taken). Of these 27.33%, the production of Toxin A and Toxin B were 37.80 and 7.31% respectively. In univariate analysis, hospitalization was a significant (P = 0.01) risk factor favoring C. difficile infection. In multivariate analysis, corticosteroids and quinolones use/administration were significantly (adjusted Odd Ratio, aOR = 14.09, 95% CI: 1.62–122.54, P = 0.02 and aOR = 3.39, 95% CI: 1.00–11.34, P = 0.05 respectively) risk factor for this infection. Conclusion The prevalence of C. difficile infections (CDI) remain high in these settings and may be related not only to permanent steroids and antibiotics. Promoting education to both medical staff and patients on the prevalence and public health impact of C. difficile can be core inimproving rationale prescription of steroids and antibiotics to patients and promote human health and exponential growth in Cameroon.
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Affiliation(s)
- Ingrid Cécile Djuikoue
- Département de Microbiologie de la Faculté des Sciences de la Santé de l'Université des Montagnes, Bangangte, Cameroon.,Prevention and Control Foundation, Bangangte, Cameroon
| | - Ernest Tambo
- Département de Microbiologie de la Faculté des Sciences de la Santé de l'Université des Montagnes, Bangangte, Cameroon. .,Prevention and Control Foundation, Bangangte, Cameroon.
| | - Gildas Tazemda
- Département de Microbiologie de la Faculté des Sciences de la Santé de l'Université des Montagnes, Bangangte, Cameroon
| | - Omer Njajou
- Prevention and Control Foundation, Bangangte, Cameroon
| | - Denise Makoudjou
- Département de Microbiologie de la Faculté des Sciences de la Santé de l'Université des Montagnes, Bangangte, Cameroon
| | - Vanessa Sokeng
- Département de Microbiologie de la Faculté des Sciences de la Santé de l'Université des Montagnes, Bangangte, Cameroon
| | - Morelle Wandji
- Département de Microbiologie de la Faculté des Sciences de la Santé de l'Université des Montagnes, Bangangte, Cameroon
| | - Charlène Tomi
- Département de Microbiologie de la Faculté des Sciences de la Santé de l'Université des Montagnes, Bangangte, Cameroon
| | | | - Audrey Dayomo
- Département de Microbiologie de la Faculté des Sciences de la Santé de l'Université des Montagnes, Bangangte, Cameroon
| | - Suzie Lacmago
- Département de Microbiologie de la Faculté des Sciences de la Santé de l'Université des Montagnes, Bangangte, Cameroon
| | - Falubert Tassadjo
- Laboratoire de Bactériologie du Centre Pasteur du Cameroun, Yaounde, Cameroon
| | - Raissa Talla Sipowo
- Département de Microbiologie de la Faculté des Sciences de la Santé de l'Université des Montagnes, Bangangte, Cameroon
| | | | - Aicha Bibiane Djoko
- Département de Microbiologie de la Faculté des Sciences de la Santé de l'Université des Montagnes, Bangangte, Cameroon
| | - Clement Nguedia Assob
- Faculty of Health Sciences, University of Buea, PO Box 63, Buea, SW Region, Cameroon
| | - Antoine Andremont
- Faculty of Medicine, Xavier-Bichat Campus, University of Paris VII - Denis Diderot, Paris, France
| | - Frédéric Barbut
- Faculty of Pharmacy, Paris - University of Paris Descartes, Paris, France
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14
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Guk J, Guedj J, Burdet C, Andremont A, de Gunzburg J, Ducher A, Mentré F. Modeling the Effect of DAV132, a Novel Colon-Targeted Adsorbent, on Fecal Concentrations of Moxifloxacin and Gut Microbiota Diversity in Healthy Volunteers. Clin Pharmacol Ther 2020; 109:1045-1054. [PMID: 32617960 DOI: 10.1002/cpt.1977] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/12/2020] [Indexed: 11/06/2022]
Abstract
To prevent antibiotic-induced perturbations on gut microbiota, DAV132, a novel colon-targeted adsorbent, which sequesters antibiotic residues in the lower gastrointestinal tract, was developed. We built an integrated pharmacological model of how DAV132 reduces fecal free moxifloxacin and preserves gut microbiota. We used plasma and fecal free moxifloxacin concentrations, and Shannon diversity index from 16S ribosomal RNA gene metagenomics analysis of fecal microbiota, of 143 healthy volunteers assigned randomly to receive moxifloxacin only, or with 10 DAV132 dose regimens, or to a control group. We modeled reduced fecal moxifloxacin concentrations using a transit model for DAV132 kinetics and a Michaelis-Menten model with an effect of the amount of activated charcoal on adsorption efficacy. Changes in moxifloxacin-induced perturbations on gut microbiota diversity were then quantified through a turnover model with the Emax model. With the developed model, the efficiency of pharmacokinetic antagonism and its consequences on gut microbiota diversity were quantified.
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Affiliation(s)
- Jinju Guk
- Université de Paris, IAME, INSERM, Paris, France
| | | | | | - Antoine Andremont
- Université de Paris, IAME, INSERM, Paris, France.,Da Volterra, Paris, France
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15
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Rousseau B, Hilmi M, Khati I, Turpin A, Andremont A, Burdet C, Grall N, Vidal J, Bousquet PJ, Le Bihan C. Impact of antibiotics (ATB) on the recurrence of resected colorectal cancer (CRC): Results of EVADER-1 a nation-wide pharmacoepidemiologic study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4106 Background: Recent studies suggest that ATB increase the overall risk of CRC incidence through disruption of gut microbiota. Impact of ATB on the risk of CRC recurrence after curative resection remains unknown. Methods: Using the French nation-wide Institut National du Cancer (INCa – Système National des Données de Santé) database of cancer patients, all newly diagnozed localized CRC patients resected between 01/2012 and 12/2014 were involved. The perioperative ATB intake (6 month before until 1 year after surgery) was classified according to the spectrum, doses and period of use. The primary endpoint was 3-year Disease-Free Survival (3-DFS), stratified on chemotherapy (chemo) administration (yes/no), and assessed using multivariate Cox models. Results: Out of 219,884 CRC patients, the present study included 36,640 patients: male 53%, age≥75 years 39%, left colon/rectal 59%, exposure to chemo 44%, at least one ATB intake 74%. At 3-years, 29% of patients had recurred and 18% had died. In multivariate analysis, in patients not receiving chemo, ATB intake as an out-patient was significantly associated with better 3-DFS [HR (one ATB only) = 0.88 (0.82-0.94)]. This effect remained in the same range whatever the number of ATB or cumulative exposure to ATB. In patients receiving chemo, ATB intake as an out-patient had a significant detrimental effect on 3-DFS [HR (one ATB only) = 1.15 (1.08-1.23)], increasing with the number of ATB [HR (≥5 ATB) = 1.54 (1.39-1.71)] and longer exposure [HR ( > 30 days) = 1.39 (1.31-1.48)]. Penicillin A, quinolones and ATB combinations were associated with worse 3-DFS. The timing of ATB intake related to chemo revealed that the strongest deleterious effect was observed when ATB were taken during chemo [HR = 1.64 (1.53-1.75)]. No difference in the mean number of chemo cycle was observed comparing patients receiving ATB or not. Conclusions: This nation-wide study is the first to suggest that ATB modulate 3-DFS in resected CRC with a differential impact according to chemo exposure. Importantly, ATB intake with chemo is detrimental in a dose- and time-dependent manner suggesting that dysbiosis of gut microbiota during adjuvant chemo might increase risk of recurrence.
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Affiliation(s)
| | | | - Ines Khati
- Public Health and Healthcare Division, French National Cancer Institute INCa, Boulogne-Billancourt, France
| | | | | | - Charles Burdet
- AP-HP, Bichat Hospital, Department of Epidemiology, Biostatistics and Clinical Research, Paris, France
| | - Nathalie Grall
- AP-HP Microbiology Laboratory, Bichat-Claude Bernard University Hospital, Paris, France
| | - Joana Vidal
- Medical Oncology Hospital del Mar, Barcelona, Spain
| | - Philippe Jean Bousquet
- Public Health and Healthcare Division, French National Cancer Institute INCa, Boulogne-Billancourt, France
| | - Christine Le Bihan
- Public Health and Healthcare Division, French National Cancer Institute INCa, Boulogne-Billancourt, France
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16
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Jouvin-Marche E, Carrara G, Pulcini C, Andremont A, Danan C, Couderc-Obert C, Lienhardt C, Kieny MP, Yazdanpanah Y. French research strategy to tackle antimicrobial resistance. Lancet 2020; 395:1239-1241. [PMID: 32305085 DOI: 10.1016/s0140-6736(20)30477-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/24/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Evelyne Jouvin-Marche
- Inserm, 75013, Paris, France; Université Grenoble Alpes, Inserm U1209, CNRS UMR 5309, Site Santé, La Tronche, France.
| | | | | | - Antoine Andremont
- Ministry of Higher Education, Research and Innovation, Directorate General for Research and Innovation, Paris, France
| | - Corinne Danan
- Ministry of Agriculture and Food, General Directorate for Research and Education, Paris, France
| | - Céline Couderc-Obert
- Ministry for an Ecological and Solidary Transition, Research Department, Tour Séquoia, La Défense, France
| | - Christian Lienhardt
- Unité Mixte Internationale TransVIHMI (UMI 233 IRD-U1175 INSERM-Université de Montpellier), Institut de Recherche pour le Développement, Montpellier, France
| | | | - Yazdan Yazdanpanah
- Inserm, 75013, Paris, France; Infection Antimicrobials Modelling Evolution, UMR 1137, Inserm, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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17
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Pierre-Audigier C, Talla C, Alame-Emane AK, Audigier B, Grall N, Ruimy R, Andremont A, Cadet-Daniel V, Sola C, Takiff H, Gicquel B, Vray M, Armand-Lefevre L. Tuberculosis trends in a hot-spot region in Paris, France. Int J Tuberc Lung Dis 2020; 24:428-435. [DOI: 10.5588/ijtld.19.0305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Tuberculosis (TB) incidence is declining overall in France, but not in Paris where some areas remain relative hot spots for TB.OBJECTIVES: To obtain a better knowledge of local TB epidemiology in order to facilitate control measures.DESIGN: Analysis
of demographic data of TB patients diagnosed at the Bichat-Claude Bernard Hospital from 2007 to 2016, with spoligotyping of Mycobacterium tuberculosis complex isolates.RESULTS: During the study period, 1096 TB patients were analysed. The incidence of TB diagnosis was stable,
averaging 115 patients per year, predominantly males (71%), foreign-born (81%), with pulmonary TB (77%) and negative HIV serology (88%). The mean age of foreign-born TB patients decreased over the study period, most significantly in recent arrivals in France, whose average age decreased by
two years (P = 0.001). The time period between arrival in France and being diagnosed with active TB decreased annually significantly by 0.75 years (P = 0.02). The proportion of L4.6.2/Cameroon and L2/Beijing sub-lineages increased annually by 0.7% (P < 0.05). Multi-drug
resistant strains, representing 4% of all strains, increased annually by 0.75% (P = 0.03)CONCLUSION: The number of TB patients remained high in northern Paris and the surrounding suburbs, suggesting the need for increased control measures.
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Affiliation(s)
- C. Pierre-Audigier
- Mycobacterial Genetics Unit, Institut Pasteur, Paris, Laboratoire de Bactériologie, Centre Hospitalo-Universitaire Bichat-Claude Bernard, APHP, Paris, France, Department of Tuberculosis Prevention and Control, Shenzhen Nanshan Center
for Chronic Disease Control, Shenzhen, 518054, China
| | - C. Talla
- Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur, Dakar, Senegal
| | - A-K. Alame-Emane
- Mycobacterial Genetics Unit, Institut Pasteur, Paris, Department of Tuberculosis Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, China
| | - B. Audigier
- Statistic Study Group, Ecole Polytechnique, Palaiseau
| | - N. Grall
- Laboratoire de Bactériologie, Centre Hospitalo-Universitaire Bichat-Claude Bernard, APHP, Paris, France, IAME, UMR 1137, Institut national de la santé et de la recherche médicale, Université Paris Diderot, Sorbonne Paris
Cité F-75018, Paris
| | - R. Ruimy
- Laboratoire de Bactériologie, Centre Hospitalo-Universitaire Bichat-Claude Bernard, APHP, Paris, France, Laboratoire de Bactériologie, Centre Hospitalo-Universitaire, Nice
| | - A. Andremont
- Laboratoire de Bactériologie, Centre Hospitalo-Universitaire Bichat-Claude Bernard, APHP, Paris, France, IAME, UMR 1137, Institut national de la santé et de la recherche médicale, Université Paris Diderot, Sorbonne
Paris Cité F-75018, Paris
| | | | - C. Sola
- Institute for Integrative Biology of the Cell (I2BC), CEA, Centre national de la Recherche scientifique, Université Paris Sud, Université Paris Saclay, Gif-sur-Yvette, France
| | - H. Takiff
- Mycobacterial Genetics Unit, Institut Pasteur, Paris, Department of Tuberculosis Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, China, Instituto Venezolano de Investigaciones Cientificas (IVIC), Caracas,
Venezuela
| | - B. Gicquel
- Mycobacterial Genetics Unit, Institut Pasteur, Paris, Department of Tuberculosis Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, 518054, China
| | - M. Vray
- Unité d'Epidémiologie des Maladies Infectieuses, Institut Pasteur, Dakar, Senegal
| | - L. Armand-Lefevre
- Laboratoire de Bactériologie, Centre Hospitalo-Universitaire Bichat-Claude Bernard, APHP, Paris, France, IAME, UMR 1137, Institut national de la santé et de la recherche médicale, Université Paris Diderot, Sorbonne
Paris Cité F-75018, Paris
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18
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Chilton CH, Crowther GS, Miossec C, de Gunzburg J, Andremont A, Wilcox MH. Investigation of the effect of the adsorbent DAV131A on the propensity of moxifloxacin to induce simulated Clostridioides (Clostridium) difficile infection (CDI) in an in vitro human gut model. J Antimicrob Chemother 2020; 75:1458-1465. [DOI: 10.1093/jac/dkaa062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/17/2020] [Accepted: 01/31/2020] [Indexed: 12/20/2022] Open
Abstract
Abstract
Background
Clostridioides difficile infection (CDI) remains a high burden worldwide. DAV131A, a novel adsorbent, reduces residual gut antimicrobial levels, reducing CDI risk in animal models.
Objectives
We used a validated human gut model to investigate the efficacy of DAV131A in preventing moxifloxacin-induced CDI.
Methods
C. difficile (CD) spores were inoculated into two models populated with pooled human faeces. Moxifloxacin was instilled (43 mg/L, once daily, 7 days) alongside DAV131A (5 g in 18 mL PBS, three times daily, 14 days, Model A), or PBS (18 mL, three times daily, 14 days, Model B). Selected gut microbiota populations, CD total counts, spore counts, cytotoxin titre and antimicrobial concentrations (HPLC) were monitored daily. We monitored for reduced susceptibility of CD to moxifloxacin. Growth of CD in faecal filtrate and medium in the presence/absence of DAV131A, or in medium pre-treated with DAV131A, was also investigated.
Results
DAV131A instillation reduced active moxifloxacin levels to below the limit of detection (50 ng/mL), and prevented microbiota disruption, excepting Bacteroides fragilis group populations, which declined by ∼3 log10 cfu/mL. DAV131A delayed onset of simulated CDI by ∼2 weeks, but did not prevent CD germination and toxin production. DAV131A prevented emergence of reduced susceptibility of CD to moxifloxacin. In batch culture, DAV131A had minor effects on CD vegetative growth, but significantly reduced toxin/spores (P < 0.005).
Conclusions
DAV131A reduced moxifloxacin-induced microbiota disruption and emergence of antibiotic-resistant CD. Delayed onset of CD germination and toxin production indicates further investigations are warranted to understand the clinical benefits of DAV131A in CDI prevention.
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Affiliation(s)
- C H Chilton
- Healthcare Associated Infections Research Group, Leeds Institute for Medical Research, University of Leeds, Old Medical School, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - G S Crowther
- Division of Pharmacy and Optometry, University of Manchester, Manchester M13 9PT, UK
| | - C Miossec
- Da Volterra, Le Dorian (bât B1), 172 rue de Charonne, 75011 Paris, France
| | - J de Gunzburg
- Da Volterra, Le Dorian (bât B1), 172 rue de Charonne, 75011 Paris, France
| | - A Andremont
- IAME INSERM, UMR 1137, University of Paris, 75018 Paris, France
| | - M H Wilcox
- Healthcare Associated Infections Research Group, Leeds Institute for Medical Research, University of Leeds, Old Medical School, Leeds General Infirmary, Leeds LS1 3EX, UK
- Microbiology, Leeds Teaching Hospitals NHS Trust, Old Medical School, Leeds General Infirmary, Leeds LS1 3EX, UK
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19
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Matar GM, Andremont A, Bazzi W. Editorial: Combating Antimicrobial Resistance - A One Health Approach. Front Cell Infect Microbiol 2020; 9:458. [PMID: 32039043 PMCID: PMC6987035 DOI: 10.3389/fcimb.2019.00458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/16/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Ghassan M Matar
- Department of Experimental Pathology, Immunology and Microbiology, Center for Infectious Diseases Research (CIDR) and WHO Collaborating Center for Reference and Research on Bacterial Pathogens, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Wael Bazzi
- Department of Experimental Pathology, Immunology and Microbiology, Center for Infectious Diseases Research (CIDR) and WHO Collaborating Center for Reference and Research on Bacterial Pathogens, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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20
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Ploy MC, Andremont A, Valtier B, Le Jeunne C. Antibiotic resistance: Tools for effective translational research. Therapie 2019; 75:7-12. [PMID: 31987590 DOI: 10.1016/j.therap.2019.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
The rising emergence of bacterial resistances has led to a crisis which threatens human, animal and environmental health. The impact of the emergency is enormous in terms of public health and economics. Although there is a global awareness of the warnings and programmes supporting innovative actions to combat fight against antibiotic resistance, it must be admitted that proposed new antibiotics fail to find the economic profitability necessary for them to reach the market and become available for patients and the community. Moreover, it is necessary to develop tools/indicators to define effective interventions against antibiotic resistance. The work of the think-tank reported in this article concentrated on two aspects of translational research: - prevention and the impact on health of the antibiotic resistance issue, and - the specific requirements of clinical research leading to innovation in the fight against antibiotic resistance. This article, which reflects the thoughts of a group of French experts, proposes directly operational solutions which could be rapidly implemented and radically transform the quality and quantity of our resources available for the combat.
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Affiliation(s)
- Marie-Cécile Ploy
- Inserm, U1092, RESINFIT, CHU de Limoges, university Limoges, 87000 Limoges, France.
| | | | | | - Claire Le Jeunne
- Service de médecine interne, site Cochin, centre université de Paris, AP-HP, 75014 Paris, France
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21
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Andremont A. Too Early to Recommend Early Fecal Microbiota Transplantation in Patients With Severe Clostridium difficile Infection, or Not Too Early? Clin Infect Dis 2019; 66:651-652. [PMID: 29020240 DOI: 10.1093/cid/cix763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/23/2017] [Indexed: 11/14/2022] Open
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22
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Dupouy V, Abdelli M, Moyano G, Arpaillange N, Bibbal D, Cadiergues MC, Lopez-Pulin D, Sayah-Jeanne S, de Gunzburg J, Saint-Lu N, Gonzalez-Zorn B, Andremont A, Bousquet-Mélou A. Prevalence of Beta-Lactam and Quinolone/Fluoroquinolone Resistance in Enterobacteriaceae From Dogs in France and Spain-Characterization of ESBL/pAmpC Isolates, Genes, and Conjugative Plasmids. Front Vet Sci 2019; 6:279. [PMID: 31544108 PMCID: PMC6730528 DOI: 10.3389/fvets.2019.00279] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/07/2019] [Indexed: 01/01/2023] Open
Abstract
Quantitative data on fecal shedding of antimicrobial-resistant bacteria are crucial to assess the risk of transmission from dogs to humans. Our first objective was to investigate the prevalence of quinolone/fluoroquinolone-resistant and beta-lactam-resistant Enterobacteriaceae in dogs in France and Spain. Due to the particular concern about possible transmission of extended-spectrum cephalosporin (ESC)-resistant isolates from dogs to their owners, we characterized the ESBL/pAmpC producers collected from dogs. Rectal swabs from 188 dogs, without signs of diarrhea and that had not received antimicrobials for 4 weeks before the study, were quantified for total and resistant Enterobacteriaceae on selective media alone or containing relevant antibiotic concentrations. Information that might explain antibiotic resistance was collected for each dog. Extended-spectrum cephalosporin-resistant isolates were subjected to bacterial species identification (API20E), genetic lineage characterization (MLST), ESBL/pAmpC genes identification (sequencing), and plasmid characterization (pMLST). Regarding beta-lactam resistance, amoxicillin- (AMX) and cefotaxime- (CTX) resistant Enterobacteriaceae were detected in 70 and 18% of the dogs, respectively, whereas for quinolone/fluoroquinolone-resistance, Nalidixic acid- (NAL) and ciprofloxacin- (CIP) resistant Enterobacteriaceae were detected in 36 and 18% of the dogs, respectively. Medical rather than preventive consultation was a risk marker for the presence of NAL and CIP resistance. CTX resistance was mainly due to a combination of specific ESBL/pAmpC genes and particular conjugative plasmids already identified in human patients: bla CTX-M-1/IncI1/ST3 (n = 4), bla CMY-2/IncI1/ST12 (n = 2), and bla CTX-M-15/IncI1/ST31 (n = 1). bla SHV-12 (n = 3) was detected in various plasmid lineages (InI1/ST3, IncI1/ST26, and IncFII). ESBL/pAmpC plasmids were located in different genetic lineages of E. coli, with the exception of two strains in France (ST6998) and two in Spain (ST602). Our study highlights dogs as a potential source of Q/FQ-resistant and ESBL/pAmpC-producing bacteria that might further disseminate to humans, and notably a serious risk of future acquisition of CTX-M-1 and CMY-2 plasmids by the owners of dogs.
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Affiliation(s)
| | | | - Gabriel Moyano
- Departamento de Sanidad Animal, Facultad de Veterinaria y Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Universidad Complutense de Madrid, Madrid, Spain
| | | | - Delphine Bibbal
- InTheRes, Université de Toulouse, INRA, ENVT, Toulouse, France
| | | | | | | | | | | | - Bruno Gonzalez-Zorn
- Departamento de Sanidad Animal, Facultad de Veterinaria y Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Universidad Complutense de Madrid, Madrid, Spain
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23
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de Gunzburg J, Ghozlane A, Ducher A, Le Chatelier E, Duval X, Ruppé E, Armand-Lefevre L, Sablier-Gallis F, Burdet C, Alavoine L, Chachaty E, Augustin V, Varastet M, Levenez F, Kennedy S, Pons N, Mentré F, Andremont A. Protection of the Human Gut Microbiome From Antibiotics. J Infect Dis 2019; 217:628-636. [PMID: 29186529 PMCID: PMC5853327 DOI: 10.1093/infdis/jix604] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 11/19/2017] [Indexed: 12/12/2022] Open
Abstract
Background Antibiotics are life-saving drugs but severely affect the gut microbiome with short-term consequences including diarrhea and selection of antibiotic-resistant bacteria. Long-term links to allergy and obesity are also suggested. We devised a product, DAV132, and previously showed its ability to deliver a powerful adsorbent, activated charcoal, in the late ileum of human volunteers. Methods We performed a randomized controlled trial in 28 human volunteers treated with a 5-day clinical regimen of the fluoroquinolone antibiotic moxifloxacin in 2 parallel groups, with or without DAV132 coadministration. Two control goups of 8 volunteers each receiving DAV132 alone, or a nonactive substitute, were added. Results The coadministration of DAV132 decreased free moxifloxacin fecal concentrations by 99%, while plasmatic levels were unaffected. Shotgun quantitative metagenomics showed that the richness and composition of the intestinal microbiota were largely preserved in subjects co-treated with DAV132 in addition to moxifloxacin. No adverse effect was observed. In addition, DAV132 efficiently adsorbed a wide range of clinically relevant antibiotics ex vivo. Conclusions DAV132 was highly effective to protect the gut microbiome of moxifloxacin-treated healthy volunteers and may constitute a clinical breakthrough by preventing adverse health consequences of a wide range of antibiotic treatments. Clinical Trials Registration NCT02176005.
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Affiliation(s)
| | - Amine Ghozlane
- Metagenopolis, Institut National de la Recherche Agronomique, Jouy-en-Josas, France
| | | | | | - Xavier Duval
- Bichat Claude Bernard Hospital, University Paris Diderot, Sorbonne Paris Cité, Paris.,Institut National de la Santé et de la Recherche Médicale, Infection Antimicrobials Modelling Evolution, Unité Mixte de Recherche, France.,University Paris Diderot, Sorbonne Paris Cité, Paris
| | - Etienne Ruppé
- Metagenopolis, Institut National de la Recherche Agronomique, Jouy-en-Josas, France
| | - Laurence Armand-Lefevre
- Bichat Claude Bernard Hospital, University Paris Diderot, Sorbonne Paris Cité, Paris.,Institut National de la Santé et de la Recherche Médicale, Infection Antimicrobials Modelling Evolution, Unité Mixte de Recherche, France.,University Paris Diderot, Sorbonne Paris Cité, Paris
| | | | - Charles Burdet
- Institut National de la Santé et de la Recherche Médicale, Infection Antimicrobials Modelling Evolution, Unité Mixte de Recherche, France.,University Paris Diderot, Sorbonne Paris Cité, Paris
| | - Loubna Alavoine
- Bichat Claude Bernard Hospital, University Paris Diderot, Sorbonne Paris Cité, Paris
| | | | | | | | - Florence Levenez
- Metagenopolis, Institut National de la Recherche Agronomique, Jouy-en-Josas, France
| | - Sean Kennedy
- Metagenopolis, Institut National de la Recherche Agronomique, Jouy-en-Josas, France
| | - Nicolas Pons
- Metagenopolis, Institut National de la Recherche Agronomique, Jouy-en-Josas, France
| | - France Mentré
- Institut National de la Santé et de la Recherche Médicale, Infection Antimicrobials Modelling Evolution, Unité Mixte de Recherche, France.,University Paris Diderot, Sorbonne Paris Cité, Paris
| | - Antoine Andremont
- Bichat Claude Bernard Hospital, University Paris Diderot, Sorbonne Paris Cité, Paris.,Institut National de la Santé et de la Recherche Médicale, Infection Antimicrobials Modelling Evolution, Unité Mixte de Recherche, France.,University Paris Diderot, Sorbonne Paris Cité, Paris
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24
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Leo S, Lazarevic V, Gaïa N, Estellat C, Girard M, Matheron S, Armand-Lefèvre L, Andremont A, Schrenzel J, Ruppé E. The intestinal microbiota predisposes to traveler's diarrhea and to the carriage of multidrug-resistant Enterobacteriaceae after traveling to tropical regions. Gut Microbes 2019; 10:631-641. [PMID: 30714464 PMCID: PMC6748584 DOI: 10.1080/19490976.2018.1564431] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The risk of acquisition of multidrug-resistant Enterobacteriaceae (MRE) and of occurrence of diarrhea is high when traveling to tropical regions. The relationships between these phenomena and the composition of human gut microbiota have not yet been assessed. Here, we investigated the dynamics of changes of metabolically active microbiota by sequencing total RNA from fecal samples taken before and after travel to tropical regions. We included 43 subjects who could provide fecal samples before and after a travel to tropical regions. When found positive by culturing for any MRE after travel, the subjects sent an additional sample 1 month later. In all, 104 fecal samples were considered (43 before travel, 43 at return, 18 one month after travel). We extracted the whole RNA, performed retrotranscription and sequenced the cDNA (MiSeq 2x300bp). The reads were mapped to the reference operational taxonomic units (OTUs) and species/strains using the 16S Greengenes and 23S SILVA databases. We found that the occurrence of diarrhea during the travel was associated with a higher relative abundance of Prevotella copri before departure and after return. The composition of microbiota, before travel as well as at return, was not correlated with the acquisition of MRE. However, the clearance of MRE one month after return was linked to a specific pattern of bacterial species that was also found before and after return. In conclusion, we found specific OTUs associated to a higher risk of diarrhea during a stay in tropical regions and to a faster clearance of MRE after their acquisition.
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Affiliation(s)
- Stefano Leo
- Genomic Research Laboratory, Service des Maladies Infectieuses, Hôpitaux Universitaires de Genève, Genève, Suisse
| | - Vladimir Lazarevic
- Genomic Research Laboratory, Service des Maladies Infectieuses, Hôpitaux Universitaires de Genève, Genève, Suisse
| | - Nadia Gaïa
- Genomic Research Laboratory, Service des Maladies Infectieuses, Hôpitaux Universitaires de Genève, Genève, Suisse
| | - Candice Estellat
- AP-HP, Hôpital Bichat, Département d’Epidémiologie et Recherche Clinique, URC Paris-Nord, F-75018 Paris, France,INSERM, CIC 1425-EC, UMR1123, F-75018 Paris, France,Université Paris Diderot, UMR 1123, Sorbonne Paris Cité, F-75018 Paris, France
| | - Myriam Girard
- Genomic Research Laboratory, Service des Maladies Infectieuses, Hôpitaux Universitaires de Genève, Genève, Suisse
| | - Sophie Matheron
- AP-HP, Hôpital Bichat, Service des Maladies Infectieuses et Tropicales, F-75018 Paris, France,INSERM and Université Paris Diderot, UMR 1137 IAME, F-75018 Paris, France,Laboratoire de Bactériologie, AP-HP, Hôpital Bichat
| | - Laurence Armand-Lefèvre
- INSERM and Université Paris Diderot, UMR 1137 IAME, F-75018 Paris, France,Laboratoire de Bactériologie, AP-HP, Hôpital Bichat
| | - Antoine Andremont
- INSERM and Université Paris Diderot, UMR 1137 IAME, F-75018 Paris, France,AP-HP, Hôpital Bichat, Laboratoire de Bactèriologie, F-75018 Paris, France
| | - Jacques Schrenzel
- Genomic Research Laboratory, Service des Maladies Infectieuses, Hôpitaux Universitaires de Genève, Genève, Suisse
| | - Etienne Ruppé
- Genomic Research Laboratory, Service des Maladies Infectieuses, Hôpitaux Universitaires de Genève, Genève, Suisse,CONTACT Etienne Ruppé IAME, EVRest team, Université Paris Diderot, Sorbonne Paris Cité, Hôpital Bichat - Claude Bernard, HUPNVS, Assistance Publique - Hôpitaux de Paris, 46 rue Henri Huchard, Paris 75877-Cedex 18
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25
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Lorme F, Maataoui N, Rondinaud E, Esposito-Farèse M, Clermont O, Ruppe E, Arlet G, Genel N, Matheron S, Andremont A, Armand-Lefevre L. Acquisition of plasmid-mediated cephalosporinase producing Enterobacteriaceae after a travel to the tropics. PLoS One 2018; 13:e0206909. [PMID: 30562395 PMCID: PMC6298645 DOI: 10.1371/journal.pone.0206909] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/22/2018] [Indexed: 12/31/2022] Open
Abstract
Travelers are at high risk of acquiring multi-drug resistant Enterobacteriaceae (MRE) while traveling abroad. Acquisition of extended spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E) while traveling has been extensively described, but not that of plasmid-mediated cephalosporinase producing Enterobacteriaceae (pAmpC-E). Here, we characterized the pAmpC-E acquired in 574 French travelers to tropical areas enrolled in the VOYAG-R study. Among the 526 MRE isolated at return, 57 (10.8%) from 49 travelers were pAmpC-E. The acquisition rate of pAmpC-E was 8.5% (49/574) ranging from 12.8% (25/195) in Asia, 7.6% (14/184) in Latin America to 5.1% (10/195) in Africa. The highest acquisition rates were observed in Peru (21.9%), India (21.4%) and Vietnam (20%). The carriage of pAmpC-E decreased quickly after return with 92.5% of colonized travelers being negative at one month. Most enzymes were CMY types (96.5%, n = 55, only met in Escherichia coli), including 40 CMY-2 (70.2%), 12 CMY-42 (21.1%), 1 CMY-6 and two new CMY-2 variants. The remaining were two DHA observed in Klebsiella pneumoniae. CMY-2 producing strains were acquired worldwide whereas CMY-42, except for one, were all acquired in Asia. BlaCMY-2 genes were associated with different plasmid types, including IncI1 (45. 2%), IncF (10%), IncF-IncI (7.5%), IncA/C (5%) and IncR (2.5%) whereas blaCMY-42 were all associated with IncI1 plasmids. Even though the pAmpC-E acquisition rate was much lower than that of ESBL-E, it was significant, especially in Asia, showing that pAmpC-E, especially CMY-type producing E. coli have spread in the community settings of tropical regions.
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Affiliation(s)
- Florian Lorme
- AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France
| | - Naouale Maataoui
- AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France
- INSERM, IAME, UMR 1137 France, Université Paris Diderot, Sorbonne Paris Cité, Paris, France, AP-HP, Hôpital Bichat, URC Paris-Nord, Paris, France
| | - Emilie Rondinaud
- AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France
- INSERM, IAME, UMR 1137 France, Université Paris Diderot, Sorbonne Paris Cité, Paris, France, AP-HP, Hôpital Bichat, URC Paris-Nord, Paris, France
| | - Marina Esposito-Farèse
- AP-HP, Hôpital Bichat, URC Paris-Nord, Paris, France
- INSERM, CIC 1425-EC, UMR1123, Paris, France
| | - Olivier Clermont
- INSERM, IAME, UMR 1137 France, Université Paris Diderot, Sorbonne Paris Cité, Paris, France, AP-HP, Hôpital Bichat, URC Paris-Nord, Paris, France
| | - Etienne Ruppe
- AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France
- INSERM, IAME, UMR 1137 France, Université Paris Diderot, Sorbonne Paris Cité, Paris, France, AP-HP, Hôpital Bichat, URC Paris-Nord, Paris, France
| | - Guillaume Arlet
- AP-HP, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Département de Bactériologie, Paris, France
- INSERM U1135, CIMI, Team E13, Paris, France, Sorbonne Université, UPMC Université Paris, Paris, France
| | - Nathalie Genel
- AP-HP, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Département de Bactériologie, Paris, France
- INSERM U1135, CIMI, Team E13, Paris, France, Sorbonne Université, UPMC Université Paris, Paris, France
| | | | - Sophie Matheron
- INSERM, IAME, UMR 1137 France, Université Paris Diderot, Sorbonne Paris Cité, Paris, France, AP-HP, Hôpital Bichat, URC Paris-Nord, Paris, France
- AP-HP, Hôpital Bichat, Maladies Infectieuses et Tropicales, Paris, France
| | - Antoine Andremont
- AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France
- INSERM, IAME, UMR 1137 France, Université Paris Diderot, Sorbonne Paris Cité, Paris, France, AP-HP, Hôpital Bichat, URC Paris-Nord, Paris, France
| | - Laurence Armand-Lefevre
- AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France
- INSERM, IAME, UMR 1137 France, Université Paris Diderot, Sorbonne Paris Cité, Paris, France, AP-HP, Hôpital Bichat, URC Paris-Nord, Paris, France
- * E-mail:
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26
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Ruppé E, Ghozlane A, Tap J, Pons N, Alvarez AS, Maziers N, Cuesta T, Hernando-Amado S, Clares I, Martínez JL, Coque TM, Baquero F, Lanza VF, Máiz L, Goulenok T, de Lastours V, Amor N, Fantin B, Wieder I, Andremont A, van Schaik W, Rogers M, Zhang X, Willems RJL, de Brevern AG, Batto JM, Blottière HM, Léonard P, Léjard V, Letur A, Levenez F, Weiszer K, Haimet F, Doré J, Kennedy SP, Ehrlich SD. Prediction of the intestinal resistome by a three-dimensional structure-based method. Nat Microbiol 2018; 4:112-123. [PMID: 30478291 DOI: 10.1038/s41564-018-0292-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/11/2018] [Indexed: 12/21/2022]
Abstract
The intestinal microbiota is considered to be a major reservoir of antibiotic resistance determinants (ARDs) that could potentially be transferred to bacterial pathogens via mobile genetic elements. Yet, this assumption is poorly supported by empirical evidence due to the distant homologies between known ARDs (mostly from culturable bacteria) and ARDs from the intestinal microbiota. Consequently, an accurate census of intestinal ARDs (that is, the intestinal resistome) has not yet been fully determined. For this purpose, we developed and validated an annotation method (called pairwise comparative modelling) on the basis of a three-dimensional structure (homology comparative modelling), leading to the prediction of 6,095 ARDs in a catalogue of 3.9 million proteins from the human intestinal microbiota. We found that the majority of predicted ARDs (pdARDs) were distantly related to known ARDs (mean amino acid identity 29.8%) and found little evidence supporting their transfer between species. According to the composition of their resistome, we were able to cluster subjects from the MetaHIT cohort (n = 663) into six resistotypes that were connected to the previously described enterotypes. Finally, we found that the relative abundance of pdARDs was positively associated with gene richness, but not when subjects were exposed to antibiotics. Altogether, our results indicate that the majority of intestinal microbiota ARDs can be considered intrinsic to the dominant commensal microbiota and that these genes are rarely shared with bacterial pathogens.
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Affiliation(s)
- Etienne Ruppé
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, Jouy en Josas, France. .,IAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité, Paris, France.
| | - Amine Ghozlane
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, Jouy en Josas, France.,Institut Pasteur - Bioinformatics and Biostatistics Hub - C3BI, USR 3756 IP CNRS, Paris, France.,Institut Pasteur - Biomics - CITECH, Paris, France
| | - Julien Tap
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, Jouy en Josas, France.,Danone Nutricia Research, Palaiseau, France
| | - Nicolas Pons
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, Jouy en Josas, France
| | | | - Nicolas Maziers
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, Jouy en Josas, France
| | | | | | - Irene Clares
- Centro Nacional de Biotecnología, CSIC, Madrid, Spain
| | | | - Teresa M Coque
- Servicio de Microbiología Instituto, Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.,CIBER en Epidemiología y Salud Pública, Madrid, Spain.,Unidad de Resistencia a Antibióticos y Virulencia Bacteriana, Madrid, Spain
| | - Fernando Baquero
- Servicio de Microbiología Instituto, Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.,CIBER en Epidemiología y Salud Pública, Madrid, Spain.,Unidad de Resistencia a Antibióticos y Virulencia Bacteriana, Madrid, Spain
| | - Val F Lanza
- Servicio de Microbiología Instituto, Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.,CIBER en Epidemiología y Salud Pública, Madrid, Spain
| | - Luis Máiz
- Unit for Cystic Fibrosis, Ramon y Cajal University Hospital, Madrid, Spain
| | - Tiphaine Goulenok
- Internal Medicine Department, Beaujon Hospital, AP-HP, Clichy, France
| | - Victoire de Lastours
- IAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité, Paris, France.,Internal Medicine Department, Beaujon Hospital, AP-HP, Clichy, France
| | - Nawal Amor
- Internal Medicine Department, Beaujon Hospital, AP-HP, Clichy, France
| | - Bruno Fantin
- IAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité, Paris, France.,Internal Medicine Department, Beaujon Hospital, AP-HP, Clichy, France
| | - Ingrid Wieder
- Bacteriology Laboratory, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Antoine Andremont
- IAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité, Paris, France.,Bacteriology Laboratory, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Willem van Schaik
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands.,Institute of Microbiology and Infection, University of Birmingham, Edgbaston, Birmingham, UK
| | - Malbert Rogers
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Xinglin Zhang
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rob J L Willems
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alexandre G de Brevern
- INSERM UMR_S 1134, Paris Diderot University, Sorbonne Paris Cité, Université de la Réunion, Université des Antilles, INTS, GR-Ex, Paris, France
| | - Jean-Michel Batto
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, Jouy en Josas, France
| | - Hervé M Blottière
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, Jouy en Josas, France
| | - Pierre Léonard
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, Jouy en Josas, France
| | - Véronique Léjard
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, Jouy en Josas, France
| | - Aline Letur
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, Jouy en Josas, France
| | - Florence Levenez
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, Jouy en Josas, France
| | - Kevin Weiszer
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, Jouy en Josas, France
| | - Florence Haimet
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, Jouy en Josas, France
| | - Joël Doré
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, Jouy en Josas, France
| | - Sean P Kennedy
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, Jouy en Josas, France.,Institut Pasteur - Biomics - CITECH, Paris, France
| | - S Dusko Ehrlich
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, Jouy en Josas, France.,Centre of Host Microbiome Interactions, King's College, London, UK
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Sanneh B, Kebbeh A, Jallow HS, Camara Y, Mwamakamba LW, Ceesay IF, Barrow E, Sowe FO, Sambou SM, Baldeh I, Jallow A, Jorge Raul MA, Andremont A. Prevalence and risk factors for faecal carriage of Extended Spectrum β-lactamase producing Enterobacteriaceae among food handlers in lower basic schools in West Coast Region of The Gambia. PLoS One 2018; 13:e0200894. [PMID: 30102698 PMCID: PMC6089431 DOI: 10.1371/journal.pone.0200894] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 07/05/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The isolation of Extended spectrum βlactamase (ESBLs) producing Enterobacteriaceae among food handlers and their implication as sources of food borne outbreaks are a public health concern. This study seeks to investigate the prevalence of faecal carriage of these bacteria among food handlers in the West Coast Region of The Gambia. METHOD This study enrolled 600 participants from 60 Lower Basic Schools in West Coast Region of the country. Stool samples collected from the participants were presumptively screened for the ESBLs producing Enterobacteriaceae, using Drigalski agar, supplemented with 2mg/L cefotaxime. The bacterial colonies that grew on each Drigalski agar were tested for ESBL production by the double disk synergy test as recommended by Clinical and Laboratory Standard Institute (CLSI-2015). The confirmatory analysis for ESBL was determined as the zone of inhibition of cefotaxime and/or ceftazidime to ≥5mm from that of cefotaxime /clavulanicacid and/or ceftazidime/clavulanic acid. The presumptive screening of isolates for AmpC phenotypes was done by testing the organism against cefoxitin. The prevalence of the ESBL carriage was presented in percentages. The association of risk factors to the faecal carriage of ESBLs producing Enterobacteriaceae was performed by Pearson Chi-squared and Fishers Exact at (p ≤ 0.05). RESULT The prevalence of faecal carriage ESBL producing Enterobacteriaceae among food handlers was 5.0% (28/565). We found50% (14/28) and3.57% (1/28) ESBL producing bacteria were presumptive AmpC and carbapenemase resistance phenotype. Themost abundant ESBL producing Enterobacteriaceae were Klebsiella spp 32.1% (9/28) and Escherichia spp 28.6% (8/28). The use of antibiotics in the last 3 months was found to be significantly associated (P = 0.012) with the faecal carriage of ESBLs producing Enterobacteriaceae. CONCLUSION The prevalence of faecal carriage of ESBLs producing Enterobacteriaceae among food handlers in the Gambia is low. The history to use of the antibiotics in the last three months was found to be significantly associated with this prevalence. Therefore, the institution of a robust antimicrobial surveillance and treatment of patients with such infections are necessary to curb the spread of these multidrug resistant bacteria in the country. Rational prescription and usage of the antibiotics especially cephalosporin should be advocated both in public and private health facilities.
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Affiliation(s)
- Bakary Sanneh
- National Public Health Laboratories, Ministry of Health and Social Welfare, Kotu Layout, Kotu, The Gambia
- * E-mail:
| | - Abou Kebbeh
- National Public Health Laboratories, Ministry of Health and Social Welfare, Kotu Layout, Kotu, The Gambia
| | - Haruna S. Jallow
- National Public Health Laboratories, Ministry of Health and Social Welfare, Kotu Layout, Kotu, The Gambia
| | - Yaya Camara
- Epidemiology and disease Control Department, Ministry of Health and Social Welfare, Kotu Layout, Kotu, The Gambia
| | | | - Ida Fatou Ceesay
- National Public Health Laboratories, Ministry of Health and Social Welfare, Kotu Layout, Kotu, The Gambia
| | - Ebrima Barrow
- Medical Microbiology Laboratory, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Fatou O. Sowe
- Department of Health Promotion and Education, Ministry of Health and Social Welfare, Kotu Layout, Kotu, The Gambia
| | - Sana M. Sambou
- Epidemiology and disease Control Department, Ministry of Health and Social Welfare, Kotu Layout, Kotu, The Gambia
| | - Ignatius Baldeh
- National Public Health Laboratories, Ministry of Health and Social Welfare, Kotu Layout, Kotu, The Gambia
| | - Alpha Jallow
- World Health Organization, CountryOffice, The Gambia
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28
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Maataoui N, Mayet A, Duron S, Delacour H, Mentré F, Laouenan C, Desvillechabrol D, Cokelaer T, Meynard JB, Ducher A, Andremont A, Armand-Lefèvre L, Mérens A. High acquisition rate of extended-spectrum β-lactamase-producing Enterobacteriaceae among French military personnel on mission abroad, without evidence of inter-individual transmission. Clin Microbiol Infect 2018; 25:631.e1-631.e9. [PMID: 30099136 DOI: 10.1016/j.cmi.2018.07.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/16/2018] [Accepted: 07/29/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Acquisition of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) by Europeans travelling individually in high-endemicity countries is common. However, how the different ESBL-E strains circulate in groups of travellers has not been studied. We investigated ESBL-E transmission within several groups of French military personnel serving overseas for 4-6 months. METHODS We conducted a prospective study among French military personnel assigned to Afghanistan, French Guiana or Côte d'Ivoire for 4-6 months. Faecal samples provided by volunteers before leaving and after returning were screened for ESBL-E isolates. ESBL Escherichia coli from each military group was characterized by repetitive element palindromic polymerase chain reaction (rep-PCR) fingerprinting followed, in the Afghanistan group, by whole-genome sequencing (WGS) if similarity was ≥97%. RESULTS Among the 189 volunteers whose samples were negative before departure, 72 (38%) were positive after return. The highest acquisition rates were observed in the Afghanistan (29/33, 88%) and Côte d'Ivoire (39/80, 49%) groups. Acquisition rates on return from French Guiana were much lower (4/76, 5%). WGS of the 20 strains from the Afghanistan group that clustered by rep-PCR identified differences in sequence type, serotype, resistance genes and plasmid replicons. Moreover, single-nucleotide polymorphism (SNP) differences across acquired strains from a given cluster ranged from 30 to 3641, suggesting absence of direct transmission. CONCLUSIONS ESBL-E. coli acquisition was common among military personnel posted overseas. Many strains clustered by rep-PCR but differed by WGS and SNP analysis, suggesting acquisition from common external sources rather than direct person-to-person transmission.
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Affiliation(s)
- N Maataoui
- Laboratoire de Bactériologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France; Inserm, IAME, UMR 1137, University of Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France.
| | - A Mayet
- Service de Santé des Armées, Centre d'épidémiologie et de santé publique des armées, Marseille, France; INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale, Université Aix Marseille, Marseille, France
| | - S Duron
- Service de Santé des Armées, Centre d'épidémiologie et de santé publique des armées, Marseille, France; INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale, Université Aix Marseille, Marseille, France
| | - H Delacour
- Laboratoire de Microbiologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France; Ecole du Val-de-Grâce, Paris, France
| | - F Mentré
- Inserm, IAME, UMR 1137, University of Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France; Biostatistics Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - C Laouenan
- Inserm, IAME, UMR 1137, University of Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France; Biostatistics Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - D Desvillechabrol
- Institut Pasteur - Bioinformatics and Biostatistics Hub, C3BI, USR 3756 IP CNRS, Paris, France
| | - T Cokelaer
- Institut Pasteur - Bioinformatics and Biostatistics Hub, C3BI, USR 3756 IP CNRS, Paris, France; Institut Pasteur, Biomics Pole, CITECH, Paris, France
| | - J B Meynard
- Service de Santé des Armées, Centre d'épidémiologie et de santé publique des armées, Marseille, France; INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé et Traitement de l'Information Médicale, Université Aix Marseille, Marseille, France; Ecole du Val-de-Grâce, Paris, France
| | | | - A Andremont
- Inserm, IAME, UMR 1137, University of Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France
| | - L Armand-Lefèvre
- Laboratoire de Bactériologie, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France; Inserm, IAME, UMR 1137, University of Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France
| | - A Mérens
- Laboratoire de Microbiologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France; Ecole du Val-de-Grâce, Paris, France
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29
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Larsson DGJ, Andremont A, Bengtsson-Palme J, Brandt KK, de Roda Husman AM, Fagerstedt P, Fick J, Flach CF, Gaze WH, Kuroda M, Kvint K, Laxminarayan R, Manaia CM, Nielsen KM, Plant L, Ploy MC, Segovia C, Simonet P, Smalla K, Snape J, Topp E, van Hengel AJ, Verner-Jeffreys DW, Virta MPJ, Wellington EM, Wernersson AS. Critical knowledge gaps and research needs related to the environmental dimensions of antibiotic resistance. Environ Int 2018; 117:132-138. [PMID: 29747082 DOI: 10.1016/j.envint.2018.04.041] [Citation(s) in RCA: 203] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/30/2018] [Accepted: 04/21/2018] [Indexed: 05/24/2023]
Abstract
There is growing understanding that the environment plays an important role both in the transmission of antibiotic resistant pathogens and in their evolution. Accordingly, researchers and stakeholders world-wide seek to further explore the mechanisms and drivers involved, quantify risks and identify suitable interventions. There is a clear value in establishing research needs and coordinating efforts within and across nations in order to best tackle this global challenge. At an international workshop in late September 2017, scientists from 14 countries with expertise on the environmental dimensions of antibiotic resistance gathered to define critical knowledge gaps. Four key areas were identified where research is urgently needed: 1) the relative contributions of different sources of antibiotics and antibiotic resistant bacteria into the environment; 2) the role of the environment, and particularly anthropogenic inputs, in the evolution of resistance; 3) the overall human and animal health impacts caused by exposure to environmental resistant bacteria; and 4) the efficacy and feasibility of different technological, social, economic and behavioral interventions to mitigate environmental antibiotic resistance.1.
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Affiliation(s)
- D G Joakim Larsson
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Guldhedsgatan 10A, SE-413 46 Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Guldhedsdsgatan 10A, SE-413 46, Sweden.
| | - Antoine Andremont
- INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
| | - Johan Bengtsson-Palme
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Guldhedsgatan 10A, SE-413 46 Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Guldhedsdsgatan 10A, SE-413 46, Sweden.
| | - Kristian Koefoed Brandt
- Department of Plant and Environmental Sciences, Faculty of Science, University of Copenhagen, Thorvaldsensvej 40, 1871 Frederiksberg, Denmark.
| | - Ana Maria de Roda Husman
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, PO Box 80175, 3508 TD Utrecht, The Netherlands; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands.
| | | | - Jerker Fick
- Department of Chemistry, Umeå University, Umeå, Sweden.
| | - Carl-Fredrik Flach
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Guldhedsgatan 10A, SE-413 46 Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Guldhedsdsgatan 10A, SE-413 46, Sweden.
| | - William H Gaze
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
| | - Makoto Kuroda
- National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama, Tokyo 208-0011, Japan.
| | - Kristian Kvint
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Guldhedsgatan 10A, SE-413 46 Gothenburg, Sweden; Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Guldhedsdsgatan 10A, SE-413 46, Sweden.
| | | | - Celia M Manaia
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Rua Arquiteto Lobão Vital, Apartado 2511, 4202-401 Porto, Portugal.
| | - Kaare Magne Nielsen
- Department of Life Sciences and Health, Oslo and Akershus University College of Applied Sciences, 0130 Oslo, Norway.
| | - Laura Plant
- Swedish Research Council, Box 1035, SE-101 38 Stockholm, Sweden.
| | | | - Carlos Segovia
- Unidad funcional de Acreditación de Institutos de Investigación Sanitaria, Instituto de Salud Carlos III, Spain.
| | - Pascal Simonet
- Environmental Microbial Genomics Group, Laboratory Ampère, UMR CNRS 5005, École Centrale de Lyon, Université de Lyon, 36 avenue Guy de Collongue, 69134 Écully Cedex, France.
| | - Kornelia Smalla
- Julius Kühn-Institut, Federal Research Centre for Cultivated Plants, Institute for Epidemiology and Pathogen Diagnostics, Messeweg 11-12, 38104 Braunschweig, Germany.
| | - Jason Snape
- Global Environment, AstraZeneca, Cheshire SK10 4TF, UK; School of Life Sciences, University of Warwick, Coventry CV4 7AL, UK.
| | - Edward Topp
- London Research and Development Center, Agriculture and Agri-Food Canada (AAFC), Department of Biology, University of Western Ontario, London, ON N5V 4T3, Canada.
| | - Arjon J van Hengel
- Directorate Health, Directorate-General for Research and Innovation, European Commission, Brussels, Belgium.
| | - David W Verner-Jeffreys
- Cefas Weymouth Laboratory, Centre for Environment, Fisheries and Aquaculture Science, Weymouth, Dorset DT4 8UB, UK.
| | - Marko P J Virta
- Department of Microbiology, University of Helsinki, Helsinki, Finland.
| | | | - Ann-Sofie Wernersson
- Swedish Agency for Marine and Water Management, Box 11 930, SE-404 39 Gothenburg, Sweden.
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Pérez-Brocal V, Andremont A, Moya A. Isolation in small populations of Wayampi Amerindians promotes endemicity and homogenisation of their faecal virome, but its distribution is not entirely random. FEMS Microbiol Ecol 2018; 94:4768065. [PMID: 29272453 DOI: 10.1093/femsec/fix184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/19/2017] [Indexed: 11/13/2022] Open
Abstract
The isolated community of the Wayampi Amerindians has been extensively studied for the presence of beta lactamase-producing enterobacteria and their gut microbiota. However, no information about their virome was available. This study tries to establish potential associations between the virome and diverse epidemiological data, through the metagenomic study of the faecal prophages and DNA viruses from 31 samples collected in 2010. Taxonomic assignments, composition, abundance and diversity analyses were obtained to characterise the virome and were compared between groups according to several demographic, environmental and medical data. Prophages outnumbered viruses. Composition and abundance of virome indicated relatively low variability. Diversity within samples showed no significant differences, regardless of the group comparison. Significant differences were observed in the beta diversity among samples according to hospitalisation and gender, but not by extended spectrum β-lactamase carriage, antibiotic intake or possession of pets, although some viruses differed in some cases (e.g. immunodeficiency-associated stool virus associated with antibiotic intake). The faecal virome of adult Wayampi is more homogeneous than that from western populations. Not a single factor analysed can explain alone the observed distribution of the virome, but differences by gender (fewer variability in females than males) may reflect differences in life habits and work.
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Affiliation(s)
- Vicente Pérez-Brocal
- Genomics and Health Area, Foundation for the Promotion of Biomedical and Sanitary Research (FISABIO), Avenida de Cataluña 21, 46020 Valencia, Spain.,CIBER in Epidemiology and Public Health (CIBERESP), c/ Moforte de Lemos 3-5, 28029. Madrid, Spain
| | - Antoine Andremont
- IAME, UMR 1137, INSERM, Université Paris Diderot, 16 rue Henri Huchard B.P. 416-75870 Paris, France
| | - Andrés Moya
- Genomics and Health Area, Foundation for the Promotion of Biomedical and Sanitary Research (FISABIO), Avenida de Cataluña 21, 46020 Valencia, Spain.,CIBER in Epidemiology and Public Health (CIBERESP), c/ Moforte de Lemos 3-5, 28029. Madrid, Spain.,Integrative Systems Biology Institute (I2Sysbio), University of Valéncia and Spanish Research Council (CSIC),c/ Catedrático José Beltrán 2, 46980 Paterna, Valéncia, Spain
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31
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Lanza VF, Baquero F, Martínez JL, Ramos-Ruíz R, González-Zorn B, Andremont A, Sánchez-Valenzuela A, Ehrlich SD, Kennedy S, Ruppé E, van Schaik W, Willems RJ, de la Cruz F, Coque TM. In-depth resistome analysis by targeted metagenomics. Microbiome 2018; 6:11. [PMID: 29335005 PMCID: PMC5769438 DOI: 10.1186/s40168-017-0387-y] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 12/17/2017] [Indexed: 05/08/2023]
Abstract
BACKGROUND Antimicrobial resistance is a major global health challenge. Metagenomics allows analyzing the presence and dynamics of "resistomes" (the ensemble of genes encoding antimicrobial resistance in a given microbiome) in disparate microbial ecosystems. However, the low sensitivity and specificity of available metagenomic methods preclude the detection of minority populations (often present below their detection threshold) and/or the identification of allelic variants that differ in the resulting phenotype. Here, we describe a novel strategy that combines targeted metagenomics using last generation in-solution capture platforms, with novel bioinformatics tools to establish a standardized framework that allows both quantitative and qualitative analyses of resistomes. METHODS We developed ResCap, a targeted sequence capture platform based on SeqCapEZ (NimbleGene) technology, which includes probes for 8667 canonical resistance genes (7963 antibiotic resistance genes and 704 genes conferring resistance to metals or biocides), and 2517 relaxase genes (plasmid markers) and 78,600 genes homologous to the previous identified targets (47,806 for antibiotics and 30,794 for biocides or metals). Its performance was compared with metagenomic shotgun sequencing (MSS) for 17 fecal samples (9 humans, 8 swine). ResCap significantly improves MSS to detect "gene abundance" (from 2.0 to 83.2%) and "gene diversity" (26 versus 14.9 genes unequivocally detected per sample per million of reads; the number of reads unequivocally mapped increasing up to 300-fold by using ResCap), which were calculated using novel bioinformatic tools. ResCap also facilitated the analysis of novel genes potentially involved in the resistance to antibiotics, metals, biocides, or any combination thereof. CONCLUSIONS ResCap, the first targeted sequence capture, specifically developed to analyze resistomes, greatly enhances the sensitivity and specificity of available metagenomic methods and offers the possibility to analyze genes related to the selection and transfer of antimicrobial resistance (biocides, heavy metals, plasmids). The model opens the possibility to study other complex microbial systems in which minority populations play a relevant role.
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Affiliation(s)
- Val F Lanza
- Department of Microbiology, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
- Joint Unit of Antibiotic Resistance and Bacterial Virulence associated with the Spanish National Research Council (CSIC), Madrid, Spain
- Network Research Center for Epidemiology and Public Health (CIBER-ESP), Madrid, Spain
- National Center of Biotechnology, CSIC, Madrid, Spain
| | - Fernando Baquero
- Department of Microbiology, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
- Joint Unit of Antibiotic Resistance and Bacterial Virulence associated with the Spanish National Research Council (CSIC), Madrid, Spain
- Network Research Center for Epidemiology and Public Health (CIBER-ESP), Madrid, Spain
| | - José Luís Martínez
- Joint Unit of Antibiotic Resistance and Bacterial Virulence associated with the Spanish National Research Council (CSIC), Madrid, Spain
- National Center of Biotechnology, CSIC, Madrid, Spain
| | | | - Bruno González-Zorn
- Faculty of Veterinary Medicine, Complutense University of Madrid, Madrid, Spain
| | - Antoine Andremont
- IAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité, Bacteriology Laboratory, Hospital Bichat, AP-HP, Paris, France
| | - Antonio Sánchez-Valenzuela
- Department of Microbiology, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Stanislav Dusko Ehrlich
- MGP MetaGénoPolis, INRA, University of Paris-Saclay, Jouy-en-Josas, France
- Center of Host Microbiome Interactions, King's College, London, UK
| | - Sean Kennedy
- MGP MetaGénoPolis, INRA, University of Paris-Saclay, Jouy-en-Josas, France
- Present Address: Bioinformatics and Biostatistics HUB, C3BI and Biomics Pole, CITECH Pasteur Institute, Centre François Jacob, Paris, France
| | - Etienne Ruppé
- IAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité, Bacteriology Laboratory, Hospital Bichat, AP-HP, Paris, France
- MGP MetaGénoPolis, INRA, University of Paris-Saclay, Jouy-en-Josas, France
| | - Willem van Schaik
- Department of Medical Microbiology, University Medical Center, Utrecht, Netherlands
- Present Address: Institute of Microbiology and Infection, University of Birmingham, Birmingham, B15 2TT, UK
| | - Rob J Willems
- Department of Medical Microbiology, University Medical Center, Utrecht, Netherlands
| | - Fernando de la Cruz
- Department of Molecular Biology, University of Cantabria, Santander, Spain
- Institute of Biomedicine and Biotechnology of Cantabria, IBBTEC (UC-CSIC), Santander, Spain
| | - Teresa M Coque
- Department of Microbiology, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain.
- Joint Unit of Antibiotic Resistance and Bacterial Virulence associated with the Spanish National Research Council (CSIC), Madrid, Spain.
- Network Research Center for Epidemiology and Public Health (CIBER-ESP), Madrid, Spain.
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Kardaś-Słoma L, Lucet JC, Perozziello A, Pelat C, Birgand G, Ruppé E, Boëlle PY, Andremont A, Yazdanpanah Y. Universal or targeted approach to prevent the transmission of extended-spectrum beta-lactamase-producing Enterobacteriaceae in intensive care units: a cost-effectiveness analysis. BMJ Open 2017; 7:e017402. [PMID: 29102989 PMCID: PMC5722099 DOI: 10.1136/bmjopen-2017-017402] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Several control strategies have been used to limit the transmission of multidrug-resistant organisms in hospitals. However, their implementation is expensive and effectiveness of interventions for the control of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) spread is controversial. Here, we aim to assess the cost-effectiveness of hospital-based strategies to prevent ESBL-PE transmission and infections. DESIGN Cost-effectiveness analysis based on dynamic, stochastic transmission model over a 1-year time horizon. PATIENTS AND SETTING Patients hospitalised in a hypothetical 10-bed intensive care unit (ICU) in a high-income country. INTERVENTIONS Base case scenario compared with (1) universal strategies (eg, improvement of hand hygiene (HH) among healthcare workers, antibiotic stewardship), (2) targeted strategies (eg, screening of patient for ESBL-PE at ICU admission and contact precautions or cohorting of carriers) and (3) mixed strategies (eg, targeted approaches combined with antibiotic stewardship). MAIN OUTCOMES AND MEASURES Cases of ESBL-PE transmission, infections, cost of intervention, cost of infections, incremental cost per infection avoided. RESULTS In the base case scenario, 15 transmissions and five infections due to ESBL-PE occurred per 100 ICU admissions, representing a mean cost of €94 792. All control strategies improved health outcomes and reduced costs associated with ESBL-PE infections. The overall costs (cost of intervention and infections) were the lowest for HH compliance improvement from 55%/60% before/after contact with a patient to 80%/80%. CONCLUSIONS Improved compliance with HH was the most cost-saving strategy to prevent the transmission of ESBL-PE. Antibiotic stewardship was not cost-effective. However, adding antibiotic restriction strategy to HH or screening and cohorting strategies slightly improved their effectiveness and may be worthy of consideration by decision-makers.
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Affiliation(s)
- Lidia Kardaś-Słoma
- IAME, UMR 1137, INSERM, Paris, France
- University of Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jean-Christophe Lucet
- IAME, UMR 1137, INSERM, Paris, France
- University of Paris Diderot, Sorbonne Paris Cité, Paris, France
- Infection Control Unit, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Anne Perozziello
- IAME, UMR 1137, INSERM, Paris, France
- University of Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Camille Pelat
- IAME, UMR 1137, INSERM, Paris, France
- University of Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Gabriel Birgand
- IAME, UMR 1137, INSERM, Paris, France
- University of Paris Diderot, Sorbonne Paris Cité, Paris, France
- Infection Control Unit, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Etienne Ruppé
- Bacteriology Laboratory, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Pierre-Yves Boëlle
- Pierre Louis Institute of Epidemiology and Public Health (IPLESPUMRS 1136), INSERM, UPMC University Paris 06, Sorbonne University, Paris, France
| | - Antoine Andremont
- Bacteriology Laboratory, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Yazdan Yazdanpanah
- IAME, UMR 1137, INSERM, Paris, France
- University of Paris Diderot, Sorbonne Paris Cité, Paris, France
- Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
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Burdet C, Nguyen TT, Saint-Lu N, Sayah-Jeanne S, Hugon P, Sablier-Gallis F, Ferreira S, Andremont A, Mentré F, Gunzburg JD. Change in Bacterial Diversity of Fecal Microbiota Drives Mortality in a Hamster Model of Antibiotic-induced Clostridium difficile Colitis. Open Forum Infect Dis 2017. [PMCID: PMC5631430 DOI: 10.1093/ofid/ofx163.947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background C. difficile (C diff) infection results from antibiotic-induced changes in colonic microbiota. DAV131A, an oral adsorbent-based product, can sequester antibiotic (AB) residues in the gut and reduce mortality in a hamster model of moxifloxacin (MXF) or clindamycin (CM) induced C diffcolitis. We studied the link between changes of the bacterial diversity within the fecal microbiota and mortality in this model. Methods Male Syrian hamsters were administered 30 mg/kg MXF or 5 mg/kg CM subcutaneously once a day for 5 days (D1 to D5) and orally infected at D3 with 104C diffspores. They were orally administered various doses of DAV131A (0, and 200 to 900 mg/kg twice a day), from D1 to D8. Survival was monitored up to D16 and feces were collected (D1 and D3) to characterize the microbiota by 16S rRNA gene profiling. Changes of various α- (Shannon, Observed OTUs and Chao1) and β- (Bray-Curtis dissimilarity and [un]weighted UniFrac) diversity indices between D1 and D3 were obtained for each animal. We analyzed links between (i) DAV131A dose and changes of bacterial diversity and (ii) changes of bacterial diversity and mortality using non parametric tests and logistic regression. Results Data from 70 and 60 animals were available in the MXF and CM studies, among which 10 and 28 died, respectively. Increasing doses of DAV131A reduced mortality from 100% to 0% and reduced changes in bacterial diversity of the fecal microbiota. Very strong predictors of mortality were changes in Shannon and unweighted UniFrac indices, which were markedly less affected in hamsters who survived (see table below median (min; max) according to vital status and area under the ROC curve, AUROC). Conclusion The extent of AB-induced changes in gut bacterial diversity correlated with increased mortality in a hamster model of C diff colitis. Higher doses of DAV131A protected fecal microbiota disruption and hence mortality. Disclosures C. Burdet, Da Volterra: Consultant and Research Contractor, Consulting fee; N. Saint-Lu, Da Volterra: Employee, Salary; S. Sayah-Jeanne, Da Volterra: Employee, Salary; P. Hugon, Da Volterra: Employee, Salary; F. Sablier-Gallis, Da Volterra: Employee, Salary; S. Ferreira, Genoscreen: Employee, Salary; A. Andremont, Da Volterra: Consultant, Consulting fee; F. Mentré, Da Volterra: Consultant and Research Contractor, Consulting fee; J. De Gunzburg, Da Volterra: Consultant and Shareholder, Consulting fee
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Affiliation(s)
- Charles Burdet
- INSERM & Paris Diderot University, IAME, UMR 1137; AP-HP, Bichat Hospital, Paris, France
| | - Thu Thuy Nguyen
- INSERM & Paris Diderot University, IAME, UMR 1137, Paris, France
| | | | | | | | | | | | - Antoine Andremont
- INSERM & Paris Diderot University, IAME, UMR 1137; AP-HP, Bichat Hospital, Paris, France
| | - France Mentré
- INSERM & Paris Diderot University, IAME, UMR 1137; AP-HP, Bichat Hospital, Paris, France
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Ruppé E, Burdet C, Grall N, de Lastours V, Lescure FX, Andremont A, Armand-Lefèvre L. Impact of antibiotics on the intestinal microbiota needs to be re-defined to optimize antibiotic usage. Clin Microbiol Infect 2017; 24:3-5. [PMID: 28970162 DOI: 10.1016/j.cmi.2017.09.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 12/22/2022]
Affiliation(s)
- E Ruppé
- INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France.
| | - C Burdet
- INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat, Département of d'Epidémiologie, Biostatistiques et Recherche Clinique, Paris, France
| | - N Grall
- INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France
| | - V de Lastours
- INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Beaujon, Equipe Mobile d'Antibiothérapie, Clichy, France
| | - F-X Lescure
- INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat, Service des Maladies Infectieuses, Paris, France
| | - A Andremont
- INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France
| | - L Armand-Lefèvre
- INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Bactériologie, Paris, France
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35
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Loubet P, Burdet C, Vindrios W, Grall N, Wolff M, Yazdanpanah Y, Andremont A, Duval X, Lescure FX. Cefazolin versus anti-staphylococcal penicillins for treatment of methicillin-susceptible Staphylococcus aureus bacteraemia: a narrative review. Clin Microbiol Infect 2017; 24:125-132. [PMID: 28698037 DOI: 10.1016/j.cmi.2017.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/27/2017] [Accepted: 07/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Anti-staphylococcal penicillins (ASPs) are recommended as first-line agents in methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia. Concerns about their safety profile have contributed to the increased use of cefazolin. The comparative clinical effectiveness and safety profile of cefazolin versus ASPs for such infections remain unclear. Furthermore, uncertainty persists concerning the use of cefazolin due to controversies over its efficacy in deep MSSA infections and its possible negative ecological impact. AIMS The aim of this narrative review was to gather and balance available data on the efficacy and safety of cefazolin versus ASPs in the treatment of MSSA bacteraemia and to discuss the potential negative ecological impact of cefazolin. SOURCES PubMed and EMBASE electronic databases were searched up to May 2017 to retrieve available studies on the topic. CONTENTS Although described in vitro and in experimental studies, the clinical relevance of the inoculum effect during cefazolin treatment of deep MSSA infections remains unclear. It appears that there is no significant difference in rate of relapse or mortality between ASPs and cefazolin for the treatment of MSSA bacteraemia but these results should be cautiously interpreted because of the several limitations of the available studies. Compared with cefazolin, there is more frequent discontinuation for adverse effects with ASP use, especially because of cutaneous and renal events. No study has evidenced any change in the gut microbiota after the use of cefazolin. IMPLICATIONS Based on currently available studies, there are no data that enable a choice to be made of one antibiotic over the other except in patients with allergy or renal impairment. This review points out the need for future prospective studies and randomized controlled trials to better address these questions.
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Affiliation(s)
- P Loubet
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - C Burdet
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Département d'épidémiologie, biostatistique et recherche clinique, Paris, France
| | - W Vindrios
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - N Grall
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Bactériologie, Paris, France
| | - M Wolff
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Service de réanimation médicale et infectieuse, Paris, France
| | - Y Yazdanpanah
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - A Andremont
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Bactériologie, Paris, France
| | - X Duval
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Centre d'Investigation Clinique, Paris, France
| | - F-X Lescure
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et Tropicales, Paris, France.
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Sangaré SA, Maïga AI, Maïga A, Diallo S, Camara N, Savadogo S, Guindo I, Bougoudogo F, Armand-Lefèvre L, Andremont A, Maïga II. Prevalence of extended-spectrum beta-lactamase phenotypes in enterobacteria isolated from blood cultures of patients at admission to the University Hospital of Bamako. Med Sante Trop 2017; 27:170-175. [PMID: 28655678 DOI: 10.1684/mst.2017.0681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of our study was to determine the frequency of extended-spectrum beta-lactamase (ESBL) phenotypes among the enterobacteria present in blood cultures of patients at admission to two university hospitals of Bamako (Mali). During a period of three months, we isolated enterobacteria from blood cultures from patients upon admission to the Point G and Gabriel Toure University Hospitals. The ESBL-positive enterobacteria were initially identified by API 20E strips and VITEK®2 and then confirmed in France by MALDI-TOF mass spectrometry at the Bichat Hospital bacteriology laboratory. Antibiotic susceptibility was determined by the diffusion method as recommended by EUCAST. The species isolated were K. pneumoniae (14/40, 35.0 %), E. coli (11/40, 27.5 %), and E. cloacae (9/40, 22.5 %); 21/34 (61.8 %) had an ESBL phenotype, including 10/14 (71.4 %) K. pneumoniae, 8/11 (72.7 %) E. coli, and 3/9 (33 3 %), E. cloacae. The ESBL strains of K. pneumoniae, E. coli, and E. cloacae were associated, respectively, with resistance to the following antibiotics: gentamicin (10/10, 100 %; 6/8, 75%; 2/3, 67%), amikacin (2/10, 20 %; 0/8, 0%; 0/3, 0%), ofloxacin (8/10, 80. %; 7/8, 87%; 3/3, 100%), cotrimoxazole (10/10, 100 %; 6/8, 75%; 3/3, 100%). Almost two thirds (61.8%) of the enterobacteria isolated from blood cultures produced extended-spectrum beta-lactamases. They retained regular sensitivity only to carbapenems and amikacin.
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Affiliation(s)
- S A Sangaré
- Laboratoire de bactériologie, CHU Gabriel Touré, Bamako, Mali, Laboratoire de bactériologie, CHU Bichat-Claude Bernard et UMR Inserm 1137 Iame Paris, France, Faculté de pharmacie (FAPH), Université des sciences des techniques, et des technologies de Bamako (USTTB), Bamako, Mali
| | - A I Maïga
- Laboratoire de bactériologie, CHU Gabriel Touré, Bamako, Mali, Faculté de pharmacie (FAPH), Université des sciences des techniques, et des technologies de Bamako (USTTB), Bamako, Mali
| | - A Maïga
- Laboratoire de bactériologie, CHU Point G, Bamako, Mali
| | - S Diallo
- Faculté de pharmacie (FAPH), Université des sciences des techniques, et des technologies de Bamako (USTTB), Bamako, Mali, Centre d'infectiologie Charles-Mérieux (CICM), Bamako, Mali
| | - N Camara
- Laboratoire de bactériologie, CHU Gabriel Touré, Bamako, Mali
| | - S Savadogo
- Laboratoire de bactériologie, CHU Point G, Bamako, Mali
| | - I Guindo
- Faculté de pharmacie (FAPH), Université des sciences des techniques, et des technologies de Bamako (USTTB), Bamako, Mali
| | - F Bougoudogo
- Faculté de pharmacie (FAPH), Université des sciences des techniques, et des technologies de Bamako (USTTB), Bamako, Mali
| | - L Armand-Lefèvre
- Laboratoire de bactériologie, CHU Bichat-Claude Bernard et UMR Inserm 1137 Iame Paris, France
| | - A Andremont
- Laboratoire de bactériologie, CHU Bichat-Claude Bernard et UMR Inserm 1137 Iame Paris, France
| | - I I Maïga
- Laboratoire de bactériologie, CHU Point G, Bamako, Mali, Faculté de médecine et d'odonto-stomatologie (FMOS), Université des sciences des techniques, et des technologies de Bamako (USTTB), Bamako, Mali
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Grall N, Lazarevic V, Gaïa N, Couffignal C, Laouénan C, Ilic-Habensus E, Wieder I, Plesiat P, Angebault C, Bougnoux ME, Armand-Lefevre L, Andremont A, Duval X, Schrenzel J. Unexpected persistence of extended-spectrum β-lactamase-producing Enterobacteriaceae in the faecal microbiota of hospitalised patients treated with imipenem. Int J Antimicrob Agents 2017; 50:81-87. [PMID: 28499958 DOI: 10.1016/j.ijantimicag.2017.02.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 02/10/2017] [Accepted: 02/22/2017] [Indexed: 11/29/2022]
Abstract
Imipenem is active against extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) but favours the intestinal emergence of resistance. The effects of imipenem on intestinal microbiota have been studied using culture-based techniques. In this study, the effects were investigated in patients using culture and metagenomic techniques. Seventeen hospitalised adults receiving imipenem were included in a multicentre study (NCT01703299, http://www.clinicaltrials.gov). Most patients had a history of antibiotic use and/or hospitalisation. Stools were collected before, during and after imipenem treatment. Bacterial and fungal colonisation was assessed by culture, and microbiota changes were assessed using metagenomics. Unexpectedly, high colonisation rates by imipenem-susceptible ESBL-E before treatment (70.6%) remained stable over time, suggesting that imipenem intestinal concentrations were very low. Carriage rates of carbapenem-resistant Gram-negative bacilli (0-25.0%) were also stable over time, whereas those of yeasts (64.7% before treatment) peaked at 76.5% during treatment and decreased thereafter. However, these trends were not statistically significant. Yeasts included highly diverse colonising Candida spp. Metagenomics showed no global effect of imipenem on the bacterial taxonomic profiles at the sequencing depth used but demonstrated specific changes in the microbiota not detected with culture, attributed to factors other than imipenem, including sampling site or treatment with other antibiotics. In conclusion, culture and metagenomics were highly complementary in characterising the faecal microbiota of patients. The changes observed during imipenem treatment were unexpectedly limited, possibly because the microbiota was already disturbed by previous antibiotic exposure or hospitalisation.
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Affiliation(s)
- N Grall
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris-Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Microbiologie, F-75018 Paris, France.
| | - V Lazarevic
- Genomic Research Laboratory, Geneva University Hospitals, Geneva, Switzerland
| | - N Gaïa
- Genomic Research Laboratory, Geneva University Hospitals, Geneva, Switzerland
| | - C Couffignal
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris-Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Service de Biostatistique, F-75018 Paris, France
| | - C Laouénan
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris-Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Service de Biostatistique, F-75018 Paris, France
| | - E Ilic-Habensus
- AP-HP, Hôpital Bichat, INSERM CIC 1425, F-75018 Paris, France
| | - I Wieder
- AP-HP, Hôpital Bichat, Laboratoire de Microbiologie, F-75018 Paris, France
| | - P Plesiat
- Laboratoire de Bactériologie EA4266, Faculté de Médecine-Pharmacie, Université de Franche-Comté, Besançon, France
| | - C Angebault
- AP-HP, Hôpital Necker-Enfants Malades, Unité de Parasitologie-Mycologie, Service de Microbiologie, F-75015 Paris, France; Université Paris Descartes, Sorbonne Paris-Cité, F-75015 Paris, France
| | - M E Bougnoux
- AP-HP, Hôpital Necker-Enfants Malades, Unité de Parasitologie-Mycologie, Service de Microbiologie, F-75015 Paris, France; Université Paris Descartes, Sorbonne Paris-Cité, F-75015 Paris, France
| | - L Armand-Lefevre
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris-Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Microbiologie, F-75018 Paris, France
| | - A Andremont
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris-Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, Laboratoire de Microbiologie, F-75018 Paris, France
| | - X Duval
- INSERM, IAME, UMR 1137, F-75018 Paris, France; Université Paris-Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France; AP-HP, Hôpital Bichat, INSERM CIC 1425, F-75018 Paris, France
| | - J Schrenzel
- Genomic Research Laboratory, Geneva University Hospitals, Geneva, Switzerland; Laboratory of Bacteriology, Geneva University Hospitals, Geneva, Switzerland
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Collignon PJ, Conly JM, Andremont A, McEwen SA, Aidara-Kane A. Reply to Cohen and Denning. Clin Infect Dis 2017; 64:987-988. [PMID: 28158496 DOI: 10.1093/cid/cix061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Peter J Collignon
- Infectious Diseases and Microbiology, Canberra Hospital, and.,Medical School, Australian National University, Acton, Australia
| | - John M Conly
- Departments of Medicine, Microbiology, Immunology & Infectious Diseases, and Pathology & Laboratory Medicine, Synder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Alberta, and
| | | | - Scott A McEwen
- Department of Population Medicine, University of Guelph, Ontario, Canada
| | - Awa Aidara-Kane
- Department of Food Safety and Zoonosis, World Health Organization, Geneva, Switzerland
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Wuijts S, van den Berg HHJL, Miller J, Abebe L, Sobsey M, Andremont A, Medlicott KO, van Passel MWJ, de Roda Husman AM. Towards a research agenda for water, sanitation and antimicrobial resistance. J Water Health 2017; 15:175-184. [PMID: 28362299 DOI: 10.2166/wh.2017.124] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Clinically relevant antimicrobial resistant bacteria, genetic resistance elements, and antibiotic residues (so-called AMR) from human and animal waste are abundantly present in environmental samples. This presence could lead to human exposure to AMR. In 2015, the World Health Organization (WHO) developed a Global Action Plan for Antimicrobial Resistance with one of its strategic objectives being to strengthen knowledge through surveillance and research. With respect to a strategic research agenda on water, sanitation and hygiene and AMR, WHO organized a workshop to solicit input by scientists and other stakeholders. The workshop resulted in three main conclusions. The first conclusion was that guidance is needed on how to reduce the spread of AMR to humans via the environment and to introduce effective intervention measures. Second, human exposure to AMR via water and its health impact should be investigated and quantified, in order to compare with other human exposure routes, such as direct transmission or via food consumption. Finally, a uniform and global surveillance strategy that complements existing strategies and includes analytical methods that can be used in low-income countries too, is needed to monitor the magnitude and dissemination of AMR.
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Affiliation(s)
- Susanne Wuijts
- National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands E-mail:
| | - Harold H J L van den Berg
- National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands E-mail:
| | - Jennifer Miller
- Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Lydia Abebe
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mark Sobsey
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Antoine Andremont
- Diderot Medical School, University of Paris, Paris, France and Bichat Hospital Bacteriology Laboratory, Paris, France
| | | | - Mark W J van Passel
- National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands E-mail:
| | - Ana Maria de Roda Husman
- National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands E-mail: ; Institute for Risk Assessment Sciences (IRAS) of Utrecht University, Utrecht, The Netherlands
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Woerther PL, Andremont A, Kantele A. Travel-acquired ESBL-producing Enterobacteriaceae: impact of colonization at individual and community level. J Travel Med 2017; 24:S29-S34. [PMID: 28520999 PMCID: PMC5441303 DOI: 10.1093/jtm/taw101] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Antibiotic resistance is a rapidly increasing global emergency that calls for action from all of society. Intestinal multidrugresistant (MDR) bacteria have spread worldwide with extended-spectrum beta-lactamase (ESBL) -producing Enterobacteriaceae (ESBL-PE) as the most prevalent type. The millions of travelers annually visiting regions with poor hygiene contribute substantially to this spread. Our review explores the underlying data and discusses the consequences of the colonization. METHODS PubMed was searched for relevant literature between January 2010 and August 2016. We focused on articles reporting (1) the rate of ESBL-PE acquisition in a group of travelers recruited before/after international travel, (2) fecal carriage of ESBL-PE as explored by culture and, for part of the studies, (3) analysis of factors predisposing to colonization. RESULTS We reviewed a total of 16 studies focusing on travel-acquired ESBL-PE. The acquisition rates reveal that 2070% of visitors to (sub)tropical regions get colonized by ESBL-PE. The main risk factors predisposing to colonization during travel are destination, travelers diarrhea, and antibiotic use. CONCLUSIONS While most of those colonized remain asymptomatic, acquisition of ESBL-PE may have consequences both at individual and community level. We discuss current efforts to restrict the spread.
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Affiliation(s)
- Paul-Louis Woerther
- Laboratory of Medical Microbiology, Institut Gustave-Roussy, Villejuif, France
| | - Antoine Andremont
- INSERM, IAME, UMR 1137, and Université Paris Diderot, Sorbonne Paris Cité, Paris, France APHP, Laboratory of Bacteriology, Hôpital Bichat-Claude Bernard, Paris, France
| | - Anu Kantele
- Department of Clinical Medicine, University of Helsinki, Helsinki, Finland.,Division of Infectious Diseases, Helsinki University Hospital, Inflammation Center, POB 348, FIN-00029, Helsinki, Finland.,Unit of Infectious Diseases, Karolinska Institutet, Solna, Stockholm, Sweden
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Sangare SA, Rondinaud E, Maataoui N, Maiga AI, Guindo I, Maiga A, Camara N, Dicko OA, Dao S, Diallo S, Bougoudogo F, Andremont A, Maiga II, Armand-Lefevre L. Very high prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae in bacteriemic patients hospitalized in teaching hospitals in Bamako, Mali. PLoS One 2017; 12:e0172652. [PMID: 28245252 PMCID: PMC5330466 DOI: 10.1371/journal.pone.0172652] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/07/2017] [Indexed: 11/19/2022] Open
Abstract
The worldwide dissemination of extended-spectrum beta-lactamase producing Enterobacteriaceae, (ESBL-E) and their subset producing carbapenemases (CPE), is alarming. Limited data on the prevalence of such strains in infections from patients from Sub-Saharan Africa are currently available. We determined, here, the prevalence of ESBL-E/CPE in bacteriemic patients in two teaching hospitals from Bamako (Mali), which are at the top of the health care pyramid in the country. During one year, all Enterobacteriaceae isolated from bloodstream infections (E-BSI), were collected from patients hospitalized at the Point G University Teaching Hospital and the pediatric units of Gabriel Touré University Teaching Hospital. Antibiotic susceptibility testing, enzyme characterization and strain relatedness were determined. A total of 77 patients had an E-BSI and as many as 48 (62.3%) were infected with an ESBL-E. ESBL-E BSI were associated with a previous hospitalization (OR 3.97 95% IC [1.32; 13.21]) and were more frequent in hospital-acquired episodes (OR 3.66 95% IC [1.07; 13.38]). Among the 82 isolated Enterobacteriaceae, 58.5% were ESBL-E (20/31 Escherichia coli, 20/26 Klebsiella pneumoniae and 8/15 Enterobacter cloacae). The remaining (5 Salmonella Enteritidis, 3 Morganella morganii 1 Proteus mirabilis and 1 Leclercia adecarboxylata) were ESBL negative. CTX-M-1 group enzymes were highly prevalent (89.6%) among ESBLs; the remaining ones being SHV. One E. coli produced an OXA-181 carbapenemase, which is the first CPE described in Mali. The analysis of ESBL-E relatedness suggested a high rate of cross transmission between patients. In conclusion, even if CPE are still rare for the moment, the high rate of ESBL-BSI and frequent cross transmission probably impose a high medical and economic burden to Malian hospitals.
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Affiliation(s)
- Samba Adama Sangare
- Bacteriology Laboratory, Centre Hospitalier Universitaire Gabriel Touré, Bamako, Mali
- Bacteriology Laboratory, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
- Faculté de Pharmacie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Emilie Rondinaud
- Bacteriology Laboratory, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
- INSERM, IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Naouale Maataoui
- Bacteriology Laboratory, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
- INSERM, IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Almoustapha Issiaka Maiga
- Bacteriology Laboratory, Centre Hospitalier Universitaire Gabriel Touré, Bamako, Mali
- Faculté de Pharmacie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Ibrehima Guindo
- Faculté de Pharmacie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | - Aminata Maiga
- Bacteriology Laboratory, Centre Hospitalier Universitaire du Point G, Bamako, Mali
| | - Namory Camara
- Bacteriology Laboratory, Centre Hospitalier Universitaire Gabriel Touré, Bamako, Mali
| | - Oumar Agaly Dicko
- Bacteriology Laboratory, Centre Hospitalier Universitaire du Point G, Bamako, Mali
| | - Sounkalo Dao
- Faculté de Médecine et d’Odonto- stomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Souleymane Diallo
- Faculté de Pharmacie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
- Centre d’Infectiologie Charles Mérieux, Bamako, Mali
| | - Flabou Bougoudogo
- Faculté de Pharmacie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
- Institut National de Recherche en Santé Publique, Bamako, Mali
| | - Antoine Andremont
- Bacteriology Laboratory, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
- INSERM, IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Ibrahim Izetiegouma Maiga
- Bacteriology Laboratory, Centre Hospitalier Universitaire du Point G, Bamako, Mali
- Faculté de Médecine et d’Odonto- stomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Laurence Armand-Lefevre
- Bacteriology Laboratory, Centre Hospitalier Universitaire Bichat-Claude Bernard, Paris, France
- INSERM, IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- * E-mail:
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Doré J, Multon MC, Béhier JM, Affagard H, Andremont A, Barthélémy P, Batista R, Bonneville M, Bonny C, Boyaval G, Chamaillard M, Chevalier MP, Cordaillat-Simmons M, Cournarie F, Diaz I, Guillaume E, Guyard C, Jouvin-Marche E, Martin FP, Petiteau D. Microbiote intestinal : qu’en attendre au plan physiologique et thérapeutique ? Therapie 2017; 72:1-19. [PMID: 28214070 DOI: 10.1016/j.therap.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/22/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Joël Doré
- INRA, Metagenopolis, 78350 Jouy-en-Josas, France
| | | | | | | | | | - Antoine Andremont
- Hôpital Bichat, université Paris Diderot, AP-HP, 92240 Malakoff, France
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Burdet C, Nguyen TT, Saint-Lu N, Sayah-Jeanne S, Andremont A, Mentré F, Gunzburg JD. Modelling helps understanding reduction of mortality provided by DAV131A in a hamster model of moxifloxacin-induced Clostridium difficile colitis. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charles Burdet
- INSERM and Paris Diderot University, IAME, UMR 1137; AP-HP, Bichat Hospital, Paris, France
| | - Thu Thuy Nguyen
- INSERM and Paris Diderot University, IAME, UMR 1137, Paris, France
| | | | | | - Antoine Andremont
- INSERM and Paris Diderot University, IAME, UMR 1137; AP-HP, Bichat Hospital, Paris, France
| | - France Mentré
- INSERM and Paris Diderot University, IAME, UMR 1137; AP-HP, Bichat Hospital, Paris, France
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Tammaro P, Richard N, Andre B, Andremont A, Mammeri H. First report of human infection due to Streptococcus devriesei. New Microbes New Infect 2016; 15:72-73. [PMID: 28053705 PMCID: PMC5198732 DOI: 10.1016/j.nmni.2016.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/03/2016] [Accepted: 11/09/2016] [Indexed: 11/30/2022] Open
Abstract
So far, Streptococcus devriesei, which belongs to the mutans streptococci group, has been incriminated in the formation of caries in Equidae. We report the first human infection due to this species in a 54-year-old man with gangrenous cholecystitis. The patient was treated successfully by cholecystectomy and ceftriaxone.
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Affiliation(s)
- P Tammaro
- Service de Chirurgie digestive, APHP, Hôpital Bichat Claude Bernard, Paris, France
| | - N Richard
- Laboratoire de Bactériologie, APHP, Hôpital Bichat Claude Bernard, Paris, France
| | - B Andre
- Laboratoire de Bactériologie, APHP, Hôpital Bichat Claude Bernard, Paris, France
| | - A Andremont
- Laboratoire de Bactériologie, APHP, Hôpital Bichat Claude Bernard, Paris, France; INSERM, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
| | - H Mammeri
- Laboratoire de Bactériologie, APHP, Hôpital Bichat Claude Bernard, Paris, France; INSERM, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
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Djuikoue IC, Woerther PL, Toukam M, Burdet C, Ruppé E, Gonsu KH, Fokunang C, El Mniai A, Larissa K, Pieme AC, Mboupaing MG, Kakam CM, Fogang HK, Andremont A, Ngogang J. Intestinal carriage of Extended Spectrum Beta-Lactamase producing E. coli in women with urinary tract infections, Cameroon. J Infect Dev Ctries 2016; 10:1135-1139. [PMID: 27801378 DOI: 10.3855/jidc.7616] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/23/2015] [Accepted: 11/30/2015] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION During the last decade, the prevalence of the intestinal carriage of extended spectrum beta-lactamases - producing Escherichia coli (ESBL-E. coli) has continued to increase worldwide in the community, especially in developing countries. Hence, we undertook a study to determine the ESBL-E. coli fecal carriage rate and the associated risk factors in Cameroonian women. METHODOLOGY A total of 86 women suspected of community-acquired urinary tract infections (UTI) were included in 10 health structures from May 2011 to April 2012. After filling a questionnaire, they provided a stool sample that was plated on selective media for ESBL producing bacteria. The identification of strains was obtained with mass spectrometry and the antibiotic susceptibility by disk diffusion in agar media. The ESBL type was determined by PCR. The relative abundance of ESBL-E. coli was measured for positive samples. Eventually, the presence of antibiotics in stool was assessed. RESULTS The carriage rate of ESBL-E. coli was 57/86 (66.3%). Phenotypic and molecular characterization showed that all ESBL-E. coli strains contained group 1 CTX-M enzymes. Multivariate analysis showed that ESBL-E. coli fecal carriage was associated with the presence of antibiotics in stools (p < 0.05). Although not significant, mean ESBL relative abundance tended to be higher in patients with antibiotic exposure. CONCLUSIONS Our results show that the carriage of ESBL-E. coli fecal carriage in women with UTI suspicion from the Cameroonian community is extremely high and associated with recent antibiotic intake.
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Sangare SA, Maiga AI, Guindo I, Maiga A, Camara N, Dicko OA, Diallo S, Bougoudogo F, Armand-Lefevre L, Andremont A, Maiga II. Prevalence of ESBL-producing Enterobacteriaceae isolated from blood cultures in Mali. J Infect Dev Ctries 2016; 10:1059-1064. [PMID: 27801367 DOI: 10.3855/jidc.7536] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/09/2016] [Accepted: 02/17/2016] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION The increasing frequency of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae is becoming a serious public health concern. This study sought to determine ESBL frequency in Enterobacteriaceae isolated from patients' blood cultures in two university teaching hospitals of Bamako, Mali. METHODOLOGY During a three-month period, the presence of Enterobacteriaceae from blood cultures of patients admitted to the university teaching hospitals of Bamako was evaluated. The microbial identifications were initially performed with an API 20E gallery and VITEK2 locally in Mali, and then confirmation in France was performed with a mass spectrometry MALDI-TOF in the bacteriology laboratory of the university teaching hospital of Bichat. Antibiotic susceptibility profiles were determined by the diffusion method as recommended by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). RESULTS The isolated species were K. pneumoniae (14/40; 35.0%), E. coli (11/40; 27.5%), and E. cloacae (9/40; 22.5%). Of the strains isolated, 21/34 (61.8%) had an ESBL phenotype, including 10/14 (71.4%) K. pneumoniae, 8/11 (72.7%) E. coli, and 3/9 (33.3%) E. cloacae. Resistances associated with ESBL strains of K. pneumoniae, E. coli, and E. cloacae were as follows: gentamicin (10/10, 100%; 6/8, 75%; 2/3, 67%, respectively), amikacin (2/10, 20%; 0/8, 0%; 0/3, 0%, respectively), ofloxacin (8/10, 80%; 7/8, 87%; 3/3, 100%, respectively), and cotrimoxazole (10/10, 100%; 6/8, 75%; 3/3, 100%, respectively). CONCLUSION Almost two-thirds (61.8%) of Enterobacteriaceae isolated from our blood cultures were ESBL producers. Only susceptibilities to carbapenems and to amikacin were fully conserved within the strains.
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Armand-Lefevre L, Ruppé E, Andremont A. ESBL-producing Enterobacteriaceae in travellers: doctors beware. Lancet Infect Dis 2016; 17:8-9. [PMID: 27751773 DOI: 10.1016/s1473-3099(16)30417-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/26/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Laurence Armand-Lefevre
- IAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité, Bactériologie Laboratory, Hôpital Bichat, AP-HP, Paris 75013, France
| | - Etienne Ruppé
- Genomic Research Laboratory, Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Antoine Andremont
- IAME, UMR 1137, INSERM, Paris Diderot University, Sorbonne Paris Cité, Bactériologie Laboratory, Hôpital Bichat, AP-HP, Paris 75013, France.
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Poirier C, Dinh A, Salomon J, Grall N, Andremont A, Bernard L. Prevention of urinary tract infections by antibiotic cycling in spinal cord injury patients and low emergence of multidrug resistant bacteria. Med Mal Infect 2016; 46:294-9. [DOI: 10.1016/j.medmal.2016.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/15/2015] [Accepted: 02/25/2016] [Indexed: 10/21/2022]
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Sangare SA, Maiga AI, Guindo I, Maiga A, Camara N, Savadogo S, Diallo S, Bougoudogo F, Armand-Lefevre L, Andremont A, Maiga II. Prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae isolated from blood cultures in Africa. Med Mal Infect 2016; 45:374-82. [PMID: 26433872 DOI: 10.1016/j.medmal.2015.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 06/09/2015] [Accepted: 08/31/2015] [Indexed: 11/15/2022]
Abstract
Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae have been isolated from many regions of the world. Epidemiological studies are being conducted in Europe, North America, and Asia. No study has however been conducted in Africa to determine the prevalence and distribution of ESBLs on the continent. This literature review aimed at describing the prevalence of ESBL-producing Enterobacteriaceae isolated from blood cultures, as well as the ESBL genes involved at the international level. Our focus was mainly on Africa. We conducted a literature review on PubMed. Articles related to our study field and published between 1996 and 2014 were reviewed and entirely read for most of them, while we only focused on the abstracts of some other articles. Relevant articles to our study were then carefully reviewed and included in the review. The prevalence of ESBL-producing Enterobacteriaceae differs from one country to another. The results of our literature review however indicate that class A ESBLs prevail over the other types. We took into consideration articles focusing on various types of samples to assess the prevalence of ESBL-producing Enterobacteriaceae, but information on isolates from blood cultures is limited. The worldwide prevalence of ESBL-producing Enterobacteriaceae has increased over time. Evidence of ESBL-producing Enterobacteriaceae can be found in all regions of the world. Studies conducted in Africa mainly focused on the Northern and Eastern parts of the continent, while only rare studies were carried out in the rest of the continent.
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Affiliation(s)
- S A Sangare
- Laboratory of bacteriology, university hospital Gabriel-Touré, Bamako, Mali; Laboratory of bacteriology, university hospital Bichat-Claude Bernard and UMR Inserm 1137 Iame, 46, rue Henri-Huchard, 75018 Paris, France; Faculty of pharmacy, university of sciences, techniques, and technologies of Bamako (USTTB), Bamako, Mali.
| | - A I Maiga
- Laboratory of bacteriology, university hospital Gabriel-Touré, Bamako, Mali; Faculty of pharmacy, university of sciences, techniques, and technologies of Bamako (USTTB), Bamako, Mali
| | - I Guindo
- Faculty of pharmacy, university of sciences, techniques, and technologies of Bamako (USTTB), Bamako, Mali; National institute for research in public health, Bamako, Mali
| | - A Maiga
- Laboratory of bacteriology, university hospital Point G, Bamako, Mali
| | - N Camara
- Laboratory of bacteriology, university hospital Gabriel-Touré, Bamako, Mali
| | - S Savadogo
- Laboratory of bacteriology, university hospital Point G, Bamako, Mali
| | - S Diallo
- Faculty of pharmacy, university of sciences, techniques, and technologies of Bamako (USTTB), Bamako, Mali; Infectious diseases center "Charles Mérieux", Bamako, Mali
| | - F Bougoudogo
- Faculty of pharmacy, university of sciences, techniques, and technologies of Bamako (USTTB), Bamako, Mali; National institute for research in public health, Bamako, Mali
| | - L Armand-Lefevre
- Laboratory of bacteriology, university hospital Bichat-Claude Bernard and UMR Inserm 1137 Iame, 46, rue Henri-Huchard, 75018 Paris, France
| | - A Andremont
- Laboratory of bacteriology, university hospital Bichat-Claude Bernard and UMR Inserm 1137 Iame, 46, rue Henri-Huchard, 75018 Paris, France
| | - I I Maiga
- Laboratory of bacteriology, university hospital Point G, Bamako, Mali; Faculty of medicine and odonto-stomatology, university of sciences, techniques, and technologies of Bamako (USTTB), Bamako, Mali
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