Characterizing carbapenemase-producing Escherichia coli isolates from Spain: high genetic heterogeneity and wide geographical spread (original) (raw)
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Escherichia coli are Gram negative, facultative anaerobic bacteria. It constitute about 0.1% normal gut flora of human it’s commonly found in lower intestine. In this study we have determined the frequency of carbapenems resistance in Escherichia coli in different clinical isolates by simply disk diffusion method. This study was conducted from 26th January 2010 to 29th December 2011, in Ziauddin university hospital Karachi Pakistan. Sum of 2710 consecutive clinical isolates of Escherichia coli were collected and identified by conventional microbiological techniques. Antimicrobial susceptibility testing and all ESBL positive bacteria antibiotic susceptibility pattern to meropenem (10 ug), and imipenem (Becton Dickinson, USA) (10 ug) was recorded for this study. By Kirby-Bauer method, as per NCCLS guidelines, isolates were considered as resistant to carbapenems. A total 2710 isolates of Escherichia coli were obtained during the study period. The isolates from females patients were 1716/2710 (63.32%), while the isolates from male patients were 994/2710 (36.68%). Female to Male ratio was 1.73:1. In these total isolates the number of Carbapenems resistant Escherichia coli is 13 which is 0.48%.The emergence of metallo-beta lactamases producing Escherichia coli which are resistant to carbapenems are becoming a severe therapeutic problem worldwide. There is strongly need to emphasize on the rational and judicious use of antimicrobials and adhere to the concept of “reserve drugs” to minimize the misuse of available antimicrobials. In addition, more effective infection control measures and regular antimicrobial susceptibility is also an essential component in reducing the emergence of these resistant organisms and should be prompted.
Antibiotic Susceptibility Patterns for Carbapenem-Resistant Enterobacteriaceae
International Journal of Microbiology
Carbapenem is a broad-spectrum beta-lactam antibiotic considered the last choice for the treatment of antibiotic-resistant Gram-negative bacteria. Thus, the increasing rate of carbapenem resistance (CR) in Enterobacteriaceae is an urgent public health threat. This study aimed to evaluate the antibiotic susceptibility pattern of carbapenem-resistant Enterobacteriaceae (CRE) to new and old antibiotics. In this study, Klebsiella pneumoniae, E. coli, and Enterobacter spp. were collected from 10 hospitals in Iran for one year. CRE is recognized by resistance to meropenem and/or imipenem disk after identification of the collected bacteria. Antibiotic susceptibility of CRE against fosfomycin, rifampin, metronidazole, tigecycline, and aztreonam was detected by disk diffusion method and colistin by MIC. In this study, 1222 E. coli, 696 K. pneumoniae, and 621 Enterobacter spp. were collected from 10 hospitals in Iran in one year. Fifty-four E. coli (4.4%), 84 K. pneumoniae (12%), and 51 Enter...
International Journal of Antimicrobial Agents, 2021
Ceftolozane-tazobactam (C/T) is frequently used for infections caused by multidrug-resistant (MDR)-Enterobacterales isolates. Whole-genome sequencing (WGS, Illumina-Hiseq 40 0 0/NovaSeq 60 0 0, OGC, UK) was used to study the population structure, the resistome and the virulome of C/T-susceptible andresistant MDR Escherichia spp. (n = 30) and Klebsiella spp. (n = 78) isolates, recovered from lower respiratory, intra-abdominal and urinary tract infections of ICU patients from 11 Portuguese Hospitals (STEP study, 2017-2018). Minimum inhibitory concentrations (MICs) were determined (ISO-broth microdilution, breakpoints EUCAST-2020). In Escherichia spp. , a weak concordance between the phenotypic and the WGS method (P = 0.051) was observed in the carbapenemase detection (3/30) [ bla VIM-2 (2/3), bla KPC-3 (1/3)]; VIM-2-Escherichia coli isolates were C/T-susceptible and only the KPC-3-Escherichia marmotae producer showed C/T-resistance. Overall, CTX-M-15-E. coli-ST131-O25:H4-H30-Rx (11/30) was the most frequent subclone, followed by CTX-M-27-E. coli-ST131-O25:H4-H30 (4/4). Moreover, a wide resistome and virulome were detected in all E. coli isolates. Among Klebsiella spp. isolates [ K. pneumoniae (67/78), K. aerogenes (7/78), K. oxytoca (2/78), K. variicola (2/78)], concordance (P < 0.001) was observed between the phenotypic and the genomic carbapenemase detection (21/78) [ bla KPC-3 (14/21), bla OXA-48 (3/21), bla OXA-181 (3/21)]. A high correlation between C/T-resistance and carbapenemase detection was established (P < 0.05). Overall, a high clonal diversity was observed, mainly in KPC-3-producing K. pneumoniae isolates. An extensive resistome was detected in Klebsiella spp. isolates, whereas virulence determinants were mostly identified in carbapenemase producers (P < 0.001). WGS is a powerful tool for typing characterization and microbiological study of MDR-Enterobacterales pathogens. Furthermore, carbapenemase genes are associated with C/T-resistance in Klebsiella spp., but other mechanisms might also be involved.
IP innovative publication pvt ltd, 2020
Introduction: The emergence and global spread of carbapenem-resistant E. coli is of great concern to the health care facilities due to high rates of morbidity and mortality associated with them. It is necessary to know its epidemiology and the resistant pattern in a geographical area to formulate a antibiotic stewardship policy. Objective: To study the occurrence and mechanisms of carbapenem resistance in Escherichia coli. Materials and Methods: A total of 1172 clinical strains of E. coli obtained from various clinical specimens were screened for carbapenem resistance during the study period. Strains showing reduced susceptibility to imipenem &/or ertapenem &/or meropenem were included in the study. The resistance mechanisms were identified using various phenotypic methods. Results: Total of 53/1172 were found to be carbapenem resistant E. coli (CRE). The most common sample in which CRE were isolated was urine (n=26, 49.1%). A total of 50 isolates were confirmed as Metallobeta- lactamase (MBL) producers using Ezy MICTM strip. One of the three non carbapenemase producing isolate was positive for ESBL with porin loss and the other two isolates were positive for AmpC with porin loss. Conclusion: MBL production being the most common mechanism of carbapenem resistance, the study indicates the importance of regular monitoring of drug resistance in the hospital for an urgent action to be taken for antibiotics stewardship in the institute.
Journal of Antimicrobial Chemotherapy, 2002
In Europe, antimicrobial resistance of invasive pathogens has been monitored since 1998 by the European Antimicrobial Resistance Surveillance System (EARSS). The goal of this study is to analyse the susceptibility data of invasive Escherichia coli collected by 27 Spanish laboratories in 2001. Each laboratory identified strains and tested their susceptibility using its own methods. To assess the comparability of susceptibility test results, a quality assurance exercise was performed. We report data from 1962 invasive isolates of E. coli: 1959 from blood and three from cerebrospinal fluid, corresponding to the same number of patients. Resistance to ampicillin, co-trimoxazole, ciprofloxacin and gentamicin was found in 58.46%, 32.91%, 17.19% and 6.39% of isolates, respectively. Extended-spectrum β-lactamase (ESBL) production was detected in 30 strains (1.55%). Ciprofloxacin resistance was higher in isolates from men and in-patients than in those from women and out-patients (P < 0.001). Resistance to ampicillin and co-trimoxazole was more widespread in children than in adults: 70.37% versus 57.87% (P = 0.01) and 41.84% versus 32.53% (P = 0.05). Non-significant differences in resistance to fluoroquinolones were observed between isolates from children (11.1%) and adults (17.54%), despite the fact that fluoroquinolones are not administered to children. Significantly, resistance to non-β-lactam antibiotics (co-trimoxazole, ciprofloxacin and gentamicin) was more prevalent in ampicillinresistant strains and ESBL-producing strains than in ampicillin-susceptible strains and non-ESBL-producing strains. Multidrug resistance was present in 13.92% of isolates; the most prevalent phenotype was resistance to ampicillin, co-trimoxazole and ciprofloxacin, which was detected in 59.36% of multiresistant strains and in 8.22% of strains overall.
Evaluation of Resistance Mechanisms in Carbapenem-Resistant Enterobacteriaceae
Infection and Drug Resistance
Background: Carbapenem-resistant Enterobacteriaceae (CRE) is a major concern leading to morbidity and mortality in the world. CRE often is becoming a cause of therapeutic failure in both hospital and community-acquired infections. Aim: This study aimed to investigate the resistance mechanisms of CRE by phenotypic and molecular methods. Materials and Methods: Sixty CRE (50 Klebsiella pneumoniae, 6 Escherichia coli, and 4 Enterobacter spp.) were isolated from October 2018 to June 2019. Antimicrobial susceptibility testing was carried out using phenotypic methods. The carbapenem resistance mechanisms including efflux pump hyperexpression, AmpC overproduction, carbapenemase genes, and deficiency in OmpK35 and OmpK36 were determined by phenotypic and molecular methods, respectively. Results: Sixty CRE (50 Klebsiella pneumoniae, 6 Escherichia coli, and 4 Enterobacter spp.) were isolated from October 2018 to June 2019. Amikacin was found to be the most effective drug against CRE isolates. All isolates were resistant to imipenem and meropenem by the micro-broth dilution. AmpC overproduction was observed in all Enterobacter spp. and three K. pneumoniae isolates. No efflux pump activity was found. Carba NP test and Modified Hodge Test could find carbapenemase in 59 (98%) isolates and 57 (95%) isolates, respectively. The most common carbapenemase gene was bla OXA-48-like (72.8%) followed by bla NDM (50.8%), bla IMP (18.6%), bla VIM (11.8%), and bla KPC (6.7%). The ompK35 and ompK36 genes were not detected in 10 and 7 K. pneumoniae isolates, respectively. Conclusion: The amikacin is considered as a very efficient antibiotic for the treatment of CRE isolates in our region. Carbapenemase production and overproduction of AmpC are the main carbapenem resistance mechanisms in CRE isolates. Finally, Carba NP test is a rapid and reliable test for early detection of carbapenemase-producing isolates.
Infection and Drug Resistance
Background: Antimicrobial resistance is a serious public health problem worldwide. We aimed to investigate the prevalence of antibiotic resistance in Escherichia coli strains simultaneously isolated from humans, animals, food, and the environment. Methods: Studies on PubMed, Embase, and the Cochrane Library published from January 1, 2000 to January 1, 2018 were searched. The quality of the included studies was assessed by the modified critical appraisal checklist recommended by the Joanna Briggs Institute. All analyses were conducted using Biostat's Comprehensive Meta-Analysis version 2.0. Depending on the heterogeneity test for each antibiotic, we used a random-or fixedeffect model for pooled prevalence of drug resistance. Studies were eligible if they had investigated and reported resistance in two or more isolation sources (human, animal, food, or environment). To decrease heterogeneity and bias, we excluded studies that had reported E. coli drug resistance isolated from one source only. We included publications that reported drug resistance with minimum inhibitory concentration or disk diffusion method (DDM) as antibiotic-susceptibility tests. Results: Of the 39 included studies, 20 used the DDM and 19 minimum inhibitory concentration for their antibiotic-susceptibility testing. Colistin had the lowest prevalence, with 0.8% (95% CI 0.2%-3.8%) and amoxicillin the highest, with 70.5% (95% CI 57.5%-81%) in isolated human E. coli strains tested with the DDM. To assess historical changes in antimicrobial drug resistance, subgroup analysis from 2000 to 2018 showed a significant increase in ciprofloxacin resistance. Conclusion: Monitoring and evaluating antibiotic-sensitivity patterns and preparation of reliable antibiotic strategies may lead to better outcomes for inhibition and control of E. coli infections in different regions of the world.
Diagnostic Microbiology and Infectious Disease, 2010
The management of patients with complicated intra-abdominal infections has increased in complexity because of the evolution of antibiotic resistance and the development of multidrug-resistant (MDR) Enterobacteriaceae implicated in this clinical infectious process. The Study for Monitoring Antimicrobial Resistance Trends study 2002 to 2007 monitored the susceptibility of Enterobacteriaceae from intraabdominal infections to a panel of appropriate antimicrobials. During 2002 to 2007, 6644 MDR (resistant to 2 or more antimicrobial classes) Enterobacteriaceae species were isolated and tested against selected antimicrobials from varying classes. The carbapenems were the most consistently active agents. Escherichia coli was the most commonly isolated MDR pathogen. The susceptibility of E. coli to the quinolone (8-21.6%), cephalosporin (30.2-70.7%), aminoglycoside (81.0-92.1%), and carbapenem (91.9-99.3%) agents varied by year. Susceptibilities of other Enterobacteriaceae were similar to those of E. coli. Surveillance of pathogens responsible for intra-abdominal infections is useful in the monitoring of changing susceptibility patterns and in the formulation of more effective treatment modalities.
Infection and Drug Resistance, 2017
Introduction: Management of infections with carbapenem-resistant Enterobacteriaceae (CRE) is challenging. In recent times, agents such as colistin and fosfomycin have been used in combination with other antibiotics to treat such infections. In this study, we aim to seek frequency of colistin and fosfomycin resistance in CRE from Pakistan. Methods: This study was conducted at clinical laboratories, Aga Khan University Hospital. In total, 251 CRE were included in the study. Colistin minimum inhibitory concentrations (MICs) were performed using broth microdilution (BMD) method and VITEK ® 2 system, whereas fosfomycin susceptibility was performed using Kirby-Bauer method. MIC 50 and MIC 90 were calculated for colistin and agreement between VITEK and BMD was also calculated. Results: Out of 251 strains colistin MIC of ≥4 µg/mL was seen in 40 (15.9%). Of these strains 20 (50%) were Klebsiella pneumoniae. Colistin MIC 50 and MIC 90 were found to be 0.5 and 16 µg/mL, respectively. BMD and VITEK 2 showed 100% categorical agreement. Essential agreement was 88.5% with kappa score 0.733 indicating strong agreement between VITEK and BMD. 31 out of 251 (12.3%) CREs were resistant to fosfomycin. Conclusion: Study shows frequency of colistin and fosfomycin resistance to be 15.9% and 12.3%, respectively. In countries where rate of CREs is high, emerging resistance against these last resort antibiotics is alarming as it leaves clinicians with almost no options to manage such multidrug resistant and extensively drug resistant infections.