Emergence of OXA-48 and OXA-181 Carbapenemases among Enterobacteriaceae in South Africa and Evidence of In Vivo Selection of Colistin Resistance as a Consequence of Selective Decontamination of the Gastrointestinal Tract (original) (raw)
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Eurosurveillance, 2016
, 972 consecutive non-replicate carbapenemase-producing Enterobacteriaceae isolates from colonised or infected patients were collected at the Associated French National Reference Centre as part of the French national survey on antimicrobial resistance. It included 577 Klebsiella spp. (59%), 236 Escherichia coli (24%), 108 Enterobacter spp. (11%), 50 Citrobacter spp. (5%), and a single Salmonella spp. isolate (0.1%). Of 561 K. pneumoniae isolates, 35 were found to be resistant to colistin (6.2%). PFGE analysis revealed a clonal outbreak involving 15 K. pneumoniae isolates belonging to sequence type ST11, recovered in a single hospital in the Picardie region in northern France. Those clonally related isolates showed variable levels of resistance to colistin, ranging from 4 to 64 mg/L. They harboured the bla OXA-48 carbapenemase gene and the bla CTX-M-15 extended-spectrum beta-lactamase gene. Among the 91 Enterobacter cloacae isolates, seven were resistant to colistin and produced different types of carbapenemases. Surprisingly, none of the E. coli and Citrobacter spp. isolates showed resistance to colistin. This national survey including carbapenemase-producing isolates recovered in 2014 reported a high rate of colistin resistance in K. pneumoniae and E. cloacae (6.2% and 7.7%, respectively) in France.
Annals of clinical and laboratory science, 2011
Carbapenem resistance in Enterobacteriaceae isolates has been reported from Turkey and is most often mediated by OXA-48 type carbapenemases. We report the identification and characterization of four carbapenem-resistant isolates (three Klebsiella pneumoniae and one Escherichia coli) among 515 clinical Enterobacteriaceae isolates collected during a 7-month study period in Ankara, Turkey. The four isolates were recovered from blood and urine specimens in patients with varied clinical manifestations. They had distinct pulsed-field gel electrophoresis patterns and harbored a variety of β-lactamases including bla(TEM-1), bla(SHV-12) genes, bla(SHV-11), and/or bla(CTX-M-15). PCR and sequencing analysis revealed that the bla(OXA-48) gene was present in all four isolates. Our data indicated that the OXA-48-type carbapenemase was the only mechanism for carbapenem resistance in our hospital.
Infections with enterobacteriaceae producing carbapenemase type OXA48
Introduction: Enterobacteriaceae producing carbapenemase, whether or not associated with extended spectrum betalactamase (ESBL), pose a health problem. They are responsible for severe infections with high epidemic potential, leading to limited therapeutic choices and prolonged hospital stay. The phenotypic and genotypic detection of these strains makes it possible to curb this problem. Material and method: Our work is a retrospective study over a period of 3 years. It concerned all enterobacteriaceae resistant to carbapenems isolated from various bacteriological samples in hospitalized patients, all departments combined, at the Ibn Tofail hospital in Marrakech. The search for carbapenemase was done by phenotypic methods (resistance to ertapenem, cloxacillin agar and hodge test). Molecular confirmation was performed by real-time PCR. Results: During our study, we isolated 22 enterobacteria resistant to carbapenems, 45% of which were also ESBL producers. Klebsiella pneumonae accounted for 61% of these strains followed by Enterobacter cloacae 33% and Klebsiella oxytoca in 8%. Co-resistance was noted for all the other bacterial families with the exception of Amikacin, 95% of the strains of which were susceptible. The hodge was positive for all strains. All these strains carried the blaOXA48 gene in addition to the presence of the blaCTXM15 gene in the strains also producing ESBL. Conclusion: The development of new real-time PCR techniques improves the specificity and sensitivity of the detection of multi-resistant bacteria.
International Journal of Infectious Diseases, 2014
Resistance to extended-spectrum cephalosporins is a wellrecognized problem among Enterobacteriaceae. 1 Carbapenems have served as an important antimicrobial class for the treatment of these organisms and, until recently, resistance to carbapenems has been uncommon among Enterobacteriaceae in Turkey. Following the first description of plasmid-encoded carbapenem-hydrolyzing oxacillinase OXA-48 in 2004, the first outbreak and subsequent spread of carbapenem-resistant Klebsiella pneumoniae (CRKp) isolates were reported from Turkey by the year 2008. 2-6 Carbapenemresistant Enterobacteriaceae (CRE), some with low imipenem and meropenem minimum inhibitory concentrations (MICs) (<4 mg/ml according to the Clinical and Laboratory Standards Institute) corresponding to susceptible or intermediate results, have continued to spread, disguised among extended-spectrum beta-lactamase
Romanian Journal of Infectious Diseases, 2016
Carbapenemase-producing Enterobacteriaceae have the potential to rapid dissemination in healthcare settings, becoming a major infection control and public health concern. PCR remains the reference method for identifying these strains, but is still expensive. We evaluated the performance of four phenotypic tests for identifying OXA-48-producing (Oxacillinase-48) Enterobacteriaceae. These were modified Hodge test (MHT), a combination disk test with meropenem alone or in combination with various inhibitors and temocillin, an enzymatic test and an immunochromatographic test. The tests were performed and interpreted according to guidelines or manufacturer's recommendations. The most frequent microorganism included in the study was Klebsiella pneumoniae. All the tests had 100% specificity, except MHT (87,5%). Sensitivity was 91,25% for MHT, 90% for the combination disk test, 95% for the enzymatic test and 82,50% for the immunochromatographic test.
Performance of CarbaNP and CIM tests in OXA-48 carbapenemase-producing Enterobacteriaceae
Acta Microbiologica et Immunologica Hungarica, 2017
This study applied two phenotypic tests, namely “Carbapenemase Nordmann–Poirel” (CarbaNP) test and “Carbapenem Inactivation Method” (CIM), against the isolates carrying the carbapenem resistance genes. The study included 83 carbapenem-resistant Enterobacteriaceae isolates producing oxacillinase-48 (OXA-48) and 30 carbapenem-sensitive Enterobacteriaceae isolates. Out of the total isolates studied, 77 isolates (92.77%) were identified as Klebsiella pneumoniae and six isolates (7.23%) were identified as Escherichia coli by Matrix Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry. Polymerase chain reaction (PCR) method used to detect resistance genes found that 74 isolates (89.16%) produced OXA-48 carbapenemase, whereas nine isolates (10.84%) produced both OXA-48 and New Delhi metallo-beta-lactamase-1 (NDM-1). The isolates producing both OXA-48 and NDM-1 were found to be positive by both phenotypic tests. Among isolates carrying only blaOXA-48 gene alone, nine isolat...
International Journal of Antimicrobial Agents
During a polymerase chain reaction (PCR)-based surveillance study of -lactam resistance, 19 OXA-48-positive enterobacterial isolates were detected at nine Belgian hospitals from January 2010 to April 2011. Most cases were presumed to have been locally acquired and were detected in patients who had not travelled abroad. Clonally related outbreaks occurred in two different cities. The majority of isolates co-produced several -lactamases as well as non--lactam resistance genes. This report highlights the rapid emergence and spread of OXA-48-producing Enterobacteriaceae in Belgium.
Carbapenems are a class of beta-lactam antibiotics with broad spectrum of activity. They are often considered as a last resort in treatment of infections caused by multidrug resistant organisms. Carbapenemase-producing Enterobacteriaceae (CPE) have been reported worldwide. Resistance to carbapenems in Enterobacteriaceae is caused mainly by carbapenemase production or by porin loss combined with the expression of b-lactamases like extended-spectrum beta-lactamases (ESBL) or AmpC b-lactamase. Class D OXA-48 carbapenemases is one of the most prevalent carbapenemases in Enterobacteriaceae. In the present study, we attempted to isolate carbapenemase-producing Enterobacteriaceae from different clinical specimens obtained from hospitalized patients at different ICU of kasr Al-Ainy hospital. Initial screening for carbapenemase-producing Enterobacteriaceae was done using ertapenem disc diffusion method and direct inoculation of the specimens into ChromID OXA-48. The phenotypic Modified Hodge Test (MHT) was used for confirmation of carbapenemse production among screened carbapenem resistant isolates.Out of 112 collected samples, 94 Enterobacteriaceae were isolated. Fifty five isolates (58.5%) were ertapenem disc resistant and 50 isolates (53%) showed positive growth on ChromID OXA-48. Fifty two (94.5%) out of 55 suspected carbapenemase-producing isolates by disc diffusion method and the 50 isolates (100%) grown on ChromID OXA-48 were MHT positive.
Clinical Microbiology and Infection, 2014
Carbapenemase-producing Enterobacteriaceae isolates are being increasingly reported, particularly from countries surrounding the Mediterranean area. We aimed to quantify the prevalence of carbapenemase-and extended-spectrum b-lactamase (ESBL)-producing Enterobacteriaceae in rectal swabs from hospitalized patients in a University hospital in Morocco, and to compare the performance of three screening media: ChromID ESBL (bioM erieux), Brilliance CRE (OXOID, Thermofisher) and SUPERCARBA (home made). Genetic detection and plasmid analysis were performed by PCR and sequencing. Strain comparison was performed by multi-locus sequence typing and the Diversilab technique (bioM erieux). The prevalence of multidrug-resistant Enterobacteriaceae was high, with 33 ESBL producers (42.85%, mainly CTX-M-15) and 10 OXA-48 producers (13%), corresponding to two major clones of K. pneumoniae (70%) and a clone of Enterobacter cloacae (30%). The three screening media showed the same sensitivity for detection of carbapenemase-producing Enterobacteriaceae, whereas the SUPERCARBA medium was more specific than the two other media. The average faecal carriage of ESBL or carbapenemase-producing Enterobacteriaceae varied from 1 9 10 2 to >1 9 10 8 CFU/g of stools. This study shows a high prevalence of multidrug-resistant Enterobacteriaceae, and particularly of OXA-48 producers. The new carbapenem-containing medium, SUPERCARBA, was as sensitive as Brilliance CRE and ChromID ESBL, and more specific for the detection of Enterobacteriaceae expressing those carbapenemases.