Coexistence of SHV-4- and TEM-24-Producing
            <i>Enterobacter aerogenes</i>
            Strains before a Large Outbreak of TEM-24-Producing Strains in a French Hospital

Mammeri, Hedi; Laurans, G.; Eveillard, Matthieu; Castelain, Sandrine; Eb, F.

doi:10.1128/jcm.39.6.2184-2190.2001

Cited by 43 publications

(27 citation statements)

References 42 publications

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“…A study by De Gheldre et al (2001) in Belgian hospitals revealed that E. aerogenes infections could be assigned to a limited number of strains, since 74% of all the isolated strains were identified as E. aerogenes strains BE1 or BE2 (De Gheldre et al 2001). Other studies also confirmed that nosocomial infections in many cases originate from a single (multiresistant) clone with a regional spread (Jalaluddin et al 1998;Mammeri et al 2001). These observations point to the potential of therapeutic use of phage UZ1 against E. aerogenes BE1 infections.…”

Section: Discussionmentioning

confidence: 67%

Stability and activity of an Enterobacter aerogenes-specific bacteriophage under simulated gastro-intestinal conditions

Verthé

Possemiers

Boon

et al. 2004

Appl Microbiol Biotechnol

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A bacteriophage, designated UZ1 and showing lytic activity against a clinically important strain (BE1) of Enterobacter aerogenes was isolated from hospital sewage. The stability and lytic activity against this strain under simulated gastro-intestinal conditions was evaluated. After addition of bacteriophage UZ1 to a liquid feed at gastric pH 2, the phage was immediately inactivated and could not be recovered. However, by use of an antacid to neutralize stomach acidity, no significant changes in phage titer were observed after 2 h incubation at 37°C. After supplementing pancreatic juice and further incubation for 4 h, the phage titer remained stable. The persistence of UZ1 in a mixed microbial ecosystem that was representative for the large intestine was monitored using an in vitro simulation of the human intestinal microbial ecosystem. A pulse administration of bacteriophage UZ1 at a concentration of 10 5 plaque-forming units (PFU)/ml to reactor 3 (which simulates the ascending colon) showed that, in the absence of the host, bacteriophage UZ1 persisted for 13 days in the simulated colon, while the theoretical washout was calculated at 16 days. To assess its lytic activity in an intestinal microbial ecosystem, a green fluorescent protein (gfp)-labeled E. aerogenes BE1 strain was constructed and gfp-specific primers were designed in order to quantify the host strain using real-time PCR. It was observed that bacteriophage UZ1 was able to replicate and showed lytic activity against E. aerogenes BE1/gfp in an intestinal microbial ecosystem. Indeed, after 17 h a 2 log unit reduction of E. aerogenes BE1/gfp was measured as compared with the assay without bacteriophage UZ1, while the phage titer increased by 2 log units at an initial multiplicity of infection of 0.07 PFU/colonyforming unit. This is the first report of an in vitro model to study bacteriophage activity in the complex intestinal microbial community.

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Section: Discussionmentioning

confidence: 67%

Stability and activity of an Enterobacter aerogenes-specific bacteriophage under simulated gastro-intestinal conditions

Verthé

Possemiers

Boon

et al. 2004

Appl Microbiol Biotechnol

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“…In addition, we investigated if our ESBL-producing Enterobacter aerogenes isolates were related to those found in large outbreaks in other European countries (7,10,19).…”

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confidence: 99%

Epidemiology of Extended-Spectrum β-Lactamase-Producing Enterobacter Isolates in a Spanish Hospital during a 12-Year Period

et al. 2002

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Fifteen Enterobacter clinical isolates (11 Enterobacter cloacae isolates, 3 Enterobacter aerogenes isolates, and 1 Enterobacter gergoviae isolate), representing 0.4% of all Enterobacter isolates recovered in our hospital from 1989 to 2000, were suspected of harboring an extended-spectrum ␤-lactamase (ESBL). These isolates were recovered from 14 different patients. ESBLs were transferred by conjugation into an Escherichia coli recipient strain. Pulsed-field gel electrophoresis (PFGE) revealed a single clone of E. aerogenes and six different clones of E. cloacae. Four of these E. cloacae clonal types were represented by only one isolate each, but the other two were represented by three and four isolates, respectively. Isoelectric focusing, susceptibility phenotyping, PCR analysis, and sequencing demonstrated the presence of three different ESBLs. The most frequent was the recently characterized CTX-M-10 ESBL, which was found in the E. gergoviae isolate and in all but one of the E. cloacae isolates. The remaining E. cloacae isolate harbored a TEM-27 ESBL, and the three E. aerogenes isolates harbored a TEM-24 ESBL. PFGE revealed that our E. aerogenes strain was indistinguishable from the French TEM-24-producing E. aerogenes endemic clone. Although a low prevalence of ESBL-producing Enterobacter isolates was found in our institution over a 12-year period, a diversity of nonepidemic E. cloacae clones was detected, as was the persistence of the CTX-M-10 ␤-lactamase. The presence of the TEM-24-producing E. aerogenes French clone in our institution also demonstrates the intercountry dissemination of ESBL-producing isolates.Plasmid-mediated extended-spectrum ␤-lactamases (ESBLs) were first reported in the mid-1980s (14, 15). Since then they have been responsible for several outbreaks caused by expanded-spectrum cephalosporin-resistant enterobacteria. Klebsiella pneumoniae and Escherichia coli are the most frequently involved organisms, and TEM-1-and SHV-1-derived ␤-lactamases are the most common ESBLs found in these species (25). These enzymes have also been reported at a much lower frequency among inducible AmpC ␤-lactamase-producing members of the family Enterobacteriaceae, such as Enterobacter spp., Citrobacter spp., Morganella morganii, and Serratia spp. (6,10,17,23,27,28,38). The most common ESBLs found in these species also belong to the TEM-and SHV-derived ␤-lactamases.Enterobacter species have been found to be one of the most important causes of nosocomial infections during the last few years (9, 30). These organisms have been associated with several outbreaks generally involving derepressed mutants overproducing their chromosomal ␤-lactamase or, more infrequently, expressing ESBL (7,10,23,30).The aims of this study were to establish the epidemiological relationship among all ESBL-producing Enterobacter isolates recovered in our institution over a decade, as well as to characterize the ESBLs expressed in these isolates and the plasmids harboring ESBL genes. In addition, we investigated if our ESBL-producing Entero...

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“…Indeed, an outbreak of nosocomial infections due to the spread of TEM-21-producing enterobacteria and a TEM-21-encoding plasmid among different species of the family Enterobacteriaceae has previously been demonstrated for other patients in this nursing home during a 6-month survey in 1999 (3). Outbreaks of ESBL-producing enterobacteria due to the spread of resistant plasmids have been described in hospitals (9,10,20,26,36) as well as in long-term-care facilities (49), but the persistence of the ESBL-producing enterobacteria in the nursing home described here during at least a 6-year period reflected an endemic situation that has, until now, been reported only in hospitals (19,29). Among the ESBLs elaborated by enterobacteria, TEM-21 is less frequent than TEM-24 and TEM-3 in France (11,12,19), but it has been already detected in the Bordeaux area (3,46) and was unknown in P. aeruginosa until our description (14).…”

Section: Discussionmentioning

confidence: 94%

Prolonged Outbreak of Infection Due to TEM-21-Producing Strains ofPseudomonas aeruginosaand Enterobacteria in a Nursing Home

Dubois

Arpin

Noury³

et al. 2005

J Clin Microbiol

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Over a 6-year period, 24 extended-spectrum ␤-lactamase (ESBL)-producing isolates of Pseudomonas aeruginosa were collected from 18 patients living in a nursing home. These isolates had a delayed development of a red pigment and exhibited a similar antibiotype (resistance to all ␤-lactams except for imipenem and to gentamicin, tobramycin, netilmicin, ciprofloxacin, and rifampin) associated with the production of the TEM-21 ␤-lactamase and a type II 3-N-aminoglycoside acetyltransferase [AAC(3)-II] enzyme. Surprisingly, serotyping showed that these isolates belonged to four successive serotypes (P2, P16, P1, and PME), although molecular typing by PCR methods and pulsed-field gel electrophoresis yielded identical or similar profiles. Moreover, in all isolates the bla TEM-21 gene was part of a chromosomally located Tn801 transposon truncated by an IS6100 element inserted within the resolvase gene, and the aac(3)-II gene was adjacent to this structure. During the same period, 17 ESBL-producing isolates of enterobacteria were also collected from 10 of these patients. These isolates harbored a similar large plasmid that contained the bla TEM-21 and the aac(3)-II genes and that conferred additional resistance to sulfonamides and chloramphenicol, as well as to kanamycin, tobramycin, netilmicin, and amikacin, conveyed by an AAC(6)-I enzyme. The bla TEM-21 gene was part of the Tn801 transposon disrupted by IS4321. Thus, a single clone of P. aeruginosa that had undergone a progressive genetic drift associated with a change in serotype appeared to be responsible for an outbreak of nosocomial infections in a nursing home. This strain has probably acquired the bla TEM-21 -encoding plasmid that was epidemic among the enterobacteria at the institution, followed by chromosomal integration and genomic reorganization.Pseudomonas aeruginosa is a saprophytic organism widespread in nature, particularly in moist environments (water, soil, plants, and sewage). This bacterial species is endowed with only a weak pathogenic potential in immunocompetent persons (2, 17, 21, 23) but can cause severe and even fatal infections in patients with impaired specific or nonspecific defense systems (40). Thus, P. aeruginosa is rarely involved in community-acquired infections, while it is responsible for a wide range of hospital-acquired infections, such as pneumonia, urinary tract infections (UTIs), and bacteremia. Moreover, a series of outbreaks due to this important and frequent nosocomial pathogen has been reported in hospital intensive care, burn wound, and cancer units (6, 13, 42). In contrast, little has been reported on P. aeruginosa-induced infections in long-term-care facilities, including nursing homes; and most of the studies that have reported such infections have described sporadic cases rather than outbreaks (16,22,44).Linked to its nosocomial status, P. aeruginosa is intrinsically resistant to most antimicrobials. In addition, resistance to the main active agents, i.e., ␤-lactams and aminoglycosides, by gene acquisition is common. However...

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Coexistence of SHV-4- and TEM-24-Producing Enterobacter aerogenes Strains before a Large Outbreak of TEM-24-Producing Strains in a French Hospital

Cited by 43 publications

References 42 publications

Stability and activity of an Enterobacter aerogenes-specific bacteriophage under simulated gastro-intestinal conditions

Stability and activity of an Enterobacter aerogenes-specific bacteriophage under simulated gastro-intestinal conditions

Epidemiology of Extended-Spectrum β-Lactamase-Producing Enterobacter Isolates in a Spanish Hospital during a 12-Year Period

Prolonged Outbreak of Infection Due to TEM-21-Producing Strains ofPseudomonas aeruginosaand Enterobacteria in a Nursing Home

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