Coproduction of NDM-1 and KPC-2 in <i>Enterobacter hormaechei</i> from Brazil

Silva, PereiraPolyana; BorghiMirla,; Albano, Rodolpho Mattos; Oliveira, LopesJonathan Christian; Chaves, S. S.; Andrade, MarquesElizabeth; Ribeiro, OliveiraJane Cleide; Dutra, AsensiMarise; D'Alincourt, Carvalho-AssefAna Paula

doi:10.1089/mdr.2014.0171

Cited by 56 publications

(58 citation statements)

References 16 publications

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“…KPCs were initially detected in a clinical isolate in 1996 in North Carolina; since then, 19 variants have been discovered (21)(22)(23)(24). KPC has been found in a variety of Enterobacteriaceae, including Klebsiella spp., Escherichia coli, Enterobacter spp., Citrobacter spp., Morganella spp., Serratia marcescens (25)(26)(27)(28)(29), Raoultella spp. (30), Kluyvera (31), and Salmonella (32), and in non-Enterobacteriaceae such as Aeromonas (33), Pseudomonas, and Acinetobacter baumannii (34).…”

Section: Current Status Of Carbapenemasesmentioning

confidence: 99%

Intestinal Carriage of Carbapenemase-Producing Organisms: Current Status of Surveillance Methods

et al. 2016

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SUMMARYCarbapenemases have become a significant mechanism for broad-spectrum β-lactam resistance inEnterobacteriaceaeand other Gram-negative bacteria such asPseudomonasandAcinetobacterspp. Intestinal carriage of carbapenemase-producing organisms (CPOs) is an important source of transmission. Isolation of carriers is one strategy that can be used to limit the spread of these bacteria. In this review, we critically examine the clinical performance, advantages, and disadvantages of methods available for the detection of intestinal carriage of CPOs. Culture-based methods (Centers for Disease Control and Prevention [CDC] protocols, chromogenic media, specialized agars, and double-disk synergy tests) for detecting carriage of CPOs are convenient due to their ready availability and low cost, but their limited sensitivity and long turnaround time may not always be optimal for infection control practices. Contemporary nucleic acid amplification techniques (NAATs) such as real-time PCR, hybridization assays, loop-mediated isothermal amplification (LAMP), or a combined culture and NAAT approach may provide fast results and/or added sensitivity and specificity compared with culture-based methods. Infection control practitioners and clinical microbiologists should be aware of the strengths and limitations of available methods to determine the most suitable approach for their medical facility to fit their infection control needs.

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Section: Current Status Of Carbapenemasesmentioning

confidence: 99%

Intestinal Carriage of Carbapenemase-Producing Organisms: Current Status of Surveillance Methods

et al. 2016

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“…The bla NDM-1 gene was found to be located on a IncFIIk in E. hormaechei and on a IncX3 plasmid in a ST2 E. coli , but both plasmids contained a new structure designated Tn3000, that could possibly mediate the transposition of the bla NDM-1 gene 91 . Subsequently, coproduction of NDM-1 and KPC-2 was described in P. rettgeri and E. cloacae from Rio de Janeiro 62, 64…”

Section: The Rise Of Carbapenemases In Brazilmentioning

confidence: 99%

Antimicrobial resistance in Enterobacteriaceae in Brazil: focus on β-lactams and polymyxins

Sampaio

Gales

2016

Brazilian Journal of Microbiology

111

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During the last 30 years there has been a dissemination of plasmid-mediated β-lactamases in Enterobacteriaceae in Brazil. Extended spectrum β-lactamases (ESBL) are widely disseminated in the hospital setting and are detected in a lower frequency in the community setting. Cefotaximases are the most frequently detected ESBL type and Klebsiella pneumoniae is the predominant species among ESBL producers. Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae became widely disseminated in Brazil during the last decade and KPC production is currently the most frequent resistance mechanism (96.2%) in carbapenem resistant K. pneumoniae. To date KPC-2 is the only variant reported in Brazil. Polymyxin B resistance in KPC-2-producing K. pneumoniae has come to an alarming rate of 27.1% in 2015 in São Paulo, the largest city in Brazil. New Delhi metallo-β-lactamase was detected in Brazil in 2013, has been reported in different Brazilian states but are not widely disseminated. Antimicrobial resistance in Enterobacteriaceae in Brazil is a very serious problem that needs urgent actions which includes both more strict adherence to infection control measures and more judicious use of antimicrobials.

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“…It is alarming that CRE isolates coproducing multiple carbapenemases recently emerged and pose significant challenges to our limited treatment strategies, as these bacteria tend to be extremely highly resistant (3)(4)(5)(6)(7)(8)(9)(10). To date, the coexistence of Klebsiella pneumoniae carbapenemase 2 (KPC-2) and New Delhi metallo-␤-lactamase-1 (NDM-1) in single clinical isolates from different species, including K. pneumoniae, Enterobacter cloacae, Enterobacter hormaechei, and Citrobacter freundii, has been reported in Brazil, India, Pakistan, and China (3-6, 8, 9).…”

mentioning

confidence: 99%

Genomic Characterization of Enterobacter cloacae Isolates from China That Coproduce KPC-3 and NDM-1 Carbapenemases

Chen

Chavda

et al. 2016

Antimicrob Agents Chemother

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c Here, we report two Enterobacter cloacae sequence type 231 isolates coproducing KPC-3 and NDM-1 that have caused lethal infections in a tertiary hospital in China. The bla NDM-1 -harboring plasmids carry IncA/C 2 and IncR replicons, showing a mosaic plasmid structure, and the bla NDM-1 is harbored on a novel class I integron-like element. bla KPC-3 is located on a Tn3-⌬bla TEM-1 -bla KPC-3 -⌬Tn1722 element, flanked by two 9-bp direct-repeat sequences and harbored on an IncX6 plasmid. Carbapenemase-producing Enterobacteriaceae (CRE) strains have spread worldwide and have become a significant public health threat (1, 2). It is alarming that CRE isolates coproducing multiple carbapenemases recently emerged and pose significant challenges to our limited treatment strategies, as these bacteria tend to be extremely highly resistant (3-10). To date, the coexistence of Klebsiella pneumoniae carbapenemase 2 (KPC-2) and New Delhi metallo-␤-lactamase-1 (NDM-1) in single clinical isolates from different species, including K. pneumoniae, Enterobacter cloacae, Enterobacter hormaechei, and Citrobacter freundii, has been reported in Brazil, India, Pakistan,8,9). However, knowledge regarding the genetic content and plasmid structure of these multicarbapenemase-producing bacteria remains limited (3,6). In this study, we used next-generation sequencing to characterize the genomes of two KPC-3-and NDM-1-coproducing E. cloacae strains and their plasmids. Our analysis revealed distinct plasmid structures that, to our knowledge, have not been described previously.Two carbapenem-resistant E. cloacae strains (SZECL1 and SZECL2) were identified in a retrospective study on CRE at a tertiary-care hospital in China. They were isolated from sputum samples from two female patients (63 and 57 years old) admitted to the same intensive care unit in 2012. The two isolates were collected 11 days apart. The patients died 13 and 18 days after the isolation of the organisms as a result of severe pulmonary infections. Antimicrobial susceptibility testing showed that the two isolates, SZECL1 and SZECL2, had the same resistance profile (Table 1). They were resistant to all ␤-lactams and inhibitors, including imipenem, meropenem, ertapenem, and ceftazidime-avibactam, and were resistant to amikacin, gentamicin, tobramycin, ciprofloxacin, levofloxacin, moxifloxacin, and trimethoprim-sulfamethoxazole but remained susceptible to tetracycline, tigecycline, and colistin.Genotyping results showed that SZECL1 carries bla KPC-3 , bla NDM-1 , and bla , while SZECL2 harbors the same ␤-lactamase genes (bla , bla NDM-1 , and bla ) as SZECL1, with an additional bla CTX-M-15 gene (11,12). Multilocus sequence typing indicated that the two isolates were of the same sequence type, ST231 (13), and they displayed indistinguishable patterns in pulsed-field gel electrophoresis analysis, suggesting that these two isolates are closely related and may have evolved from the same ancestor.The bla KPC-3 -harboring plasmids in SZECL1 and SZECL2 were successfully transferred to...

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Coproduction of NDM-1 and KPC-2 in Enterobacter hormaechei from Brazil

Cited by 56 publications

References 16 publications

Intestinal Carriage of Carbapenemase-Producing Organisms: Current Status of Surveillance Methods

Intestinal Carriage of Carbapenemase-Producing Organisms: Current Status of Surveillance Methods

Antimicrobial resistance in Enterobacteriaceae in Brazil: focus on β-lactams and polymyxins

Genomic Characterization of Enterobacter cloacae Isolates from China That Coproduce KPC-3 and NDM-1 Carbapenemases

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