Current perspectives on tigecycline resistance in Enterobacteriaceae: susceptibility testing issues and mechanisms of resistance

Pournaras, Spyros; Koumaki, Vasiliki; Spanakis, Nicholas; Gennimata, Vasiliki; Tsakris, Athanassios

doi:10.1016/j.ijantimicag.2016.04.017

Cited by 77 publications

(61 citation statements)

References 117 publications

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“…Most problematic are isolates that produce carbapenemases, as they often combine resistance to beta-lactamases, quinolones and aminoglycosides. Furthermore, resistance to the lastresort therapeutic molecules colistin and tigecycline can rapidly evolve in such strains, leaving few therapeutic options (Olaitan et al, 2014;Pournaras et al, 2016). Second, K. pneumoniae is also responsible for invasive community-acquired infections including pyogenic liver abscess, pneumonia and meningitis.…”

Section: Introductionmentioning

confidence: 99%

Metabolic diversity of the emerging pathogenic lineages of Klebsiella pneumoniae

Blin

Passet

Touchon

et al. 2017

Environmental Microbiology

104

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Multidrug resistant and hypervirulent clones of Klebsiella pneumoniae are emerging pathogens. To understand the association between genotypic and phenotypic diversity in this process, we combined genomic, phylogenomic and phenotypic analysis of a diverse set of K. pneumoniae and closely related species. These species were able to use an unusually large panel of metabolic substrates for growth, many of which were shared between all strains. We analysed the substrates used by only a fraction of the strains, identified some of their genetic basis, and found that many could not be explained by the phylogeny of the strains. Puzzlingly, few traits were associated with the ecological origin of the strains. One noticeable exception was the ability to use D-arabinose, which was much more frequent in hypervirulent strains. The broad carbon and nitrogen core metabolism of K. pneumoniae might contribute to its ability to thrive in diverse environments. Accordingly, even the hypervirulent and multidrug resistant clones have the metabolic signature of ubiquitous bacteria. The apparent few metabolic differences between hypervirulent, multi-resistant and environmental strains may favour the emergence of dual-risk strains that combine resistance and hypervirulence.

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Section: Introductionmentioning

confidence: 99%

Metabolic diversity of the emerging pathogenic lineages of Klebsiella pneumoniae

Blin

Passet

Touchon

et al. 2017

Environmental Microbiology

104

View full text Add to dashboard Cite

show abstract

“…Worryingly, carbapenem-resistant bacteria are often resistant to other classes of antibiotics including aminoglycosides, fluoroquinolones and other ß-lactams, with often colistin and tigecycline as the only effective drugs. Resistance to both these antibiotics can also easily evolve making them unreliable as ‘last resort’ therapies[12, 13].…”

Section: Introductionmentioning

confidence: 99%

Opening Pandora’s box: high level resistance to antibiotics of last resort in Gram negative bacteria from Nigeria

Ogbolu

Webber

Piddock

2018

Preprint

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23Antimicrobial resistance (AMR) is a global problem but information about the 24 prevalence and mechanisms of resistance in sub-Saharan Africa are lacking. We 25 determined the percentage of drug resistant isolates and resistance mechanisms in 307 26Gram negative isolates randomly collected from south western Nigeria. Susceptibility 27 testing revealed 78.1%, 92.2% and 52.6% of all isolates were resistant to 28 fluoroquinolones, third generation cephalosporins and carbapenems respectively. There 29 were more resistant isolates from the stools of uninfected patients than from specimens 30 of patients with symptoms of infections. Only a small proportion of E. coli (10%) and 31

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“…The mechanism of tigecycline resistance is complex and has not yet been fully elucidated [12]. Previous studies have reported that increased expression of efflux pumps such as AcrAB and OqxAB play an essential role in the tigecycline resistance mechanisms of K .…”

Section: Introductionmentioning

confidence: 99%

Tigecycline resistance among carbapenem-resistant Klebsiella Pneumoniae: Clinical characteristics and expression levels of efflux pump genes

et al. 2017

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ObjectivesTigecycline is a treatment option for infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). Emerging tigecycline resistance in CRKP represents a growing threat. Knowledge of the clinical, microbiological, and molecular characteristics of tigecycline- and carbapenem-resistant Klebsiella pneumoniae (TCRKP) is limited.MethodsPatients infected with TCRKP were identified from a Taiwanese national surveillance study. Clinical data were collected from medical records. We performed susceptibility tests, carbapenemase gene detection, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Furthermore, we performed quantitative real-time polymerase chain reaction (qRT-PCR) analyses to assess the expression levels of the efflux pump genes acrB and oqxB.ResultsWe identified 16 patients infected with TCRKP, with urinary tract infection (UTI) being the most common type of infection (63%). The all-cause 30-day mortality rate was 44% in patients with TCRKP infection. Patients with a site of infection other than the urinary tract had a significantly higher mortality rate than patients with UTIs (83% vs. 20%, p = 0.035). PFGE and MLST revealed no dominant clone or sequence type. Using qRT-PCR, overexpression of both the acrB and oqxB genes was identified in seven isolates, and overexpression of the oqxB gene was observed in another seven. There was poor correlation between acrB or oqxB expression and tigecycline MICs (r = -0.038 and -0.166, respectively).ConclusionsThe mortality rate in patients infected with TCRKP in this study was 44% and this is an important subset of patients. The absence of a linear relationship between efflux pump genes expression and MICs indicates that tigecycline resistance may be mediated by other factors. Continuous monitoring of tigecycline resistance among CRKP isolates and resistance mechanisms are necessary.

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Current perspectives on tigecycline resistance in Enterobacteriaceae: susceptibility testing issues and mechanisms of resistance

Cited by 77 publications

References 117 publications

Metabolic diversity of the emerging pathogenic lineages of Klebsiella pneumoniae

Metabolic diversity of the emerging pathogenic lineages of Klebsiella pneumoniae

Opening Pandora’s box: high level resistance to antibiotics of last resort in Gram negative bacteria from Nigeria

Tigecycline resistance among carbapenem-resistant Klebsiella Pneumoniae: Clinical characteristics and expression levels of efflux pump genes

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