Detection of AmpC β Lactamases in Gram-negative Bacteria

Gupta, Garima; Tak, Vibhor; Mathur, Purva

doi:10.4103/0974-2727.129082

Cited by 61 publications

(42 citation statements)

References 9 publications

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“…The occurrence, types and rate of dissemination of AmpC enzymes has increased worldwide, their early detection is crucial and critical since AmpC β-lactamases show marked variation in geographic distribution [ 17 ]. Detection of pathogens producing AmpC β-lactamases is often associated with potentially fatal laboratory reports of false susceptibility to β-lactams phenotypically [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Co-Occurrence of Plasmid-Mediated AmpC β-Lactamase Activity Among Klebsiella pneumoniae and Escherichia Coli

Zorgani¹,

Daw²,

Sufya³

et al. 2017

TOMICROJ

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Introduction:Extended-spectrum β-lactamases (ESBLs), including the AmpC type, are important mechanisms of resistance among Klebsiella pneumoniae and Escherichia coli isolates.Objective:The aim of the study was to investigate the occurrence of AmpC-type β-lactamase producers isolated from two hospitals in Tripoli, Libya.Methods:All clinical isolates (76 K. pneumoniae and 75 E. coli) collected over two years (2013-2014) were evaluated for susceptibility to a panel of antimicrobials and were analyzed phenotypically for the ESBL and AmpC phenotype using E-test and ESBL and AmpC screen disc test. Both ESBL and AmpC-positive isolates were then screened for the presence of genes encoding plasmid-mediated AmpC β-lactamases by polymerase chain reaction (PCR).Results:Of the K. pneumoniae and E. coli tested, 75% and 16% were resistant to gentamicin, 74% and 1.3% to imipenem, 71% and 12% to cefoxitin, 80% and 12% to cefepime, 69% and 22.6% to ciprofloxacin, respectively. None of the E. coli isolates were multidrug resistant compared with K. pneumoniae (65.8%). K. pneumoniae ESBL producers were significantly higher (85.5%) compared with (17.3%) E. coli isolates (P <0.0001, OR=4.93). Plasmid-mediated AmpC genes were detected in 7.9% of K. pneumoniae, and 4% E. coli isolates. There was low agreement between phenotypic and genotypic methods, phenotypic testing underestimated detection of AmpC enzyme and did not correlate well with molecular results. The gene encoding CMY enzyme was the most prevalent (66.6%) of AmpC positive isolates followed by MOX, DHA and EBC. Only one AmpC gene was detected in 5/9 isolates, i.e, blaCMY (n=3), bla MOX (n=1), blaDHA (n=1). However, co-occurrence of AmpC genes were evident in 3/9 isolates with the following distribution: bla CMY and blaEBC (n=1), and blaCMY and blaMOX (n=2). Neither blaFOX nor blaACC was detected in all tested isolates. All AmpC positive strains were resistant to cefoxitin and isolated from patients admitted to intensive care units.Conclusion:Further studies are needed for detection of other AmpC variant enzyme production among such isolates. Continued surveillance and judicious antibiotic usage together with the implementation of efficient infection control measures are absolutely required.

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Section: Discussionmentioning

confidence: 99%

Co-Occurrence of Plasmid-Mediated AmpC β-Lactamase Activity Among Klebsiella pneumoniae and Escherichia Coli

Zorgani¹,

Daw²,

Sufya³

et al. 2017

TOMICROJ

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“…10 Whereas phenotypic detection of methicillin resistant-Staph aureus (MRSA) was done by cefoxitin susceptibility test according to the CLSI (2017). 9,10 An approximation test was used to detect AmpC according to Gupta et al 11 Phase II: (bundle training phase) included meetings, education and training of personnel including doctors, nurses and workers on the implementation of the Bundle components with collaboration with the infection control team. It took several weeks to ensure adequate training and compliance.…”

Section: Methodsmentioning

confidence: 99%

<p>Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, Egypt</p>

Wassef¹,

Mukhtar²,

Nabil³

et al. 2020

IDR

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Introduction: Surgical site infections (SSIs) are one of the most frequently reported hospital acquired infections associated with significant spread of antibiotic resistance. Purpose: We aimed to evaluate a bundle-based approach in reducing SSI at acute surgical intensive care unit of the Emergency Hospital of Cairo University. Patients and Methods: Our prospective study ran from March 2018 to February 2019 and used risk assessment. The study was divided into three phases. Phase I: (pre-bundle phase) for 5 months; data collection, active surveillance of the SSIs, screening for OXA-48 producing Enterobacteriaceae and multidrug resistant Acinetobacter baumannii colonizers using Chrom agars were carried out. Phase II: (bundle-implementation) a 6-S bundle approach included education, training and postoperative bathing with Chlorhexidine Gluconate in collaboration with the infection control team. Finally, Phase III: (post-implementation) for estimation of compliance, rates of colonization, and infection. Results: Phase I encompassed 177 patients, while Phase III included 93 patients. A significant reduction of colonization from 24% to 15% (p<0.001) was observed. Similarly, a decrease of SSI from 27% to 15% (p=0.02) was noticed. A logistic regression was performed to adjust for confounding in the implementation of the bundle and we found a 70% reduction of SSI odd's ratio (OR's ratio = 0.3) confidence interval (95% CI 0.14-0.6) with significant Apache II (p=0.04), type of wound; type II (p=0.002), type III (p=0.001) and duration of surgery (p=0.04) as independent risk factors for SSI. Klebsiella pneumoniae was the most prevalent organism during phase I (34.7%). On the other hand, A. baumannii was the commonest organism to be isolated during phase III with (38.5%) preceding K. pneumoniae (30%). Conclusion: Our study demonstrated that the implementation of a multidisciplinary bundle containing evidence-based interventions was associated with a significant reduction of colonization and SSIs and was met with staff approval and acceptable compliance.

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“…Bacteria resistant to imipenem and/or meropenem were subjected to the Imipenem-EDTA double-disk synergy test as described previously (47). Isolates resistant to cefotaxime and/or ceftazidime were subjected to ESBL testing following the CLSI guidelines and AmpC testing using phenylboronic acid (45, 48).…”

Section: Methodsmentioning

confidence: 99%

Antibiotic resistant and extended-spectrum β-lactamase producing faecal coliforms in wastewater treatment plant effluent

Smyth

O’Flaherty

Walsh

et al. 2019

Preprint

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26Wastewater treatment plants (WWTPs) provide optimal conditions for the maintenance and 27 spread of antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs). In this 28 work we describe the occurrence of antibiotic resistant faecal coliforms and their mechanisms 29 of antibiotic resistance in the effluent of two urban WWTPs in Ireland. Effluent samples were 30 collected from two WWTPs in Spring and Autumn of 2015 and 2016. The bacterial 31 susceptibility patterns to 13 antibiotics were determined. The phenotypic tests were carried out 32 to identify AmpC or extended-spectrum β-lactamase (ESBL) producers. The presence of ESBL 33 genes were detected by PCR. Plasmids carrying ESBL genes were transformed into 34Escherichia coli DH5α recipient and underwent plasmid replicon typing to identify 35 incompatibility groups. More than 90% of isolated faecal coliforms were resistant to 36 amoxicillin and ampicillin, followed by tetracycline (up to 39.82%), ciprofloxacin (up to 37 31.42%) and trimethoprim (up to 37.61%). Faecal coliforms resistant to colistin and imipenem 38 were detected in all effluent samples. Up to 53.98% of isolated faecal coliforms expressed a 39 multi-drug resistance (MRD) phenotype. AmpC production was confirmed in 5.22% of 40 isolates. The ESBL genes were confirmed for 11.84% of isolates (9.2% of isolates carried 41 blaTEM, 1.4% blaSHV-12, 0.2% blaCTX-M-1 and 1% blaCTX-M-15). Plasmids extracted from 52 ESBL 42 isolates were successfully transformed into recipient E. coli. The detected plasmid 43 incompatibility groups included the IncF group, IncI1, IncHI1/2 and IncA/C. These results 44 provide evidence that treated wastewater is polluted with ARB and MDR faecal coliforms and 45 are sources of ESBL-producing, carbapenem and colistin resistant Enterobacteriaceae. 46 47 48 49 Keywords 50 Antibiotic resistance, multidrug resistance, AmpC, extended-spectrum β-lactamase (ESBL), 51 plasmids 52 53 54 55 56 3

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Detection of AmpC β Lactamases in Gram-negative Bacteria

Cited by 61 publications

References 9 publications

Co-Occurrence of Plasmid-Mediated AmpC β-Lactamase Activity Among Klebsiella pneumoniae and Escherichia Coli

Co-Occurrence of Plasmid-Mediated AmpC β-Lactamase Activity Among Klebsiella pneumoniae and Escherichia Coli

<p>Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, Egypt</p>

Antibiotic resistant and extended-spectrum β-lactamase producing faecal coliforms in wastewater treatment plant effluent

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