Detection of mutations in thegyrA gene in fluoroquinolone resistanceSalmonella entericaserotypestyphiandparatyphiA isolated from the Infectious Diseases Hospital, Kuwait

Dimitrov, T; Dashti, Ali A.; Albaksami, Osama; Jadaon, Mehrez M.

doi:10.1136/jcp.2009.070664

Cited by 8 publications

(8 citation statements)

References 26 publications

(34 reference statements)

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“…Two studies reported MDR S. Paratyphi A, with 24% in Nigeria [37] and 15% in Kuwait [75]. Three studies reported FQNS S. Paratyphi A, with 18% [37] and 47% [57] in Nigeria and 70% in Kuwait [75]. Kuwait has a large migrant worker population from South Asia, and although we tried to exclude imported cases, this may have affected the level of resistance observed here.…”

Section: Resultsmentioning

confidence: 92%

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Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis

Browne

Hamadani

Kumaran

et al. 2020

BMC Med

502

401

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BackgroundAntimicrobial resistance (AMR) is an increasing threat to global health. There are > 14 million cases of enteric fever every year and > 135,000 deaths. The disease is primarily controlled by antimicrobial treatment, but this is becoming increasingly difficult due to AMR. Our objectives were to assess the prevalence and geographic distribution of AMR in Salmonella enterica serovars Typhi and Paratyphi A infections globally, to evaluate the extent of the problem, and to facilitate the creation of geospatial maps of AMR prevalence to help targeted public health intervention.MethodsWe performed a systematic review of the literature by searching seven databases for studies published between 1990 and 2018. We recategorised isolates to allow the analysis of fluoroquinolone resistance trends over the study period. The prevalence of multidrug resistance (MDR) and fluoroquinolone non-susceptibility (FQNS) in individual studies was illustrated by forest plots, and a random effects meta-analysis was performed, stratified by Global Burden of Disease (GBD) region and 5-year time period. Heterogeneity was assessed using the I2 statistics. We present a descriptive analysis of ceftriaxone and azithromycin resistance.FindingsWe identified 4557 articles, of which 384, comprising 124,347 isolates (94,616 S. Typhi and 29,731 S. Paratyphi A) met the pre-specified inclusion criteria. The majority (276/384; 72%) of studies were from South Asia; 40 (10%) articles were identified from Sub-Saharan Africa. With the exception of MDR S. Typhi in South Asia, which declined between 1990 and 2018, and MDR S. Paratyphi A, which remained at low levels, resistance trends worsened for all antimicrobials in all regions. We identified several data gaps in Africa and the Middle East. Incomplete reporting of antimicrobial susceptibility testing (AST) and lack of quality assurance were identified.InterpretationDrug-resistant enteric fever is widespread in low- and middle-income countries, and the situation is worsening. It is essential that public health and clinical measures, which include improvements in water quality and sanitation, the deployment of S. Typhi vaccination, and an informed choice of treatment are implemented. However, there is no licenced vaccine for S. Paratyphi A. The standardised reporting of AST data and rollout of external quality control assessment are urgently needed to facilitate evidence-based policy and practice.Trial registrationPROSPERO CRD42018029432.

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Section: Resultsmentioning

confidence: 92%

“…There were few reports of S. Paratyphi A in Africa and the Middle East where the burden of disease is not well described [23]. Two studies reported MDR S. Paratyphi A, with 24% in Nigeria [37] and 15% in Kuwait [75]. Three studies reported FQNS S. Paratyphi A, with 18% [37] and 47% [57] in Nigeria and 70% in Kuwait [75].…”

Section: Resultsmentioning

confidence: 99%

Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis

Browne

Hamadani

Kumaran

et al. 2020

BMC Med

502

401

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“…Among enteric bacteria, fluoroquinolone resistance has predominantly been reported in the literature on E. coli (Robicsek et al, 2006 ), Enterobacter sp. (Robicsek et al, 2006 ; Cattoir et al, 2007 ), Citrobacter freundii (Cattoir et al, 2007 ) Klebsiella pneumoniae (Robicsek et al, 2006 ), Salmonella T yphi (Dimitrov et al, 2010 ; Baker et al, 2013 ), Salmonella enterica (Yanagi et al, 2009 ), Shigella flexneri (Hata et al, 2005 ), and Vibrio cholerae (Ismail et al, 2011 ). There are multiple mechanisms by which these species acquire resistance to fluoroquinolones.…”

Section: Introductionmentioning

confidence: 99%

Fluoroquinolone-Resistant Enteric Bacteria in Sub-Saharan Africa: Clones, Implications and Research Needs

et al. 2016

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Fluoroquinolones came into widespread use in African countries in the early 2000s, after patents for the first generation of these drugs expired. By that time, quinolone antibacterial agents had been used intensively worldwide and resistant lineages of many bacterial species had evolved. We sought to understand which Gram negative enteric pandemic lineages have been reported from Africa, as well as the nature and transmission of any indigenous resistant clones. A systematic review of articles indexed in the Medline and AJOL literature databases was conducted. We report on the findings of 43 eligible studies documenting local or pandemic fluoroquinolone-resistant enteric clones in sub-Sahara African countries. Most reports are of invasive non-typhoidal Salmonella and Escherichia coli lineages and there have been three reports of cholera outbreaks caused by fluoroquinolone-resistant Vibrio cholerae O1. Fluoroquinolone-resistant clones have also been reported from commensals and animal isolates but there are few data for non-Enterobacteriaceae and almost none for difficult-to-culture Campylobacter spp. Fluoroquinolone-resistant lineages identified in African countries were universally resistant to multiple other classes of antibacterial agents. Although as many as 972 non-duplicate articles refer to fluoroquinolone resistance in enteric bacteria from Africa, most do not report on subtypes and therefore information on the epidemiology of fluoroquinolone-resistant clones is available from only a handful of countries in the subcontinent. When resistance is reported, resistance mechanisms and lineage information is rarely investigated. Insufficient attention has been given to molecular and sequence-based methods necessary for identifying and tracking resistant clones in Africa and more research is needed in this area.

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“…Nucleotide changes in the quinolone resistance-determining region (QRDR) of gyrA in Salmonella are more common than mutations in gyrB or the topoisomerase genes (6,7,12,33,36). In S. Typhi, nucleotide substitutions at Ser-83, Asp-87, Glu-133, Asp-76, Phe-72, Leu-55, and Gln-106 of the gyrA gene have been previously reported, with mutation at codon 83 being the most common (6,9,36). A clonal expansion of NAL-resistant strains with or without the MDR phenotype has been observed by SNP analysis.…”

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confidence: 99%

“…Quinolone resistance in Salmonella spp. is often due to mutations in the DNA gyrase (gyrA and gyrB) or topoisomerase (parC and parE) genes (7,9,10) or to decreased permeability to the agents or to overexpression of efflux pumps (34). More recently, qnr genes, the products of which inhibit quinolone action by binding to gyrA and gyrB subunits, have been reported (11,26).…”

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confidence: 99%

Molecular Typing and Resistance Analysis of Travel-Associated Salmonella enterica Serotype Typhi

et al. 2012

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b Salmonella enterica serotype Typhi is a human pathogen causing 12 to 30% mortality and requiring antibiotic therapy to control the severity of the infection. Typhoid fever in United States is often associated with foreign travel to areas of endemicity. Increasing resistance to multiple drugs, including quinolones, is associated with decreased susceptibility to ciprofloxacin (DCS). We investigated 31 clinical strains isolated in Florida from 2007 to 2010, associated with travel to six countries, to examine the clonal distribution of the organism and apparent nalidixic acid (NAL) resistance. The strains were isolated from blood or stool of patients aged 2 to 68 years. The isolates were subtyped by ribotyping and pulsed-field gel electrophoresis. Susceptibilities to 15 antimicrobials were determined, and the isolates were screened for integrons and gyrase A gene mutations. Both typing techniques effectively segregated the strains. Identical clones were associated with different countries, while diverse types coexisted in the same geographic location. Fifty-one percent of the strains were resistant to at least one antimicrobial, and five were resistant to three or more drugs (multidrug resistant [MDR]). All 12 isolates from the Indian subcontinent were resistant to at least one drug, and 83% of those were resistant to NAL. Three of the MDR strains harbored a 750-bp integron containing the dfr7 gene. Ninety-three percent of the resistant strains showed a DCS profile. All the NAL-resistant strains contained point mutations in the quinolone resistance-determining region of gyrA. This study affirms the global clonal distribution, concomitant genetic heterogeneity, and increased NAL resistance of S. enterica serovar Typhi.

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Detection of mutations in thegyrA gene in fluoroquinolone resistanceSalmonella entericaserotypestyphiandparatyphiA isolated from the Infectious Diseases Hospital, Kuwait

Abstract: It is very important to keep searching for new mutations and continuously monitor drug resistance in different parts of the world in order to efficiently manage cases with enteric fever.

Cited by 8 publications

References 26 publications

Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis

Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis

Fluoroquinolone-Resistant Enteric Bacteria in Sub-Saharan Africa: Clones, Implications and Research Needs

Molecular Typing and Resistance Analysis of Travel-Associated Salmonella enterica Serotype Typhi

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