Draft Genome Sequence of a Salmonella enterica Serovar Typhi Strain Resistant to Fourth-Generation Cephalosporin and Fluoroquinolone Antibiotics

Gul, Danish; Potter, Robert F.; Riaz, Hurmat; Ashraf, Shifa Tariq; Wallace, Meghan A.; Munir, Tehmina; Ali, Amjad; Dantas, Gautam; Andleeb, Saadia

doi:10.1128/genomea.00850-17

Cited by 10 publications

(9 citation statements)

References 16 publications

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“…These events shifted the first-line and empirical treatments to other classes of antimicrobial agents, such as ceftriaxone (cro) and azithromycin. Alarmingly, reports of resistance against these agents have now been published ( 6 , 12 – 18 ). Moreover, a recent report from Pakistan described the first large-scale outbreak of an S .…”

Section: Introductionmentioning

confidence: 99%

Salmonella enterica Serovar Typhi in Bangladesh: Exploration of Genomic Diversity and Antimicrobial Resistance

Tanmoy

Westeel

Bruyne³

et al. 2018

mBio

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Typhoid fever, caused by Salmonella enterica serovar Typhi, is responsible for an estimated burden of approximately 17 million new episodes per year worldwide. Adequate and timely antimicrobial treatment invariably cures typhoid fever. The increasing antimicrobial resistance (AMR) of S. Typhi severely limits the treatment options. We studied whole-genome sequences (WGS) of 536 S. Typhi isolates collected in Bangladesh between 1999 and 2013 and compared those sequences with data from a recent outbreak in Pakistan and a laboratory surveillance in Nepal. The analysis suggests that multiple ancestral origins of resistance against ciprofloxacin and ceftriaxone are present in three countries. Such independent genetic events and subsequent dissemination could enhance the risk of a rapid global spread of these highly resistant clones. Given the current treatment challenges, vaccination seems to be the most appropriate short-term intervention to reduce the disease burden of typhoid fever at a time of increasing AMR.

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Section: Introductionmentioning

confidence: 99%

Salmonella enterica Serovar Typhi in Bangladesh: Exploration of Genomic Diversity and Antimicrobial Resistance

Tanmoy

Westeel

Bruyne³

et al. 2018

mBio

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“…The Bangladesh and Iraq isolates also harbor bla CTX-M ESBL genes, but the Iraq isolate reportedly had an IncN plasmid, which differs from the IncY plasmid identified in this study. A draft genome of the Pakistan case from Rawalpindi has been released ( 20 ), and it harbors the same plasmid that we identified in the Sindh, Pakistan, cases.…”

Section: Discussionmentioning

confidence: 73%

“…Of those, only four individual cases (single patients) have reported S . Typhi that was also both MDR and fluoroquinolone resistant ( 16 – 20 ). These cases originated from Iraq, Bangladesh, India, and Pakistan.…”

Section: Discussionmentioning

confidence: 99%

Emergence of an Extensively Drug-Resistant Salmonella enterica Serovar Typhi Clone Harboring a Promiscuous Plasmid Encoding Resistance to Fluoroquinolones and Third-Generation Cephalosporins

Klemm

Shakoor

Page

et al. 2018

mBio

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Antibiotic resistance is a major problem in Salmonella enterica serovar Typhi, the causative agent of typhoid. Multidrug-resistant (MDR) isolates are prevalent in parts of Asia and Africa and are often associated with the dominant H58 haplotype. Reduced susceptibility to fluoroquinolones is also widespread, and sporadic cases of resistance to third-generation cephalosporins or azithromycin have also been reported. Here, we report the first large-scale emergence and spread of a novel S. Typhi clone harboring resistance to three first-line drugs (chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole) as well as fluoroquinolones and third-generation cephalosporins in Sindh, Pakistan, which we classify as extensively drug resistant (XDR). Over 300 XDR typhoid cases have emerged in Sindh, Pakistan, since November 2016. Additionally, a single case of travel-associated XDR typhoid has recently been identified in the United Kingdom. Whole-genome sequencing of over 80 of the XDR isolates revealed remarkable genetic clonality and sequence conservation, identified a large number of resistance determinants, and showed that these isolates were of haplotype H58. The XDR S. Typhi clone encodes a chromosomally located resistance region and harbors a plasmid encoding additional resistance elements, including the blaCTX-M-15 extended-spectrum β-lactamase, and carrying the qnrS fluoroquinolone resistance gene. This antibiotic resistance-associated IncY plasmid exhibited high sequence identity to plasmids found in other enteric bacteria isolated from widely distributed geographic locations. This study highlights three concerning problems: the receding antibiotic arsenal for typhoid treatment, the ability of S. Typhi to transform from MDR to XDR in a single step by acquisition of a plasmid, and the ability of XDR clones to spread globally.

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“…The isolates from Iraq and Bangladesh were found to harbor blaCTX-M genes, and the Iraqi isolate was found to have an IncN plasmid whereas the isolates from Pakistan were having the blaCTX-M gene and the IncY plasmid [4]. A similar plasmid was identified from the draft genome of a single isolate from Rawalpindi, Pakistan as identified in the isolate from Sindh, Pakistan [4,22].…”

Section: Discussionmentioning

confidence: 83%

“…The literature has proposed the term "extensively drugresistant" (XDR) for the S. Typhi isolates which are resistant to five antimicrobial agents consistent with the nomenclature recommended for other pathogenic bacterial species [4,14]. The sporadic cases of cephalosporin-resistant have been reported in few studies and of which few individual cases have found XDR S. Typhi isolates which were resistant to cephalosporins and fluoroquinolone in addition to the MDR phenotypes [5,7,[20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Extended-spectrum beta-lactamases producing extensively drug-resistant Salmonella Typhi in Punjab, Pakistan

Saeed

Rasool

Rasheed

et al. 2020

J Infect Dev Ctries

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Introduction: The multidrug-resistant (MDR) Salmonella enterica serovar Typhi isolates have been increasingly reported from the Asian and African countries. The emergence of isolates with decreased susceptibility to fluoroquinolones and cephalosporins has worsened the situation. Recently, an outbreak from Sindh, Pakistan was reported caused by extensively drug-resistant (XDR) S. Typhi strains. Methodology: In the present study, a total of 82 cases of typhoid have been investigated during 2018 from the febrile children referred to a tertiary care hospital in the population-wise largest province (Punjab) of Pakistan. S. Typhi was identified by standard microbiological techniques and isolates were characterized for antimicrobial resistance profiling and minimum inhibitory concentrations were determined. The presence of various ESBL genes in S. Typhi was confirmed by the PCR. Results: Out of the 82 isolates tested, 35 (43%) were found to be XDR; resistant to the first-line drugs. The resistance to third-generation cephalosporins was mainly mediated by extended-spectrum beta-lactamases i.e. blaTEM and blaCTX-M genes. Conclusions: The higher prevalence of ESBL producing Salmonella typhi clinical strains raises the concern about transmission prevention and infection management in the community as well as clinical settings. Moreover, the study highlights the problem concerning the declining antibiotic arsenal for the therapeutic management of typhoid fever and the emergence and spread of XDR strains in Pakistan.

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Draft Genome Sequence of a Salmonella enterica Serovar Typhi Strain Resistant to Fourth-Generation Cephalosporin and Fluoroquinolone Antibiotics

Cited by 10 publications

References 16 publications

Salmonella enterica Serovar Typhi in Bangladesh: Exploration of Genomic Diversity and Antimicrobial Resistance

Salmonella enterica Serovar Typhi in Bangladesh: Exploration of Genomic Diversity and Antimicrobial Resistance

Emergence of an Extensively Drug-Resistant Salmonella enterica Serovar Typhi Clone Harboring a Promiscuous Plasmid Encoding Resistance to Fluoroquinolones and Third-Generation Cephalosporins

Extended-spectrum beta-lactamases producing extensively drug-resistant Salmonella Typhi in Punjab, Pakistan

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