Emergence of clinical mcr-1-positive Escherichia coli in Lebanon

Al-Mir, Hiba; Osman, Marwan; Azar, Nadim; Madec, Jean‐Yves; Hamzé, Monzer; Haenni, Marisa

doi:10.1016/j.jgar.2019.08.019

Cited by 25 publications

(22 citation statements)

References 7 publications

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“…Finally, mcr-1 has also been reported in human clinical isolates in Lebanon that had been collected as early as 2011 (Al-Mir et al, 2019). The plasmidic location of the mcr-1 gene has, however, rarely been investigated in those studies: it was found located on an IncX4 plasmid in human isolates and in a rainbow trout isolate, and on IncX4 and IncI2 in water isolates (Al-Mir et al, 2019;Hassan et al, 2020;Sourenian et al, 2020). Likewise, data on the bacterial population structure hosting mcr-1-mediated colistin-resistance remain largely unknown.…”

Section: Introductionmentioning

confidence: 86%

“…The presence of the mcr-1 gene was also detected in water samples, from either irrigation water or the Mediterranean Sea (Hmede et al, 2019;Sourenian et al, 2020), suggesting environmental contamination. Finally, mcr-1 has also been reported in human clinical isolates in Lebanon that had been collected as early as 2011 (Al-Mir et al, 2019). The plasmidic location of the mcr-1 gene has, however, rarely been investigated in those studies: it was found located on an IncX4 plasmid in human isolates and in a rainbow trout isolate, and on IncX4 and IncI2 in water isolates (Al-Mir et al, 2019;Hassan et al, 2020;Sourenian et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

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WGS Analysis of Clonal and Plasmidic Epidemiology of Colistin-Resistance Mediated by mcr Genes in the Poultry Sector in Lebanon

et al. 2021

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Poultry and poultry meat are important contributors to the global antimicrobial burden. Unregulated and illegal use of extended-spectrum cephalosporins (ESC) in this sector has long been identified as a major cause of massive spread of ESC-resistant Escherichia coli, and colistin usage is considered a main driver of plasmid-mediated mcr genes dissemination. In Lebanon, the first mcr-1-positive E. coli found in poultry dates back to 2015, followed by a few reports of mcr-1-positive E. coli in poultry, swine, humans, and the environment. On the contrary, a comprehensive picture of the population structure of mcr-1-positive E. coli and mcr-1-bearing plasmids carrying the mcr-1 gene using whole-genome analysis is largely lacking. This study reports the prevalence of mcr-1-positive E. coli in poultry originating from 32 farms across three Lebanese governorates and slaughtered in the same place. We report 27/32 (84.4%) mcr-1 positive farms, leading to a total of 84 non-duplicate E. coli collected, of which 62 presented the mcr-1 gene. Numerous associated resistances were identified, including to ESC through the presence of blaCTX–M or blaCMY genes. The mcr-1 gene was mostly carried by IncX4 (n = 36) and IncI2 (n = 24) plasmids, which are both known for their efficient transfer capacities. A high genetic diversity was detected, arguing for the lack of contamination during the slaughter process. ST744 and ST1011 were the most widely identified clones, which have been both regularly associated to mcr-1-carrying E. coli and to the poultry sector. The wide dissemination of colistin-resistance, coupled to resistances to ESC and numerous other molecules, should urge authorities to implement efficient guidelines for the use of antibiotics in the poultry sector in Lebanon.

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Section: Introductionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

WGS Analysis of Clonal and Plasmidic Epidemiology of Colistin-Resistance Mediated by mcr Genes in the Poultry Sector in Lebanon

et al. 2021

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“…In Lebanon, carbapenem resistance has been on the rise over the past 10 years in clinically-relevant Gram-negative bacteria, an alarming situation in light of limited resources [23][24][25][26]. Colistin resistance has also recently been detected in Enterobacteriaceae and Acinetobacter species from clinical samples [40,41].…”

Section: Discussionmentioning

confidence: 99%

The effect of an antibiotic stewardship program on tigecycline use in a Tertiary Care Hospital, an intervention study

Moghnieh

Abdallah

Awad

et al. 2020

Ann Clin Microbiol Antimicrob

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Background: A drug-oriented antibiotic stewardship intervention targeting tigecycline utilization was launched at Makassed General Hospital, Beirut, Lebanon, in 2016 as a part of a comprehensive Antibiotic Stewardship Program (ASP). In this study, we evaluated the effect of this intervention on changing tigecycline prescription behavior in different types of infections, patient outcome and mortality, along with tigecycline drug use density, when compared to an earlier period before the initiation of ASP. Methods: This is a retrospective chart review of all adult inpatients who received tigecycline for more than 72 h between Jan-2012 and Dec-2013 [period (P) 1 before ASP] and between Oct-2016 and Dec-2018 [period (P) 2 during ASP]. Results: Tigecycline was administered to 153 patients during P1 and 116 patients during P2. The proportion of patients suffering from cancer, those requiring mechanical ventilation, and those with hemodynamic failure was significantly reduced between P1 and P2. The proportion of patients who received tigecycline for FDA-approved indications increased from 19% during P1 to 78% during P2 (P < 0.001). On the other hand, its use in off-label indications was restricted, including ventilator-associated pneumonia (26.1% in P1, 3.4% in P2, P < 0.001), hospital-acquired pneumonia (19.6% in P1, 5.2% in P2, P = 0.001), sepsis (9.2% in P1, 3% in P2, P = 0.028), and febrile neutropenia (15.7% in P1, 0.9% in P2, P < 0.001). The clinical success rate of tigecycline therapy showed an overall significant increase from 48.4% during P1 to 65.5% during P2 (P = 0.005) in the entire patient population. All-cause mortality in the tigecycline-treated patients decreased from 45.1% during P1 to 20.7% during P2 (P < 0.0001). In general, mean tigecycline consumption decreased by 55% between P1 and P2 (P < 0.0001). Conclusion: The drug-oriented ASP intervention targeting tigecycline prescriptions improved its use and patient outcomes, where it helped curb the over-optimistic use of this drug in off-label indications where it is not a suitable treatment option.

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“…This is the first report of 1) transmissible plasmid-borne mcr-1 in P. mirabilis from humans and 2) the detection of mcr-1 in the Lebanese population. During the peer-review assessment of this study, a manuscript reported the detection of mcr-1 in six clinical E. coli isolates of human origins in Lebanon [11]. Also, as previously mentioned, our study targeted the Lebanese population at large and was conducted on the level of the community in a non-clinical setting.…”

Section: Discussionmentioning

confidence: 99%

First report of the plasmid-borne colistin resistance gene (mcr-1) in Proteus mirabilis isolated from a toddler in non-clinical settings

Hmede

Kassem

2019

IDCases

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Emergence of clinical mcr-1-positive Escherichia coli in Lebanon

Cited by 25 publications

References 7 publications

WGS Analysis of Clonal and Plasmidic Epidemiology of Colistin-Resistance Mediated by mcr Genes in the Poultry Sector in Lebanon

WGS Analysis of Clonal and Plasmidic Epidemiology of Colistin-Resistance Mediated by mcr Genes in the Poultry Sector in Lebanon

The effect of an antibiotic stewardship program on tigecycline use in a Tertiary Care Hospital, an intervention study

First report of the plasmid-borne colistin resistance gene (mcr-1) in Proteus mirabilis isolated from a toddler in non-clinical settings

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