Hospital Outbreak of a Colistin-Resistant, NDM-1- and OXA-48-Producing<i>Klebsiella pneumoniae</i>: High Mortality from Pandrug Resistance

Güdücüoğlu, Hüseyin; Gürsoy, Nafia Canan; Yakupoğulları, Yusuf; Parlak, Mehmet; Karaşin, Gökhan; Sünnetçioğlu, Mahmut; Otlu, Barış

doi:10.1089/mdr.2017.0173

Cited by 71 publications

(51 citation statements)

References 30 publications

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“…In our study, 31.0% of strains exhibited varying increases in biofilm formation ability after obtaining the p3R-IncX3 plasmid. Although most evidence to date suggests that p3R-IncX3 plasmids are narrow host range plasmids of the Enterobacteriaceae [9], a growing number of studies show that bla NDM -carrying p3R-IncX3 plasmids have the capacity to expand their host range among E. coli with different MLST profiles [7,12]. Given the broad-spectrum resistance conferred by these plasmids, treatment failure is likely to become more common, especially given that some highly virulent strains, such as ST131 strains carrying mcr-1, also demonstrated enhanced biofilm formation following acquisition of the p3R-IncX3 plasmid.…”

Section: Changes In Biofilm Formation As a Results Of P3r-incx3 Plasmimentioning

confidence: 99%

Fitness Cost of blaNDM-5-Carrying p3R-IncX3 Plasmids in Wild-Type NDM-Free Enterobacteriaceae

Xie

et al. 2020

Microorganisms

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The wide dissemination of New Delhi metallo-β-lactamase genes (blaNDM) has resulted in the treatment failure of most available β-lactam antibiotics, with IncX3-type blaNDM-5-carrying plasmids recognised as having spread worldwide. In China, bacteria carrying these plasmids are increasingly being detected from diverse samples, including hospitals, communities, livestock and poultry, and the environment, suggesting that IncX3 plasmids are becoming a vital vehicle for blaNDM dissemination. To elucidate the fitness cost of these plasmids on the bacterial host, we collected blaNDM-negative strains from different sources and tested their ability to acquire the blaNDM-5-harboring p3R-IncX3 plasmid. We then measured changes in antimicrobial susceptibility, growth kinetics, and biofilm formation following plasmid acquisition. Overall, 70.7% (29/41) of our Enterobacteriaceae recipients successfully acquired the blaNDM-5-harboring p3R-IncX3 plasmid. Contrary to previous plasmid burden theory, 75.9% (22/29) of the transconjugates showed little fitness cost as a result of plasmid acquisition, with 6.9% (2/29) of strains exhibiting enhanced growth compared with their respective wild-type strains. Following plasmid acquisition, all transconjugates demonstrated resistance to most β-lactams, while several strains showed enhanced biofilm formation, further complicating treatment and prevention measures. Moreover, the highly virulent Escherichia coli sequence type 131 strain that already harbored mcr-1 also demonstrated the ability to acquire the blaNDM-5-carrying p3R-IncX3 plasmid, resulting in further limited therapeutic options. This low fitness cost may partly explain the rapid global dissemination of blaNDM-5-harboring IncX3 plasmids. Our study highlights the growing threat of IncX3 plasmids in spreading blaNDM-5.

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Section: Changes In Biofilm Formation As a Results Of P3r-incx3 Plasmimentioning

confidence: 99%

Fitness Cost of blaNDM-5-Carrying p3R-IncX3 Plasmids in Wild-Type NDM-Free Enterobacteriaceae

Xie

et al. 2020

Microorganisms

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“…Colistin is used for treating infections with carbapenem-resistant Enterobacteriaceae (CRE) that belong to multi-resistant isolates and have already been reported worldwide (Grundmann et al 2010). The seriousness of the problem is underlined by high (> 30%) mortality of hospitalized patients infected with carbapenem-resistant strains (Capone et al 2013;Ghafur et al 2014;Guducuoglu et al 2018;Zhang et al 2018). Such infections are difficult to treat and with limited therapeutic options (Parisi et al 2015;Baraniak et al 2016).…”

Section: Colistin Uses In Human Medicinementioning

confidence: 99%

Colistin Resistance in Enterobacterales Strains – A Current View

Stefaniuk

Tyski

2019

Polish Journal of Microbiology

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Colistin is a member of cationic polypeptide antibiotics known as polymyxins. It is widely used in animal husbandry, plant cultivation, animal and human medicine and is increasingly used as one of the last available treatment options for patients with severe infections with carbapenem-resistant Gram-negative bacilli. Due to the increased use of colistin in treating infections caused by multidrug-resistant (MDR) bacteria, the resistance to this antibiotic ought to be monitored. Bacterial resistance to colistin may be encoded on transposable genetic elements (e.g. plasmids with the mcr genes). Thus far, nine variants of the mcr gene, mcr-1 – mcr-9, have been identified. Chromosomal resistance to colistin is associated with the modification of lipopolysaccharide (LPS). Various methods, from classical microbiology to molecular biology methods, are used to detect the colistin-resistant bacterial strains and to identify resistance mechanisms. The broth dilution method is recommended for susceptibility testing of bacteria to colistin.

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“…NDM-positive strains are usually resistant to most antimicrobial agents in addition to ␤-lactams due to the coexistence of other resistance mechanisms (1). NDM-positive strains cause a variety of infections that have been reported to be associated with high mortality rates (6). NDM-positive strains have been found worldwide, representing a significant challenge for clinical management and public health (7,8).…”

Section: Introductionmentioning

confidence: 99%

NDM Metallo-β-Lactamases and Their Bacterial Producers in Health Care Settings

et al. 2019

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SUMMARYNew Delhi metallo-β-lactamase (NDM) is a metallo-β-lactamase able to hydrolyze almost all β-lactams. Twenty-four NDM variants have been identified in >60 species of 11 bacterial families, and several variants have enhanced carbapenemase activity.Klebsiella pneumoniaeandEscherichia coliare the predominant carriers ofblaNDM, with certain sequence types (STs) (forK. pneumoniae, ST11, ST14, ST15, or ST147; forE. coli, ST167, ST410, or ST617) being the most prevalent. NDM-positive strains have been identified worldwide, with the highest prevalence in the Indian subcontinent, the Middle East, and the Balkans. MostblaNDM-carrying plasmids belong to limited replicon types (IncX3, IncFII, or IncC). Commonly used phenotypic tests cannot specifically identify NDM. Lateral flow immunoassays specifically detect NDM, and molecular approaches remain the reference methods for detectingblaNDM. Polymyxins combined with other agents remain the mainstream options of antimicrobial treatment. Compounds able to inhibit NDM have been found, but none have been approved for clinical use. Outbreaks caused by NDM-positive strains have been reported worldwide, attributable to sources such as contaminated devices. Evidence-based guidelines on prevention and control of carbapenem-resistant Gram-negative bacteria are available, although none are specific for NDM-positive strains. NDM will remain a severe challenge in health care settings, and more studies on appropriate countermeasures are required.

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Hospital Outbreak of a Colistin-Resistant, NDM-1- and OXA-48-ProducingKlebsiella pneumoniae: High Mortality from Pandrug Resistance

Cited by 71 publications

References 30 publications

Fitness Cost of blaNDM-5-Carrying p3R-IncX3 Plasmids in Wild-Type NDM-Free Enterobacteriaceae

Fitness Cost of blaNDM-5-Carrying p3R-IncX3 Plasmids in Wild-Type NDM-Free Enterobacteriaceae

Colistin Resistance in Enterobacterales Strains – A Current View

NDM Metallo-β-Lactamases and Their Bacterial Producers in Health Care Settings

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