Long-term dissemination of acquired AmpC β-lactamases among Klebsiella spp. and Escherichia coli in Portuguese clinical settings

Freitas, Francisco; Machado, Elisabete; Ribeiro, Teresa Gonçalves; Novais, Ângela; Peixe, Luı́sa

doi:10.1007/s10096-013-1983-9

Cited by 15 publications

(24 citation statements)

References 51 publications

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“…Results are in agreement with previous studies that demonstrated a wide dissemination of resistance to these antibiotics among E. coli isolates from Portuguese clinical settings (Freitas et al, 2014), animals (Radhouani et al, 2009) and aquatic systems (Pereira et al, 2013). For antibiotics mainly used in human medicine such as 3rd generation cephalosporins, ciprofloxacin and imipenem, levels of resistance were low.…”

Section: Discussionsupporting

confidence: 93%

“…In fact, it is a matter of concern that levels of resistance to 3rd generation cephalosporins have been consistently increasing in isolates from clinical settings in Portugal (ECDC, 2013). For example, gene bla CMY−2 , which was here detected in one isolate from seagull feces, has been detected in E. coli from clinical samples in Portuguese health care settings (Freitas et al, 2014). …”

Section: Discussionmentioning

confidence: 83%

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Seawater is a reservoir of multi-resistant Escherichia coli, including strains hosting plasmid-mediated quinolones resistance and extended-spectrum beta-lactamases genes

et al. 2014

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The aim of this study was to examine antibiotic resistance (AR) dissemination in coastal water, considering the contribution of different sources of fecal contamination. Samples were collected in Berlenga, an uninhabited island classified as Natural Reserve and visited by tourists for aquatic recreational activities. To achieve our aim, AR in Escherichia coli isolates from coastal water was compared to AR in isolates from two sources of fecal contamination: human-derived sewage and seagull feces. Isolation of E. coli was done on Chromocult agar. Based on genetic typing 414 strains were established. Distribution of E. coli phylogenetic groups was similar among isolates of all sources. Resistances to streptomycin, tetracycline, cephalothin, and amoxicillin were the most frequent. Higher rates of AR were found among seawater and feces isolates, except for last-line antibiotics used in human medicine. Multi-resistance rates in isolates from sewage and seagull feces (29 and 32%) were lower than in isolates from seawater (39%). Seawater AR profiles were similar to those from seagull feces and differed significantly from sewage AR profiles. Nucleotide sequences matching resistance genes blaTEM, sul1, sul2, tet(A), and tet(B), were present in isolates of all sources. Genes conferring resistance to 3rd generation cephalosporins were detected in seawater (blaCTX-M-1 and blaSHV-12) and seagull feces (blaCMY-2). Plasmid-mediated determinants of resistance to quinolones were found: qnrS1 in all sources and qnrB19 in seawater and seagull feces. Our results show that seawater is a relevant reservoir of AR and that seagulls are an efficient vehicle to spread human-associated bacteria and resistance genes. The E. coli resistome recaptured from Berlenga coastal water was mainly modulated by seagulls-derived fecal pollution. The repertoire of resistance genes covers antibiotics critically important for humans, a potential risk for human health.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 83%

Seawater is a reservoir of multi-resistant Escherichia coli, including strains hosting plasmid-mediated quinolones resistance and extended-spectrum beta-lactamases genes

et al. 2014

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“…To be more specific, the majority of Acinetobacter baumannii isolates were producers of carbapenemase and metallo-β-lactamase (12). In a study of isolates collected between 2002 and 2008, DHA-1 was the most prevalent acquired AmpC (94%), which was first identified in 2003 and was detected throughout the studied period in different institutions (13). Klebsiella pneumoniae is an important cause of nosocomial infection, and ESBLs and carbapenemases are a cause of emergency in multidrug-resistant (MDR) Klebsiella pneumoniae treatment (14).…”

Section: Introductionmentioning

confidence: 99%

Detection and genotype analysis of AmpC β-lactamase in Klebsiella pneumoniae from tertiary hospitals

Liu

2016

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to investigate the phenotype and genotype of plasmid-mediated AmpC (pAmpC) β-lactamase in Klebsiella pneumoniae and its antibiotic resistance. A total of 130 non-repetitive clinical isolates of Klebsiella pneumoniae, obtained from tertiary hospitals, were phenotypically screened for pAmpC β-lactamase production with the cefoxitin disk diffusion test. β-lactamase genes in the screened isolates were detected using multiplex polymerase chain reaction (PCR); carbapenemase genes in pAmpC β-lactamase-producing isolates that were resistant to imipenem were detected using PCR. Out of the 130 isolates of Klebsiella pneumoniae, 62 strains (47.7%) were resistant to cefoxitin, including 14 strains (10.8%) positive for pAmpC β-lactamase (DHA type), among which 12 strains (85.7%) were susceptible to imipenem, and 2 strains, which were carrying Klebsiella pneumoniae carbapenemase (KPC)-2 gene, were resistant to imipenem. The pAmpC β-lactamase-producing Klebsiella pneumoniae isolates from the tertiary hospitals were mainly of DHA-1 genotype, and the majority were susceptible to carbapenems; drug-resistant strains were associated with KPC-2 expression. IntroductionAmpC β-lactamase, which is a type of cephalosporinase (1), is known to be responsible for antimicrobial resistance in gram-negative bacilli (2). The knowledge of potential risk factors for that resistance may help to limit its impact by enabling the implementation of effective control measures and judicious antimicrobial therapy (3). AmpC β-lactamases are either plasmid-or chromosomal-mediated (4). With regard to plasmid-mediated AmpC (pAmpC), no single phenotypic method is satisfactory for its detection; the combined application of phenotypic tests is necessary for the screening and confirmation of the presence of pAmpC-mediated resistance (5). Chromosomal-mediated AmpC hyperproducing Escherichia coli (E. coli) continues to be mostly susceptible to third-generation cephalosporins (6). Polymerase chain reaction (PCR) remains the gold standard for the detection of AmpC β-lactamases (7). As β-lactam antibiotics are widely used, the production of AmpC β-lactamases by bacteria results in considerable antibiotic resistance (8).Resistance to broad-spectrum β-lactams mediated by extended spectrum broad-spectrum β-lactamases (ESBLs) and AmpC β-lactamase enzymes is an increasing problem worldwide (9). In Portugal, 104/124 (83.9%) of Enterobacteriaceae isolates that were resistant to third generation cephalosporins were also resistant to fourth generation cephalosporins (10). In comparison with ESBL-producing gram-negative bacilli, AmpC β-lactamase-producing strains show more extensive antibiotic resistance; 29% of Acinetobacter strains, for example, were found to produce both ESBL and AmpC enzymes (11). To be more specific, the majority of Acinetobacter baumannii isolates were producers of carbapenemase and metallo-β-lactamase (12). In a study of isolates collected between 2002 and 2008, DHA-1 was the most prevalent acquired AmpC (94%)...

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“…They were recovered during a 4-year period (2010-2013) from general hospitals located at the North (HA; 63.2%; 2010-2012) and Centre (HD; 5.5%; June 2012-August 2013) of Portugal, and a community laboratory at the North (CL2; 31.4%; August 2012-August 2013), all serving a population of almost 3 000 000 people. Bacterial identification and antibiotic susceptibility testing were performed as described [8] .…”

Section: Methodsmentioning

confidence: 99%

“…Our previous survey on qAmpC-producing Enterobacteriaceae dates back to the period of 2002 to 2008, and indicated a high occurrence of DHA-1-producing K. pneumoniae isolates [8] , but detailed molecular analysis was not performed and more recent epidemiological trends are not known. We aim to provide detailed molecular data on clinical qAmpC producing Enterobacteriaceae from two different periods (2002-2008 and 2010-2013) in order to clarify the contribution of clonal and plasmid genetic platforms for the current epidemiological scenario concerning extended-spectrum beta-lactams resistance.…”

Section: Introductionmentioning

confidence: 99%

Significant temporal shifts on clonal and plasmid backgrounds of Enterobacteriaceae producing acquired AmpC in Portuguese clinical settings

Novais

Rodrigues

et al. 2019

Preprint

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Running title: Molecular epidemiology of qAmpC among clinical Enterobacteriaceae. 30 31 # These authors were equally contributed in this work. 32 33 34 Abbreviations 35 CS, conserved segment; ESBL, extended-spectrum β-lactamases; ICE, integrative and 36 conjugative element; icr-AmpC, inducible chromosomal AmpC; KL, capsular locus; MDR, 37 multidrug-resistant; MRR, multidrug resistance region; PMQR, plasmid-mediated quinolone 38 resistance; qAmpC, acquired AmpC β-lactamases; VR1, variable region 1. 39 ABSTRACT 40 OBJECTIVES: To provide detailed molecular data on clinical acquired AmpC (qAmpC)-41producing Enterobacteriaceae from two different periods (42 order to clarify the contribution of clonal and plasmid genetic platforms for the current 43 epidemiological scenario concerning extended-spectrum beta-lactams resistance. 44 METHODS:We analysed 1246 Enterobacteriaceae non-susceptible to third-generation 45 cephalosporins from 2 hospitals and 1 community laboratory between 2010 and 2013. 46Bacterial identification, antibiotic susceptibility, identification of qAmpC and plasmid-47 mediated quinolone resistance genes, clonal (PFGE, MLST) and plasmid (S1-/I-CeuI-PFGE, 48 replicon typing, hybridization) analysis were performed by standard methods. WGS was 49 performed in two ST11-K. pneumoniae isolates harbouring DHA-1. 50 RESULTS:The occurrence of qAmpC was lower (2.6%) than that observed in a previous 51 survey (7.4%), and varied slightly over time. Isolates produced DHA-1 (53%), CMY-2 (44%) 52 or DHA-6 (3%), but significant epidemiological changes were observed in the two surveys. 53While DHA-1 persisted in different institutions by selection of a worldwide epidemic IncR 54 plasmid in a ST11 harbouring KL105, CMY-2 rates increased over time linked to IncI1 55 plasmids (instead of IncK or IncA/C 2 ) in multiple E. coli clones. 56 CONCLUSIONS:The higher frequency of DHA-1 qAmpC in these species contrasts with 57 the scenario of most European countries. Furthermore, the different genetic backgrounds 58 associated with either ESBL or qAmpC in our country might have contributed to their 59 differential expansion. 60 61 IncR. 63 64 65 The worldwide contemporary epidemiology of Enterobacteriaceae resistant to broad-66 spectrum cephalosporins seems to be largely dominated by extended-spectrum β-lactamases 67 (ESBL) than acquired AmpC β-lactamases (qAmpC) [1]. However, the occurrence and 68 clinical impact of Enterobacteriaceae producing qAmpC is probably underestimated, since 69 qAmpC producers are difficult to identify by conventional methods and qAmpC expression is 70 frequently masked by other resistance mechanisms [2, 3]. Recent studies described an 71 increase of specific qAmpC enzymes among clinical Enterobacteriaceae [1, 2, 4], mostly 72 CMY-2-producing Escherichia coli associated either with hospital or community infections 73 and DHA-1-producing Klebsiella pneumoniae especially linked to nosocomial outbreaks [2, 74 3, 5, 6]. 75 76 In Portugal, relevant epidemiological changes regarding resistance to extended-spectr...

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Long-term dissemination of acquired AmpC β-lactamases among Klebsiella spp. and Escherichia coli in Portuguese clinical settings

Cited by 15 publications

References 51 publications

Seawater is a reservoir of multi-resistant Escherichia coli, including strains hosting plasmid-mediated quinolones resistance and extended-spectrum beta-lactamases genes

Seawater is a reservoir of multi-resistant Escherichia coli, including strains hosting plasmid-mediated quinolones resistance and extended-spectrum beta-lactamases genes

Detection and genotype analysis of AmpC β-lactamase in Klebsiella pneumoniae from tertiary hospitals

Significant temporal shifts on clonal and plasmid backgrounds of Enterobacteriaceae producing acquired AmpC in Portuguese clinical settings

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