Mise en évidence de la céphalosporinase plasmidique ACC-1 dans différentes entérobactéries (Klebsiella pneumoniae, Proteus mirabilis, Salmonella) isolées dans un hôpital tunisien (Sfax 1997–2000)

Rhimi-Mahjoubi, F.; Bernier, Michel; Arlet, Guillaume; jemaa, Z Ben; Jouve, P.; Hammami, Adnane; Philippon, A.

doi:10.1016/s0369-8114(01)00260-7

Cited by 27 publications

(15 citation statements)

References 22 publications

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“…Salmonella serotype Wien, producing SHV-2 ESBL, caused a nosocomial outbreak in a neonatal care unit in Sfax in 1988 (14). In the same hospital in 2000, three ESC-resistant strains of Salmonella serotype Livingstone were found to produce cephalosporinase ACC-1 (36). One isolate also produced SHV-2.…”

Section: Discussionmentioning

confidence: 99%

Nosocomial Outbreak Caused by Salmonella enterica Serotype Livingstone Producing CTX-M-27 Extended-Spectrum β-Lactamase in a Neonatal Unit in Sousse, Tunisia

Bouallègue-Godet¹,

Salem²,

Fabre

et al. 2005

J Clin Microbiol

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In this study, we report an outbreak of Salmonella enterica serotype Livingstone resistant to extendedspectrum cephalosporins that occurred in a neonatal ward of the maternity department of Farhat Hached Hospital, Sousse, Tunisia, in 2002. A total of 16 isolates were recovered from 16 babies hospitalized in the ward during the period 1 to 16 July. All these babies developed diarrhea, and three of them developed septicemia. All the isolates demonstrated resistance to ceftriaxone and ceftazidime due to the production of an extendedspectrum ␤-lactamase (ESBL). The isolates were also resistant to aminoglycosides (kanamycin, tobramycin, netilmicin, gentamicin, and amikacin) and sulfamethoxazole-trimethoprim. DNA profiles were determined by pulsed-field gel electrophoresis using the XbaI and SpeI endonucleases and by ribotyping with PstI digestion. They yielded the same patterns, showing that the outbreak was caused by a single clone. The ESBL was identified as CTX-M-27 by sequencing of PCR products and by isoelectric focusing. The ESBL resistance was transferred by a 40-kb conjugative plasmid. The mobile insertion sequence ISEcp1 was found to be located upstream of bla CTX-M-27 in the same position as that known for a bla CTX-M-14 sequence. A new gene named dfrA21, encoding resistance to trimethoprim and carried by a 90-kb plasmid, was characterized. The dfrA21 gene was inserted as a single resistance cassette in a class I integron. The babies were treated with colistin, and all except two recovered. The outbreak came to an end when appropriate actions were taken: patient isolation, hand washing, and disinfection of the ward.Salmonellosis in humans is usually a self-limited gastroenteritis that does not warrant antimicrobial therapy. However, these infections can occasionally lead to life-threatening systemic infections that require effective chemotherapy. With the emergence of ampicillin-resistant Salmonella enterica serotype Typhimurium DT104 isolates, extended-spectrum cephalosporins (ESC) are currently the agents of choice for such chemotherapy, especially for children, for whom the use of fluroquinolones is not yet approved. The selective pressure created by the use of ESC has been described as one of the most important factors in the appearance of extended-spectrum

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Section: Discussionmentioning

confidence: 99%

Nosocomial Outbreak Caused by Salmonella enterica Serotype Livingstone Producing CTX-M-27 Extended-Spectrum β-Lactamase in a Neonatal Unit in Sousse, Tunisia

Bouallègue-Godet¹,

Salem²,

Fabre

et al. 2005

J Clin Microbiol

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“…Studies at Sfax Hospital (Tunisia) reveled the ACC-1 enzyme in K. pneumoniae, P. mirabilis, and S. enterica serovars Livingstone and Mbandaka (4,10). This is the first time that the AAC-1 enzyme has been reported in Spain, now the fourth country in the world where strains carrying this enzyme have been isolated.…”

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confidence: 82%

Escherichia coli Producing an ACC-1 Class C β-Lactamase Isolated in Barcelona, Spain

Miró

Mirelis

Navarro

et al. 2005

Antimicrob Agents Chemother

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“…pneumoniae strains producing plasmid-mediated AmpC ␤-lactamases such as MIR-1 (15), ACT-1 (4), and more recently ACC-1 (14) have been implicated in numerous nosocomial outbreaks (16). AmpC ACC-1 is a plasmid-encoded class C ␤-lactamase originating from Hafnia alvei and now found in various members of the family Enterobacteriaceae in North Africa and Europe (2,7,8,11,13,14,18). Combination of a plasmid-mediated AmpC ␤-lactamase and loss of an outer membrane protein can lead to imipenem resistance in K. pneumoniae (4,5); the two incriminated enzymes were ACT-1 and CMY-4, which are closely related to their chromosomal counterparts in Enterobacter cloacae and Citrobacter freundii, respectively (16).…”

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confidence: 99%

In Vivo Transfer of Plasmid-Encoded ACC-1 AmpC from Klebsiella pneumoniae to Escherichia coli in an Infant and Selection of Impermeability to Imipenem in K. pneumoniae

Bidet

Burghoffer

Gautier

et al. 2005

Antimicrob Agents Chemother

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We describe in vivo selection of a Klebsiella pneumoniae strain with diminished imipenem susceptibility attributable to plasmid-encoded ACC-1 ␤-lactamase production and loss of a 36-kDa major outer membrane protein, together with transfer of this plasmid from K. pneumoniae to Escherichia coli in a Tunisian infant.Resistance to carbapenems in gram-negative bacteria may be due either to carbapenemase production or to combination of chromosomal or plasmid-mediated class C ␤-lactamase overproduction and impermeability (20). Among plasmid-mediated AmpC proteins, only ACT-1 and CMY-2 types have been reported to confer resistance to imipenem in association with porin loss (4,5,12).We isolated a Klebsiella pneumoniae strain with diminished imipenem susceptibility from a Tunisian infant. This resistance was related to a combination of plasmid-mediated AmpC ACC-1 expression and impermeability acquired under antimicrobial pressure.A 1-year-old boy from Tunisia with spina bifida and cloacal extrophy was admitted to Robert-Debré hospital (Paris, France) for reconstruction, enterocystoplasty (Mitrofanoff procedure), and pelvic osteotomy. Surgery was complicated by suppuration and disunion of the pubic symphysis. Pus culture yielded ampicillin-resistant Escherichia coli and ceftazidimeresistant Pseudomonas aeruginosa. Imipenem and amikacin were given for 20 days postoperatively. Before surgery, fecal analysis showed carriage of a cefotaxime-resistant, imipenemsusceptible K. pneumoniae strain (isolate K1, 10 5 CFU/g). At the end of antibacterial chemotherapy (postoperative day 20), the ileal flora grew a cefotaxime-resistant K. pneumoniae strain with diminished imipenem sensitivity (isolate K2, 10 5 CFU/g). The child subsequently developed two urinary tract infections due to an ampicillin-resistant E. coli strain (isolate E1), on postoperative days 30 and day 45, both episodes being treated with cefotaxime and gentamicin. A third culture of the enteric flora on day 45 grew both a cefotaxime-resistant E. coli strain (isolate E2, 10 8 CFU/g) and the previous K. pneumoniae isolate, K2 (10 5 CFU/g). K. pneumoniae and E. coli were identified using commercial kits (API 20E and ID32GN; Biomerieux, Marcy l'Etoile, France). Antimicrobial susceptibility was tested by the disk diffusion method on Mueller-Hinton agar (Sanofi-Diagnostics Pasteur, Marnes-La-Coquette, France), as recommended by the Clinical and Laboratory Standards Institute. The MICs of amoxicillin, cefoxitin, cefotaxime, ceftazidime, cefepime, and imipenem were determined by the E-test method (Biodisk, Solna, Sweden). The imipenem and cefepime MICs were also determined by the E-test method on Mueller-Hinton agar containing 250 g/ml cloxacillin (17).Resistance transfer experiments from E. coli E1 and K. pneumoniae K1 and K2 were performed by conjugation with E. coli J53-2 as previously described (1). The MICs of selected ␤-lactam antibiotics and associated resistance markers for the clinical isolates and transconjugants are shown in Table 1.Clinical isolates E2, K1, and K2 w...

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Mise en évidence de la céphalosporinase plasmidique ACC-1 dans différentes entérobactéries (Klebsiella pneumoniae, Proteus mirabilis, Salmonella) isolées dans un hôpital tunisien (Sfax 1997–2000)

Cited by 27 publications

References 22 publications

Nosocomial Outbreak Caused by Salmonella enterica Serotype Livingstone Producing CTX-M-27 Extended-Spectrum β-Lactamase in a Neonatal Unit in Sousse, Tunisia

Nosocomial Outbreak Caused by Salmonella enterica Serotype Livingstone Producing CTX-M-27 Extended-Spectrum β-Lactamase in a Neonatal Unit in Sousse, Tunisia

Escherichia coli Producing an ACC-1 Class C β-Lactamase Isolated in Barcelona, Spain

In Vivo Transfer of Plasmid-Encoded ACC-1 AmpC from Klebsiella pneumoniae to Escherichia coli in an Infant and Selection of Impermeability to Imipenem in K. pneumoniae

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