Multidrug-Resistant Tuberculosis Complicated by Nosocomial Infection with Multidrug-Resistant Enterobacteriaceae

Gröschel, Matthias I.; Omansen, Till F.; Lange, Wiel de; Werf, Tjip S. van der; Lokate, Mariëtte; Bathoorn, Erik; Akkerman, Onno W.; Stienstra, Ymkje

doi:10.4269/ajtmh.15-0690

Cited by 6 publications

(5 citation statements)

References 9 publications

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“…Although the abundance of these ARGs approaches pretreatment baseline by treatment cessation, the AMR expansion is persistent for at least the first 6 months of MDR TB treatment. Although there are scattered case reports of resistant infections in patients with MDR TB (86,87), our data suggest that MDR TB treatment might be a risk factor for antimicrobial-resistant Gram-negative infection. Such associations should be sought in future studies, both in individuals and in communities with high rates of MDR TB (88).…”

Section: Discussionmentioning

confidence: 66%

Commensal antimicrobial resistance mediates microbiome resilience to antibiotic disruption

Bhattarai,

Du,

Zeamer

et al. 2024

Sci. Transl. Med.

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Despite their therapeutic benefits, antibiotics exert collateral damage on the microbiome and promote antimicrobial resistance. However, the mechanisms governing microbiome recovery from antibiotics are poorly understood. Treatment of Mycobacterium tuberculosis , the world’s most common infection, represents the longest antimicrobial exposure in humans. Here, we investigate gut microbiome dynamics over 20 months of multidrug-resistant tuberculosis (TB) and 6 months of drug-sensitive TB treatment in humans. We find that gut microbiome dynamics and TB clearance are shared predictive cofactors of the resolution of TB-driven inflammation. The initial severe taxonomic and functional microbiome disruption, pathobiont domination, and enhancement of antibiotic resistance that initially accompanied long-term antibiotics were countered by later recovery of commensals. This resilience was driven by the competing evolution of antimicrobial resistance mutations in pathobionts and commensals, with commensal strains with resistance mutations reestablishing dominance. Fecal-microbiota transplantation of the antibiotic-resistant commensal microbiome in mice recapitulated resistance to further antibiotic disruption. These findings demonstrate that antimicrobial resistance mutations in commensals can have paradoxically beneficial effects by promoting microbiome resilience to antimicrobials and identify microbiome dynamics as a predictor of disease resolution in antibiotic therapy of a chronic infection.

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Section: Discussionmentioning

confidence: 66%

Commensal antimicrobial resistance mediates microbiome resilience to antibiotic disruption

Bhattarai,

Du,

Zeamer

et al. 2024

Sci. Transl. Med.

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“…11 We previously raised special attention for MDRO resistance among patients with TB, leading to complications during TB treatment like bacteraemia and sepsis. 12 This patient illustrates the rationale behind screening for MDRO. The detection of carriage of CP microorganisms resulted in targeted prophylaxis during the surgical intervention and would have resulted in an adapted choice of empirical antimicrobial therapy in the case of infection.…”

Section: Discussionmentioning

confidence: 92%

Case Report: Carbapenemase-Producing Enterobacteriaceae in an Asylum Seeker with Multidrug–Resistant Tuberculosis

Ravensbergen

Louka

Lokate

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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A Syrian asylum seeker with multidrug-resistant tuberculosis (TB) developed a bronchopleural fistula after pneumonectomy. Although screening tests were negative on admission, carbapenemase-producing Enterobacteriaceae were cultured after a few months of TB treatment. Prevalence of multidrug-resistant organisms is reported to be increased in asylum seekers compared with the general Dutch population. Arduous conditions during transit and interrupted health care delivery in our patient led to multiple-resistant microorganisms that complicated treatment.

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“…This is an encouraging finding, as the occurrence of both in bacteria can yield both untreatable and virulent species. Co‐occurence of virulence and/or pathogenic factors is often problematic, as demonstrated with the recent COVID‐19 pandemic, with tuberculosis, and with other difficult‐to‐treat infections 87–89 . Bacteria develop resistance in response to exposure to antibiotics, while they develop virulence genes to survive in the host.…”

Section: Discussionmentioning

confidence: 99%

“…Co-occurence of virulence and/or pathogenic factors is often problematic, as demonstrated with the recent COVID-19 pandemic, with tuberculosis, and with other difficult-to-treat infections. [87][88][89] Bacteria develop resistance in response to exposure to antibiotics, while they develop virulence genes to survive in the host. Whereas resistance genes are mostly transmitted horizontally through plasmids or other mobile genetic elements, virulence genes are mainly transmitted vertically/clonally.…”

Section: F I G U R Ementioning

confidence: 99%

Molecular characterization of hypermucoviscous carbapenemase‐encoding Klebsiella pneumoniae isolates from an Egyptian hospital

Ragheb,

Osei Sekyere

2024

Annals of the New York Academy of Sciences

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This study aimed to screen antibiotic resistance and virulence genes in carbapenem‐resistant hypermucoviscous Klebsiella pneumoniae isolates from an Egyptian hospital. Among 38 previously confirmed carbapenem‐nonsusceptible K. pneumoniae isolates, a string test identified three isolates as positive for hypermucoviscosity. Phenotypic characterization and molecular detection of carbapenemase‐ and virulence‐encoding genes were performed. PCR‐based multilocus sequence typing and phylogenetics were used to determine the clonality and global epidemiology of the strains. The coexistence of virulence and resistance genes in the isolates was analyzed statistically using a chi‐square test. Three isolates showed the presence of carbapenemase‐encoding genes (blaNDM, blaVIM, and blaIMP), adhesion genes (fim‐H‐1 and mrkD), and siderophore genes (entB); the isolates belonged to sequence types (STs) 101, 1310, and 1626. The relatedness between these sequence types and the sequence types of globally detected hypermucoviscous K. pneumoniae that also harbor carbapenemases was determined. Our analysis showed that the resistance and virulence profiles were not homogenous. Phylogenetically, different clones clustered together. There was no significant association between the presence of resistance and virulence genes in the isolates. There is a need for periodic surveillance of the healthcare settings in Egypt and globally to understand the true epidemiology of carbapenem‐resistant, hypermucoviscous K. pneumoniae.

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Multidrug-Resistant Tuberculosis Complicated by Nosocomial Infection with Multidrug-Resistant Enterobacteriaceae

Cited by 6 publications

References 9 publications

Commensal antimicrobial resistance mediates microbiome resilience to antibiotic disruption

Commensal antimicrobial resistance mediates microbiome resilience to antibiotic disruption

Case Report: Carbapenemase-Producing Enterobacteriaceae in an Asylum Seeker with Multidrug–Resistant Tuberculosis

Molecular characterization of hypermucoviscous carbapenemase‐encoding Klebsiella pneumoniae isolates from an Egyptian hospital

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