Rapid and widespread dissemination of multidrug-resistant blaCMY-2Salmonella Typhimurium in Mexico

Zaidi, Mussaret B.; Leon, Verónica; Canche, Claudia; Perez, Carolina Grande; Zhao, Shaohua; Hubert, Susannah K.; Abbott, Jason; Blickenstaff, Karen; McDermott, Patrick F.

doi:10.1093/jac/dkm168

Cited by 57 publications

(51 citation statements)

References 9 publications

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“…Plasmid-mediated AmpC resistance has recently been reported in clinical isolates of the Enterobacteriaceae worldwide (6,7,9,22,23,(30)(31)(32). Few population-based studies have reported on the frequency or clinical impact of these isolates, and very little is known about the associated epidemiology in pediatrics.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Mechanisms of Broad-Spectrum β-Lactam Resistance in Enterobacteriaceae : a Children's Hospital Experience

Qin

Zerr

Weissman

et al. 2008

Antimicrob Agents Chemother

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The objective of this study was to investigate the trends and patterns of resistance in ␤-lactamase-producing members of the family Enterobacteriaceae in a children's hospital over a 9-year period (1999 to 2007). Clinically significant isolates of the Enterobacteriaceae were screened for patterns of broad-spectrum resistance to ␤-lactams. The strains likely to be resistant were subsequently confirmed by an inhibitor-based disc test. The plasmid-mediated resistance determinants in these isolates were identified by PCR and by in vitro transformation, which successfully reproduced the AmpC phenotype unrestricted by the species of the host organisms. Among 8,048 Enterobacteriaceae isolates belonging to the four chromosomal ampC-negative or -nonfunctional genera, 86 (1.07%) isolates (56 Escherichia coli isolates, 22 Klebsiella species isolates, 1 Proteus mirabilis isolate, and 7 Salmonella species isolates) exhibited broad-spectrum ␤-lactam resistance patterns. These organisms collectively produced three classes of ␤-lactamases, including class A extended-spectrum ␤-lactamases (n ‫؍‬ 47), class C or AmpC ␤-lactamases (n ‫؍‬ 36, including 4 isolates that produced both class A and class C enzymes), and class A or B carbapenem-hydrolyzing ␤-lactamases (n ‫؍‬ 3). The proportion increased from 0.46% during the first 3 years to 1.84% during the last 3 years (relative risk [RR], 4.04; 95% confidence interval [CI], 2.28 to 7.42; P < 0.001). The increase was mainly due to the emergence of a plasmid-mediated bla CMY-2 ␤-lactamase, the incidence of which increased from 0.11% during the first 3 years to 0.96% during the last 3 years (RR, 9.11; 95% CI, 2.76 to 30.1; P ‫؍‬ 0.001). Class A-type resistance increased slightly during the study period, from 0.35% during the first 3 years to 0.85% during the last 3 years (RR, 2.42; 95% CI, 1.15 to 5.07; P ‫؍‬ 0.02). A Proteus mirabilis strain was documented to possess a novel bla DHA determinant. Of special concern, three carbapenemase-producing isolates were identified between 2003 and 2006. The infections caused by resistant isolates of the Enterobacteriaceae mainly affected hospitalized patients with underlying conditions; however, 19 (22%) episodes were of community onset in otherwise well children. The rate of resistance to broad-spectrum ␤-lactams among isolates of the Enterobacteriaceae is increasing in children in both hospitaland community-acquired settings, and the resistance is driven largely by plasmid-mediated AmpC ␤-lactamases. These data have important implications for empirical antimicrobial strategies targeting serious pediatric infections. Further study of this problem is warranted.The ever increasing variety of ␤-lactamases produced by isolates of the family Enterobacteriaceae raises concerns about our dependence on ␤-lactam drugs and the emergence of panresistant species. Rapidly emerging ␤-lactamases include extended-spectrum ␤-lactamases (molecular class A ␤-lactamases and, to a lesser extent, class D ␤-lactamases in the Enterobacteriaceae), AmpC ␤-lactamases (clas...

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Section: Discussionmentioning

confidence: 99%

Prevalence and Mechanisms of Broad-Spectrum β-Lactam Resistance in Enterobacteriaceae : a Children's Hospital Experience

Qin

Zerr

Weissman

et al. 2008

Antimicrob Agents Chemother

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“…Multidrug resistance in our S. Typhimurium isolates is the most pressing concern. bla CMY-2 S. Typhimurium is now a major public health problem in Yucatan, where its prevalence in- and where it has caused fatal infections in young infants (18). The higher rate of ESC resistance in ill children with S. Typhimurium infection than in asymptomatic children has 2 possible explanations.…”

Section: Discussionmentioning

confidence: 99%

Integrated Food Chain Surveillance System forSalmonellaspp. in Mexico1

Zaidi¹,

Calva

Estrada-Garcia

et al. 2008

Emerg. Infect. Dis.

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Few developing countries have foodborne pathogen surveillance systems, and none of these integrates data from humans, food, and animals. We describe the implementation of a 4-state, integrated food chain surveillance system (IFCS) for Salmonella spp. in Mexico. Signifi cant fi ndings were 1) high rates of meat contamination (21.3%-36.4%), 2) high rates of ceftriaxone-resistant S. Typhimurium in chicken, ill humans, and swine (77.3%, 66.3%, and 40.4% of S. Typhimurium isolates, respectively), and 3) the emergence of ciprofl oxacin resistance in S. Heidelberg (10.4%) and S. Typhimurium (1.7%) from swine. A strong association between Salmonella spp. contamination in beef and asymptomatic Salmonella spp. infection was only observed in the state with the lowest poverty level (Pearson r = 0.91, p<0.001). Pulsed-fi eld gel electrophoresis analysis of 311 S. Typhimurium isolates showed 14 clusters with 102 human, retail meat, and food-animal isolates with indistinguishable patterns. An IFCS is technically and economically feasible in developing countries and can effectively identify major public health priorities.

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“…In samples of pig origin, the percentages of AmpCcarrying Salmonella or E. coli isolates ranged from 2.4 to 23% in Canada, Taiwan and México (Kozak et al, 2009;Yan et al, 2004;Zaidi et al, 2007).…”

Section: Cattle Originmentioning

confidence: 99%

Scientific Opinion on the public health risks of bacterial strains producing extended-spectrum β-lactamases and/or AmpC β-lactamases in food and food-producing animals

2011

EFSA Journal

246

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The potential contribution of food-producing animals or foods to public health risks by ESBL and/or AmpCproducing bacteria is related to specific plasmid-mediated ESBL and/or AmpC genes encoded by a number of organisms. The predominant ESBL families encountered are CTX-M, TEM, and SHV; the predominant AmpCfamily is CMY. The most common genes associated with this resistance in animals are bla CTX-M-1 (the most commonly identified ESBL), and bla CTX-M-14 , followed by bla and bla Among the genes encoding AmpC-type β-lactamases, bla CMY-2 is the most common.The bacterial species most commonly identified with these genes are Escherichia coli and non-typhoidal Salmonella. ESBL/AmpC transmission is mainly driven by integrons, insertion sequences, transposons and plasmids, some of which are homologous in isolates from both food-production animals and humans. Cefotaxime is used as the drug of choice for optimum detection of bla ESBL and/or bla AmpC genes. The preferred method for isolation of ESBL-and/or AmpC-producers is screening on selective agar preceded by selective enrichment in a broth.The establishment of risk factors for occurrence of ESBL/AmpC-producing bacteria is particularly complicated by the data unavailability or lack of its accuracy. The use of antimicrobials is a risk factor for the selection and spread of resistant clones, resistance genes and plasmids. Since most ESBL-and AmpC-producing strains carry additional resistances to other commonly-used veterinary drugs, generic antimicrobial use is a risk factor for ESBL/AmpC and it is not restricted specifically to the use of cephalosporins. An additional risk factor is extensive trade of animals in EU MS. There are no data on the comparative efficiency of individual control options in reducing public health risks caused by ESBL and/or AmpC-producing bacteria related to food-producing animals. Prioritisation is complex, but it is considered that a highly effective control option would be to stop all uses of cephalosporins/systemically active 3 rd /4 th generation cephalosporins, or to restrict their use (use only allowed under specific circumstances). As co-resistance is an important issue, it is also of high priority to decrease the total antimicrobial use in animal production in the EU. KEY WORDSResistance, ESBLs, AmpC, occurrence, transmission, control options, public health microbiology. SUMMARYFollowing a request from the European Commission, the Panel on Biological Hazards (BIOHAZ) was asked to deliver a Scientific Opinion on the public health risks of bacterial strains producing extended-spectrum beta (β)-lactamases (ESBL) and/or AmpC β-lactamases (AmpC) in food and foodproducing animals. In particular, the Panel was asked: (i) to propose a definition of the ESBL-and/or AmpC-producing bacterial strains and genes relevant for public health and linked to food-producing animals or food borne transmission; (ii) to review the information on the epidemiology of acquired resistance to broad spectrum cephalosporins including the genes coding for ...

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Rapid and widespread dissemination of multidrug-resistant blaCMY-2Salmonella Typhimurium in Mexico

Abstract: The rapid and widespread dissemination of MDR blaCMY-2 Salmonella Typhimurium in Mexico calls for urgent interventions to contain this potentially fatal pathogen.

Cited by 57 publications

References 9 publications

Prevalence and Mechanisms of Broad-Spectrum β-Lactam Resistance in Enterobacteriaceae : a Children's Hospital Experience

Prevalence and Mechanisms of Broad-Spectrum β-Lactam Resistance in Enterobacteriaceae : a Children's Hospital Experience

Integrated Food Chain Surveillance System forSalmonellaspp. in Mexico1

Scientific Opinion on the public health risks of bacterial strains producing extended-spectrum β-lactamases and/or AmpC β-lactamases in food and food-producing animals

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