Risk factors for colistin-resistant Enterobacteriaceae in a low-endemicity setting for carbapenem resistance – a matched case–control study

Büchler, Andrea; Gehringer, Christian; Widmer, Andreas F.; Egli, Adrian; Tschudin‐Sutter, Sarah

doi:10.2807/1560-7917.es.2018.23.30.1700777

Cited by 20 publications

(19 citation statements)

References 22 publications

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“…Independent risk factors for isolation of CORE and COSE in this study were similar. This echoes prior data from Europe, where the characteristics of patients with colistin-resistant and colistin-susceptible E. coli or K. pneumonia did not differ; prior meropenem exposure was the only variable uniquely associated with colistin-resistant isolates [ 14 ]. Of note, meropenem use was uncommon in our current cohort.…”

Section: Discussionsupporting

confidence: 79%

Risk Factors for and Mechanisms of COlistin Resistance Among Enterobacterales: Getting at the CORE of the Issue

Mills

Rojas

Marshall

et al. 2021

Open Forum Infectious Diseases

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Background Despite the recent emergence of plasmid-mediated colistin resistance, the epidemiology and mechanisms of colistin-resistant Enterobacterales (CORE) infections remain poorly understood. Methods A case-case-control study was conducted utilizing routine clinical isolates obtained at a single tertiary health system in Ann Arbor, MI. Patients with CORE isolates from January 1st 2016 to March 31st 2017 were matched 1:1 with patients with colistin-susceptible Enterobacterales (COSE) and uninfected controls. Multivariable logistic regression was used to compare clinical and microbiologic features of patients with CORE and COSE to controls. A subset of available CORE isolates underwent whole genome sequencing to identify putative colistin resistance genes. Results Of 16,373 tested clinical isolates, 166 (0.99%) were colistin-resistant, representing 103 unique patients. Among 103 CORE isolates, 103 COSE isolates, and 102 uninfected controls, antibiotic exposure in the antecedent 90 days and age > 55 years were predictors of both CORE and COSE. Of 33 isolates that underwent WGS, a large variety of mutations associated with colistin resistance were identified, including 4 mcr-1/mcr-1.1 genes and 4 pmrA/B mutations among 9 Escherichia coli isolates; 5 mgrB and 3 PmrA mutations among 8 Klebsiella pneumoniae isolates. Genetic mutations found in Enterobacter species were not associated with known phenotypic colistin resistance. Conclusions Increased age and prior antibiotic receipt were associated with increased risk for patients with CORE, and for patients with COSE. Mcr-1, pmrA/B, and mgrB were the predominant colistin resistance-associated mutations identified among E. coli and K. pneumoniae, respectively. Mechanisms of colistin resistance among Enterobacter species could not be determined.

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Section: Discussionsupporting

confidence: 79%

Risk Factors for and Mechanisms of COlistin Resistance Among Enterobacterales: Getting at the CORE of the Issue

Mills

Rojas

Marshall

et al. 2021

Open Forum Infectious Diseases

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“…In recent years, to tackle the rapid increase in prevalence of carbapenem-resistant isolates in human infections, the use of the relatively toxic polymyxins has become more frequent, and multiple studies from various parts of the world have also confirmed the parallel increase in dissemination of colistin-resistant isolates in wastewater and water bodies [41][42][43][44][45]. Regardless of an increase in polymyxin sales in India between 2000-2015 [4], data on dissemination has been lacking.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Colistin-Resistant, Carbapenem-Hydrolyzing Proteobacteria in Hospital Water Bodies and Out-Falls of West Bengal, India

Bardhan

Chakraborty

Bhattacharjee

2020

IJERPH

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Indiscriminate use of antibiotics has resulted in a catastrophic increase in the levels of antibiotic resistance in India. Hospitals treat critical bacterial infections and thus can serve as reservoirs of multidrug resistant (MDR) bacteria. Hence, this study was conducted to gauge the prevalence patterns of MDR bacteria in hospital wastewater. Water samples collected from 11 hospitals and 4 environmental sources belonging to 5 most-densely populated districts of West Bengal, India were grown on MacConkey and Eosin Methylene Blue agar. A total of 84 (hospital-associated = 70, environmental water sources = 14) isolates were characterized. The predominant species found in water from hospital-associated areas (HAA) were Acinetobacter baumannii (22.9%), Escherichia coli (28.6 %), and Klebsiella pneumoniae (25.7%). Greater than 75% of the HAA isolates were found to be mcr-1 gene negative and colistinresistant. Meropenem non-susceptibility was also high among the HAA isolates at 58.6%, with the presence of the carbapenemase gene and blaNDM in 67.1% of the non-susceptible isolates. Among the three predominant species, significantly higher numbers of E. coli isolates were found to be non-susceptible to meropenem ((80%), p-value = 0.00432) and amikacin (AK (90%), p-value = 0.00037). This study provides evidence for the presence of high numbers of colistin-resistant and carbapenem-hydrolyzing Proteobacteriain hospital wastewater.

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“…The mcr-1 gene can be transmitted through the plasmid to colistin-sensitive strains. [33][34][35][36] Another concern is the emergence of colistin resistance during therapy among KPCproducing strains of P. aeruginosa in Switzerland, 37 USA, 38 and Australia. 8 As the main benefit of this study was to develop an HRMA assay to detect low levels KPC-producing, ESBL producing simultaneously, and CRPA strains, we next selected the KPC/IMP/mprA primer set1 and TEM/ SHV/mcr-1 primers set2 combination for a multiplex assay assessment.…”

Section: Dovepressmentioning

confidence: 99%

<p>Prevalence and Molecular Typing of Colistin-Resistant <em>Pseudomonas aeruginosa</em> (CRPA) Among β-Lactamase-Producing Isolates: A Study Based on High-Resolution Melting Curve Analysis Method</p>

Tahmasebi¹,

Dehbashi²,

Arabestani³

2020

IDR

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Background: The frequency and production of β-lactamase enzymes may be different in colistin-resistant Pseudomonas aeruginosa (CRPA) strains compared to susceptible strains. The purpose of this study was to investigate the relationship between colistin resistance and β-lactamase enzymes in different Sequence Types (ST) of P. aeruginosa. Methods: A total of 101 P. aeruginosa isolates were collected from different samples. The antimicrobial susceptibilities of the bacterial isolates were examined by disk diffusion and MIC E-test methods. Also, real-time PCR and high-resolution melting curve analysis (HRMA) assay were performed to detect the resistance genes. Results: Out of the 101 P. aeruginosa isolates, four isolates (3.96%) were resistant to colistin. Also, 39 isolates (38.61%) were considered as MDR, and eight isolates (7.92%) were considered as XDR. Further, 25 (24.75%) and 26 isolates (25.74%) were produced ESBL and carbapenemase enzymes, respectively. According to HRMA results, four isolates (3.96%) were positive for pmrA, three isolates (2.97%) were positive for mcr-1, 25 isolates (24.75%) were positive for blaTEM, 24 isolates (23.76%) were positive for blaSHV, 26 isolates (25.75%) were positive for blaKPC, and 23 isolates (22.77%) were positive for blaIMP genes. Furthermore, ST108 and ST250 showed the highest distribution in P. aeruginosa isolates. Also, ST217, ST1078, and ST3340 were reported as novel types in CRPA strains. Conclusion: Concerns about the prevalence of CRPA strains should be taken seriously. Also, our results showed that the mcr-1 gene plays a vital role in the distribution of ESBL and KPC-producing P. aeruginosa strains.

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Risk factors for colistin-resistant Enterobacteriaceae in a low-endemicity setting for carbapenem resistance – a matched case–control study

Cited by 20 publications

References 22 publications

Risk Factors for and Mechanisms of COlistin Resistance Among Enterobacterales: Getting at the CORE of the Issue

Risk Factors for and Mechanisms of COlistin Resistance Among Enterobacterales: Getting at the CORE of the Issue

Prevalence of Colistin-Resistant, Carbapenem-Hydrolyzing Proteobacteria in Hospital Water Bodies and Out-Falls of West Bengal, India

<p>Prevalence and Molecular Typing of Colistin-Resistant <em>Pseudomonas aeruginosa</em> (CRPA) Among β-Lactamase-Producing Isolates: A Study Based on High-Resolution Melting Curve Analysis Method</p>

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