Spread of multidrug-resistant Proteus mirabilis isolates producing an AmpC-type β-lactamase: epidemiology and clinical management

Luzzaro, Francesco; Brigante, Gioconda; D’Andrea, Marco Maria; Pini, Beatrice; Giani, Tommaso; Mantengoli, Elisabetta; Rossolini, Gian María; Toniolo, Antonio

doi:10.1016/j.ijantimicag.2008.09.007

Cited by 49 publications

(45 citation statements)

References 26 publications

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“…ESBLs belong to group 2be in this classification scheme [9]. Evolution and spread of a multidrug-resistant Proteus mirabilis with chromosomal AmpC-type beta-lactamase were reported in Europe [10]. Several local researches revealed that clinical P. mirabilis isolates from different anatomical sites are ESBLs producer [11][12] The present study was aimed to isolate P. mirabilis from various clinical and animal sources and comparing between their -lactamases production.…”

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confidence: 99%

Antimicrobial Resistance Patterns and Extended Spectrum Beta-lactamases Producing by Proteus mirabilis Isolated from Different Sources

Kadhim

2017

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A total of 801 samples included 179 clinical samples and 622 animal samples were collected from Baghdad province. All samples were cultured on blood agar and MacConkey agar plates to isolate Proteus mirabilis bacteria. Results showed that rate isolates of P. mirabilis from clinical and animal samples were 25.89% (51/179) and 5.95% (37/622) respectively. Antibiotic susceptibility test showed that lowest resistance rates for clinical P. mirabilis isolates were 3.9% for ciprofloxacin, 7.8% for norfloxacin, 9.8% for imipenem, 13.7% for levofloxacin and 15.7% for cefotaxime, and highest resistance rates were 82.4% for cefepime, 78.4% for piperacillin, 56.9% for ceftazidime and 54.9% for cefoxitin. In regards to animal isolates, they were 100% sensitive to cefoxitin and 100% resistance to piperacillin. Their resistance rates were 2.7% to amikacin, 5.4% to ciprofloxacin and 8.1% to cefepime, imipenem and levofloxacin. The results revealed that all P. mirabilis isolates were 100% multidrug resistance for 2-8 antibiotics. Extended -lactamases produced were detected in 52.94% of clinical P. mirabilis isolates and in 48.65% of animal isolates.

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Section: Introductionmentioning

confidence: 99%

Antimicrobial Resistance Patterns and Extended Spectrum Beta-lactamases Producing by Proteus mirabilis Isolated from Different Sources

Kadhim

2017

MJS

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“…Like many other members of the family Enterobacteriaceae, P. mirabilis can harbor numerous plasmid-and integron-mediated determinants of antimicrobial resistance (18). Multidrug-resistant (MDR) strains of P. mirabilis generally produce extended-spectrum ␤-lactamases (ESBLs) or the AmpC-type cephalosporinase and rarely carbapenemases, and their prevalence in some settings is relatively high (8,10,12,13,25,31,39,41).Over the past decade, the proportion of BSIs caused by Gramnegative bacteria has risen sharply (11,26,38,51). Although 1 to 3% of all BSIs are caused by P. mirabilis (11,26,38,51), the incidence of MDR in the strains responsible for these infections is a cause for concern.…”

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Multidrug-Resistant Proteus mirabilis Bloodstream Infections: Risk Factors and Outcomes

Tumbarello

Trecarichi

Fiori

et al. 2012

Antimicrob Agents Chemother

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Our aims were to identify (i) risk factors associated with the acquisition of multidrug-resistant (MDR, to 3 or more classes of antimicrobials) Proteus mirabilis isolates responsible for bloodstream infections (BSIs) and (ii) the impact on mortality of such infections. Risk factors for acquiring MDR P. mirabilis BSIs were investigated in a case-case-control study; those associated with mortality were assessed by comparing survivors and nonsurvivors in a cohort study. The population consisted of 99 adult inpatients with P. mirabilis BSIs identified by our laboratory over an 11-year period (1999 to 2009), 36 (33.3%) of which were caused by MDR strains, and the overall 21-day mortality rate was 30.3%. Acquisition of an MDR strain was independently associated with admission from a long-term care facility (odds ratio to which the isolate displayed in vitro resistance) more frequently than those with non-MDR infections; they also had increased mortality and (for survivors) longer post-BSI-onset hospital stays. In multivariate regression analysis, 21-day mortality was associated with septic shock at BSI onset (OR, 12.97; 95% CI, 32.2 to 52.23), P. mirabilis isolates that were MDR (OR, 6.62; 95% CI, 16.4 to 26.68), and IIAT (OR, 9.85; 95% CI, 26.7 to 36.25), the only modifiable risk factor of the 3. These findings can potentially improve clinicians' ability to identify P. mirabilis BSIs likely to be MDR, thereby reducing the risk of IIAT-a major risk factor for mortality in these cases-and facilitating the prompt implementation of appropriate infection control measures. The Gram-negative enteric bacterium Proteus mirabilis is an important cause of community-and health care-associated infections, including those involving the urinary tract, the abdominal cavity, and the bloodstream itself (13,19,50). Like many other members of the family Enterobacteriaceae, P. mirabilis can harbor numerous plasmid-and integron-mediated determinants of antimicrobial resistance (18). Multidrug-resistant (MDR) strains of P. mirabilis generally produce extended-spectrum ␤-lactamases (ESBLs) or the AmpC-type cephalosporinase and rarely carbapenemases, and their prevalence in some settings is relatively high (8,10,12,13,25,31,39,41).Over the past decade, the proportion of BSIs caused by Gramnegative bacteria has risen sharply (11,26,38,51). Although 1 to 3% of all BSIs are caused by P. mirabilis (11,26,38,51), the incidence of MDR in the strains responsible for these infections is a cause for concern. In general, MDR infections are known to have a significant impact on the prognosis and survival of hospitalized patients (9,14,24,42,43,46), but it is unclear whether MDR strains are associated with worse clinical outcomes in P. mirabilis BSIs. Endimiani et al. (13) found that treatment failure and death are likely to occur in ESBL-producing P. mirabilis BSIs. Unfortunately, this study was small, including 23 patients and only 9 patients with ESBL BSIs. However, we can reasonably assume that empirical therapy is even more likely to be inadequate...

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“…However, as with other Enterobacteriaceae, P. mirabilis strains exhibiting resistance to expandedspectrum ␤-lactam agents have been widely reported in many parts of the world (1,5,12,18). Because P. mirabilis lacks species-specific chromosome-borne ␤-lactamases, resistance in this microorganism is wholly dependent on the acquisition of plasmid-encoded ␤-lactamases, such as extended-spectrum ␤-lactamases (ESBLs), AmpC enzymes, and metallo-␤-lactamases (10,15,24).…”

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Chromosome-Encoded AmpC and CTX-M Extended-Spectrum β-Lactamases in Clinical Isolates of Proteus mirabilis from Korea

Song

Kim

Bae

et al. 2011

Antimicrob Agents Chemother

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Among 222 Proteus mirabilis clinical isolates collected from 17 hospitals in Korea in 2008, 28 (12.6%) and 8 (3.6%) isolates exhibited extended-spectrum ␤-lactamase (ESBL) and AmpC phenotypes, respectively. The most common type of ESBL gene identified by PCR and sequencing experiments was bla CTX-M-14a (n ‫؍‬ 12). The bla CTX-M-90 (n ‫؍‬ 4), bla CTX-M-15 (n ‫؍‬ 3), bla CTX-M-12 (n ‫؍‬ 3), bla CTX-M-2 (n ‫؍‬ 2), bla CTX-M-14b (n ‫؍‬ 1), bla TEM-52 (n ‫؍‬ 5), and bla SHV-12 (n ‫؍‬ 1) genes were also detected. Eight isolates carried an AmpC ␤-lactamase gene, such as bla CMY-2 (n ‫؍‬ 6) or bla DHA-1 (n ‫؍‬ 2). All bla genes encoding CTX-M-1-and CTX-M-9-type enzymes and all bla CMY-2 genes were preceded by ISEcp1-like elements. The bla CTX-M-2 gene found in two isolates was located on a complex class 1 integron. The bla DHA-1 gene was preceded by a transcriptional regulator gene and was followed by phage shock protein genes. The bla CTX-M genes were located on the chromosome in 21 isolates. A plasmid location for the bla CTX-M gene was found in only four isolates: the bla CTX-M-14a gene was located on ϳ150-kbp IncA/C plasmids in three isolates and on a ϳ50-kbp IncN plasmid in one isolate. The bla TEM-52 gene was located on ϳ50-kbp IncN plasmids in all five isolates. The AmpC ␤-lactamase genes were located on the chromosome in seven of eight isolates; one isolate carried the bla CMY-2 gene on a ϳ150-kbp IncA/C plasmid. Our results show that a chromosomal location of CTX-M ESBL and AmpC ␤-lactamase genes in P. mirabilis is no longer an unusual phenomenon in hospital environments.

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Spread of multidrug-resistant Proteus mirabilis isolates producing an AmpC-type β-lactamase: epidemiology and clinical management

Cited by 49 publications

References 26 publications

Antimicrobial Resistance Patterns and Extended Spectrum Beta-lactamases Producing by Proteus mirabilis Isolated from Different Sources

Antimicrobial Resistance Patterns and Extended Spectrum Beta-lactamases Producing by Proteus mirabilis Isolated from Different Sources

Multidrug-Resistant Proteus mirabilis Bloodstream Infections: Risk Factors and Outcomes

Chromosome-Encoded AmpC and CTX-M Extended-Spectrum β-Lactamases in Clinical Isolates of Proteus mirabilis from Korea

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