Treatment options for extended-spectrum beta-lactamase (ESBL) and AmpC-producing bacteria

D’Angelo, Ryan G.; Johnson, J. Kristie; Bork, Jacqueline T.; Heil, Emily L.

doi:10.1517/14656566.2016.1154538

Cited by 67 publications

(47 citation statements)

References 44 publications

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“…They are widely used in the treatment of various infections, such as those of the lungs, urinary tract, and the bloodstream. However, widespread use of antibiotics has intensified the problem of antibiotic resistance in bacteria (Paterson and Bonomo, 2005; Biedenbach et al, 2014; D'Angelo et al, 2016). The production of extended-spectrum beta-lactamases (ESBLs) is an important mechanism of antimicrobial resistance in Enterobacteriaceae, especially Escherichia coli ( E. coli ) and Klebsiella pneumoniae ( K. pneumoniae ), and the enzyme can hydrolyze penicillin, cephalosporin, and monocyclic amide antibiotics, but its activity is usually inhibited by beta-lactamase inhibitors, such as sulbactam, clavulanic acid, and tazobactam (Bush et al, 1995; Bradford, 2001).…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial Resistance and Molecular Epidemiology of ESBL-Producing Escherichia coli Isolated from Outpatients in Town Hospitals of Shandong Province, China

Miao

Wang

et al. 2017

Front. Microbiol.

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This study aimed to investigate antimicrobial resistance and molecular epidemiology of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) isolated from outpatients in town hospitals of Shandong province, China. Antimicrobial susceptibility of ESBL-producing E. coli was tested using the disk diffusion and resistance genes encoding for β-lactamases (blaTEM, blaCTXM, and blaSHV) were detected by polymerase chain reaction (PCR). Multilocus sequence typing (ST) of ESBL-producing E. coli was analyzed in this study. Our results showed that of 320 E. coli isolates, 201 carried ESBL genes (201/320, 62.8%), and these isolates all carried blaCTX-M genes, the most common being blaCTX-M-14 (116/201, 57.7%), followed by blaCTX-M-55 (47/201, 23.4%) and blaCTX-M-15 (31/201, 15.4%). ESBL-producing E. coli exhibited highly resistant to penicillin derivatives, fluoroquinolones, folate pathway inhibitors, and third-generation cephalosporins, but no carbapenem-resistant isolates were found in this study. Forty-two STs were found among the 201 ESBL-producing E. coli, and the most common ST was ST131 (27/201, 13.4%), followed by ST405 (19/201, 9.5%) and ST69 (15/201, 7.5%). Taken together, a high isolation rate of ESBL-producing E. coli (62.8%) was found among outpatients in town hospitals. blaCTX-M gene was most dominant and was composed of a variety of subtypes. No dominant ST was detected among ESBL-producing E. coli, indicating that these ESBL-producing E. coli isolates derive from different clones.

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Section: Introductionmentioning

confidence: 99%

Antimicrobial Resistance and Molecular Epidemiology of ESBL-Producing Escherichia coli Isolated from Outpatients in Town Hospitals of Shandong Province, China

Miao

Wang

et al. 2017

Front. Microbiol.

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“…AmpC genes may be located on chromosome or plasmids. In addition to resistance to penicillins and most cephalosporins, unlike ESBLs, AmpC-producing organisms can degrade cephamycins [8]. AmpC beta-lactamase-producing organisms show more extensive antibiotic resistance features in comparison with other ESBLs-producing organisms [9].…”

Section: Introductionmentioning

confidence: 99%

First report of coexistence of AmpC beta-lactamase genes in Klebsiella pneumoniae strains isolated from burn patients

Ghanavati

Darban-Sarokhalil

Navab-Moghadam

et al. 2017

AMicr

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Klebsiella spp. are among the most frequently isolated bacteria from burn wounds. These organisms are among the most important opportunistic pathogens, causing hospital-acquired and healthcare-associated infections worldwide. Limited information is available about prevalence of AmpC-producing Klebsiella pneumoniae from burn patients. Therefore, the aim of this study was to determine the characterization of AmpC beta-lactamase among K. pneumoniae isolated from burn patients. Samples were collected from wound specimens of patients with burn injury from a burn hospital in Tehran during 18 months (March 2015 to August 2016). For phenotypic detection of AmpC beta-lactamase, disk diffusion method with cefoxitin was used for screening, AmpC disk test and boronic acid inhibitor-based method were used as confirmatory tests. Polymerase chain reaction (PCR) was performed to screen all isolates with AmpC genes including ACCM, DHAM, EBCM, FOXM, MOXM, and CITM. Finally, PCR products were validated using sequencing. During this study, 102 isolates of K. pneumoniae were collected. Among these isolates, 52.9% suspected as AmpC producer by disk agar diffusion cefoxitin screening method. By confirmatory phenotypic methods, 19.6% of isolates considered as AmpC producer. Molecular analysis revealed 43.1% of cefoxitin-resistant isolates harbored at least one of the AmpC genes including CITM (22.5%), EBCM (21.5%), DHAM (7.8%), and FOXM (0.98%). In addition, 5.8% of isolates harbored two AmpC genes and 2.9% harbored three AmpC genes. In conclusion, K. pneumoniae is becoming a serious problem in burn patients. Accurate and precise methods and guidelines should be designed for detection of antibiotic-resistant mechanisms. Our data showed the high rate of AmpC beta-lactamase among K. pneumoniae isolated from burn patients, which limit the treatment options. Therefore, the results of this study can provide evidence to help for appropriate treatment of burn patients.

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“…ESBL hyper-producing isolates. 1 Unfortunately, since the introduction of carbapenems into the clinical practice, nosocomial infections caused by carbapenem-resistant Enterobacteriaceae (CRE) have been increasing rapidly and posing serious challenges to the clinical management of infections caused by the gram-negatives. 2 To help direct research and development efforts toward the production of novel drugs, CRE was recently listed as one of the three critical-priority pathogens by the World Health Organization (WHO).…”

mentioning

confidence: 99%

<p>Carbapenem-Resistant <em>Klebsiella aerogenes</em> Clinical Isolates from a Teaching Hospital in Southwestern China: Detailed Molecular Epidemiology, Resistance Determinants, Risk Factors and Clinical Outcomes</p>

Ma¹,

Huang²,

Zhang³

et al. 2020

IDR

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Little is known about the epidemiology and carbapenem-resistance determinants of carbapenem-resistant K. aerogenes (CRKA) isolated from a single medical center. The present study was initiated to characterize the molecular epidemiology and the carbapenemresistance mechanisms of CRKA isolated during 2012-2018 from a teaching hospital in southwest China, and to investigate the risk factors and clinical outcomes of CRKA infections as well. Methods: Pulsed-field gel electrophoresis (PFGE) was employed for epidemiological analysis. PCR amplification and DNA sequencing were used to examine the antibiotic-resistance determinants. Plasmids were extracted and characterized by PCR-based replicon typing and conjugation assays. In order to further investigate the risk factors and clinical outcomes of CRKA infections, a retrospective case-control study was also performed. Results: PFGE analysis showed 32 different PFGE patterns among the 36 non-duplicated CRKA strains collected. Most of the isolates harbored multi-drug resistance (MDR) genes, including 2 (5.6%) carrying bla NDM-1 , 1 (2.8%) harboring bla KPC-2 , 13 (36.1%) carrying ESBL genes, 23 (63.9%) carrying ampC genes, 34 (94.4%) carrying quinolone resistance determinants (QRD) genes and 9 (25%) carrying aminoglycoside resistance determinants (ARD) genes. The outer membrane porins, OmpE35 and OmpE36, were, respectively, lost in 4 and 2 isolates. The efflux pump inhibition experiments were positive in 25 (69.4%) of the CRKA strains. Multivariate analysis indicated that hypo-albuminaemia, invasive procedures, and carbapenem exposure were independent risk factors for acquiring CRKA infections. Conclusion: No clonality relationship was identified among most of the 36 CRKA isolates. The over-expression of ESBLs and AmpC coupled with the efflux pumps contributed to carbapenem resistance in K. aerogenes. Additionally, this is the first report of CRKA isolate co-harboring bla NDM-1 , bla CTX-M-15 , bla EBC , bla ACC , acc (6ʹ)-Ib, armA, qnrD and loss of OmpE36 in China. Hypo-albuminaemia, invasive procedures and carbapenem exposure were associated with acquisition of CRKA infections.

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Treatment options for extended-spectrum beta-lactamase (ESBL) and AmpC-producing bacteria

Cited by 67 publications

References 44 publications

Antimicrobial Resistance and Molecular Epidemiology of ESBL-Producing Escherichia coli Isolated from Outpatients in Town Hospitals of Shandong Province, China

Antimicrobial Resistance and Molecular Epidemiology of ESBL-Producing Escherichia coli Isolated from Outpatients in Town Hospitals of Shandong Province, China

First report of coexistence of AmpC beta-lactamase genes in Klebsiella pneumoniae strains isolated from burn patients

<p>Carbapenem-Resistant <em>Klebsiella aerogenes</em> Clinical Isolates from a Teaching Hospital in Southwestern China: Detailed Molecular Epidemiology, Resistance Determinants, Risk Factors and Clinical Outcomes</p>

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