LABORATORY DETECTION OF COLISTIN-RESISTANT ENTEROBACTERALES IN TANDEM WITH ROUTINE ANTIBIOGRAM

Since the emergence and spread of carbapenemase-producing Enterobacterales, particularly those carrying metallo-β-lactamases with 16S rRNA methyltransferases for which newly introduced antibiotics are inactive, colistin is a last resort therapy for life-threatening extensively drug-resistant infections. This requires that laboratories use an accurate and reliable method for routine colistin susceptibility testing. The aim of this study was to evaluate the performance and applicability of a colistin screening medium for detection of colistin-resistant isolates simultaneously with routine susceptibility testing. It was evaluated with fifty colistin-resistant and the same number of colistin-susceptible comparator isolates. Our results showed that all colistin-resistant isolates grew on DiaPlate™ EMB Agar + Colistin medium within the standard antibiogram period. In contrast, no growth was observed among the colistin susceptible comparators. DiaPlate™ EMB Agar + Colistin is a screening medium that can detect colistin- resistant Enterobacterales isolates when pure bacterial cultures are tested. As this method for detecting colistin-resistant isolates uses the same inoculum as the Kirby-Bauer method, the screening test for colistin resistance can be conveniently performed on clinical isolates along with routine antimicrobial susceptibility testing

EVALUATION OF THE APPLICABILITY OF THE O.K.N.V.I. RESIST-5 AND THE KPC&MBL&0XA-48 DISK TESTS IN A ROUTINE MICROBIOLOGY LABORATORY

Background: The global spread of carbapenemase-producing Enterobacterales (CPE) and the increasing emergence of clinical Enterobacterales harboring multiple carbapenemases of different molecular classes have prioritized the use of rapid molecular detection methods in routine microbiology laboratories. The aim of this study was to evaluate the applicability of the immunochromatographic O. K.N.V.I. RESIST-5 and the KPC&MBL&0XA-48 disc tests in a clinical microbiology laboratory. Material and methods: The tests were performed with 50 CPE belonging to 8 species and producing 7 molecularly characterized carbapenemases. Six of these isolates carried two different carbapenemases. To assess the specificity of the assays, 18 non-carbapenemase-producing but carbapenem-resistant Enterobacterales (non-CP CRE) were also included. Both tests were performed from a common overnight culture on Mueller-Hinton agar with inoculum harvested around an ertapenem disk. Results: The O.K.N.V.I. RESIST-5 correctly detected all 56 carbapenemases, including KPC-2 in Klebsiella pneumoniae; OX-48 in Serratia marcescens, Citrobacter freundii, Enterobacter hormaechei and K. pneumoniae; NDM-1 in Escherichia coli, Morganella morganii, E. hormaechei, C. freundii, S. marcescens and K. pneumoniae; VIM-1 in Proteus mirabilis; VIM-4 in C. freundii and S. marcescens; VIM-86 with and without NDM-1 in Providencia stuartii, and NDM-5 with and without OXA-232 in K. pneumoniae. The KPC&MBL&0XA-48 disc tests correctly confirmed KPC, OX-48-like and most MBL except VIM in P. mirabilis. Furthermore, the combination disc tests failed to detect OXA-48-like in pairs with MBL in K. pneumoniae. Conclusions:The O.K.N.V.I. RESIST-5 multiplex lateral assay is an excellent test for rapid diagnostic of CPE in routine microbiology laboratories. It is easy to handle and provides results with 100% sensitivity and specificity when an inoculum around ertapenem disc from routine antibiogram was used

Aminoglycoside Susceptibility Profiles of Enterobacter cloacae Isolates Harboring the aac(6')-Ib Gene

The aminoglycoside 6'-N-acetyltransferases of type Ib (aac(6')-Ib) gene confers resistance to amikacin, tobramycin, kanamycin, and netilmicin but not gentamicin. However, some isolates harboring this gene show reduced susceptibility to amikacin. The European Committee on Antimicrobial Susceptibility Testing (EUCAST) recommends a revision of the phenotypic description for isolates harboring the aac(6')-Ib gene. In this study, we determined the aminoglycoside susceptibility profiles of 58 AAC(6')-Ib-producing Enterobacter cloacae isolates. On the basis of the CLSI and EUCAST breakpoints, a large proportion (84.5% and 55.2%, respectively) of these 58 isolates were found to be susceptible to amikacin. However, among the isolates that were shown to be anikacin-susceptible according to the CLSI and EUCAST breakpoints, only 30.6% and 18.8% isolates, respectively, could be considered to have intermediate resistance on the basis of the EUCAST expert rules. Further studies should be conducted to determine the aminoglycoside susceptibility profiles of aac(6')-Ib-harboring isolates from various geographic regions and to monitor the therapeutic efficacy of amikacin in infections caused by these isolates

DEVELOPMENT AND PILOT VALIDATION OF A NOVEL PCR-BASED REPLICON TYPING SCHEME FOR PLASMID FAMILIES ASSOCIATED WITH ANTIBIOTIC RESISTANCE IN PSEUDOMONAS SPP.

Background. Pseudomonas species are ubiquitous environmental Gram-negative bacteria increasingly associated with difficult to treat healthcare-associated infections. Along with their substantial intrinsic antimicrobial resistance, the ability to acquire additional resistance and pathogenicity determinants contributes to increased morbidity and mortality. Plasmids represent the major vehicles of gene transfer among hospital strains. Accumulation and dissemination of resistance genes through horizontal gene transfer is exceptionally problematic since it leads to the emergence of multi-resistant and stable phenotypes highlighting the importance of novel tools for studying plasmid epidemiology. Materials and Methods. In this study we introduce a novel PCR-based replicon typing (PBRT) scheme for differentiation of various Pseudomonas spp. plasmid families requiring only two multiplex PCR (mPCR) assays. mPCR 1 is composed of previously published primer sets for IncP-1, IncP-7, IncP-9, IncQ, A/C, N, W, IncU. Primers for multiplex PCR 2 were designed after an in-depth in-silico bioinformatic analysis of the repA gene of more than 50 reference IncP-2, IncP-6, IncP-10, pKLC102-like and pMOS94-like plasmids some of which studied for the first time as a group. Results. The scheme was tested on a set of 90 previously genotyped multi-resistant clinical Pseudomonas spp. isolates. The detection rate of the target plasmid families was low in our strain collection. Replicons were registered in only 3/90 isolates from the IncP-7 (n=1), IncP-10 (n=1), and pMOS94-like (n=1) families.  This pilot study demonstrates a novel PBRT scheme applicable to Pseudomonas spp. targeting plasmids of incompatibility groups known to harbour genes associated with antibiotic resistance

High prevalence of plasmid-mediated 16S rRNA methylase gene rmtB among Escherichia coli clinical isolates from a Chinese teaching hospital

<p>Abstract</p> <p>Background</p> <p>Recently, production of 16S rRNA methylases by Gram-negative bacilli has emerged as a novel mechanism for high-level resistance to aminoglycosides by these organisms in a variety of geographic locations. Therefore, the spread of high-level aminoglycoside resistance determinants has become a great concern.</p> <p>Methods</p> <p>Between January 2006 and July 2008, 680 distinct <it>Escherichia coli </it>clinical isolates were collected from a teaching hospital in Wenzhou, China. PCR and DNA sequencing were used to identify 16S rRNA methylase and extended-spectrum β-lactamase (ESBL) genes, including <it>armA </it>and <it>rmtB</it>, and in situ hybridization was performed to determine the location of 16S rRNA methylase genes. Conjugation experiments were subsequently performed to determine whether aminoglycoside resistance was transferable from the <it>E. coli </it>isolates via 16S rRNA methylase-bearing plasmids. Homology of the isolates harboring 16S rRNA methylase genes was determined using pulse-field gel electrophoresis (PFGE).</p> <p>Results</p> <p>Among the 680 <it>E. coli </it>isolates, 357 (52.5%), 346 (50.9%) and 44 (6.5%) isolates were resistant to gentamicin, tobramycin and amikacin, respectively. Thirty-seven of 44 amikacin-resistant isolates harbored 16S rRNA methylase genes, with 36 of 37 harboring the <it>rmtB </it>gene and only one harboring <it>armA</it>. The positive rates of 16S rRNA methylase genes among all isolates and amikacin-resistant isolates were 5.4% (37/680) and 84.1% (37/44), respectively. Thirty-one isolates harboring 16S rRNA methylase genes also produced ESBLs. In addition, high-level aminoglycoside resistance could be transferred by conjugation from four <it>rmtB</it>-positive donors. The plasmids of incompatibility groups IncF, IncK and IncN were detected in 34, 3 and 3 isolates, respectively. Upstream regions of the <it>armA </it>gene contained <it>IS</it>CR1 and <it>tnpU</it>, the latter a putative transposase gene,. Another putative transposase gene, <it>tnpD</it>, was located within a region downstream of <it>armA</it>. Moreover, a transposon, Tn<it>3</it>, was located upstream of the <it>rmtB</it>. Nineteen clonal patterns were obtained by PFGE, with type H representing the prevailing pattern.</p> <p>Conclusion</p> <p>A high prevalence of plasmid-mediated <it>rmtB </it>gene was found among clinical <it>E. coli </it>isolates from a Chinese teaching hospital. Both horizontal gene transfer and clonal spread were responsible for the dissemination of the <it>rmtB </it>gene.</p

Worldwide Disseminated armA Aminoglycoside Resistance Methylase Gene Is Borne by Composite Transposon Tn1548

The armA (aminoglycoside resistance methylase) gene, which confers resistance to 4,6-disubstituted deoxystreptamines and fortimicin, was initially found in Klebsiella pneumoniae BM4536 on IncL/M plasmid pIP1204 of ca. 90 kb which also encodes the extended-spectrum β-lactamase CTX-M-3. Thirty-four enterobacteria from various countries that were likely to produce a CTX-M enzyme since they were more resistant to cefotaxime than to ceftazidime were studied. The armA gene was detected in 12 clinical isolates of Citrobacter freundii, Enterobacter cloacae, Escherichia coli, K. pneumoniae, Salmonella enterica, and Shigella flexneri, in which it was always associated with bla(CTX-M-3) on an IncL/M plasmid. Conjugation, analysis of DNA sequences, PCR mapping, and plasmid conduction experiments indicated that the armA gene was part of composite transposon Tn1548 together with genes ant3"9, sul1, and dfrXII, which are responsible for resistance to streptomycin-spectinomycin, sulfonamides, and trimethoprim, respectively. The 16.6-kb genetic element was flanked by two copies of IS6 and migrated by replicative transposition. This observation accounts for the presence of armA on self-transferable plasmids of various incompatibility groups and its worldwide dissemination. It thus appears that posttranscriptional modification of 16S rRNA confers high-level resistance to all the clinically available aminoglycosides except streptomycin in gram-negative human and animal pathogens

Aminoglycoside Resistance Gene ant(4′)-IIb of Pseudomonas aeruginosa BM4492, a Clinical Isolate from Bulgaria

The ant(4′)-IIb gene of Pseudomonas aeruginosa BM4492, which encodes an aminoglycoside 4′-O-adenylyltransferase, was identified as a coding sequence of 756 bp corresponding to a protein with a calculated mass of 27,219 Da. Analysis of the deduced sequence indicated that the protein was related to aminoglycoside 4′-O-adenylyltransferases IIa and Ia found in P. aeruginosa and gram-positive bacteria, respectively. The enzyme conferred resistance to amikacin and tobramycin but not to dibekacin, gentamicin, or netilmicin. The ant(4′)-IIb gene had a chromosomal location in five of six clinical isolates of P. aeruginosa tested and was plasmid borne in the remaining strain. The ant(4′)-IIb gene was detected by PCR in some clinical strains of P. aeruginosa from the same hospital but not in members of other bacterial genera