Emergence and spread of NDM-1 producer Enterobacteriaceae with contribution of IncX3 plasmids in the United Arab Emirates

2013 ◽  
Vol 62 (7) ◽  
pp. 1044-1050 ◽  
Author(s):  
Agnes Sonnevend ◽  
Amna Al Baloushi ◽  
Akela Ghazawi ◽  
Rayhan Hashmey ◽  
Safinaz Girgis ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Middle East ◽  
Klebsiella Pneumoniae ◽  
United Arab Emirates ◽  
Indian Subcontinent ◽  
Enterobacter Cloacae ◽  
Sequence Type ◽  
Restriction Patterns ◽  
Foreign Travel ◽  
Similar Restriction

Among 28 clinically relevant, carbapenem non-susceptible Enterobacteriaceae isolates collected in 2009–2011 in the United Arab Emirates three Klebsiella pneumoniae, two Escherichia coli, one Enterobacter cloacae and one Citrobacter freundi were identified to produce NDM-1 carbapenemase. Unexpectedly, with the exception of a K. pneumoniae strain, sequence type ST11, originally acquired in India and subsequently spread nosocomially in the UAE, the majority of the strains could not be directly linked to foreign travel. All isolates harboured the bla NDM-1 gene on plasmids of IncA/C, IncHI1b and IncX3 types, or were untypable. IncX3 type plasmids with a mass of 50 kb and with the same or highly similar restriction patterns, with regions flanking the bla NDM-1 gene identical to the IncX3 NDM plasmids described from China were present in three different species, Enterobacter cloacae, Escherichia coli and C. freundii. Our findings strongly support the assumptions that, beyond the Indian subcontinent, the Middle East is an important reservoir of NDM-producing organisms. Furthermore, we also provide evidence that IncX3 plasmids, recently implicated in the spread of bla NDM-1 in China, have been widely distributed and are important vehicles of the inter-species spread of the NDM-1 gene.

scholarly journals Cooccurrence of NDM-1, ESBL, RmtC, AAC(6′)-Ib, and QnrB in Clonally Related Klebsiella pneumoniae Isolates Together with Coexistence of CMY-4 and AAC(6′)-Ib in Enterobacter cloacae Isolates from Saudi Arabia

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Mohamed H. Al-Agamy ◽  
Taghrid S. El-Mahdy ◽  
Hesham H. Radwan ◽  
Laurent Poirel
Keyword(s):  
Escherichia Coli ◽  
Saudi Arabia ◽  
16S Rrna ◽  
Klebsiella Pneumoniae ◽  
High Resistance ◽  
Enterobacter Cloacae ◽  
Sequence Type ◽  
Quinolone Resistance ◽  
Synergy Test ◽  
16S Rrna Methylase

The aim of this study was to investigate the mechanisms responsible for resistance to antimicrobials in a collection of enterobacterial isolates recovered from two hospitals in Saudi Arabia. A total of six strains isolated from different patients showing high resistance to carbapenems was recovered in 2015 from two different hospitals, with four being Klebsiella pneumoniae and two Enterobacter cloacae. All isolates except one K. pneumoniae were resistant to tigecycline, but only one K. pneumoniae was resistant to colistin. All produced a carbapenemase according to the Carba NP test, and all were positive for the EDTA-disk synergy test for detection of MBL. Using PCR followed by sequencing, the four K. pneumoniae isolates produced the carbapenemase NDM-1, while the two E. cloacae isolates produced the carbapenemase VIM-1. Genotyping analysis by Multilocus Sequence Typing (MLST) showed that three out of the four K. pneumoniae isolates were clonally related. They had been recovered from the same hospital and belonged to Sequence Type (ST) ST152. In contrast, the fourth K. pneumoniae isolate belonged to ST572. Noticeably, the NDM-1-producing K. pneumoniae additionally produced an extended-spectrum ß-lactamase (ESBL) of the CTX-M type, together with OXA-1 and TEM-1. Surprisingly, the three clonally related isolates produced different CTX-M variants, namely, CTX-M-3, CTX-M-57, and CTX-M-82, and coproduced QnrB, which confers quinolone resistance, and the 16S rRNA methylase RmtC, which confers high resistance to all aminoglycosides. The AAC(6′)-Ib acetyltransferase was detected in both K. pneumoniae and E. cloacae. Mating-out assays using Escherichia coli as recipient were successful for all isolates. The blaNDM-1 gene was always identified on a 70-kb plasmid, whereas the blaVIM-1 gene was located on either a 60-kb or a 150-kb plasmid the two E. cloacae isolates, respectively. To the best of our knowledge, this is the first report of the coexistence of an MBL (NDM-1), an ESBL (CTX-M), a 16S rRNA methylase (RmtC), an acetyltransferase (AAC[6′]-Ib), and a quinolone resistance enzyme (QnrB) in K. pneumoniae isolates recovered from different patients during an outbreak in a Saudi Arabian hospital.

scholarly journals blaNDM-5-Bearing IncFII-Type Plasmids of Klebsiella pneumoniae Sequence Type 147 Transmitted by Cross-Border Transfer of a Patient

2016 ◽  
Vol 60 (3) ◽  
pp. 1932-1934 ◽  
Author(s):  
Juyoun Shin ◽  
Jin Yang Baek ◽  
Sun Young Cho ◽  
Hee Jae Huh ◽  
Nam Yong Lee ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Klebsiella Pneumoniae ◽  
South Korea ◽  
United Arab Emirates ◽  
Sequence Type ◽  
Content Type ◽  
Korean Patient ◽  
Cross Border ◽  
Genetic Structures

The two plasmids extracted fromKlebsiella pneumoniaesequence type 147 (ST147) isolates were analyzed. The first isolate was obtained from a patient transferred from United Arab Emirates to South Korea. The second isolate was obtained from a Korean patient and was suspected to be transmitted from the first patient. Sequences of two plasmids were almost the same, and genetic structures, includingblaNDM-5, of these plasmids were similar to plasmids of NDM-1-producingEscherichia coliST131 isolates found in Europe.

Антимікробна резистентність провідних збудників інфекцій сечових шляхів у Києві (Україна)

2017 ◽  
Vol 1 (2) ◽  
pp. 48-60
Author(s):  
A.G. Salmanov ◽  
A.V. Rudenko
Keyword(s):  
Escherichia Coli ◽  
Pseudomonas Aeruginosa ◽  
Klebsiella Pneumoniae ◽  
Staphylococcus Epidermidis ◽  
Klebsiella Oxytoca ◽  
Enterobacter Aerogenes ◽  
Enterobacter Cloacae ◽  
Proteus Vulgaris ◽  
Providencia Rettgeri ◽  
E Coli

Мета роботи — вивчити резистентність до антибіотиків бактеріальних збудників інфекцій сечових шляхів (ІСШ), виділених у пацієнтів урологічного стаціонару в м. Києві. Матеріали і методи. Досліджено 1612 штамів бактерій, виділених із сечі хворих з ІСШ (цистит, уретрит, пієлонефрит), госпіталізованих в урологічне відділення ДУ «Інститут урології НАМН України» у м. Києві протягом 2016 р. Серед пацієнтів переважали жінки — 1201 (74,5 %). Вік хворих становив від 17 до 74 років. Для збору даних використано медичну документацію лікарні. Мікробіологічні дослідження виконано у лабораторії мікробіології ДУ «Інститут урології НАМН України». Аналізували результати культурального дослідження зразків сечі, зібраних за наявності клінічних ознак ІСШ. Дослідження клінічного матеріалу та інтерпретацію отриманих результатів проводили загальноприйнятими методами. Вивчено чутливість уропатогенів до 31 антибіотика дискодифузійним методом відповідно до рекомендацій Інституту клінічних та лабораторних стандартів США (Clinical and Laboratory Standards Institute (CLSI)). Результати та обговорення. Аналіз мікробного спектра сечі виявив домінування серед уропатогенів штамів Escherichia coli (32,0 %), Enterococcus faecalis (19,5 %), Klebsiella pneumoniae (10,9 %), Staphylococcus epidermidis (8,9 %), S. haemolyticus (6,5 %) та Pseudomonas aeruginosa (6,4 %). Частка Enterococcus faecium, Enterobacter aerogenes і Streptococcus viridans становила відповідно 2,5, 2,2 і 1,6 %, Enterobacter cloacae, Klebsiella oxytoca, Acinetobacter baumannii, Proteus vulgaris та Providencia rettgeri — менше 1,0 %. У більшості випадків (69,7 %) мікроорганізми виділено у монокультурі, у решті випадків — у мікробних асоціа- ціях. Високу резистентність до тестованих антибіотиків виявили штами E. aerogenes (45,1 %), E. cloacae (45,7 %), E. faecium (40,9 %), E. faecalis (40,7 %), E. coli (39,9 %), P. aeruginosa (34,0 %), K. pneumoniae (28,6 %). Найбільш активними до уропатогенів були іміпенем (E. coli — 87,6 %, P. aeruginosa — 75,7 %, E. cloacae — 67,3 %, E. aerogenes — 72,6 %, K. pneumoniae — 93,2 %), меропенем (E. coli — 89,1 %, P. aeruginosa — 76,7 %, K. pneumoniae — 82,6 %), лефлоцин (E. coli — 74,5 %, ентерококи — 78,7 %, P. aeruginosa — 76,7 %, E. cloacae — 73,9 %, E. aerogenes — 80,4 %, K. pneumoniae — 83,5 %), амоксицилін/клавуланат (ентерококи — 84,6 %), фурагін (ентерококи — 82,6 %), цефоперазон (K. pneumoniae — 89,2 %, P. aeruginosa — 73,8 %), цефтріаксон (K. pneumoniae — 80,1 %). Висновки. Антибіотикорезистентність збудників ІСШ — важлива терапевтична проблема. Найбільшою активністю до уропатогенів характеризуються іміпенем, меропенем, лефлоцин, амоксицилін/ клавуланат, фурагін, цефоперазон, цефтріаксон, які можна розглядати як препарат вибору для призначення стартової терапії ІСШ. Необхідно здійснювати постійний моніторинг за резистентністю до дії антибіотиків. Політику використання антибіотиків у кожному стаціонарі слід визначати залежно від локальних даних щодо резистентності до протимікробних препаратів.

scholarly journals Importation of Entamoeba histolytica and predominance of Klebsiella pneumoniae in liver abscesses: a 7-year retrospective cohort study from the United Arab Emirates

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hussam Mousa ◽  
Ghada Salameh Mohammed Al-Bluwi ◽  
Zainab Fathi Mohammed Al Drini ◽  
Huda Imam Gasmelseed ◽  
Jamal Aldeen Alkoteesh ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
United Arab Emirates ◽  
Liver Abscess ◽  
Hospital Admissions ◽  
Indian Subcontinent ◽  
Pyogenic Liver Abscess ◽  
Primary Diagnosis ◽  
Incidence Rates ◽  
Liver Abscesses ◽  
Potential Risk Factors

Abstract Background There is a dearth of information on liver abscesses in the United Arab Emirates. Herein, we describe the clinical features of liver abscesses and determine their incidence rates and clinical outcomes. Methods We retrospectively reviewed the clinical charts of adult patients with a primary diagnosis of liver abscess at a major hospital over a 7-year period. Results Amongst 45 patients, 82.2% (37/45) had a pyogenic liver abscess (PLA) and 17.8% (8/45) had amoebic liver abscesses (ALA). Overall, patients were young (median age 42 years, IQR 35–52), mostly males (77.8%, 35/45) from the Indian subcontinent (55.6%, 25/45), presented with fever (88.9%, 40/45) and abdominal pain (88.9%, 40/45), and had a solitary abscess on imaging (71.1% (32/45). Crude annual incidence rates were 35.9/100,000 hospital admissions (95% CI 26.2–48.0) and 5.9/100,000 inhabitants (95% CI 4.3–7.9). All ALA patients were from the Indian subcontinent (100%, 8/8). Klebsiella pneumoniae was the most frequent pathogen in PLA (43.2% [16/37], 95% CI 27.1–60.5%). The hospital stay was shorter in ALA (7.5 days, IQR 7–8.5) than in PLA (14 days, IQR 9–17). No deaths were recorded within 30 days of hospitalisation. Conclusions ALA was exclusively seen in migrants from the Indian subcontinent, suggesting importation. Further research to characterise K. pneumoniae isolates and assess potential risk factors is needed.

A multi-institutional outbreak of New Delhi metallo-β-lactamase–producing Escherichia coli with subsequent acquisition of the Klebsiella pneumoniae carbapenemase gene

2020 ◽  
pp. 1-4
Author(s):  
Ester Solter ◽  
Jason C. Kwong ◽  
Aaron Walton ◽  
Norelle Sherry ◽  
Benjamin P. Howden ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Klebsiella Pneumoniae ◽  
Common Ancestor ◽  
Sequence Type ◽  
Second Phase ◽  
New Delhi ◽  
Genetic Sequencing ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenemase Gene

Abstract We characterized 57 isolates from a 2-phase clonal outbreak of New Delhi metallo-β-lactamase–producing Eschericha coli, involving 9 Israeli hospitals; all but 1 isolate belonged to sequence-type (ST) 410. Most isolates in the second phase harbored blaKPC-2 in addition to blaNDM-5. Genetic sequencing revealed most dual-carbapenemase–producing isolates to be monophyletically derived from a common ancestor.

scholarly journals Comparison of the Superpolymyxin and ChromID Colistin R Screening Media for the Detection of Colistin-Resistant Enterobacteriaceae from Spiked Rectal Swabs

2018 ◽  
Vol 63 (1) ◽  
Author(s):  
Delphine Girlich ◽  
Thierry Naas ◽  
Laurent Dortet
Keyword(s):  
Escherichia Coli ◽  
Klebsiella Pneumoniae ◽  
Confidence Interval ◽  
Enterobacter Cloacae ◽  
Bacterial Isolates ◽  
Colistin Resistance ◽  
Gram Negative ◽  
Content Type ◽  
Rectal Swabs ◽  
Stool Samples

ABSTRACT The dissemination of carbapenemase-producing Enterobacteriaceae (CPE) has led to the increased use of colistin, which has resulted in the emergence of colistin-resistant Enterobacteriaceae worldwide. One of the most threatening scenarios is the dissemination of colistin resistance in CPE, particularly the plasmid-encoded resistance element MCR. Thus, it has now become mandatory to possess reliable media to screen for colistin-resistant Gram-negative bacterial isolates, especially Enterobacteriaceae. In this study, we evaluated the performances of the Superpolymyxin medium (ELITechGroup) and the ChromID Colistin R medium (bioMérieux) to screen for colistin-resistant Enterobacteriaceae from spiked rectal swabs. Stool samples were spiked with a total of 94 enterobacterial isolates (Escherichia coli, Klebsiella pneumoniae, Salmonella enterica, Enterobacter cloacae), including 53 colistin-resistant isolates. ESwabs (Copan Diagnostics) were then inoculated with those spiked fecal suspensions, and culture proceeded as recommended by both manufacturers. The sensitivity of detection of colistin-resistant Enterobacteriaceae was 86.8% (95% confidence interval [95% CI] = 74.0% to 94.0%) using both the Superpolymyxin medium and the ChromID Colistin R plates. Surprisingly, the isolates that were not detected were not the same for both media. The specificities were high for both media, at 97.9% (95% CI = 87.3% to 99.9%) for the Superpolymyxin medium and 100% (95% CI = 90.4% to 100%) for the ChromID Colistin R medium. Both commercially available media, ChromID Colistin R and Superpolymyxin, provide useful tools to screen for colistin-resistant Enterobacteriaceae from patient samples (rectal swabs) regardless of the level and mechanism of colistin resistance.

scholarly journals PERFIL DE SENSIBILIDADE A ANTIMICROBIANOS POR COMPONENTES DA MICROBIOTA BACTERIANA ORAL E RETAL DE PRIMATAS NÃO HUMANOS

2019 ◽  
Vol 20 ◽  
Author(s):  
Marcone Helmer Silva ◽  
Hilma Lúcia Tavares Dias ◽  
Ednaldo da Silva Filho ◽  
Sarah Raphaela Rocha de Azevedo Scalercio ◽  
Wellington Bandeira da Silva ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Klebsiella Pneumoniae ◽  
Serratia Marcescens ◽  
Proteus Mirabilis ◽  
Enterobacter Cloacae ◽  
Callithrix Jacchus ◽  
E Coli ◽  
Staphylococcus Xylosus

Resumo Os objetivos desta pesquisa foram identificar bactérias isoladas da cavidade oral e da ampola retal de Saimiri collinsi e Callithrix jacchus e determinar a sensibilidade a 16 antimicrobianos. Trinta indivíduos de cada espécie foram analisados e foram isoladas 136 bactérias em C. jacchus e 84 em S. collinsi. As bactérias isoladas em maior número em S. collinsi foram Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, Raoutella ornithinolytica, Staphylococcus xylosus e Proteus mirabilis. As bactérias isoladas em C. jacchus foram K. pneumoniae, E. cloacae, E. coli, Serratia marcescens e S. xylosus na cavidade oral e ampola retal. O teste de sensibilidade mostrou que, dentre as cepas isoladas, os maiores percentuais de resistência foram observados para ampicilina, amoxicilina, cefalotina e nitrofurantoína. Na cavidade oral de ambas as espécies as cepas foram sensíveis à ceftazidima, ceftriaxona, meropenem, amicacina, levofloxacina e a sulfametoxazol/trimetoprim. Na ampola retal, as isoladas foram sensíveis à cefoxitina, ceftazidima, ceftriaxona, ertapenem, meropenem, amicacina e levofloxacina. Conclui-se que as espécies de S. collinsi e C. jacchus apresentam sua microbiota oral e retal composta por várias espécies bacterianas e que a resistência pode ser um problema no criatório, uma vez que as cepas mostraram percentuais elevados de resistência a diferentes antimicrobianos.

scholarly journals Multihospital Occurrence of Pan-Resistant Klebsiella pneumoniae Sequence Type 147 with an ISEcp1-Directed blaOXA-181 Insertion in the mgrB Gene in the United Arab Emirates

2017 ◽  
Vol 61 (7) ◽  
Author(s):  
Ágnes Sonnevend ◽  
Akela Ghazawi ◽  
Rayhan Hashmey ◽  
Aliasgher Haidermota ◽  
Safinaz Girgis ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
South Korea ◽  
United Arab Emirates ◽  
Resistance Genes ◽  
Extended Period ◽  
Sequence Type ◽  
Resistant Clone ◽  
Colistin Resistance ◽  
Content Type ◽  
Resistance Island

ABSTRACT The emergence of pan-resistant Klebsiella pneumoniae strains is an increasing concern. In the present study, we describe a cluster of 9 pan-resistant K. pneumoniae sequence type 147 (ST147) isolates encountered in 4 patients over nearly 1 year in 3 hospitals of the United Arab Emirates (UAE). The isolates exhibited highly similar genotypes. All produced chromosomally encoded OXA-181, and the majority also produced the NDM-5 carbapenemase. As with the previously described single isolate from the UAE, MS6671, the mgrB was disrupted by a functional, ISEcp1-driven bla OXA-181 insertion causing resistance to carbapenems. The mutation was successfully complemented with an intact mgrB gene, indicating that it was responsible for colistin resistance. bla NDM-5 was located within a resistance island of an approximately 100-kb IncFII plasmid carrying ermB, mph(A), bla TEM-1B, rmtB, bla NDM-5, sul1, aadA2, and dfrA12 resistance genes. Sequencing this plasmid (pABC143-NDM) revealed that its backbone was nearly identical to that of plasmid pMS6671E from which several resistance genes, including bla NDM-5, had been deleted. More extensive similarities of the backbone and the resistance island were found between pABC143C-NDM and the bla NDM-5-carrying IncFII plasmids of two K. pneumoniae ST147 isolates from South Korea, one of which was colistin resistant, and both also produced OXA-181. Notably, one of these strains was isolated from a patient transferred from the UAE. Our data show that this pan-resistant clone has an alarming capacity to maintain itself over an extended period of time and is even likely to be transmitted internationally.

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