Antibiotic resistance among invasive Neisseria meningitidis isolates in England, Wales and Northern Ireland (2010/11 to 2018/19)

Invasive meningococcal disease (IMD), caused by Neisseria meningitidis, can have a fatality rate as high as 10%, even with appropriate treatment. In the UK, penicillin is administered to patients in primary care whilst third generation cephalosporins, cefotaxime and ceftriaxone, are administered in secondary care. The first-choice antibiotic for chemoprophylaxis of close contacts is ciprofloxacin, followed by rifampicin. Immunocompromised individuals are often recommended antibiotic chemoprophylaxis and vaccination due to a greater risk of IMD. Resistance to antibiotics among meningococci is relatively rare, however reduced susceptibility and resistance to penicillin are increasing globally. Resistance to third generation cephalosporins is seldom reported, however reduced susceptibility to both cefotaxime and ceftriaxone has been observed. Rifampicin resistance has been reported among meningococci, mainly following prophylaxis, and ciprofloxacin resistance, whilst uncommon, has also been reported across the globe. The Public Health England Meningococcal Reference Unit receives and characterises the majority of isolates from IMD cases in England, Wales and Northern Ireland. This study assessed the distribution of antibiotic resistance to penicillin, rifampicin, ciprofloxacin and cefotaxime among IMD isolates received at the MRU from 2010/11 to 2018/19 (n = 4,122). Out of the 4,122 IMD isolates, 113 were penicillin-resistant, five were ciprofloxacin-resistant, two were rifampicin-resistant, and one was cefotaxime-resistant. Penicillin resistance was due to altered penA alleles whilst rifampicin and ciprofloxacin resistance was due to altered rpoB and gyrA alleles, respectively. Cefotaxime resistance was observed in one isolate which had an altered penA allele containing additional mutations to those harboured by the penicillin-resistant isolates. This study identified several isolates with resistance to antibiotics used for current treatment and prophylaxis of IMD and highlights the need for continued surveillance of resistance among meningococci to ensure continued effective use.

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Changing patterns and widening of antibiotic resistance inShigellaspp. over a decade (2000–2011), Andaman Islands, India

Epidemiology and Infection ◽

10.1017/s0950268814000958 ◽

2014 ◽

Vol 143 (3) ◽

pp. 470-477 ◽

Cited By ~ 12

Author(s):

D. BHATTACHARYA ◽

H. BHATTACHARYA ◽

D. S. SAYI ◽

A. P. BHARADWAJ ◽

M. SINGHANIA ◽

...

Keyword(s):

Drug Resistance ◽

Antibiotic Resistance ◽

Wide Spectrum ◽

Resistance Pattern ◽

Third Generation ◽

Isolation And Identification ◽

Antimicrobial Drugs ◽

Drug Resistance Pattern ◽

Resistance Patterns ◽

Third Generation Cephalosporins

SUMMARYThis study is a part of the surveillance study on childhood diarrhoea in the Andaman and Nicobar Islands; here we report the drug resistance pattern of recent isolates ofShigellaspp. (2006–2011) obtained as part of that study and compare it with that ofShigellaisolates obtained earlier during 2000–2005. During 2006–2011, stool samples from paediatric diarrhoea patients were collected and processed for isolation and identification ofShigellaspp. Susceptibility to 22 antimicrobial drugs was tested and minimum inhibitory concentrations were determined for third-generation cephalosporins, quinolones, amoxicillin-clavulanic acid combinations and gentamicin. A wide spectrum of antibiotic resistance was observed in theShigellastrains obtained during 2006–2011. The proportions of resistant strains showed an increase from 2000–2005 to 2006–2011 in 20/22 antibiotics tested. The number of drug resistance patterns increased from 13 in 2000–2005 to 43 in 2006–2011. Resistance to newer generation fluoroquinolones, third-generation cephalosporins and augmentin, which was not observed during 2000–2005, appeared during 2006–2011. The frequency of resistance inShigellaisolates has increased substantially between 2000–2006 and 2006–2011, with a wide spectrum of resistance. At present, the option for antimicrobial therapy in shigellosis in Andaman is limited to a small number of drugs.

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Clinical and laboratory differences between extended-spectrum β-lactamase-positive and extended-spectrum β-lactamase-negative bacteria in febrile urinary tract infection in pediatrics

Journal of Renal Injury Prevention ◽

10.34172/jrip.2022.02 ◽

2021 ◽

Vol 11 (1) ◽

pp. e2-e2

Author(s):

Manijeh Kahbazi ◽

Parsa Yousefichaijan ◽

Danial Habibi ◽

Somaie Nejabat ◽

Amirreza Najmi ◽

...

Keyword(s):

Urinary Tract ◽

Recurrence Rate ◽

Urine Analysis ◽

Third Generation ◽

Extended Spectrum ◽

First Choice ◽

Febrile Uti ◽

History Of ◽

Tract Infections ◽

Third Generation Cephalosporins

Introduction: The prevalence of urinary tract infections (UTIs) due to extended-spectrum beta-lactamase (ESBL)-producing bacteria is rising, which needs more potent antibiotics, such as carbapenems. Objectives: To evaluate the clinical and laboratory differences between ESBL-positive and ESBL-negative bacteria in febrile UTI in children between one month to seven years to indicate prognostic parameters for ESBL+ UTI and to suggest appropriate antibiotic treatment. Patients and Methods: This cross-sectional study investigated 282 patients diagnosed with the first febrile UTI. The participants were assigned to ESBL-positive and ESBL-negative UTI groups. The groups were compared based on their clinical and laboratory characteristics and outcomes; the infant group was assessed separately (with the onset age of <3 months). Results: The ESBL UTI was detected in 10.2% of the cases with a history of more frequent hospitalization (P=0.002), longer hospitalization (P=0.04), higher recurrence rate (P=0.003), and more red blood cell count in urine analysis findings (P=0.02). In the antimicrobial susceptibility assay, the ESBL-positive UTI group indicated resistance to third-generation cephalosporins; nevertheless, 93.1% of the cases responded clinically. The infant group showed 13% of the patients with ESBL-positive UTI that was correlated with a history of longer preonset hospital stay (P=0.001), elevated C-reactive protein (CRP) concentration (P=0.002), and elevated recurrence rate (P=0.03), compared to the older group. Conclusion: The ESBL UTI should be further considered due to the resulted recurrence rate. The antimicrobial sensitivity assay indicated resistance to third-generation cephalosporins; however, these drugs are applied as the first choice due to the high response rate. Aminoglycosides are applicable as second choice drugs prior to initiating the use of carbapenems, if third-generation cephalosporins did not indicate bactericidal impacts on ESBL UTI.

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Infections Due to Salmonella

10.2310/im.1482 ◽

2021 ◽

Author(s):

Marcia B Goldberg ◽

Molly Paras

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Therapy ◽

Enteric Fever ◽

Carrier State ◽

Surgical Removal ◽

Third Generation ◽

Food Borne ◽

Extraintestinal Disease ◽

Immunocompromised Hosts ◽

Third Generation Cephalosporins

Salmonella, which is acquired via ingestion, is classified as nontyphoidal or typhoidal disease. Typhoidal disease is caused by S typhi or S paratyphi, and nontyphoidal disease is caused by all other serovars. Salmonella causes a range of infectious syndromes that include gastroenteritis, bacteremia, endovascular infections, and enteric fever. For immunocompromised hosts or patients with extraintestinal disease, antibiotic therapy should be provided. Effective agents often include third-generation cephalosporins and fluoroquinolones, although rates of resistance of Salmonella isolates to many antibiotics are increasing. A carrier state exists whereby patients may shed bacteria despite being asymptomatic. To eradicate the carrier state, longer courses of antibiotics and, in rare instances, surgical removal of the reservoir, which is most commonly the gallbladder, may be required. This review contains 2 figures, 4 tables, and 24 references. Key Words: Salmonella, typhoidal, non-typhoidal, enteric fever, endovascular infection, gastroenteritis, carrier, food-borne, antibiotic resistance

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Case 34

Oxford Case Histories in Infectious Diseases and Microbiology ◽

10.1093/med/9780198846482.003.0034 ◽

2020 ◽

pp. 233-240

Author(s):

Hilary Humphreys

Keyword(s):

Genome Sequencing ◽

Prevention And Control ◽

Infection Prevention And Control ◽

Whole Genome ◽

Third Generation ◽

Gram Negative ◽

First Choice ◽

Phenotypic Tests ◽

And Control ◽

Third Generation Cephalosporins

Multi-drug-resistant Enterobacteriales are an increasing problem and include those mediated by extended-spectrum β‎-lactamases (ESBLs) and carpapenemase production (CPE). Third-generation cephalosporins are inactivated by ESBLs but for CPEs there are much fewer options for treatment. The challenge in detection, management, and treatment is compounded by CPEs occurring amongst such a broad category of Gram-negative bacilli and because the genetic elements are very mobile, often being quickly and widely disseminated through plasmids. Phenotypic tests for identification have their limitations and there is increasing emphasis on PCR with microarrays and whole genome sequencing being available in specialist centres. Colistin is often the drug of first choice for CPE infections but is usually combined with another agent such as an aminoglycoside. Aggressive infection prevention and control precautions are mandatory given the propensity to spread, the reduced options for treatment, and a lack of insight to patterns and duration of carriage.

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Comparison of beta-lactamase genes in clinical and food bacterial isolates in India

The Journal of Infection in Developing Countries ◽

10.3855/jidc.550 ◽

2009 ◽

Vol 3 (08) ◽

pp. 593-598 ◽

Cited By ~ 21

Author(s):

Mohd. Shahid ◽

Abida Malik ◽

Mohd. Adil ◽

Noor Jahan ◽

Ritu Malik

Keyword(s):

Antibiotic Resistance ◽

Bacterial Species ◽

Enteric Bacteria ◽

Generation Cephalosporin ◽

Clinical Isolates ◽

Third Generation ◽

Bacterial Isolates ◽

Food Borne ◽

Resistance Rates ◽

Third Generation Cephalosporins

BACKGROUND: The present study aimed to determine the occurrence of human disease-causing enteric bacteria on raw vegetables, fruits, meats, and milk products sold in Indian markets. The study further aimed to analyze antibiotic resistance rates and the presence of blaCTX-M, blaTEM, blaSHV, and blaAmpC. METHODOLOGY: Twenty-three food-borne and 23 clinical isolates were compared for antibiotic resistance rates and the presence of blaCTX-M, blaTEM, blaSHV, and blaAmpC. Swabs were taken from unwashed and washed food items, as well as from some chopped food specimens, and inoculated on appropriate culture medium. Bacterial isolates were identified, antibiotic susceptibility was performed, and bla genes were detected by PCR. RESULTS: Thirty-eight bacterial isolates were obtained from the food specimens, of which 36 (94.7%) were Gram-negative and two (5.3%) were Gram-positive bacterial species. Klebsiella pneumoniae was the most prevalent (52.6%; 20/38) bacterial species isolated, followed by Citrobacter koseri (18.4%; 7/38). In food isolates, the majority of the isolates were resistant to gentamicin (33.3%) followed by amikacin (11.1%). Resistance to a third-generation cephalosporin was noticed in only 5.6% isolates. However, in clinical isolates, maximal resistance was noticed against third-generation cephalosporins followed by ofloxacin in 91.3% and 86.9% isolates, respectively, and resistance to gentamicin and amikacin was noticed in 78.3% and 52.2% isolates, respectively. The presence of blaCTX-M, blaTEM, blaSHV, and blaAmpC in clinical isolates was noticed in 52.2%, 60.9%, 21.7%, and 43.5%, respectively. None of the isolates from food showed the presence of any of the above-cited genes. CONCLUSIONS: Probably bla genes have not yet disseminated to raw-food vegetation in India.

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Cross-sectional survey of antibiotic resistance in Escherichia coli isolated from diseased farm livestock in England and Wales

Epidemiology and Infection ◽

10.1017/s0950268814003963 ◽

2015 ◽

Vol 143 (12) ◽

pp. 2653-2659 ◽

Cited By ~ 11

Author(s):

T. E. A. CHENEY ◽

R. P. SMITH ◽

J. P. HUTCHINSON ◽

L. A. BRUNTON ◽

G. PRITCHARD ◽

...

Keyword(s):

Escherichia Coli ◽

Antibiotic Resistance ◽

Third Generation ◽

Cross Sectional Survey ◽

Cross Sectional ◽

England And Wales ◽

E Coli ◽

Third Generation Cephalosporins ◽

Farm Livestock ◽

Government Laboratories

SUMMARYBetween 2005 and 2007, E. coli obtained from clinical diagnostic submissions from cattle, goats, pigs and sheep to government laboratories in England and Wales were tested for sensitivity to 16 antimicrobials. Resistance was most commonly observed against ampicillin, streptomycin, sulphonamides and tetracyclines. Resistance levels varied significantly between species, with isolates from cattle frequently showing the highest levels. Verocytotoxigenic E. coli (VTEC) expressed less resistance than non-VTEC. Only 19·3% of non-VTEC and 43·5% of VTEC were susceptible to all antimicrobials, while 47·1% and 30·4%, respectively, were resistant to ⩾5 antimicrobials. The resistance phenotype SSuT was commonly observed, and isolates resistant to third-generation cephalosporins were also identified. We recommend judicious antimicrobial usage in the livestock industry in order to preserve efficacy.

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Emergence of an Extensively Drug-Resistant Salmonella enterica Serovar Typhi Clone Harboring a Promiscuous Plasmid Encoding Resistance to Fluoroquinolones and Third-Generation Cephalosporins

mBio ◽

10.1128/mbio.00105-18 ◽

2018 ◽

Vol 9 (1) ◽

Cited By ~ 186

Author(s):

Elizabeth J. Klemm ◽

Sadia Shakoor ◽

Andrew J. Page ◽

Farah Naz Qamar ◽

Kim Judge ◽

...

Keyword(s):

Antibiotic Resistance ◽

Typhoid Fever ◽

Salmonella Enterica ◽

Large Scale ◽

Enteric Bacteria ◽

Whole Genome ◽

Third Generation ◽

Drug Resistant ◽

Extensively Drug Resistant ◽

Third Generation Cephalosporins

ABSTRACT Antibiotic resistance is a major problem in Salmonella enterica serovar Typhi, the causative agent of typhoid. Multidrug-resistant (MDR) isolates are prevalent in parts of Asia and Africa and are often associated with the dominant H58 haplotype. Reduced susceptibility to fluoroquinolones is also widespread, and sporadic cases of resistance to third-generation cephalosporins or azithromycin have also been reported. Here, we report the first large-scale emergence and spread of a novel S. Typhi clone harboring resistance to three first-line drugs (chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole) as well as fluoroquinolones and third-generation cephalosporins in Sindh, Pakistan, which we classify as extensively drug resistant (XDR). Over 300 XDR typhoid cases have emerged in Sindh, Pakistan, since November 2016. Additionally, a single case of travel-associated XDR typhoid has recently been identified in the United Kingdom. Whole-genome sequencing of over 80 of the XDR isolates revealed remarkable genetic clonality and sequence conservation, identified a large number of resistance determinants, and showed that these isolates were of haplotype H58. The XDR S. Typhi clone encodes a chromosomally located resistance region and harbors a plasmid encoding additional resistance elements, including the bla CTX-M-15 extended-spectrum β-lactamase, and carrying the qnrS fluoroquinolone resistance gene. This antibiotic resistance-associated IncY plasmid exhibited high sequence identity to plasmids found in other enteric bacteria isolated from widely distributed geographic locations. This study highlights three concerning problems: the receding antibiotic arsenal for typhoid treatment, the ability of S. Typhi to transform from MDR to XDR in a single step by acquisition of a plasmid, and the ability of XDR clones to spread globally. IMPORTANCE Typhoid fever is a severe disease caused by the Gram-negative bacterium Salmonella enterica serovar Typhi. Antibiotic-resistant S. Typhi strains have become increasingly common. Here, we report the first large-scale emergence and spread of a novel extensively drug-resistant (XDR) S. Typhi clone in Sindh, Pakistan. The XDR S. Typhi is resistant to the majority of drugs available for the treatment of typhoid fever. This study highlights the evolving threat of antibiotic resistance in S. Typhi and the value of antibiotic susceptibility testing and whole-genome sequencing in understanding emerging infectious diseases. We genetically characterized the XDR S. Typhi to investigate the phylogenetic relationship between these isolates and a global collection of S. Typhi isolates and to identify multiple genes linked to antibiotic resistance. This S. Typhi clone harbored a promiscuous antibiotic resistance plasmid previously identified in other enteric bacteria. The increasing antibiotic resistance in S. Typhi observed here adds urgency to the need for typhoid prevention measures.

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Evidence of Failure of Oral Third-Generation Cephalosporin Treatment for Shigella sonnei Infection

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa113 ◽

2020 ◽

Vol 7 (4) ◽

Author(s):

Jennifer P Collins ◽

Cindy R Friedman ◽

Meseret G Birhane ◽

Beth E Karp ◽

Anthony Osinski ◽

...

Keyword(s):

Antibiotic Resistance ◽

Disease Control ◽

Generation Cephalosporin ◽

Shigella Sonnei ◽

Third Generation ◽

Health Departments ◽

State Health ◽

Need To Evaluate ◽

Control And Prevention ◽

Third Generation Cephalosporins

Abstract In 2017, state health departments notified the Centers for Disease Control and Prevention about 4 patients with shigellosis who experienced persistent illness after treatment with oral third-generation cephalosporins. Given increasing antibiotic resistance among Shigella, these cases highlight the need to evaluate the efficacy of oral cephalosporins for shigellosis.

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Antibiotic resistance among Escherichia coli and Salmonella isolated from dairy cattle feces in Texas

PLoS ONE ◽

10.1371/journal.pone.0242390 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0242390

Author(s):

Rosine Manishimwe ◽

Paola M. Moncada ◽

Marie Bugarel ◽

H. Morgan Scott ◽

Guy H. Loneragan

Keyword(s):

Escherichia Coli ◽

Antibiotic Resistance ◽

Antimicrobial Resistance ◽

Dairy Cattle ◽

Third Generation ◽

Bacterial Isolates ◽

Macconkey Agar ◽

Selective Media ◽

Cattle Feces ◽

Third Generation Cephalosporins

In several developing countries, studies on antimicrobial resistance among bacteria from food animals are rare mostly because of under-resourced laboratories. The objective of this study was to develop and field-test a low cost protocol to estimate the isolate- and sample-level prevalence of resistance to critically important antibiotics among Escherichia coli and Salmonella isolated from dairy cattle feces. Using a predesigned protocol, fecal samples were collected to isolate non-type-specific E. coli and Salmonella using selective media without antibiotic supplements. Besides, samples were screened for E. coli and Salmonella isolates not susceptible to third-generation cephalosporins and quinolones using selective media supplemented with cefotaxime (1.0 μg/mL) and ciprofloxacine (0.5 μg/mL), respectively. All bacterial isolates were further tested for antibiotic susceptibility using disk diffusion. Bacterial isolates not susceptible to third-generation cephalosporins were tested for extended spectrum beta-lactamase (ESBL) phenotype using the combination disk test. Molecular methods were performed on selected bacterial isolates to identify and distinguish genetic determinants associated with the observed phenotypes. Among 85 non-type-specific E. coli isolated from MacConkey agar without antibiotics, the isolate-level prevalence of resistance to tetracycline was the highest (8.2%). Among 37 E. coli recovered from MacConkey agar with cefotaxime, 56.8% were resistant ceftriaxone. Among 22 E. coli isolates recovered from MacConkey agar with ciprofloxacin, 77.3% and 54.5% were resistant to nalidixic acid and ciprofloxacin, respectively. Sixteen Salmonella were isolated and only one demonstrated any resistance (i.e., single resistance to streptomycin). Among E. coli isolates not susceptible to ceftriaxone, an AmpC phenotype was more common than an ESBL phenotype (29 versus 10 isolates, respectively). Whole genome sequencing showed that phenotypic profiles of antibiotic resistance detected were generally substantiated by genotypic profiles. The tested protocol is suited to detecting and estimating prevalence of antimicrobial resistance in bacteria isolated from food animal feces in resource-limited laboratories in the developing world.

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Retrospective 8-Year Study on the Antibiotic Resistance of Uropathogens in Children Hospitalised for Urinary Tract Infection in the Emilia-Romagna Region, Italy

Antibiotics ◽

10.3390/antibiotics10101207 ◽

2021 ◽

Vol 10 (10) ◽

pp. 1207

Author(s):

Susanna Esposito ◽

Giuseppe Maglietta ◽

Margherita Di Costanzo ◽

Martina Ceccoli ◽

Gianluca Vergine ◽

...

Keyword(s):

Urinary Tract Infection ◽

Antibiotic Resistance ◽

Urinary Tract ◽

Tract Infection ◽

Third Generation ◽

First Line ◽

First Line Therapy ◽

Line Therapy ◽

Amoxicillin Clavulanate ◽

Third Generation Cephalosporins

The development and spread of antibiotic resistance is an increasingly important global public health problem, even in paediatric urinary tract infection (UTI). In light of the variability in the data, it is necessary to conduct surveillance studies to determine the prevalence of antibiotic resistance in specific geographical areas to optimize therapeutic management. In this observational, retrospective, multicentre study, the medical records of 1801 paediatric patients who were hospitalised for UTI between January 1st, 2012, and June 30th, 2020, in Emilia-Romagna, Italy, were analysed. Escherichia coli was the most frequently detected pathogen (75.6%), followed by Klebsiella pneumoniae (6.9%) and Pseudomonas aeruginosa (2.5%). Overall, 840 cases (46.7%) were due to antimicrobial-resistant uropathogens: 83 (4.7%) extended spectrum beta-lactamase (ESBL)-producing, 119 (6.7%) multidrug resistant (MDR) and 4 (0.2%) extensively drug resistant (XDR) bacteria. Empirical antibiotic therapy failed in 172 cases (9.6%). Having ESBL or MDR/XDR uropathogens, a history of recurrent UTI, antibiotic therapy in the preceding 30 days, and empirical treatment with amoxicillin or amoxicillin/clavulanate were significantly associated with treatment failure, whereas first-line therapy with third-generation cephalosporins was associated with protection against negative outcomes. In conclusion, the increase in the resistance of uropathogens to commonly used antibiotics requires continuous monitoring, and recommendations for antibiotic choice need updating. In our epidemiological context, amoxicillin/clavulanate no longer seems to be the appropriate first-line therapy for children hospitalised for UTI, whereas third-generation cephalosporins continue to be useful. To further limit the emergence of resistance, every effort to reduce and rationalise antibiotic consumption must be implemented.

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