scholarly journals Multidrug-Resistant Enterobacteriaceae in Coastal Water: An Emerging Threat

2020 ◽  
Author(s):  
Regev Cohen ◽  
Svetlana Paikin ◽  
Assaf Rokney ◽  
Maxim Rubin-Blum ◽  
Peleg Astrahan

Abstract Background: The environmental role of carbapenemase-producing Enterobacteriaceae (CPE) acquisition and infection in human disease has been described but not thoroughly investigated. We aimed to assess the occurrence of CPE in nearshore aquatic bodies.Methods: Enterobacteriaceae were cultured from coastal and estuary water near Netanya, Israel in June and July of 2018. Bacteria were identified by VITEK2® and their antimicrobial susceptibility was tested according to the CLSI guidelines. Enterobacteriaceae genomes were sequenced to elucidate their resistome and carbapenemase types. Results: Among other clinically relevant bacteria, four CPE (three Enterobacter spp and one Escherichia coli isolate) were isolated from two river estuaries (Poleg and Alexander Rivers) and coastal water at a popular recreational beach (Beit Yanai). Molecular analysis and genome sequencing revealed the persistent presence of rare beta-lactamase resistance genes, including blaIMI-2 and a previously unknown blaIMI-20 allele, which were not found among the local epidemiological strains. Genome comparisons revealed the high identity of riverine and marine CPE that were cultivated one month apart. Conclusions: We show that CPE contamination was widespread in nearshore marine and riverine habitats. The high genome-level similarity of riverine and marine CPEs, isolated one month apart, hints at the common source of infection We discuss the clinical implications of these findings and stress the urgent need to assess the role of the aquatic environment in CPE epidemiology.

Author(s):  
Regev Cohen ◽  
Svetlana Paikin ◽  
Assaf Rokney ◽  
Maxim Rubin-Blum ◽  
Peleg Astrahan

Abstract Background The environmental role of carbapenemase-producing Enterobacteriaceae (CPE) acquisition and infection in human disease has been described but not thoroughly investigated. We aimed to assess the occurrence of CPE in nearshore aquatic bodies. Methods Enterobacteriaceae were cultured from coastal and estuary water near Netanya, Israel in June and July of 2018. Bacteria were identified by VITEK2® and their antimicrobial susceptibility was tested according to the CLSI guidelines. Enterobacteriaceae genomes were sequenced to elucidate their resistome and carbapenemase types. Results Among other clinically relevant bacteria, four CPE (three Enterobacter spp and one Escherichia coli isolate) were isolated from two river estuaries (Poleg and Alexander Rivers) and coastal water at a popular recreational beach (Beit Yanai). Molecular analysis and genome sequencing revealed the persistent presence of rare beta-lactamase resistance genes, including blaIMI-2 and a previously unknown blaIMI-20 allele, which were not found among the local epidemiological strains. Genome comparisons revealed the high identity of riverine and marine CPE that were cultivated one month apart. Conclusions We show that CPE contamination was widespread in nearshore marine and riverine habitats. The high genome-level similarity of riverine and marine CPEs, isolated one month apart, hints at the common source of infection. We discuss the clinical implications of these findings and stress the urgent need to assess the role of the aquatic environment in CPE epidemiology.


2020 ◽  
Author(s):  
Regev Cohen ◽  
Svetlana Paikin ◽  
Assaf Rokney ◽  
Maxim Rubin-Blum ◽  
Peleg Astrahan

Abstract Background To assess the environmental aspects of carbapenemase-producing Enterobacteriaceae (CPE) epidemiology in nearshore aquatic bodies.MethodsEnterobacteriaceae were cultured from coastal and estuary water near Netanya, Israel in June and July of 2018. Growth rates in freshwater and seawater media were determined. Bacteria were identified by VITEK2® and their antimicrobial susceptibility was tested according to the CLSI guidelines. Enterobacteriaceae genomes were sequenced to elucidate their resistome and carbapenemase types. ResultsAmong other clinical strains, four CPE were isolated from two river estuaries (Poleg and Alexander Rivers) and from coastal water at a popular recreational beach (Beit Yanai). Molecular analysis and genome sequencing revealed the persistent presence of rare beta-lactamase resistance genes, including blaIMI-2 and a previously unknown blaIMI-20 allele, which were not found among the local epidemiological strains. Genome comparisons revealed the high identity of riverine and marine CPE that were cultivated month apart. Growth rate measurements show that the environmental strains grow best is freshwater, yet viable in marine media. ConclusionsWe suggest that nearshore CPE contamination may originate from a single source via a riverine route, based on the high similarity of riverine and marine CPE genomes, and the viability of these bacteria in marine and freshwater media. We discuss the clinical implications of these findings, and stress the urgent need to assess the role of the aquatic environment in CPE epidemiology.


2005 ◽  
Vol 77 (4) ◽  
pp. 695-715 ◽  
Author(s):  
Michele A. Zacks ◽  
Jian-Jun Wen ◽  
Galina Vyatkina ◽  
Vandanajay Bhatia ◽  
Nisha Garg

There is growing evidence to suggest that chagasic myocardia are exposed to sustained oxidative stress-induced injuries that may contribute to disease progression. Pathogen invasion- and replication-mediated cellular injuries and immune-mediated cytotoxic reactions are the common source of reactive oxygen species (ROS) in infectious etiologies. However, our understanding of the source and role of oxidative stress in chagasic cardiomyopathy (CCM) remains incomplete. In this review, we discuss the evidence for increased oxidative stress in chagasic disease, with emphasis on mitochondrial abnormalities, electron transport chain dysfunction and its role in sustaining oxidative stress in myocardium. We discuss the literature reporting the consequences of sustained oxidative stress in CCM pathogenesis.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S590-S591
Author(s):  
Regev Cohen ◽  
Svetlana Paikin ◽  
Peleg Astrahan

Abstract Background The role of the environment in the human epidemiology of carbapenem-resistant Enterobacteriaceae (CREs) is poorly understood. Several reports described carbapenemase-producing Enterobacteriaceae (CPE), cultivated from freshwaters of rivers and seawater, but there are no data from Israel. We encountered a young patient diagnosed as a rectal-carrier of 2 CPEs, both harboring the blaKPC sequence, after near-drowning in seawater near Netanya. In this study, we aimed to study river estuaries and the nearby Netanya beaches for the presence of CPEs. Methods On 2 occasions (June, July 2018) we filtered coastal water (Beit-Yanai and Sironit beaches) and freshwater (Alexander and Poleg estuaries) through 0.2µm sterile cellulose acetate membranes. Filtered bacteria were cultured in thioglycolyte broth media and transferred to different solid media. Enterobacteriaceae growing on Chromagar MSupercarba (Hylabs®) plates were isolated, identified, and subjected to modified Hodge test or CARBA-NP hydrolysis. Carbapenemase genes (blaKPC, blaVIM, blaNDM, blaIMP, blaOXA-48) were identified using Cepheid® GeneXpert Carba-R and blaIMI using homemade-PCR in the reference laboratory. Results Four CREs were identified from the environment: 2 CP E. cloacae blaIMI, found in both Alexander estuary and seawater of Beit-Yanai; 1 CP E. coli blaOXA-48 found in Poleg estuary, and 1 E. cloacae non-CP CRE found in Alexander estuary (Table 1, Figure 1). The 3 Enterobacter spp had similar antibiogram phenotype. Conclusion On two occasions CREs were easily cultivated from seawater of a popular recreational beach as well as from 2 river estuaries in Netanya. The bacterial species as well as the carbapenemase types found in the environment are quite rare compared with the clinical human epidemiology in the hospital serving the population of this district. More research is required in order to reproduce these findings, to investigate sources and persistence of rivers and coastal water pollution and to define the role “environmental” strains have in human epidemiology and disease. Disclosures All authors: No reported disclosures.


2002 ◽  
Vol 128 (1) ◽  
pp. 1-5 ◽  
Author(s):  
M. L. LING ◽  
K. T. GOH ◽  
G. C. Y. WANG ◽  
K. S. NEO ◽  
T. CHUA

Multidrug-resistant Salmonella enterica subsp. enterica serotype Typhimurium DT104L was first reported in Singapore from mid-July to mid-October 2000. Salmonella strains isolated from clinical laboratories were submitted to a reference laboratory for serotyping, phage-typing and pulsed-field gel electrophoresis (PFGE) using XbaI restriction endonuclease. An epidemiological investigation was conducted to determine the source of infection and mode of transmission using a structured questionnaire. A total of 33 cases involving mainly infants and toddlers were detected in the 3-month long outbreak. The outbreak strain was of the R-type ACGSTSu, i.e. resistant to ampicillin, chloramphenicol, gentamicin, streptomycin, tetracycline and sulphonamide. PFGE showed all isolates had an indistinguishable pattern, indicating a common source of infection. Consumption of imported dried anchovy was found to be the vehicle of transmission after adjusting for all confounding variables in the case-control study using stepwise logistic regression (OR 25·6; 95% CI 3·9–167·9; P = 0·001). Imported dried seafood should be properly processed, packed, labelled, and thoroughly cooked to prevent transmission of multidrug-resistant S. Typhimurium.


2005 ◽  
Vol 27 (1) ◽  
pp. 107
Author(s):  
P Kerr

THE three volumes of this book set out to cover the common and not so common zoonotic diseases. As the title implies, in many cases, for example actinomycosis, the diseases covered are common to humans and animals rather than being transmitted from animals to man. Volume 1 covers bacterial and mycotic diseases, volume 2, chlamydial, rickettsial and viral diseases and volume 3 deals with parasitic diseases. Each disease is dealt with systematically under the headings of: Etiology, Geographic Distribution, Occurrence in man, Occurrence in animals, Disease in man, Disease in animals, Source of infection and mode of transmission, Role of animals in the epidemiology of the disease, Diagnosis, and Control. This is followed by a bibliography. The style makes it easy to gain a quick overview or refresher on any particular disease that is covered. However, it does not lend itself to differential diagnosis based on clinical signs or symptoms. This means that the books are probably more useful for students, clinicians, epidemiologists, researchers and public health workers needing a quick update on a particular disease than for the diagnostician in the field or clinic.


Diachronica ◽  
2000 ◽  
Vol 17 (1) ◽  
pp. 111-138 ◽  
Author(s):  
Peter Trudgill ◽  
Elizabeth Gordon ◽  
Gillian Lewis ◽  
Margaret Maclagan

SUMMARY Similarities between different geographically separated varieties of a single language may in some cases be due not to characteristics inherited directly from some parent variety, nor to any diffusion or direct contact between them, but to processes of the type which Sapir labelled ‘drift’. We argue that there are clear examples of drift phenomena in modern English and that it is possible in the case of recently formed colonial Englishes to confirm that drift occurs, and to produce contemporary illustrations of how it operates. Sapir’s argument was that language varieties may resemble one another because, having derived from some common source, they continue to evolve linguistically in similar directions by undergoing similar linguistic changes. We amplify Sapir’s approach by showing that drift in our data is of two major types. In the first, linguistic changes that are already in progress in the common source may be continued even after separation. In the second, varieties with a common source inherit shared tendencies or propensities which may lead to the development of similar but new changes and hence similar but new characteristics, even after separation. These propensities lie in that fact that the related varieities inherit the same general structural properties which can interact with one another in a way which involves tensions which are the “seeds” which can bring about parallel changes in the distinct languages. RÉSUMÉ Les similitudes qui existent entre différentes variétés géographiques d’une même langue peuvent dans certains cas être dues non pas à des caractéristiques héritées directement d’une variété parente, ni à une situation de diffusion ou de contact direct entre elles, mais à un type de processus que Sapir appelle ‘drift’. Nous formons l’hypothèse qu’il y a des exemples évidents de drift en anglais moderne et qu’il est possible, pour des variétés d’anglais colonial d’origine récente, de confirmer qu’un drift est en cours et de fournir une illustration contemporaine du phénomène. L’idée de Sapir consistait à envisager que les variétés linguistiques puissent se ressembler l’une l’autre, du fait que — étant issues d’une même source commune — elles continuent à évoluer linguistiquement dans des directions similaires au travers de changements linguistiques semblables. Nous généralisons l’approche de Sapir en montrant que nos données tendent à identifier deux types principaux de drift. Dans le premier cas, les changements linguistiques qui sont déjà en cours dans la langue-source commune peuvent se poursuivre même après séparation. Dans le second cas, des variétés issues d’une source commune héritent de tendances ou d’une propension qui peuvent conduire à l’apparition de changements similaires, bien que nouveaux, et de ce fait à des caractéristiques semblables, quoique nouvelles, ceci même après séparation. Cette propension s’explique du fait que ces variétés apparentées héritent des mêmes propriétés structurelles générales qui vont ensuite interagir les unes avec les autres, donnant lieu à des tensions qui seront le “ferment” potentiel de changements parallèles dans des langues pourtant distinctes. ZUSAMMENFASSUNG Ähnlichkeiten zwischen geographisch getrennten Dialekten einer selben Sprache können in gewissen Fällen weder mit den Eigenschaften der ursprünglichen Varietät erklärt werden, noch durch Diffusion oder direkten Kontakt zwischen diesen, sondern mit Prozessen welche Sapir als “Drift” bezeichnet hat. Wir argumentieren dass es eindeutige Beispiele von Driftvorgängen im modernen Englisch gibt und dass es möglich ist, diese Prozesse in kolonialen Varietäten der Englischen Sprache nachzuweisen und deren Funktionsweise zu erklären. Sapir glaubte dass Sprachvarietäten Parallelen aufweisen können weil sie ursprünglich von der gleichen Sprache abstammen und sich dementsprechend auf ähnliche Weise linguistisch weiterentwickeln indem sie ähnlich Sprachveränderungen durchgehen. Wir amplifizieren Sapir’s Theorie indem wir zeigen dass es in unseren Daten zwei verschieden Arten von Drift gibt. Zum ersten sprachliche Veränderungen, die schon in der Ursprungsvarietät aktualisiert wurden und die nach der räumlichen Trennung weitergehen. Zum zweiten, Varietäten die von einer gemeinsamen Sprache gewisse Eigenschaften erben welche nach deren Verbreitung zur Entwicklung von ähnlichen aber neuartigen Vorgängen führen. Diese Eigenschaften können damit erklärt werden dass verwandte Varietäten die gleichen strukturellen Charakteristika erben, und diese können unabhängig von anderen Varietäten miteinander agieren. Diese Prozesse sind die Ursache von parallelen Veränderungen in verschiedenen Sprachen.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S767-S767
Author(s):  
Kieu-Nhi Tran ◽  
Ryan Mynatt ◽  
Keith S Kaye ◽  
Jason M Pogue

Abstract Background The increase in drug-resistant pathogens has prompted interest in dosing of β-lactams (BLs) via EI. Available data on this practice are conflicting, rarely assess non-critically ill patients or low MIC pathogens, and do not focus on outcomes other than clinical cure or mortality. Further assessment of this practice is warranted. Methods This is a retrospective cohort study of adult patients who received FEP, TZP, or MEM for GN bacteremia via INI or EI from 2010 to 2018. Patients were included if the pathogen was susceptible to the target BL and they received study drug within 24 hours of bacteremia onset and continued it for ≥ 48 hours. Patients were excluded if they had a mixed infection or received > 48 hours of combination therapy. Patients were matched 1:1 based on study drug utilized, sepsis severity, ICU status, bacteremia source, and causative pathogen. Outcomes assessed included time to clinical stabilization as well as treatment failure, mortality, length of stay (LOS), and recurrence. Results 268 patients (134 matched patients in each group) were included. Median (IQR) age of the cohort was 64 (55–77) years, and 57% were male. Common comorbidities were diabetes (35%) and CKD (26%), and the median (IQR) Charlson Comorbidity Index (CCI) was 3 (1–4). 40% of the population presented with severe sepsis or septic shock, and 42% were in the ICU at infection onset. Baseline characteristics were similar between the two groups except patients receiving EI were older (65.5 (58–78) vs. 61.5 (52–73); P = 0.006 and had higher median CCI (3 (2–4) vs. 2 (1–3); P < 0.001,) while patients in the II group had a higher mean weight (85.5 ± 27.8 vs. 78.8 ± 19.2, P = 0.02.) The most common organisms isolated were E. coli(41%), K. pneumoniae (18%), and P. aeruginosa (13%), and the most common source of infection was the urine (51%). Outcomes are listed in Table 1. EI was associated with decreases in time to defervescence, WBC normalization, and SIRS resolution. Furthermore, EI was associated with a lower incidence of treatment failure and recurrence as well as decreases in LOS and ICU-LOS. There was no difference in mortality. Conclusion The findings of this analysis highlight the role of EI in BL therapy as an important stewardship strategy to optimize clinical outcomes in all patients with GN bacteremia. Disclosures All authors: No reported disclosures.


1996 ◽  
Vol 7 (2) ◽  
pp. 147-151 ◽  
Author(s):  
Matthew W Morgan ◽  
Irving E Salit

In fall 1993 a man and a dog developed blastomycosis after visiting an island off Bayfield Inlet, Georgian Bay, located near Parry Sound, Ontario. The man recovered but the dog died of blastomycosis. It was hypothesized that the common source of exposure was the island since the permanent residences of the two cases were in different cities. One further case of human infection, based on positive serology, and four additional cases of probable canine blastomycosis were identified. All cases had travelled to Bayfield Inlet during summer and early fall 1993. To the authors’ knowledge this is the first Canadian report of a common source of infection of human and canine blastomycosis. This report also provides evidence for a new endemic area of blastomycosis infection.


Sign in / Sign up

Export Citation Format

Share Document