Detection of different colistin resistance mechanisms among multidrug resistant Klebsiella pneumoniae isolates in Bulgaria.

The more frequent usage of colistin resulted in an increase of colistin resistance due to lipopolysaccharide modifications. The aim of this study was to reveal the prevalence and mechanisms of colistin resistance among multidrug-resistant Klebsiella pneumoniae isolates collected in Bulgaria. One hundred multidrug resistant K. pneumoniae isolates were collected in a period between 2017 and 2018. Among them, 29 colistin resistant and 8 heteroresistant isolates were observed and further investigated. Clonal relatedness was detected by RAPD and MLST. Сarbapenemases, two component system phoQ/phoP, pmrA/B, and mgrB were investigated by PCR amplification and Sanger sequencing. Among 37 colistin nonsusceptible isolates, we detected 25 NDM-1 producers. The isolates belonged mainly to ST11 (80%), and also to ST147, ST35, ST340, ST219 (1-2 members per clone). Nine colistin resistant isolates showed changes in mgrB. IS903B-like elements truncated mgrB in five isolates. In two isolates, premature stopcodon (Q30stopcodon) was observed and another two isolates did not amplify mgrB, possibly due to bigger deletion or insertion. No isolates showed phoQ/phoP and pmrA/B mutations except for pmrB (four isolates had R256G). All isolates with IS903B insertions belonged to ST11 clone. The mgrB alterations play major role in colistin resistance in K. pneumoniae isolates studied in the current work. We report truncation of mgrB by IS903 like element in colistin resistant NDM-1 producing K. pneumoniae ST11 clone in Bulgaria.

Detection and characterization of OXA-48-producing Klebsiella pneumoniae originated in Bulgaria.

We report the identification of OXA-48-producing Klebsiella pneumoniae, causing peritonitis in a cancer patient admitted to the Oncology Hospital in Sofia. The isolate had reduced susceptibility to carbapenems but remained susceptible to extended-spectrum cephalosporins. PCR and sequencing confirmed the presence of blaOXA-48 gene flanked by two intact copies of IS1999 on truncated ΔTn1999.1. This transposon was located on unusual non-typeable 29-kb plasmid that could be transferred only by transformation. Multilocus sequence typing (MLST) indicated the presence of the sequence type ST530.This is the first documented infection due to OXA-48-producing Enterobacteriaceae strain in Bulgaria.

First detection of OXA-24 carbapenemase-producing Acinetobacter baumannii isolates in Bulgaria.

This report describes the first identification of OXA-24 carbapenemase-producing Acinetobacter baumannii isolates from Bulgaria. According to national surveillance data A. baumannii along with Pseudomonas aeruginosa are the most troublesome microorganisms in hospital environment with high rates of acquired carbapenem resistance. In the present study real-time multiplex PCR was performed to identify the most common carbapenemase genes in 15 non-duplicate carbapenem-resistant A. baumannii isolates collected in 2012. The results showed lack of KPC, GES, VIM, IMP-type enzymes. Four A. baumannii isolates tested positive by PCR for the acquired OXA-24 together with the intrinsic OXA-51 carbapenemase. OXA-24 and OXA-23 were determined as co-existent in one isolate. Two isolates were identified with OXA-23 in addition to the OXA-51 carbapenemase.

Molecular epidemiology and multidrug resistance mechanisms of Pseudomonas aeruginosa isolates from Bulgarian hospitals.

A panel of 29 multidrug-resistant (MDR) Pseudomonas aeruginosa isolates recovered from seven hospitals as part of a country-wide surveillance of antimicrobial resistance in Bulgarian hospitals was studied. Molecular typing through multiple-locus variable number tandem-repeat analysis (MLVA6) yielded 23 different profiles. Phenotypic and genotypic tests for the detection of acquired carbapenemases yielded negative results in all cases. In contrast, 76% of the isolates produced other acquired ß-lactamases, including extended-spectrum ß-lactamases (ESBLs). Namely, 6 of the isolates (21%) produced a VEB-1 ESBL; 14 (48%) produced an OXA-10-type enzyme (7 OXA-10 and 7 OXA-10 ESBL variants, including 2 OXA-17 [A218G], 2 OXA-74 [C197T, A218G], and 3 OXA-142 [A218G, G470A]); 8 (28%) an OXA-2-type enzyme (all OXA-2); and 1 (3%) a PSE-1 carbenicillinase. Further analysis through multilocus sequence typing (MLST) revealed that the six VEB-1-producing strains, recovered from four hospitals, belonged to ST111 or ST244 international high-risk clones. Additionally, nearly all of the isolates (97%) lacked OprD production, explaining carbapenem resistance. Overexpression of AmpC was documented in 5 (17%) of the isolates, including most of the MDR isolates not producing any acquired ß-lactamase. Particularly noteworthy was the very high prevalence of MexXY-OprM overexpression, documented in 72% of the isolates, whereas the prevalence of MexAB-OprM overexpression was lower (21%). In summary, while the production of metallo-ß-lactamases is uncommon among P. aeruginosa isolates from Bulgarian hospitals, MDR profiles frequently result from the production of ESBLs combined with the lack of production of the carbapenem porin OprD and the overexpression of the MexXY-OprM efflux pump.

Total internal reflection imaging of microorganism adhesion using an oil immersion objective.

In this paper, we report the results of total internal reflection microscopy investigations of the interaction of two types of microorganisms: Saccharomyces cerevisiae and Escherichia coli with substrates. It is shown that with this method qualitative and quantitative information about cells-substrate interaction can be obtained. One can easily make a difference between attached and non-attached as well as between dead and alive cells, and more generally can follow the dynamics of the process of cells' attachment to substrates. Quantitative information about the cell size and cell-substrate distance is obtained by using a model in which yeast cells and bacteria are approximated by ellipsoids, and multiple reflections of the evanescent waves between the cells and the substrate are neglected.

Plasmon microscopy and imaging ellipsometry of Artrobacter oxydans attached on polymer films.

The attachment of Artrobacter oxydans 1,388 on a newly synthesized biodegradable copolymer of poly-(hexanlactam)-co-block-poly-(delta-valerolactone) is investigated by optical, microscopic and biochemical methods. The potentials of surface plasmon microscopy and imaging ellipsometry for detecting microorganisms when Al films are used to excite plasmons is assessed by comparing images obtained by these methods with dark field microscopy pictures. The experimental results demonstrate that in this case imaging ellipsometry and plasmon microscopy in transmission are promising methods and can be used in optical sensors for monitoring cell adhesion.

Tularemia outbreak, Bulgaria, 1997-2005.

The 1997-2005 tularemia outbreak in Bulgaria affected 285 people. Ten strains were isolated from humans, a tick, a hare, and water. Amplified fragment length polymorphism typing of the present isolates and of the strain isolated in 1962 suggests that a new genetic variant caused the outbreak.

Tularaemia outbreak in Bulgaria.

During the last 40 y, 2 large tularaemia outbreaks occurred in Bulgaria. We report the second outbreak, in 1998--2003, including a total of 262 laboratory confirmed cases. The majority of the patients presented with oropharyngeal tularaemia (89.7%). Less common were the glandular, pulmonary and oculoglandular forms. The diagnosis of tularaemia was confirmed serologically. In 5 cases, F. tularensis was detected by immunofluorescent assay in lymph node biopsies. By PCR, all 5 samples yielded successful amplification of the tul4 gene and the feredoxin gene of F. tularensis. Cultivation of the biopsies resulted in 2 F. tularensis isolates. Three additional F. tularensis isolates were obtained from an open well, a dead hare and a tick. All 5 isolates were identified as F. tularensis subsp. holarctica seu palaearctica. F. tularensis was detected by PCR amplification of the tul4 gene in spleen samples from 9 (21%) of 42 captured rodents. Our study indicated food and water contamination by rodents as important sources of human infection. The high prevalence of the oropharyngeal form of tularaemia supported the assumption that humans contracted the infection by alimentary route.