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1.
J Med Microbiol ; 69(1): 82-86, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31904319

RESUMO

In recent years, Serratia marcescens has emerged as an important agent of hospital-acquired infections, such as pneumonia, urinary tract infection, septicaemia and meningitis, particularly in vulnerable patients. Compared to Klebsiella pneumoniae and Escherichia coli, S. marcescens is less commonly associated with bla KPC genes, yet few cases of plasmid transmission at the gastrointestinal level from K. pneumoniae carbapenemase (KPC)-producing Enterobacterales to S. marcescens have been described. Here we report a case of in vivo acquisition, during a 3-month period of hospitalization in the intensive care unit, of a bla KPC-3 gene carried by a pKpQIL-IT plasmid, and its probable transmission at the bronchial level among different species of Enterobacterales, including K. pneumoniae and S. marcescens. By using whole genome sequence analyses we were able provide insight into the dynamics of carbapenem-resistance determinants acquisition in the lower respiratory tract, a novel anatomical region for such plasmid transmission events, that usually involve the gastrointestinal tract. The co-presence at the same time of both wild-type and resistant Enterobacterales could have been the critical factor leading to the spread of plasmids harbouring carbapenem-resistance genes, of particular importance during surveillance screenings. The possibility of such an event may have significant consequences in terms of antimicrobial treatment, with a potential limitation of therapeutic options, thereby further complicating the clinical management of high-risk critically ill patients.


Assuntos
Proteínas de Bactérias/genética , Transferência Genética Horizontal , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/genética , Plasmídeos , Serratia marcescens/enzimologia , Serratia marcescens/genética , beta-Lactamases/genética , Adulto , Infecção Hospitalar/microbiologia , Humanos , Unidades de Terapia Intensiva , Infecções por Klebsiella/microbiologia , Masculino , Infecções Respiratórias/microbiologia , Infecções por Serratia/microbiologia , Sequenciamento Completo do Genoma
2.
Mymensingh Med J ; 29(1): 37-42, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915333

RESUMO

Uropathogenic Escherichia coli is frequently resistant to different antibiotic leading to a critical condition of the patients. The purpose of the present study was to see antibiotic resistance pattern and genetic characteristics of ESBL and Carbapenemase-producing Escherichia coli. This cross sectional study was conducted in the Department of Microbiology at Mymensingh Medical College, Mymensingh, Bangladesh from October 2014 to December 2015. Patients presented with clinically diagnosed urinary tract infection at any age with both sexes who attended in the OPD of Mymensingh Medical College Hospital and the Doctors Diagnostic Centre in Mymensingh, Bangladesh was selected as study population. Non duplicate clinical isolates from urine were collected in full aseptic precaution for culture of bacteria. Escherichia coli were confirmed by PCR Stargetingadk. Antimicrobial susceptibility was measured by broth microdilution test. Minimum inhibitory concentrations against 18 antimicrobial agents were measured. Beta-lactamase genes were detected by multiplex PCR. For all the isolates showing resistance to imipenem and/or meropenem, presence of carbapenemase genes was confirmed by multiplex/uniplex PCR using primers. A total of 233 non-duplicate clinical isolates of Escherichia coli were collected from patients of which dominant phylogenetic group was B2 which was 78(33.5%) isolates of which 71 isolates were B2a and 7 isolates were B2b. Furthermore, Group A was in 29.6% isolates and Group D was in 26.6% isolates. E. coli showed significantly higher resistance rates to piperacillin, cephalosporins, and some other antimicrobials. Meropenem-resistance was detected in 8.2% of E. coli. The detection rate of blaTEM was 41.6% in E. coli. Carbapenemase genes were detected in 9(3.9%) isolates of E. coli and identified as genes encoding NDM-1, -5, and 7 and OXA-181. All the blaNDM-positive E. coli isolates carried also blaCTX-M-15, except for a group B1 isolate. E. coli is significantly higher resistance rates to piperacillin, cephalosporins, and some other antimicrobials and possesses different ESBL and carbapenemase genes.


Assuntos
Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Farmacorresistência Bacteriana/genética , Infecções por Escherichia coli/tratamento farmacológico , Escherichia coli/genética , beta-Lactamases/genética , Bangladesh , Estudos Transversais , Escherichia coli/classificação , Escherichia coli/efeitos dos fármacos , Escherichia coli/enzimologia , Infecções por Escherichia coli/microbiologia , Feminino , Genes Bacterianos , Humanos , Masculino , Testes de Sensibilidade Microbiana/métodos , Filogenia , Reação em Cadeia da Polimerase , Centros de Atenção Terciária , beta-Lactamases/metabolismo
3.
Water Res ; 170: 115277, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31756613

RESUMO

The emergence and spread of resistance to antibiotics among bacteria is the most serious global threat to public health in recent and coming decades. In this study, we characterized qualitatively and quantitatively ß-lactamase and carbapenemase genes in the wastewater resistome of Central Wastewater Treatment Plant in Kozieglowy, Poland. The research concerns determination of the frequency of genes conferring resistance to ß-lactam and carbapenem antibiotics in the genomes of culturable bacteria, as well as in the wastewater metagenome at three stages of treatment: raw sewage, aeration tank, and final effluent. In the final effluent we found bacteria with genes that pose the greatest threat to public health, including genes of extended spectrum ß-lactamases - blaCTX-M, carbapenemases - blaNDM, blaVIM, blaGES, blaOXA-48, and showed that during the wastewater treatment their frequency increased. Moreover, the wastewater treatment process leads to significant increase in the relative abundance of blaTEM and blaGES genes and tend to increase the relative abundance of blaCTX-M, blaSHV and blaOXA-48 genes in the effluent metagenome. The biodiversity of bacterial populations increased during the wastewater treatment and there was a correlation between the change in the composition of bacterial populations and the variation of relative abundance of ß-lactamase and carbapenemase genes. PCR-based quantitative metagenomic analysis combined with analyses based on culture methods provided significant information on the routes of ARBs and ARGs spread through WWTP. The limited effectiveness of wastewater treatment processes in the elimination of antibiotic-resistant bacteria and resistance genes impose the need to develop an effective strategy and implement additional methods of wastewater disinfection, in order to limit the increase and the spread of antibiotic resistance in the environment.


Assuntos
Metagenoma , Águas Residuárias , Antibacterianos , Proteínas de Bactérias , Polônia , beta-Lactamases
4.
BJOG ; 127(2): 217-227, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31006170

RESUMO

OBJECTIVE: To evaluate the potential impact of intrapartum antibiotics, and their specific classes, on the infant gut microbiota in the first year of life. DESIGN: Prospective study of infants in the New Hampshire Birth Cohort Study (NHBCS). SETTINGS: Rural New Hampshire, USA. POPULATION OR SAMPLE: Two hundred and sixty-six full-term infants from the NHBCS. METHODS: Intrapartum antibiotic use during labour and delivery was abstracted from medical records. Faecal samples collected at 6 weeks and 1 year of age were characterised by 16S rRNA sequencing, and metagenomics analysis in a subset of samples. EXPOSURES: Maternal exposure to antibiotics during labour and delivery. MAIN OUTCOME MEASURE: Taxonomic and functional profiles of faecal samples. RESULTS: Infant exposure to intrapartum antibiotics, particularly to two or more antibiotic classes, was independently associated with lower microbial diversity scores as well as a unique bacterial community at 6 weeks (GUnifrac, P = 0.02). At 1 year, infants in the penicillin-only group had significantly lower α diversity scores than infants not exposed to intrapartum antibiotics. Within the first year of life, intrapartum exposure to penicillins was related to a significantly lower increase in several taxa including Bacteroides, use of cephalosporins was associated with a significantly lower rise over time in Bifidobacterium and infants in the multi-class group experienced a significantly higher increase in Veillonella dispar. CONCLUSIONS: Our findings suggest that intrapartum antibiotics alter the developmental trajectory of the infant gut microbiome, and specific antibiotic types may impact community composition, diversity and keystone immune training taxa. TWEETABLE ABSTRACT: Class of intrapartum antibiotics administered during delivery relates to maturation of infant gut microbiota.


Assuntos
Antibioticoprofilaxia , Fezes/microbiologia , Microbioma Gastrointestinal/efeitos dos fármacos , Vagina/microbiologia , Bacteroides/crescimento & desenvolvimento , Bacteroidetes , Bifidobacterium , Feminino , Humanos , Recém-Nascido , Lactobacillus , Exposição Materna , Mães , Gravidez , Estudos Prospectivos , RNA Ribossômico 16S , Análise de Sequência de RNA , Nascimento a Termo , beta-Lactamases
5.
Sr Care Pharm ; 34(10): 645-659, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31818350

RESUMO

OBJECTIVE: To review the treatment options for extended-spectrum beta-lactamase (ESBL) urinary tract infections (UTIs) in the long-term care facility setting.
DATA SOURCES: A PubMed search from January 1, 1990, through December 31, 2018, using terms "extended spectrum beta lactamase" and "urinary tract infection" was performed. Current guidelines, drug databases, and manufacturer package inserts were also used.
STUDY SELECTION: All English-language articles during the above time frame appearing in these searches were reviewed for relevance to this paper. In addition, their bibliographies were reviewed to identify any articles not originally identified.
DATA SYNTHESIS: ESBL UTIs are a growing concern in the long-term care facility as these pathogens are becoming more prevalent. Patients residing in long-term care facilities have fewer treatment modalities because of medication administration and care issues. This review highlights the data on different antibiotics and their efficacy toward ESBLs in the setting of UTI.
CONCLUSIONS: Despite the challenges and limitations, there are still options for clinicians to provide optimal care, including antibiotics with different routes of administration, as well as different administration techniques. Clinicians can be successful with treating ESBL UTIs in older adults.


Assuntos
Infecções Urinárias , Idoso , Antibacterianos , Humanos , beta-Lactamases
6.
Rev Soc Bras Med Trop ; 53: e20190044, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31859941

RESUMO

INTRODUCTION: Acinetobacter baumannii are opportunistic bacteria, highly capable of acquiring antimicrobial resistance through the production of carbapenemases and aminoglycoside modifying enzymes (AMEs). METHODS: Carbapenemase and AME genes were investigated in A. baumannii recovered from inpatients of a Brazilian hospital. RESULTS: The key genes found were bla OXA-51-like, the association ISAba1- bla OXA-23-like, and the AME genes aph(3´)-VI, aac(6´)-Ib, aac(3)-Ia, and aph(3´)-Ia. Different clusters spread through the institution wards. CONCLUSIONS: The dissemination of bla OXA-23-like and AME-carrying A. baumannii through the hospital highlights the need for improved preventive measures to reduce the spread of infection.


Assuntos
Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/enzimologia , Aminoglicosídeos/genética , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , beta-Lactamases/genética , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/isolamento & purificação , Brasil , Farmacorresistência Bacteriana Múltipla , Humanos , Unidades de Terapia Intensiva , Testes de Sensibilidade Microbiana , Centros de Atenção Terciária
7.
Bratisl Lek Listy ; 120(12): 935-940, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31855054

RESUMO

OBJECTIVES: We focused on detecting the most frequent resistance mechanisms in selected multidrug-resistant (MDR) strains and determining their antimicrobial resistance. BACKGROUND: MDR pathogens pose urgent public health threat due to limited treatment options, rigorous control measures and significant mortality. METHODS: We confirmed extended-spectrum ß-lactamase (ESBL) and carbapenemase producing Enterobacteriaceae through guidelines, as well following ß-lactamases: AmpC by cloxacillin, class A carbapenemase with phenylboronic acid, class B metallo-ß-lactamase with ethylenediaminetetraacetic acid. Multilocus sequence typing was used to investigate 20 Escherichia coli strains. RESULTS: Overall 205 mostly ESBL Escherichia coli demonstrated resistance against amikacin (4.7 %), tigecycline (1.2 %), and no resistance to ceftazidime/avibactam, meropenem, nitrofurantoin and fosfomycin. Out of 41 Klebsiella species (spp.), 37 (90.2 %) showed carbapenemase activity, 13 (35.1 %) of class A and 24 (64.9 %) of class B. Resistance was following: meropenem 66.7 %, tigecyclin 10.2 % and colistin 0 %. From Enterobacter spp. 21 strains, 14 (66.7 %) were ESBL, 5 produced ESBL and/or AmpC and 2 were MDR. We ascertained 14 (70 %) E. coli sequence type - ST131. CONCLUSIONS: The study revealed various resistance mechanisms in concert with different agents and association of specific ST131 within E. coli. These characteristics considerably contribute to emergence of antimicrobial resistance (Tab. 4, Ref. 30).


Assuntos
Antibacterianos/farmacologia , Proteínas de Bactérias/metabolismo , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Enterobacteriaceae/enzimologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/enzimologia , Klebsiella pneumoniae/efeitos dos fármacos , beta-Lactamases/metabolismo , Adulto , Idoso , Proteínas de Bactérias/genética , Enterobacteriáceas Resistentes a Carbapenêmicos/enzimologia , Enterobacteriáceas Resistentes a Carbapenêmicos/genética , Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Farmacorresistência Bacteriana , Enterobacteriaceae/classificação , Infecções por Enterobacteriaceae/microbiologia , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Humanos , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/isolamento & purificação , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , beta-Lactamases/genética
8.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(10): 1212-1218, 2019 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-31771717

RESUMO

OBJECTIVE: To evaluate the in vitro activity of ceftazidime-avibactam (CAZ-AVI) alone or in combination with colistin (COL) against clinically isolated extensively drug-resistant Pseudomonas aeruginosa (XDR-PA). METHODS: Minimum inhibitory concentration (MIC) of 16 clinical XDR-PA isolates was determined by broth dilution method and chessboard design when CAZ-AVI and COL were used alone or in combination, then the combined inhibitory concentration index (FICI) was calculated. Class A [Klebsiella pneumoniae carbapenemase ß-lactamase (blaKPC), Guiana extended-spectrum ß-lactamase (blaGES)], Class B [imipenemase ß-lactamase (blaIMP), Verona-Integronmetallo ß-lactamase (blaVIM), New Delhi metallo ß-lactamase (blaNDM), German imipenemase ß-lactamase (blaGIM), Sao Paulo metallo-ß-lactamase (blaSPM)], Class C [AmpC ß-lactamase (blaAmpC)], Class D [oxacillinase ß-lactamase (blaOXA)] ß-lactamase-related resistance genes were detected by polymerase chain reaction. Drug-resistant mutation frequencies of each strain were determined on a drug-containing plate. The time kill curves of three XDR-PA were plotted by colony counting method. A biofilm model was established in vitro, and the synergistic effect of CAZ-AVI and COL on biofilm inhibition was detected by methythiazolyl tetrazolium assay (MTT). RESULTS: The MICs of 16 XDR-PA for CAZ-AVI ranged from 1 mg/L to 128 mg/L, and three of the isolates showed resistance (MIC > 8 mg/L). The FICI range of CAZ-AVI combined with COL was 0.312-1.000. Four isolates were synergistic, while the other 12 isolates were additive. Three isolates resistant to CAZ-AVI contained Class B resistance genes such as blaIMP and blaVIM, while 13 susceptible isolates carried resistance genes belonging to Class A, C or D. The logarithm values of mutation frequencies of drug resistance in CAZ-AVI group, COL group and combination group were -4.81±0.88, -7.06±0.69 and -9.70 (-9.78, -9.53), respectively. There were significant differences among the three groups (H = 33.601, P < 0.001), and between every two groups (adjusted P < 0.05). In time kill curves, the phytoplankton load of three XDR-PA decreased more than 6 log CFU/L when these two drugs were used together, and number of PA1819 planktonic bacteria decreased more than 5.1 log CFU/L compared with monotherapy group. Viable quantity in biofilm (A490) of normal saline group, CAZ-AVI group, COL group and CAZ-AVI-COL group were 0.665±0.068, 0.540±0.072, 0.494±0.642 and 0.317±0.080, respectively. There was significant difference between the other two groups (all P < 0.001), except for that between CAZ-AVI group and COL group (P = 0.109). CONCLUSIONS: CAZ-AVI combined with COL can effectively improve the bactericidal effect of each drug alone on XDR-PA. The regimen can also reduce the production of drug-resistant bacteria and inhibit the formation of biofilm. Therefore, it is a potential treatment for XDR-PA infection.


Assuntos
Antibacterianos/uso terapêutico , Compostos Azabicíclicos/uso terapêutico , Ceftazidima/uso terapêutico , Colistina/uso terapêutico , Farmacorresistência Bacteriana/genética , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa , Combinação de Medicamentos , Testes de Sensibilidade Microbiana , beta-Lactamases
9.
Zhonghua Shao Shang Za Zhi ; 35(11): 798-803, 2019 Nov 20.
Artigo em Chinês | MEDLINE | ID: mdl-31775468

RESUMO

Objective: To explore the resistance mechanism and gene type of carbapenems-resistant Klebsiella pneumoniae (CRKP) in burn care unit. Methods: A total of 27 CRKP strains were primarily isolated from 22 patients [20 males, 2 females, aged (42±16) years] admitted to burn care unit of Institute of Burn Research of the First Affiliated Hospital of Army Medical University (the Third Military Medical University, hereinafter referred to as our department) from January to December 2017. After identification of bacteria, the months of detection and distribution of sample source were analyzed. Drug resistance tests of 15 antibiotics were conducted. Polymerase chain reaction was used to detect the drug resistant genes. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) were used to analyze the gene type of strains. Results: (1) During the whole year of 2017, CRKP strains were mostly detected in August (8 strains), September (6 strains), and October (5 strains), with no CRKP in January, March, June, November, and December. Five strains from bed units were detected in August (2 strains), September (1 strain), and October (2 strains). (2) Twenty-seven CRKP strains were derived from blood samples (40.7%, 11/27), wound exudate samples (18.5%, 5/27), deep vein catheter samples (11.1%, 3/27), sputum samples (7.4%, 2/27), urine samples (3.7%, 1/27), and bed unit samples (18.5%, 5/27). (3) The 27 CRKP strains were detected with drug-resistance rates of 100.0% to 7 antibiotics including cefoperazone/sulbactam, piperacillin/tazobactam, cefazolin, ceftriaxone, cefepime, ertapenem, and compound sulfamethoxazole, no drug-resistance to tigecycline, with drug-resistance rates higher than 81.0% to the rest 7 antibiotics. (4) Detection rates for resistance gene bla(CTX-M-10), bla(SHV), bla(TEM), bla(CTX-M-14), bla(ACT), and bla(KPC) were all above 92.5%. (5) According to PFGE, the 27 CRKP strains had 6 types (A, A(1), A(2), B, C, and D). Strains of type A were mainly detected in February, May, and September, with detection rate of 37.0% (10/27). Strains of type C were mainly detected in July, August, and October, with detection rate of 48.1% (13/27). Strains of types A(1), A(2), B, and D were scatteredly detected, with detection rate of 3.7% (1/27) respectively. According to MLST, the 27 CRKP strains had 6 STs. ST11 was the most frequent type, accounting for 74.1% (20/27), which was detected in August to October. The detection rate of ST395, ST2230, ST215, ST260, and STnew ranged from 3.7%(1/27) to 7.4%(2/27), and the strains were scatteredly detected. Conclusions: The main source of CRKP from burn care unit of our department was bloodstream. All the CRKP strains showed high drug-resistance rate and complicated resistance mechanism. There were small scale outbreaks caused by CRKP of type A, type C, and ST11, which should be paid more attention to in clinical treatment and infection control.


Assuntos
Queimaduras/microbiologia , Carbapenêmicos/farmacologia , Farmacorresistência Bacteriana , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/efeitos dos fármacos , Adulto , Antibacterianos/farmacologia , Unidades de Queimados , Feminino , Humanos , Klebsiella pneumoniae/classificação , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , beta-Lactamases/genética
10.
Emerg Microbes Infect ; 8(1): 1688-1700, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31749408

RESUMO

Resistance to ß-lactams is one of the most serious problems associated with Gram-negative infections. ß-Lactamases are able to hydrolyze ß-lactams such as cephalosporins and/or carbapenems. Evolutionary origin of metallo-ß-lactamases (MBLs), conferring critical antibiotic resistance threats, remains unknown. We discovered PNGM-1, the novel subclass B3 MBL, in deep-sea sediments that predate the antibiotic era. Here, our phylogenetic analysis suggests that PNGM-1 yields insights into the evolutionary origin of subclass B3 MBLs. We reveal the structural similarities between tRNase Zs and PNGM-1, and demonstrate that PNGM-1 has both MBL and tRNase Z activities, suggesting that PNGM-1 is thought to have evolved from a tRNase Z. We also show kinetic and structural comparisons between PNGM-1 and other proteins including subclass B3 MBLs and tRNase Zs. These comparisons revealed that the B3 MBL activity of PNGM-1 is a promiscuous activity and subclass B3 MBLs are thought to have evolved through PNGM-1 activity.


Assuntos
Bactérias/enzimologia , Proteínas de Bactérias/genética , Evolução Molecular , Sedimentos Geológicos/microbiologia , beta-Lactamases/genética , Sequência de Aminoácidos , Bactérias/química , Bactérias/classificação , Bactérias/genética , Proteínas de Bactérias/química , Proteínas de Bactérias/metabolismo , Domínio Catalítico , Filogenia , beta-Lactamases/química , beta-Lactamases/metabolismo
11.
BMC Infect Dis ; 19(1): 927, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684875

RESUMO

BACKGROUND: Capnocytophaga canimorsus is a gram-negative bacterium and an oral commensal in dogs and cats, but occasionally causes serious infections in humans. Septicemia is one of the most fulminant forms, but diagnosis of C. canimorsus infection is often difficult mainly because of its very slow growth. C. canimorsus infective endocarditis (IE) is rare and is poorly understood. Since quite a few strains produce ß-lactamase, antimicrobial susceptibility is pivotal information for adequate treatment. We herein report a case with C. canimorsus IE and the results of drug susceptibility test. CASE PRESENTATION: A 46-year-old man had a dog bite in his left hand 3 months previously. The patient was referred to our hospital for fever (body temperature > 38 °C), visual disturbance, and dyspnea. Echocardiography showed aortic valve regurgitation and vegetation on the leaflets. IE was diagnosed, and we initially administered cefazolin and gentamycin assuming frequently encountered microorganisms and the patient underwent aortic valve replacement. C. canimorsus was detected in the aortic valve lesion and blood cultures. It was also identified by 16S ribosome DNA sequencing. Ceftriaxone were started and continued because disk diffusion test revealed the isolate was negative for ß-lactamase and this case had cerebral symptoms. The patient successfully completed antibiotic treatment following surgery. CONCLUSIONS: We diagnosed C. canimorsus sepsis and IE by extended-period blood cultures and 16S ribosome DNA sequencing by polymerase chain reaction, and successfully identified its drug susceptibility.


Assuntos
Mordeduras e Picadas/complicações , Capnocytophaga/patogenicidade , Endocardite Bacteriana/etiologia , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Negativas/terapia , Animais , Antibacterianos/uso terapêutico , Hemocultura , Capnocytophaga/genética , Cefazolina/uso terapêutico , Ceftriaxona/uso terapêutico , Cães , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/terapia , Gentamicinas/uso terapêutico , Infecções por Bactérias Gram-Negativas/microbiologia , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase/métodos , Sepse/tratamento farmacológico , beta-Lactamases
12.
BMC Infect Dis ; 19(1): 928, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684890

RESUMO

BACKGROUND: Endemic presence of Klebsiella pneumoniae resistant to carbapenem in Italy has been due principally to the clonal expansion of CC258 isolates; however, recent studies suggest an ongoing epidemiological change in this geographical area. METHODS: 50 K. pneumoniae strains, 25 carbapenem-resistant (CR-Kp) and 25 susceptible (CS-Kp), collected from march 2014 to march 2016 at the Laboratory of Bacteriology of the Paolo Giaccone Polyclinic University hospital of Palermo, Italy, were characterized for antibiotic susceptibility and fully sequenced by next generation sequencing (NGS) for the in silico analysis of resistome, virulome, multi-locus sequence typing (MLST) and core single nucleotide polymorphism (SNP) genotypes RESULTS: MLST in silico analysis of CR-Kp showed that 52% of isolates belonged to CC258, followed by ST395 (12%), ST307 (12%), ST392 (8%), ST348 (8%), ST405 (4%) and ST101 (4%). In the CS-Kp group, the most represented isolate was ST405 (20%), followed by ST392 and ST15 (12%), ST395, ST307 and ST1727 (8%). The in silico ß-lactamase analysis of the CR-Kp group showed that the most detected gene was blaSHV (100%), followed by blaTEM (92%), blaKPC (88%), blaOXA (88%) and blaCTX-M (32%). The virulome analysis detected mrk operon in all studied isolates, and wzi-2 was found in three CR-Kp isolates (12%). Furthermore, the distribution of virulence genes encoding for the yersiniabactin system, its receptor fyuA and the aerobactin system did not show significant distribution differences between CR-Kp and CS-Kp, whereas the Klebsiella ferrous iron uptake system (kfuA, kfuB and kfuC genes), the two-component system kvgAS and the microcin E495 were significantly (p < 0.05) prevalent in the CS-Kp group compared to the CR-Kp group. Core SNP genotyping, correlating with the MLST data, allowed greater strain tracking and discrimination than MLST analysis. CONCLUSIONS: Our data support the idea that an epidemiological change is ongoing in the Palermo area (Sicily, Italy). In addition, our analysis revealed the co-existence of antibiotic resistance and virulence factors in CR-Kp isolates; this characteristic should be considered for future genomic surveillance studies.


Assuntos
Farmacorresistência Bacteriana/genética , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Fatores de Virulência/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Técnicas de Tipagem Bacteriana , Carbapenêmicos/farmacologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Genótipo , Humanos , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/classificação , Klebsiella pneumoniae/isolamento & purificação , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Filogenia , Polimorfismo de Nucleotídeo Único , Sicília , beta-Lactamases/genética
13.
J Med Microbiol ; 68(12): 1740-1746, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31718745

RESUMO

Introduction. One of the most important resistant mechanisms in Gram-negative bacteria is extended spectrum ß-lactamases (ESBLs). Harbour-related genes on plasmids, increase the risk of resistance transmission among commonly reported hospital infections.Aim. This study was designed to explore the dissemination of Pseudomonas aeruginosa producing ESBLs on their plasmids recovered from the different wards of Amir-Al-Momenin burn center, Affiliated with Shiraz University of Medical Sciences.Methodology. Among 256 isolates, 88 (34.38 %) P. aeruginosa strains were isolated from burn hospitalized patients. Samples were processed for antibiotic resistance using the Kirby-Bauer method while MIC was performed for colistin. MIC was used by the microdilution broth method as recommended by Clinical and Laboratory Standards Institute guidelines. Related studied genes were evaluated on extracted plasmids by the PCR method.Results. According to the phenotypic and molecular steps, a total of 58 (65.91 %) and 74 (84.10 %) strains detected positive ESBLs, respectively. Based on antibiogram tests, a total of 63 (71.59 %) isolates were detected as multidrug resistant. All ESBL P. aeruginosa isolates showed identical antimicrobial susceptibility profiles. The genotypic prevalence of ESBLs for bla SHV, bla TEM, bla GES, bla OXA-10 and bla PSE genes was 47.73, 78.41, 5.58, 3.41, 4.55 %, respectively.Conclusion. All P. aeruginosa strains producing ESBLs had plasmids containing related genes. The data indicated a high prevalence of ESBL among P. aeruginosa isolates in the southwest of the Iran burn center and their enzyme types were diverse.


Assuntos
Queimaduras/microbiologia , Plasmídeos , Pseudomonas aeruginosa/genética , beta-Lactamases/genética , Farmacorresistência Bacteriana Múltipla , Humanos , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/enzimologia
15.
Mem Inst Oswaldo Cruz ; 114: e190232, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31778426

RESUMO

BACKGROUND: Acinetobacter baumannii is a leading cause of nosocomial infections. This species is characterised by the presence of pandemic lineages (International Clones) that present a broad antimicrobial resistance profile. OBJECTIVE: To perform the molecular epidemiology of carbapenem-resistant A. baumannii from a clinical setting in the Amazon Basin, and to characterise their antimicrobial resistance determinants. METHODS: The genetic relationship of carbapenem-resistant A. baumannii were assessed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Class A, B and D ß-lactamase genes were screened by polymerase chain reaction (PCR) and sequencing. The antimicrobial susceptibility profile was obtained by Disc-diffusion method and minimum inhibitory concentration (MIC) determination. FINDINGS: All carbapenem-resistant A. baumannii strains belonged to three international clones, IC-1, IC-5 and IC-6, the latter recently reported by the first time in Brazil. The major determinant of carbapenem resistance in IC-1 and IC-5 strains was bla OXA-23, associated with ISAba1 and ISAba3, respectively, while IC-6 harboured the bla OXA-72. CONCLUSIONS: The A. baumannii epidemiology in Brazilian Amazon Region was unknown. It was demonstrated that A. baumannii XDR international clones were responsible for nosocomial infections in Boa Vista during 2016-2018, revealing that the epidemiological scenario of A. baumannii infections in Amazon Region resembles those from the cosmopolitan regions worldwide.


Assuntos
Infecções por Acinetobacter/virologia , Acinetobacter baumannii/genética , Antibacterianos/farmacologia , Farmacorresistência Bacteriana/genética , beta-Lactamases/genética , Acinetobacter baumannii/classificação , Acinetobacter baumannii/efeitos dos fármacos , Brasil , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Eletroforese em Gel de Campo Pulsado , Genótipo , Humanos , Tipagem de Sequências Multilocus , Fenótipo
16.
J Med Microbiol ; 68(12): 1723-1731, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31746726

RESUMO

Introduction. Carbapenems are often described as the most effective weapon against infections caused by multidrug-resistant bacteria especially those belonging to the group of non-fermenting bacteria such as Pseudomonas. The main mechanisms leading to resistance are the hyperexpression of certain efflux pumps belonging to the resisto-nodular division and the lower expression of the transmembrane porin OprD, sometimes in combination with excessive production of the intrinsic AmpC. Carbapenemases are assumed to play a secondary role.Aim. The aim of this study was to determine the exact mechanisms of carbapenem resistance in Pseudomonas aeruginosa isolates from the largest Bulgarian University hospital 'St. George'- Plovdiv.Methodology. A total of 32 clinical isolates collected from different patients' samples resistant to imipenem and/or meropenem were examined via phenotypic and molecular-genetic tests.Results. No metallo-enzyme production was detected. Three isolates were positive for OXA-50-encoding genes in two of them in combination with other oxacillinases or the bla VEB-1 gene. For the first time, OXA-50-producing P. aeruginosa have been reported in Bulgaria. The increased expression or hyperexpression of MexXY-OprM efflux pump was observed as the main mechanism of resistance. In most cases, it was combined with lower expression or lack of OprD with or without MexAB-OprM hyperexpression. No excessive production of AmpC was detected in comparison to the reference ATCC 27853 P. aeruginosa strain.Conclusion. The increased expression or overexpression of MexXY-OprM efflux pumps is the leading cause of carbapenem resistance in our isolates Pseudomonas, detected in 94 % of the bacteria investigated.


Assuntos
Proteínas de Bactérias/análise , Proteínas de Bactérias/fisiologia , Carbapenêmicos/farmacologia , Porinas/fisiologia , Pseudomonas aeruginosa/isolamento & purificação , beta-Lactamases/análise , beta-Lactamases/fisiologia , Farmacorresistência Bacteriana , Humanos , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/enzimologia
17.
BMC Infect Dis ; 19(1): 900, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660862

RESUMO

BACKGROUND: Carbapenem resistance among Acinetobacter species has become a life-threatening problem. As a last resort in the treatment of gram-negative bacteria infection, resistance to colistin is also a serious problem. The aim of study was to analyze the mechanism of resistance and perform genotyping of carbapenem-resistant Acinetobacter from clinical infection and fecal survey samples in Southern China. METHODS: One hundred seventy and 74 carbapenem-resistant Acinetobacter were isolated from clinical infection samples and fecal survey samples, respectively. We detected the related genes, including carbapenemase genes (blaKPC, blaIMP, blaSPM, blaVIM, blaNDM, blaOXA-23-like, blaOXA-24/40-like, blaOXA-51-like, and blaOXA-58-like), colistin resistance-related genes (mcr-1, mcr-2, mcr-3, mcr-4, and mcr-5), a porin gene (carO), efflux pump genes (adeA, adeB, adeC, adeI, adeJ, and adeK), mobile genetic element genes (intI1, intI2, intI3, tnpU, tnp513, IS26, ISAba1, and ISAba125), and the integron variable region. Genotyping was analyzed by enterobacterial repetitive intergenic consensus (ERIC)-PCR and dendrogram cluster analysis. RESULTS: Among the 244 carbapenem-resistant Acinetobacter, the common carbapenemase-positive genes included the following: blaOXA-51-like, 183 (75.00%); blaOXA-23-like, 174 (71.30%); blaNDM-1, 57 (23.40%); and blaOXA-58-like, 30 (12.30%). The coexistence of mcr-1 and blaNDM-1 in five strains of A. junii was found for the first time. Eleven distinct carO gene variants were detected in 164 (67.20%) strains, and ten novel variants, which shared 92-99% identity with sequences in the Genbank database, were first reported. Efflux system genes were present in approximately 70% of the isolates; adeABC and adeIJK were observed in 76.23 and 72.13%, respectively. Class 1 integrons were detected in 180 (73.80%) strains and revealed that four gene cassette arrays contained 11 distinct genes. The genotyping by ERIC-PCR demonstrated a high genetic diversity of non-baumannii Acinetobacter, and greater than 90% similarity to A. baumannii. CONCLUSIONS: The blaNDM-1 gene was identified in up to 77% of the carbapenem-resistant Acinetobacter isolated from fecal survey samples, indicating that the gut might be a reservoir of resistant opportunistic bacteria. Intestinal bacteria can be transmitted through the fecal-hand, which is a clinical threat, thus, the monitoring of carbapenem-resistant bacteria from inpatients' feces should be improved, especially for patients who have been using antibiotics for a long time.


Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Acinetobacter baumannii/genética , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Carbapenêmicos/efeitos adversos , Carbapenêmicos/uso terapêutico , Farmacorresistência Bacteriana/genética , Acinetobacter baumannii/isolamento & purificação , Proteínas de Bactérias/genética , China , Colistina/efeitos adversos , Colistina/uso terapêutico , Doenças Transmissíveis/tratamento farmacológico , Fezes/microbiologia , Variação Genética , Genótipo , Humanos , Integrons/genética , Testes de Sensibilidade Microbiana , Reação em Cadeia da Polimerase/métodos , Análise de Sequência de DNA , beta-Lactamases/genética
18.
BMC Infect Dis ; 19(1): 897, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660887

RESUMO

BACKGROUND: The impact of animals sources of food as a possible reservoir for extended-spectrum ß-lactamase (ESBL) - Producing E. coli, and the dissemination of such strains into the food production chain need to be assessed. This study was aimed to assess the presence and antimicrobial susceptibility patterns of ESBLs - producing E. coli isolates from minced meat and environmental swab samples at meat retailer shops of Jimma town, Southwest Ethiopia. METHODOLOGY: A cross-sectional descriptive study was conducted from March to June, 2016. A total of 168 minced meat and swab samples were first enriched by buffered peptone water (BPW) for overnight and streaked onto MacConkey agar. Double disk synergy (DDS) method was used for detection of ESBL-producing strains. A disk of amoxicillin + clavulanic acid (20/10 µg) was placed in the center of Mueller-Hinton agar plate, and cefotaxime (30 µg) and ceftazidime (30 µg) were placed at a distance of 20 mm from the central disk. Checklist was used to assess hygienic status of butcher shops and practices meat handlers. RESULTS: A total of 35 (20.80%) biochemically confirmed E. coli were obtained from 168 samples. Of these, 21 (23.9%) of them were detected from 88 minced meat and the other 14 (17.5%) from 80 swab samples taken from butcher's hand, knives, chopping board and protective clothing. From 35 E. coli isolates, 7(20%) of them were confirmed as ESBL- producers. Among ESBL- producing strains, 85.7% were resistant for cefotaxime and ceftriaxone and 71.4% for ceftazidime. Among non-ESBLs-producing strains only seven isolates were resistant to third generation cephalosporin. All E. coli isolates were resistant to ampicillin, penicillin and erythromycin, and susceptible to amikacin. Poor hygienic status of butcher shops and unhygienic practice of meat handlers were observed. CONCLUSION: The detections of ESBLs- producing strains could be contributed for the increment of multi drug resistant isolates. This study also concluded that, unhygienic meat handling and processing practice can contribute for contaminations of meat. Thus, strategies should be planned and implemented to improve the knowledge and practice of butchers about handling and processing of meat.


Assuntos
Escherichia coli/enzimologia , Microbiologia de Alimentos/métodos , Carne/microbiologia , Saúde do Trabalhador , beta-Lactamases/análise , Animais , Bovinos , Vestuário , Estudos Transversais , Farmacorresistência Bacteriana Múltipla , Escherichia coli/classificação , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/prevenção & controle , Etiópia , Mãos/microbiologia , Higiene das Mãos , Humanos , Testes de Sensibilidade Microbiana
19.
J Med Microbiol ; 68(12): 1707-1715, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31661049

RESUMO

Purpose. Carbapenemase-producing Enterobacteriaceae (CPE) have become a global concern and a serious threat to human health due to their resistance to multiple antibiotics. In this study, we identified and characterized CPE for the first time in Malawi, southeastern Africa.Methodology. We investigated the possible presence of carbapenemases among a collection of 200 ceftriaxone-nonsusceptible Gram-negative clinical isolates obtained from five Malawian hospitals between January 2016 and December 2017, using both phenotypic and genotypic tests. Molecular typing of CPE was done by PFGE, multilocus sequence typing (ST) or phylogenetic grouping. Resistant plasmids were characterized by S1 PFGE, Southern blotting and conjugation assays.Results. Out of 200 isolates, we detected 16 (8 %) CPE of which all originated from one referral hospital, Kamuzu Central Hospital, in the Central part of Malawi. Of 16 isolates, seven Klebsiella pneumoniae ST340/CC258 carried bla KPC-2, two Escherichia coli ST636 (phylogroup B2) carried bla NDM-5, six E. coli ST617 (phylogroup A) and one Klebsiella variicola carried bla OXA-48. All carbapenemases were plasmid-encoded, but only bla NDM-5-carrying plasmids could be conjugated. Most isolates co-harboured other ß-lactamases and consequently exhibited a wider spectrum of resistance to commonly used antibiotics. We observed indistinguishable genetic profiles between strain types, despite originating from different wards, suggesting acquisition during admission and intra-hospital spread.Conclusion. This report strongly suggests a probable existence of highly resistant various types of CPE organisms in Malawi including KPC-2-producing K. pneumoniae ST340/CC258, a known high-risk epidemic lineage.


Assuntos
Proteínas de Bactérias/biossíntese , Enterobacteriaceae/isolamento & purificação , beta-Lactamases/biossíntese , Farmacorresistência Bacteriana Múltipla , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/enzimologia , Enterobacteriaceae/genética , Genoma Bacteriano , Humanos , Testes de Sensibilidade Microbiana
20.
N Engl J Med ; 381(21): 2043-2050, 2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31665575

RESUMO

Fecal microbiota transplantation (FMT) is an emerging therapy for recurrent or refractory Clostridioides difficile infection and is being actively investigated for other conditions. We describe two patients in whom extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli bacteremia occurred after they had undergone FMT in two independent clinical trials; both cases were linked to the same stool donor by means of genomic sequencing. One of the patients died. Enhanced donor screening to limit the transmission of microorganisms that could lead to adverse infectious events and continued vigilance to define the benefits and risks of FMT across different patient populations are warranted.


Assuntos
Bacteriemia/etiologia , Disbiose/terapia , Escherichia coli/isolamento & purificação , Transplante de Microbiota Fecal/efeitos adversos , Fezes/microbiologia , Idoso , Bacteriemia/microbiologia , Farmacorresistência Bacteriana , Disbiose/etiologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/metabolismo , Evolução Fatal , Encefalopatia Hepática/complicações , Encefalopatia Hepática/terapia , Humanos , Masculino , Síndromes Mielodisplásicas/complicações , Síndromes Mielodisplásicas/terapia , beta-Lactamases/metabolismo
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