Investigation of extended-spectrum beta-lactamases produced by clinical isolates of Klebsiella pneumoniae and Escherichia coli in Korea

AIMS: Isolates obtained from various regions in Korea in 2002 were identified and their susceptibility to extended-spectrum cephalosporins, monobactams and/or cephamycins was studied along with any production of extended-spectrum beta-lactamases (ESBLs). METHODS AND RESULTS: Bacteria identified by the conventional techniques and Vitek GNI card were Klebsiella pneumoniae and Escherichia coli. Using disk diffusion and double-disk synergy tests, we found that 39.2% of strains produced ESBLs. About 52% of isolates transferred resistance to ceftazidime by conjugation. Banding patterns of PCR amplification with the designed primers showed that 837- and 259-bp fragments specific to bla(TEM) genes were amplified in 63.3% of strains. 929- and 231-bp fragments (bla(SHV)), 847- and 520-bp fragments (bla(CMY)), 597- and 858-bp fragments (bla(CTX-M)) were amplified in 61.5, 17.3 and 7.7% of strains respectively. About 51.9% of strains contained more than two types of beta-lactamase genes. Especially, one strain contained bla(TEM), bla(CMY) and bla(CTX-M) genes. SIGNIFICANCE: Resistance mechanisms to beta-lactams, comprising mostly ESBL production, lead to the resistance against even recently developed beta-lactams in enterobacteria, which is now a serious threat to antibiotic therapy. The high prevalence of bla(CMY) genes and multidrug-resistant genes may also make therapeutic failure and lack of eradiation of these strains by extended-spectrum cephalosporins or cephamycins.     

Diversity of CTX-M beta-lactamases and their promoter regions from Enterobacteriaceae isolated in three Parisian hospitals

Nine clinical isolates of Enterobacteriaceae (six Escherichia coli and three Proteus mirabilis) isolated in three Parisian hospitals between 1989 and 2000 showed a particular extended-spectrum cephalosporin-resistance profile characterized by resistance to cefotaxime and aztreonam but not to ceftazidime. CTX-M-1, CTX-M-2, CTX-M-9, CTX-M-14 and two novel plasmid-mediated CTX-M beta-lactamases (CTX-M-20, and CTX-M-21) were identified by polymerase chain reaction and isoelectric focusing (pI>8) and were associated in eight cases with TEM-1 (pI=5.4) or TEM-2 (pI=5.6) beta-lactamases. We used internal ISEcp1 and IS26 forward primers and the CTX-M consensus reverse primer to characterize the CTX-M beta-lactamase promoter regions and showed their high degree of structure diversity. We found upstream of some bla(CTX-M) genes, a 266-bp sequence 100% identical to the sequence upstream of the Kluyvera ascorbata beta-lactamase gene, suggesting that this chromosomal enzyme is the progenitor of the CTX-M-2/5 cluster.     

Migratory birds as the vehicle of transmission of multi drug resistant extended spectrum β lactamase producing Escherichia fergusonii,an emerging zoonotic pathogen

The acquisition of multi-drug resistance (MDR) genes by pathogenic bacterial bugs and their dispersal to different food webs has become a silent pandemic. The multiplied use of different antibacterial therapeutics during COVID-19 pandemic has accelerated the process among emerging pathogens. Wild migratory birds play an important role in the spread of MDR pathogens and MDR gene flow due to the consumption of contaminated food and water. Escherichia fergusonii is an emerging pathogen of family Enterobacteriaceae and commonly causes disease in human and animals. The present study focused on the isolation of E. fergusonii from blood, saliva, and intestine of selected migratory birds of the Hazara Division. The sensitivity of isolated strains was assessed against ten different antibiotics. The isolation frequency of E. fergusonii was 69%. In blood samples, a high rate of resistance was observed against ceftriaxone (80%) followed by ampicillin (76%) whereas, in oral and intestinal samples, ceftriaxone resistant strains were 56% and 57% while ampicillin resistance was 49% and 52% respectively. The overall ceftriaxone and ampicillin-resistant cases in all three sample sources were 71% and 65% respectively. In comparison to oral and intestinal samples, high numbers of ceftriaxone-resistant strains were isolated from the blood of mallard while ampicillin-resistant strains were observed in blood samples of cattle egrets. 16S rRNA-based confirmed strains of E. fergusonii were processed for detection of CTX-M and TEM-1 gene through Polymerase chain reaction (PCR) after DNA extraction. Hundred percent ceftriaxone resistant isolates possessed CTX-M and all ampicillin-resistant strains harbored TEM-1 genes. Amplified products were sequenced by using the Sanger sequencing method and the resulted sequences were checked for similarity in the nucleotide Database through the BLAST program. TEM-1 gene showed 99% and the CTX-M gene showed 98% similar sequences in the Database. The 16S rRNA sequence and nucleotide sequences for TEM-1 and CTX-M genes were submitted to Gene Bank with accession numbers LC521304, LC521306, LC521307 respectively. We posit to combat MDR gene flow among the bacterial pathogens across different geographical locations, regular surveillance of new zoonotic pathogens must be conducted.     

市售畜禽肉产CTX-M酶大肠杆菌的流行病学调查

【目的】调查市售畜禽肉类中大肠杆菌的耐药状况和bla_CTX-M基因的流行病学特征。【方法】采集广州市不同区域零售市场和超市畜禽肉类样品进行大肠杆菌的分离,通过基因phoA扩增和测序进行大肠杆菌鉴定,采用琼脂扩散法和微量肉汤稀释法测定药物敏感性,通过PCR扩增检测bla_CTX-M基因,对bla_CTX-M阳性大肠杆菌进行全基因组测序。【结果】从323份市售畜禽肉样品中分离获得大肠杆菌241株;药物敏感性结果表明大肠杆菌对氨苄西林(63.07%)、多西环素(47.72%)和复方新诺明(43.15%)耐药率较高;bla_CTX-M基因检出率为3.32%(n=8),其中4株携带bla_CTX-M-14,3株携带bla_CTX-M-65,1株携带bla_CTX-M-55;8株产CTX-M大肠杆菌可分为4种不同的ST型,且携带多种耐药基因和毒力基因。【结论】市售畜禽肉中大肠杆菌污染严重。产CTX-M酶大肠杆菌均为多重耐药菌株,且bla_CTX-M<...     

CTX-M型阴沟肠杆菌插入序列的检测

目的研究插入序列ISEcp1B及超广谱β-内酰胺酶(extended spectrum beta-lactamase,ESBLs)、AmpC酶基因在CTX-M型阴沟肠杆菌(Enterobacter cloacae,ECL)中的分布,并分析其与耐药的关系。方法用MIC法分析2株含CTX-M基因的阴沟肠杆菌的耐药性;用多重聚合酶链反应(PCR)技术扩增ESBLs、AmpC、ISEcp1B基因及I类整合子,对PCR产物进行DNA测序。结果 2株阴沟肠杆菌对青霉素类、四代头孢菌素、喹诺酮类和呋喃类抗生素耐药,对氨基糖苷类和碳青霉烯类表现为敏感。在ECL15同时检出TEM、CTX-M-G1、ACT-1、I类整合子及ISEcp1B基因;在ECL45同时检出SHV、CTX-M-G1及ISEcp1B基因。ECL45(400 bp)ISEcp1B的右端均连接一个反向重复序列,有-35及-10两个启动子,与CTX-M型ESBLs编码起始距离不相同,与ECL15序列一致,GenBank登录号:EF437434;ECL45(500 bp)无反向重复序列,只有一个-35启动子,与CTX-M型ESBLs编码起始距离不相同,与ECL15序列不相同,GenBank登录号:EF441350。结论在CTX-M型阴沟肠杆菌中检出2种新的插入序列ISEcp1B,其对CTX-M的高水平表达和传播可能起重要的调控作用。     

Dissemination of transferable CTX-M-type extended-spectrum beta-lactamase-producing Escherichia coli in Korea

AIMS: Among 365 Escherichia coli isolated in 2003, 31 cefotaxime-resistant isolates were obtained from clinical specimens taken from adults hospitalized in Busan, Korea. Six extended-spectrum beta-lactamase (ESBL)-producing isolates were investigated further to determine the mechanism of resistance. METHODS AND RESULTS: These isolates were analysed by antibiotic susceptibility testing, pI determination, plasmid profiles, transconjugation test, PCR-restriction fragment length polymorphism (RFLP), enterobacterial repetitive consensus (ERIC)-PCR and DNA sequencing. All six of these isolates were found to contain the CTX-M-type ESBL genes. Five clinical isolates and their transconjugants produced CTX-M-3. One clinical isolate (K17391) and its transconjugant (trcK17391) produced CTX-M-15. Five clinical isolates also produced another TEM-1. One clinical isolate (K12776) also contained another TEM-52. CTX-M-3 ESBL gene was responsible for the resistance to piperacillin, cephalothin, cefotaxime, cefepime and aztreonam. CTX-M-15 or TEM-52 was especially responsible for the resistance to ceftazidime. CONCLUSIONS: These results appear to represent the in vivo evolution of CTX-M-type beta-lactamase genes (bla(CTX-M-3) --> bla(CTX-M-15)) under the selective pressure of antimicrobial therapy (especially ceftazidime). PCR-RFLP is a reliable method to discriminate CTX-M-15 gene from CTX-M-3 gene. ERIC-PCR analysis revealed that dissemination of CTX-M-3 was not due to a clonal outbreak of a resistant strain but to the intra-species spread of resistance to piperacillin, cephalothin, cefotaxime, cefepime and aztreonam in Korea. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first report of the occurrence of CTX-M-1 cluster ESBLs in Korea. A more comprehensive survey of these ESBL types from Korea is urgently needed because of the in vivo evolution of CTX-M-15 from CTX-M-3. The emergence of these CTX-M-type ESBLs suggests that diagnostic laboratories should screen for ESBLs with ceftazidime as well as cefotaxime; they should still perform clavulanate synergy tests on resistant isolates.     

Evidence for convergent evolution of CTX-M-14 ESBL in Escherichia coli and its prevalence

A total of 2440 Escherichia coli strains isolated in 2003 at the Hospital de la Santa Creu i Sant Pau were evaluated for the presence of extended-spectrum beta-lactamases. Two different nucleotide sequences that encode the same beta-lactamase, CTX-M-14, were detected when the bla(CTX-M-14)-genes of 35 E. coli isolates were analysed. Thirty-two of the 35 had the previously described sequence of the bla(CTX-M-14) (AF252622), named bla(CTX-M-14a), and the remaining three isolates showed a nucleotide sequence identical to that of the bla(CTX-M-9) gene except for one nucleotide, named bla(CTX-M-14b). Characterisation of the regions surrounding the bla(CTX-M-14a) showed the ISEcp1 and the IS903 upstream and downstream, respectively, of the bla gene, whereas the regions surrounding the bla(CTX-M-14b) contained the genetic environment described for the bla(CTX-M-9) gene, the In60. Characterisation by hybridisation showed that the bla(CTX-M-14a) was present in IncK plasmids, whereas the bla(CTX-M-14b) was found in the HI2 Inc group. The CTX-M-14 ESBL in E. coli isolates is the result of the convergence of two different genes.     

High presence of extended-spectrum beta-lactamases and resistance to quinolones in clinical isolates of Escherichia coli

A study was conducted to detect the presence of extended-spectrum β-lactamases (ESBLs) in 706 isolates of Escherichia coli, largely from outpatients (75.2%). The Clinical and Laboratory Standards Institute (formerly NCCLS)-recommended disk diffusion procedure was used to detect ESBL presence; the VITEK 2 system (bioMérieux, Marcy L’Etoile, France) was used to determine the susceptibility to antibiotics of clinical interest, and the ESBLs were characterized by biochemical study, determining the isoelectric point, and by molecular study with PCR. Clonal distribution was studied in eight hospital isolates. There were 115 ESBL-producing isolates (16.3%), with a predominance of CTX-M9 type (58.3%). We draw attention to the high resistance to quinolones (>70%) in CTX-M9 and SHV enzyme producing isolates and the lower aminoglycoside activity in the latter.     

产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌blaCTX-M基因的检测

目的了解产CTX-M型超广谱β-内酰胺酶 (ESBLs) 大肠埃希菌和肺炎克雷伯菌在深圳市人民医院的分布情况.方法应用美国国家临床实验室标准化委员会(NCCLS)推荐的表型确证试验,从2000年6月～2003年8月该院临床标本分离株中筛选出不重复的产ESBLs菌株215株,其中大肠埃希菌151株,肺炎克雷伯菌64株,应用聚合酶链反应(PCR)检测所有产ESBLs株的bla(CTX-M)基因.结果 PCR结果显示,大肠埃希菌bla(CTX-M)基因阳性率为92.1%(139/151),肺炎克雷伯菌的阳性率为65.6%(42/64).bla(CTX-M)基因阳性菌株主要来源于临床送检尿和痰标本,并广泛分布于20多个临床科室.结论该院临床分离的大肠埃希菌和肺炎克雷伯菌产生的ESBL大多数为CTX-M型,该类酶广泛分布于各临床科室,需引起重视.     

Migratory birds as the vehicle of transmission of multi drug resistant extended spectrum β lactamase producing Escherichia fergusonii,an emerging zoonotic pathogen

The acquisition of multi-drug resistance (MDR) genes by pathogenic bacterial bugs and their dispersal to different food webs has become a silent pandemic. The multiplied use of different antibacterial therapeutics during COVID-19 pandemic has accelerated the process among emerging pathogens. Wild migratory birds play an important role in the spread of MDR pathogens and MDR gene flow due to the consumption of contaminated food and water. Escherichia fergusonii is an emerging pathogen of family Enterobacteriaceae and commonly causes disease in human and animals. The present study focused on the isolation of E. fergusonii from blood, saliva, and intestine of selected migratory birds of the Hazara Division. The sensitivity of isolated strains was assessed against ten different antibiotics. The isolation frequency of E. fergusonii was 69%. In blood samples, a high rate of resistance was observed against ceftriaxone (80%) followed by ampicillin (76%) whereas, in oral and intestinal samples, ceftriaxone resistant strains were 56% and 57% while ampicillin resistance was 49% and 52% respectively. The overall ceftriaxone and ampicillin-resistant cases in all three sample sources were 71% and 65% respectively. In comparison to oral and intestinal samples, high numbers of ceftriaxone-resistant strains were isolated from the blood of mallard while ampicillin-resistant strains were observed in blood samples of cattle egrets. 16S rRNA-based confirmed strains of E. fergusonii were processed for detection of CTX-M and TEM-1 gene through Polymerase chain reaction (PCR) after DNA extraction. Hundred percent ceftriaxone resistant isolates possessed CTX-M and all ampicillin-resistant strains harbored TEM-1 genes. Amplified products were sequenced by using the Sanger sequencing method and the resulted sequences were checked for similarity in the nucleotide Database through the BLAST program. TEM-1 gene showed 99% and the CTX-M gene showed 98% similar sequences in the Database. The 16S rRNA sequence and nucleotide sequences for TEM-1 and CTX-M genes were submitted to Gene Bank with accession numbers {"type":"entrez-nucleotide","attrs":{"text":"LC521304","term_id":"1806500528","term_text":"LC521304"}}LC521304, {"type":"entrez-nucleotide","attrs":{"text":"LC521306","term_id":"1806500530","term_text":"LC521306"}}LC521306, {"type":"entrez-nucleotide","attrs":{"text":"LC521307","term_id":"1806500532","term_text":"LC521307"}}LC521307 respectively. We posit to combat MDR gene flow among the bacterial pathogens across different geographical locations, regular surveillance of new zoonotic pathogens must be conducted.