The emergence and spread of carbapenem-resistant gram-negative bacteria poses a serious threat to human health worldwide. Currently, little is known about the molecular mechanisms underlying carbapenem resistance and their prevalence among gram-negative bacteria in Egypt. In this study, we analyzed carbapenemase production in gram-negative bacteria isolated from hospitalized patients in Egypt in 2014. All isolates were subjected to phenotypic and genotypic susceptibility testing for carbapenem resistance. Our results indicated a high level of carbapenem-resistant gram-negative bacteria in Egypt, with 50.8% of the isolates harboring at least one carbapenem resistance gene. OXA-48-like and NDM-1 were the most prevalent carbapenemases, being detected in 49.2%, and 47.7% of carbapenemase-positive isolates, respectively, whereas Verona integron-encoded metallo-β-lactamase (VIM) was detected in only 26.2% of carbapenemase-positive isolates. This study reports for the first time carbapenemase-producing Serratia marcescens, Morganella morganii, and bla-producing Pseudomonas aeruginosa in Egypt. It is also the first demonstration of the coexistence of different carbapenemases, being detected in 21.5% of carbapenemase-positive isolates. Effective antibiotic supervision, regional surveillance, and early detection of carbapenemase producers are imperative to prevent their future spread to epidemic levels.
C olistin is considered a last resort for the treatment of infections caused by carbapenemase-producing members of the family Enterobacteriaceae. Recently, a transferable plasmid conferring resistance to colistin was discovered in Escherichia coli and Klebsiella pneumoniae from China (1) and was then reported in various bacteria from many other countries (2-4). This spread of antibiotic resistance heralds a return to the preantibiotic era, especially with no new antibiotics in the pipeline. The plasmid-mediated colistin resistance gene mcr-1 has been identified mainly in bacterial species from animals and animal products (pork and chicken meat) (1, 2). However, it was also detected in humans, i.e., patients (1-4), asymptomatic people (5), and some people by whom it was community acquired (6). Therefore, we used PCR and DNA sequencing to screen for the presence of mcr-1 in 241 nonduplicate Gram-negative clinical bacterial isolates collected from hospitals in different cities in Egypt during 2015. A universal primer pair, CLR5-F (5=-CGGTCAGTCCGTT TGTTC-3=) and CLR5-R (5=-CTTGGTCGGTCTGTAGGG-3=), was used for screening as previously described (1). In addition, the entire mcr-1 region was amplified and sequenced with MCR-1-F2 (5=-CTCATGATGCAGCATACTTC-3=) and MCR-1-R2 (5=-CGAATGGAGTGTGCGGTG-3=), which were based on the consensus sequences that flank mcr-1 (GenBank accession no. KP347127). Analysis showed that mcr-1 was present in only one E. coli isolate (SP-1), which was from the sputum of a patient with bacteremia who was hospitalized in the intensive care unit of a Cairo City hospital with no history of traveling abroad. The MIC of both colistin and polymyxin B for this isolate was 16 mg/liter. E. coli SP-1 had phenotypic resistance to colistin, ciprofloxacin, nalidixic acid, kanamycin, tetracycline, chloramphenicol, ceftriaxone, ampicillin, and cefotaxime but was susceptible to carbapenems. Multilocus sequence typing (MLST) indicated that E. coli SP-1 belonged to sequence type 1011 (ST1011), which differed from sequence types identified for clinical E. coli isolates harboring mcr-1 in Denmark (ST744) (2) and Cambodia (ST354) (3). According to the MLST database (http://mlst.ucc.ie/mlst/mlst /dbs/Ecoli), E. coli ST1011 was reported in humans in Egypt and in cats and swine in Germany. Of note, E. coli ST1011 was detected previously as an avian fecal E. coli strain in Egypt (7) and it was found to be shared by avian pathogenic E. coli and human extraintestinal pathogenic E. coli by phylogenetic grouping in Brazil (8). Also, it was found as CTX-M-64-harboring E. coli isolates from chickens in China (9). Therefore, E. coli ST1011 may have potential zoonotic importance. Southern hybridization showed that mcr-1 was located on a plasmid of Ͼ90 kb. This plasmid was successfully transferred to E. coli J53 recipient cells through conjugation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.