Emergence of Enterobacteriaceae producing extended-spectrum β-lactamases (ESBLs) in the community

Pitout, Johann; Nordmann, Patrice; Laupland, Kevin B.; Poirel, Laurent

doi:10.1093/jac/dki166

Cited by 699 publications

(554 citation statements)

References 71 publications

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“…The multidrug resistance of bla CTX-M is due to the association of Class I integrons responsible for resistance to b-lactams, aminoglycosides, cholarmphenicol, sulphonamides [17]. All of the isolates were 100% resistant to cefepime, the fourth generation cephalosporin, which correlates with the finding that cefipime resistance may be more frequent in strains which produce the CTX-M-type ESBLs [18].…”

Section: Antibiotic Susceptibility Testingmentioning

confidence: 69%

Study of CTX-M Type of Extended Spectrum β-Lactamase among Nosocomial Isolates of Escherichia coli and Klebsiella pneumoniae in South India

et al. 2011

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Data on CTX-M type extended-spectrum b-lactamase (ESBL) produced by Gram-negative bacteria by molecular methods are limited from India. This study was conducted to investigate the prevalence of CTX-M type ESBL producing Escherichia coli and Klebsiella pneumoniae from nosocomial isolates in a tertiary care hospital in southern India. A total of 179 clinical isolates of K. pneumoniae (n = 72) and E. coli (n = 107) were obtained in a period of 3 months and assessed for ESBL production phenotypically. Associated resistance to a panel of antibiotics and Minimum Inhibitory Concentration for 3rd generation cephalosporins was determined. Phenotypically ESBL positive isolates were subjected to PCR for bla CTX-M gene using two sets of primers for the simultaneous detection of all the five major groups of CTX-M types. All the positive isolates were then subjected to a group specific PCR to detect the prevalent group. Out of 179 isolates, 156 (87.1%) were positive for ESBL phenotypically, which includes 39.2% of K. pneumoniae and 60.8% of E. coli. All of them were examined by PCR using two primers for the presence of bla CTX-M genes. Among the 156 phenotypic positive isolates, 124 (79.4%) were positive for bla CTX-M genes, of which 45 (36.2%) were K. pneumoniae, 79 (63.7%) were E. coli. When the 124 positive clinical isolates were further tested with CTX-M group-specific primers, all were positive for the CTX-M-1 group. Our findings document evidence of the high prevalence of multidrug resistant CTX-M group 1 type ESBL among nosocomial isolates in this region. High co-resistance to other non-b-lactam antibiotics is a major challenge for management of ESBL infections. This is alarming and calls for the judicious use of carbapenems, especially in developing countries. This has significant implications for patient management, and indicates the need for increased surveillance and for further molecular characterization of these isolates.

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Section: Antibiotic Susceptibility Testingmentioning

confidence: 69%

Study of CTX-M Type of Extended Spectrum β-Lactamase among Nosocomial Isolates of Escherichia coli and Klebsiella pneumoniae in South India

et al. 2011

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“…ST131 strains that produce CTX-M-15 have emerged since 2003 as important pathogens causing worldwide community-associated infections (Pitout et al, 2005). A study from Calgary demonstrated that travel to the Indian subcontinent was associated with high risk of community-onset infections with ESBL-producing E. coli in returning travellers .…”

Section: Resultsmentioning

confidence: 99%

Virulence potential and adherence properties of Escherichia coli that produce CTX-M and NDM β-lactamases

Peirano

Mulvey

Armstrong

et al. 2013

Journal of Medical Microbiology

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The success of certain sequence types such as ST131 that produce CTX-M or NDM blactamases, and ST405 that produce CTX-M b-lactamases, among extraintestinal Escherichia coli (ExPEC) had previously been linked to a combination of antimicrobial resistance and certain virulence factors. The adherence properties of these sequence types to gastro-intestinal epithelial cells had not been investigated. A study was therefore designed to investigate the phylogenetic groups, virulence factors and adherence properties of E. coli sequence types ST101, ST131 and ST405 that produce CTX-M-15 and NDM-1. Our results show that ST131 was positive for phylogenetic group B2, ST101 for B1 and ST404 for D. ST131 had more virulence factors than ST101 or ST405. Interestingly, ST101 adhered more avidly to HEp-2 and Caco-2 cells than did ST131 and ST405. Our study showed that adherence to gastro-intestinal cells did not seem to play an important role in the worldwide epidemiological success of ST131 and ST405. The exact role of ExPEC-associated virulence genes is unknown and it is unlikely that one set of factors determines the virulence properties and epidemiological success of certain sequence types. Future investigations should be undertaken to study the microbiological and ecological factors that make certain sequence types among ExPEC such successful pathogens. INTRODUCTIONEscherichia coli is an important cause of community and hospital-associated human infections and is responsible for considerable morbidity, mortality and increased health costs (Russo & Johnson, 2003). The management of infections due to extraintestinal E. coli (ExPEC) has been complicated by the emergence of antimicrobial resistance, especially since the late 1990s .b-Lactamases are bacterial enzymes that inactivate blactam antibiotics by hydrolysis, which results in ineffective compounds. Most important within ExPEC is the increasing recognition of isolates producing 'newer' b-lactamases that consist of extended-spectrum b-lactamases (ESBLs) (e.g. CTX-M types) and carbapenemases [e.g. metallo-blactamases (MBLs) such as the NDMs, serine b-lactamases such as KPCs and OXA-48-like enzymes] (Pitout, 2012). Since the late 1990s, CTX-M types of ESBL enzymes have emerged worldwide among E. coli, and have become the most widespread type of ESBL in the world . A new type of MBL, named NDM, has been described in Klebsiella pneumoniae and E. coli recovered from a Swedish patient who was previously hospitalized in New Delhi, India (Yong et al., 2009). Recent reports from the Indian subcontinent (including India, Pakistan and Bangladesh) show that the distribution of NDM b-lactamases among Enterobacteriaceae is widespread in these countries, while sporadic cases of infections due to bacteria with these enzymes have been reported from different parts of the world, including several countries in Europe, North America, the Middle East, Asia, Africa and Australia (Nordmann et al., 2011).Multilocus sequence typing (MLST), which uses sequence variation in a number of housekeeping gen...

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“…This structure is genetically linked to class 1 integrons known to integrate antibiotic-resistant gene cassettes responsible for resistance to β-lactams, aminoglycosides, chloramphenicol, sulphonamides, and to a lesser extent rifampicin. [3] The belief that organisms producing CTX-M enzymes display higher levels of resistance to cefotaxime than ceftazidime is not universal among all CTX-M producers. Majority of the isolates in our study conferred highlevel resistance to cefotaxime (>64 μg/mL) as well as to ceftazidime (>32 μg/mL) as evidenced by MIC determination (Table).…”

Section: Discussionmentioning

confidence: 99%

Detection of <i> Enterobacteriaceae</i> producing CTX-M extended spectrum β-lactamases from a tertiary care hospital in south India

Padmini¹,

Raju²,

Mani³

2008

Indian J Med Microbiol

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A total of 23 clinical isolates (15 Escherichia coli and 8 Klebsiella pneumoniae), resistant to cefotaxime and ceftazidime recovered during 2002 and 2003, were investigated for production of CTX-M extended spectrum β-lactamase (ESBL) by phenotypic and molecular methods. The presence of ESBL was tested by NCCLS phenotypic conÞ rmatory test using cephalosporin/clavulanate combination discs and E-test ESBL strips. Determination of MIC of cefotaxime and ceftazidime was done with and without the presence of clavulanic acid by agar dilution technique. Polymerase chain reaction revealed the presence of CTX-M type ESBLs in 19 isolates. Further sequencing resulted in identiÞ cation of CTX-M-15 ESBLs. This is the Þ rst report identifying CTX-M type ESBL from clinical isolates of E. coli and K. pneumoniae from a tertiary care hospital in south India.

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Emergence of Enterobacteriaceae producing extended-spectrum β-lactamases (ESBLs) in the community

Cited by 699 publications

References 71 publications

Study of CTX-M Type of Extended Spectrum β-Lactamase among Nosocomial Isolates of Escherichia coli and Klebsiella pneumoniae in South India

Study of CTX-M Type of Extended Spectrum β-Lactamase among Nosocomial Isolates of Escherichia coli and Klebsiella pneumoniae in South India

Virulence potential and adherence properties of Escherichia coli that produce CTX-M and NDM β-lactamases

Detection of <i> Enterobacteriaceae</i> producing CTX-M extended spectrum β-lactamases from a tertiary care hospital in south India

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