First Report of Group CTX-M-9 Extended Spectrum Beta-Lactamases in Escherichia coli Isolates from Pediatric Patients in Mexico

Mérida-Vieyra, Jocelin; Colsa, Agustin De; Castañeda, Yair Calderon; Barbosa, Patricia Arzate; Andrade, Alejandra Aquino

doi:10.1371/journal.pone.0168608

Cited by 10 publications

(9 citation statements)

References 67 publications

(74 reference statements)

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“…A notable example is the widespread CTX-M-9-group ESBL genes (e.g., bla CTX-M-9 , bla CTX-M-14 , bla CTX-M-27 ), which are the most common CTX-M genes circulating in Ent in some geographic regions [ 10 ]. A 2016 US study of the prevalence of CTX-M genes in Enterobacteriaceae found relative stability of bla CTX-M-15 in E. coli .…”

Section: Introductionmentioning

confidence: 99%

“…Unlike the clonal ST131 E. coli strains, CTX-M-9-group genes are associated with multiple strain types, and horizontal gene transfer via mobile genetic elements likely plays an important role in their dissemination [ 12 ]. While studies of ESBL-Ent in US children and internationally have reported infections due to CTX-M-9-group-producing Enterobacteriaceae (CTX-M-9-grp-Ent) [ 10 , 13 ], pediatric studies have not focused on the clinical and molecular epidemiology and impact of infections specifically due to CTX-M-9-grp-Ent.…”

Section: Introductionmentioning

confidence: 99%

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The Clinical and Molecular Epidemiology of CTX-M-9 Group Producing Enterobacteriaceae Infections in Children

et al. 2019

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Introduction The pandemic of extended-spectrum beta-lactamase-(ESBL)-producing Enterobacteriaceae (Ent) is strongly linked to the dissemination of CTX-M-type-ESBL-Ent. We sought to define the epidemiology of infections in children due to an emerging resistance type, CTX-M-9-group-producing-Ent (CTX-M-9-grp-Ent). Methods A retrospective matched case-control analysis of children with CTX-M-9-grp-Ent infections who received medical care at three Chicago area hospitals was performed. Cases were defined as children possessing extended-spectrum cephalosporin-resistant (ESC-R) infections due to bla CTX-M-9 . PCR and DNA analysis assessed beta-lactamase ( bla ) genes, multi-locus sequence types (MLST) and phylogenetic grouping of E. coli . Controls were children with ESC-susceptible (ESC-S)-Ent infections matched one case to three controls by age, source, and hospital. The clinical-epidemiologic predictors of CTX-M-9-grp-Ent infection were assessed. Results Of 356 ESC-R-Ent isolates from children (median age 4.1 years), the CTX-M-9-group was the solely detected bla gene in 44 (12.4%). The predominant species was E. coli (91%) of virulent phylogroups D (60%) and B2 (40%). MLST revealed multiple strain types. On multivariable analysis, CTX-M-9-grp-Ent occurred more often in E. coli than other Ent genera (OR 7.4, 95% CI 2.4, 27.2), children of non-Black-White-Hispanic race (OR 7.4, 95% CI 2.4, 28.2), and outpatients (OR 4.5, 95% CI 1.7, 12.3), which was a very unexpected finding for infections due to antibiotic-resistant bacteria. Residents of South Chicago had a 6.7 times higher odds of having CTX-M-9-grp-Ent infections than those in the reference region (West), while residence in Northwestern Chicago was associated with an 81% decreased odds of infection. Other demographic, comorbidity, invasive-device, and antibiotic use differences were not found. Conclusion CTX-M-9-grp-Ent infection may be associated with patient residence and is occurring in children without traditional in-patient exposure risk factors. This suggests that among children, the community environment may be a key contributor in the spread of these resistant pathogens.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Clinical and Molecular Epidemiology of CTX-M-9 Group Producing Enterobacteriaceae Infections in Children

et al. 2019

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“…pneumoniae and E . coli ) [ 3 ][ 27 , 28 ]. The CTX-M groups 2 and 8 have been reported in Asia, particularly in Salmonella species [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Rapid in vitro detection of CTX-M groups 1, 2, 8, 9 resistance genes by LAMP assays

et al. 2018

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BackgroundThe prevalence of bacteria producing CTX-M Extended-Spectrum β-lactamases (ESBLs) has increased around the world and some of them became a major cause of infections such as bloodstream or urinary tract infections (UTI). We developed a loop-mediated isothermal amplification (LAMP) assay for a simple, rapid and sensitive detection of the four most common CTX-M groups, namely CTX-M groups 1, 2, 8 and 9.MethodsLAMP primers targeting the four ESBLs CTX-M groups were designed using the Primer Explorer V4 software. The detection limit of the method was tested by serial dilution of reference DNAs. The primer specificity of the LAMP reaction was tested on DNA extracted from six strains producing various group of CTX-M and validated using DNA extracted from CTX-M-resistant clinical isolates (isolated from pus, urine, or blood). Results were compared with those of conventional PCR.ResultsWe were able to detect down to 0.1 pg/ul of DNA using the newly developed LAMP assays whereas the minimal amount detectable for conventional PCR was 50 to 100pg/ul, indicating that the LAMP assay was found to have a detection limit at least 500 to 1000 times lower than the PCR. Additionally, representative genes from the CTX-M groups 1, 2, 8 and 9 were amplified using the designed assay and no cross amplification was observed between the four CTX-M groups, demonstrating the specificity of the LAMP assay. Of the 37 clinical strains tested, the four LAMP assays showed 100% sensitivity and 87%, 97%, 100%, 100% specificity for the CTX-M groups 1, 2, 8 and 9 respectively.ConclusionBeing sensitive, specific, rapid and standard methods, the LAMP assays developed in this study have a potential to be beneficial tools in molecular epidemiology and surveillance studies of the four prevalent EBSLs CTX-M groups even in low cost laboratory.

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“…A notable example is the widespread CTX-M-9-group ESBL genes (e.g. blaCTX-M-9, blaCTX-M- 14, which are the most common CTX-M genes circulating in Ent in some geographic regions 10 . A 2016 U.S. study of prevalence of CTX-M genes in Enterobacteriaceae found relative stability of blaCTX-M-15 in E. coli.…”

Section: Introductionmentioning

confidence: 99%

“…Unlike the clonal ST131 E. coli strains, CTX-M-9-group genes are associated with multiple strain types and horizontal gene transfer via mobile genetic elements likely plays an important role in their dissemination 12 . While studies of ESBL-Ent in U.S. children and internationally have reported infections due to CTX-M-9-group-producing Enterobacteriaceae (CTX-M-9-grp-Ent) 10,13 , pediatric studies have not focused on the clinical and molecular epidemiology and impact of infections specifically due to CTX-M-9-grp-Ent.…”

Section: Introductionmentioning

confidence: 99%

The Clinical and Molecular Epidemiology of CTX-M-9 Group Producing Enterobacteriaceae infections in children

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Medernach

Domitrovic³

et al. 2018

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Background:The pandemic of extended-spectrum-beta-lactamase (ESBL)-producing-Enterobacteriaceae (Ent) is strongly linked to the dissemination of CTX-M-type-ESBL-Ent. We sought to define the epidemiology of infections in children due to an emerging resistance type, CTX-M-9-group-producing-Ent (CTX-M-9-grp-Ent). Methods:A multi-centered case-control analysis of Chicago children with CTX-M-9-grp-Ent infections was performed. Cases were defined as children possessing extended-spectrumcephalosporin-resistant (ESC-R) infections. PCR and DNA analysis assessed beta-lactamase (bla) genes, multi-locus sequence types (MLST) and phylogenetic grouping of E. coli. Controls were children with ESC-susceptible (ESC-S)-Ent infections matched 3:1 by age, source, and hospital. The clinical-epidemiologic predictors of CTX-M-9-grp-Ent infection were assessed. Results: Of 356 ESC-R-Ent isolates from children (median age 4.1 years), CTX-M-9-group was the solely detected bla gene in 44(12.4%). The predominant species was E. coli (91%) of virulent phylogroups D(60%) and B2(40%). MLST revealed multiple strain types. On multivariable analysis, CTX-M-9-grp-Ent occurred more often in E. coli (OR 7.0), children of non-black-white-Hispanic race (OR 6.5), and outpatients (OR 4.5) which was a very unexpected finding for infections due to antibiotic-resistant bacteria. Residents of South Chicago were 6.7 times more likely to have CTX-M-9-grp-Ent infections than those in the reference region (West), while residence in Northwestern Chicago was associated with an 81% decreased risk. Other demographic, comorbidity, invasive-device, and antibiotic use differences were not found.Conclusions: CTX-M-9-grp-Ent infection is strikingly associated with patient residence and is occurring in children without traditional in-patient exposure risk factors. This suggests that among children, the community environment may be a key contributor in the spread of these resistant pathogens. of participating institutions for collection, shipping, and cultivation of organisms. We thank the team of curators of the Institut Pasteur MLST and whole-genome MLST databases for curating the data and making them publicly available at

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First Report of Group CTX-M-9 Extended Spectrum Beta-Lactamases in Escherichia coli Isolates from Pediatric Patients in Mexico

Cited by 10 publications

References 67 publications

The Clinical and Molecular Epidemiology of CTX-M-9 Group Producing Enterobacteriaceae Infections in Children

The Clinical and Molecular Epidemiology of CTX-M-9 Group Producing Enterobacteriaceae Infections in Children

Rapid in vitro detection of CTX-M groups 1, 2, 8, 9 resistance genes by LAMP assays

The Clinical and Molecular Epidemiology of CTX-M-9 Group Producing Enterobacteriaceae infections in children

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