High-risk lineages among extended-spectrum β-lactamase-producing Escherichia coli from extraintestinal infections in Maputo Central Hospital, Mozambique

Santona, Antonella; Sumbana, José João; Fiamma, Maura; Deligios, Massimo; Taviani, Elisa; Simbine, Samuel; Zimba, Tomás F.; Sacarlal, Jahit; Rubino, Salvatore; Paglietti, Bianca

doi:10.1016/j.ijantimicag.2022.106649

Cited by 6 publications

(5 citation statements)

References 20 publications

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“…Interestingly, we have also noticed the same genetic context around bla CTX-M-15 (e.g. , ISEcp1-bla CTX-M-15 -orf477), which was also observed in extraintestinal E. coli strains from the same hospital [27], suggesting a possible interspecies intra-hospital spread.…”

Section: Discussionsupporting

confidence: 73%

“…ESBL-producing Klebsiella isolates are spreading worldwide [ 23 ], including in Africa [ 24 , 25 ]. In particular, in Mozambique, CTX-M-15 has been often reported in E. coli [ 26 , 27 , 28 ], in Klebsiella [ 14 , 16 ], and, recently, also in Enterobacter cloacae complex isolates [ 29 ]. In our studied isolates, the dissemination of the bla CTX-M-15 gene could be occurring through the mobility of plasmids, with IncF being the most common type, and the mobilization element IS Ecp1 or IS26 truncating IS Ecp1, which have been associated with the horizontal dissemination of resistance to beta-lactams [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

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Polyclonal Multidrug ESBL-Producing Klebsiella pneumoniae and Emergence of Susceptible Hypervirulent Klebsiella pneumoniae ST23 Isolates in Mozambique

Sumbana,

Santona,

Abdelmalek

et al. 2023

Antibiotics

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Globally, antibiotic-resistant Klebsiella spp. cause healthcare-associated infections with high mortality rates, and the rise of hypervirulent Klebsiella pneumoniae (hvKp) poses a significant threat to human health linked to community-acquired infections and increasing non-susceptibility. We investigated the phenotypic and genetic features of 36 Klebsiella isolates recovered from invasive infections at Hospital Central of Maputo in Mozambique during one year. The majority of the isolates displayed multidrug resistance (MDR) (29/36) to cephalosporins, gentamicin, ciprofloxacin, and trimethoprim–sulfamethoxazole but retained susceptibility to amikacin, carbapenems, and colistin. Most isolates were ESBLs-producing (28/36), predominantly carrying the blaCTX-M-15 and other beta-lactamase genes (blaSHV, blaTEM-1, and blaOXA-1). Among the 16 genomes sequenced, multiple resistance genes from different antibiotic classes were identified, with blaCTX-M-15, mostly in the ISEcp1-blaCTX-M-15-orf477 genetic environment, co-existing with blaTEM-1 and aac(3)-IIa in five isolates. Our results highlight the presence of polyclonal MDR ESBL-producing K. pneumoniae from eight sequence types (ST), mostly harbouring distinct yersiniabactin within the conjugative integrative element (ICE). Further, we identified susceptible hvKp ST23, O1-K1-type isolates carrying yersiniabactin (ybt1/ICEKp10), colibactin, salmochelin, aerobactin, and hypermucoid locus (rmpADC), associated with severe infections in humans. These findings are worrying and underline the importance of implementing surveillance strategies to avoid the risk of the emergence of the most threatening MDR hvKp.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Polyclonal Multidrug ESBL-Producing Klebsiella pneumoniae and Emergence of Susceptible Hypervirulent Klebsiella pneumoniae ST23 Isolates in Mozambique

Sumbana,

Santona,

Abdelmalek

et al. 2023

Antibiotics

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“…However, the presence of bla CTX-M-27 in ST38, as reported in our survey, is less frequent. This association was described in the United States [ 28 ], and also in Tunisian wastewater [ 29 ] and other African countries [ 30 ]. CTX-M-15 is the predominant ESBL described in Tunisia, as also reported in two other phylogroup B1 clones, ST224 and ST1431.…”

Section: Discussionmentioning

confidence: 90%

Detection of Clones B2-ST131-C2 and A-ST617 in Escherichia coli Producing Both CTX-M-15 and CTX-M-27 from Tunisian Community Patients

et al. 2022

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During a two-month period (2017–2018), 336 urine samples positive for Escherichia coli were collected from Tunisian patients. Of the 336 samples, 266 were collected from community patients and 70 from hospital settings. In all, 15 ESBL producers were identified (8 and 7, respectively) and assigned to 13 pulsotypes, including four ESBL-producing E. coli (ESBL-E) with E1 and E2 profiles (2 isolates each) from community patients. The two strains E1 were identified as B2-ST131 subclade C2 and the two isolates E2, A-ST617. The four strains carrying both CTX-M-15 and CTX-M-27, exhibited the multireplicon IncFII/F1A/F1B with the same formula F31:A4:B1. Two isolates with patterns E3 and E4 (Dice coefficient, 78.7%) isolated from community and hospital settings of two geographic areas were assigned to the emerging ST131 C1-M27 subclade and contained the replicon F1:A-:B20. The remaining ESBL-E divided into different sequence types/associated CTX-M: 2 ST131-C2/CTX-M-15 and ST744/CTX-M-55, ST617/CTM-15, ST2973/CTX-M-55, ST6448/CTX-M-15, ST224/CTX-M-15, ST1431/CTX-M-15, and ST38/CTX-M-27, one isolate each. Our study reports for the first time the presence in the Tunisian community of two clones of E. coli, including the virulent clone ST131-C2 harboring both CTX-M-15 and CTX-M-27, and confirms the spread of the emergent clone ST131-C1-M-27, notably in community urinary tract infections.

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“…The strains belonged to a new ST from CC155/phylogroup B1 (EC52) and to the local ST1196 belonging to phylogroup AxB1 (EC47) (Table 2). A recent study in Mozambique demonstrated that a hybrid ExPEC/EAEC strain recovered from blood belonged to the pandemic ST131 lineage and presented a remarkable virulence profile [28]. These findings revealed that ExPEC/EAEC hybrids are associated with distinct lineages.…”

Section: Resultsmentioning

confidence: 97%

Pandemic ST131Escherichia colipresenting the UPEC/EAEC and ExPEC/EAEC hybrid pathotypes recovered from extraintestinal infections in a clinical setting of the Brazilian Amazon region

Bighi,

Fonseca,

Freitas

et al. 2024

Preprint

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Escherichia coli is part of the commensal microbiota of human and animal gut. However, they may become pathogenic due to the acquisition of virulence factors that provide the ability to cause intestinal or extraintestinal infections, which makes E. coli the main cause of diarrheagenic diseases and urinary tract infections (UTIs) worldwide, respectively. Some strains, known as hybrids, may harbour a mix of virulence determinants of both diarrheagenic (DEC) and extraintestinal E. coli (ExPEC) pathotypes. Reports of hybrid E. coli in Brazil are rare, and the lineages associated with such pathotypes were poorly explored. This study aimed to characterize E. coli strains recovered from extraintestinal infections in a clinical setting of the Brazilian Amazon Region by means of lineage determination, antibiotic resistance profile, and investigation of DEC and ExPEC virulence markers. Fifteen ExPEC strains were recovered from distinct extraintestinal sites from inpatients of the General Hospital of Roraima (GHR), placed in the Brazilian Amazon region. Antibiotic susceptibility test revealed that all strains were multidrug-resistant and most of them, including those recovered from urine, were resistant to fluoroquinolones, the main therapeutic option for treating UTIs, probably due to the presence of Ser83Leu and Asp87Asn substitutions in GyrA. The MLST analysis revealed the polyclonal nature of these ExPEC strains since 11 STs were determined, including local and pandemic lineages, such as ST69 and ST131. Among the 15 isolates, 12 were classified as hybrids, due to the presence of the aggR virulence marker of the Enteroaggregative E. coli (EAEC) pathotype together with at least one ExPEC (iutA, KPSMTII, sfaDE, papC, afaBC, iucD) or Uropathogenic E. coli (UPEC) (vat, fuyA, chuA and yfcV) virulence determinants. These UPEC/EAEC (n=10) and ExPEC/EAEC (n=2) hybrid strains were found among distinct lineages, including new STs, and phylogroups (ST131/B2; ST1196/AxB1; ST9403/A; ST12394/A; NEW1-CC14/B2; NEW2-CC155/B1; NEW3-CC155/B1; NEW4-CC131/B2) and, for the first time, a hybrid phenotype was found in the pandemic ST131 lineage in Brazil. Therefore, this study provides new information on the epidemiological scenario of hybrid E. coli strains, contributing to a better understanding of the occurrence and pathogenic potential of these organisms.

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High-risk lineages among extended-spectrum β-lactamase-producing Escherichia coli from extraintestinal infections in Maputo Central Hospital, Mozambique

Cited by 6 publications

References 20 publications

Polyclonal Multidrug ESBL-Producing Klebsiella pneumoniae and Emergence of Susceptible Hypervirulent Klebsiella pneumoniae ST23 Isolates in Mozambique

Polyclonal Multidrug ESBL-Producing Klebsiella pneumoniae and Emergence of Susceptible Hypervirulent Klebsiella pneumoniae ST23 Isolates in Mozambique

Detection of Clones B2-ST131-C2 and A-ST617 in Escherichia coli Producing Both CTX-M-15 and CTX-M-27 from Tunisian Community Patients

Pandemic ST131Escherichia colipresenting the UPEC/EAEC and ExPEC/EAEC hybrid pathotypes recovered from extraintestinal infections in a clinical setting of the Brazilian Amazon region

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