Interspecies plasmid transfer appears rare in sequential infections with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae

Lindblom, Anna; Kk, Sriram; Müller, Vilhelm; Öz, Robin; Sandström, Hilda; Åhrén, Christina; Westerlund, Fredrik; Karami, Nahid

doi:10.1016/j.diagmicrobio.2018.10.014

Cited by 19 publications

(25 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In concordance with our previous study [21], ODM analysis demonstrated that transmission of bla CTX-M carrying plasmids seems to be a rare event during the course of RUTI caused by CTX-M-producing bacteria in a patient. We also found all bla CTX-M carrying plasmids to be stable over time when the same ESBL E. coli strain reoccurred in the following episode, which it does in a majority of patients with RUTI.…”

Section: Introductionsupporting

confidence: 91%

“…To fully understand the entire pathophysiology of RUTI due to ESBL E. coli, the likelihood of a possible horizontal transfer of the bla CTX-M encoding plasmid between the bacteria causing the first and the following RUTI episodes needs to be explored. We recently reported that plasmid transmission appears to be a rare event when the sequential isolates in RUTI are of different species, that is E. coli and Klebsiella pneumoniae, though we could demonstrate a few such possible events using ODM [21].…”

Section: Introductionmentioning

confidence: 72%

See 1 more Smart Citation

Identity of blaCTX-M Carrying Plasmids in Sequential ESBL-E. coli Isolates from Patients with Recurrent Urinary Tract Infections

Karami

Yazdanshenas

et al. 2021

Microorganisms

Self Cite

View full text Add to dashboard Cite

Plasmid-mediated multidrug resistance in E. coli is becoming increasingly prevalent. Considering this global threat to human health, it is important to understand how plasmid-mediated resistance spreads. From a cohort of 123 patients with recurrent urinary tract infections (RUTI) due to extended spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL E. coli), only five events with a change of ESBL E. coli strain between RUTI episodes were identified. Their blaCTX-M encoding plasmids were compared within each pair of isolates using optical DNA mapping (ODM) and PCR-based replicon typing. Despite similar blaCTX-M genes and replicon types, ODM detected only one case with identical plasmids in the sequential ESBL E. coli strains, indicating that plasmid transfer could have occurred. For comparison, plasmids from seven patients with the same ESBL E. coli strain reoccurring in both episodes were analyzed. These plasmids (encoding blaCTX-M-3, blaCTX-M-14, and blaCTX-M-15) were unaltered for up to six months between recurrent infections. Thus, transmission of blaCTX-M plasmids appears to be a rare event during the course of RUTI. Despite the limited number (n = 23) of plasmids investigated, similar blaCTX-M-15 plasmids in unrelated isolates from different patients were detected, suggesting that some successful plasmids could be associated with specific strains, or are more easily transmitted.

show abstract

Section: Introductionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 72%

Identity of blaCTX-M Carrying Plasmids in Sequential ESBL-E. coli Isolates from Patients with Recurrent Urinary Tract Infections

Karami

Yazdanshenas

et al. 2021

Microorganisms

Self Cite

View full text Add to dashboard Cite

show abstract

“…Early identification of transmission of resistant strains is highly important in any environment, but particularly important in the vulnerable population of NICU patients. Importantly, while conjugation of plasmids did not occur in this outbreak, we have demonstrated the potential of the method to detect such events in previous studies (12–14).…”

Section: Discussionmentioning

confidence: 59%

“…To visualize this variation in emission intensity, the DNA barcode, we stretch single intact plasmids in nanochannels and image them using fluorescence microscopy (8). We have demonstrated that the method can with high confidence measure the number and sizes of all large plasmids in a bacterial cell (11) and produce a unique barcode for each plasmid that can be used to identify conjugation of plasmids between different strains and species of bacteria (12–14). The method can also identify previously sequenced plasmids by comparing experimental barcodes with theoretical barcodes of the thousands of plasmids in the NCBI public database (15).…”

Section: Introductionmentioning

confidence: 99%

Optical DNA Mapping Combined with Cas9-Targeted Resistance Gene Identification for Rapid Tracking of Resistance Plasmids in a Neonatal Intensive Care Unit Outbreak

Bikkarolla

Nordberg

Rajer

et al. 2019

mBio

Self Cite

View full text Add to dashboard Cite

The global spread of antibiotic resistance among Enterobacteriaceae is largely due to multidrug resistance plasmids that can transfer between different bacterial strains and species. Horizontal gene transfer of resistance plasmids can complicate hospital outbreaks and cause problems in epidemiological tracing, since tracing is usually based on bacterial clonality. We have developed a method, based on optical DNA mapping combined with Cas9-assisted identification of resistance genes, which is used here to characterize plasmids during an extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae outbreak at a Swedish neonatal intensive care unit. The outbreak included 17 neonates initially colonized with ESBL-producing Klebsiella pneumoniae (ESBL-KP), some of which were found to carry additional ESBL-producing Escherichia coli (ESBL-EC) in follow-up samples. We demonstrate that all ESBL-KP isolates contained two plasmids with the blaCTX-M-15 gene located on the smaller one (~80 kbp). The same ESBL-KP clone was present in follow-up samples for up to 2 years in some patients, and the plasmid carrying the blaCTX-M-15 gene was stable throughout this time period. However, extensive genetic rearrangements within the second plasmid were observed in the optical DNA maps for several of the ESBL-KP isolates. Optical mapping also demonstrated that even though other bacterial clones and species carrying blaCTX-M group 1 genes were found in some neonates, no transfer of resistance plasmids had occurred. The data instead pointed toward unrelated acquisition of ESBL-producing Enterobacteriaceae (EPE). In addition to revealing important information about the specific outbreak, the method presented is a promising tool for surveillance and infection control in clinical settings. IMPORTANCE This study presents how a novel method, based on visualizing single plasmids using sequence-specific fluorescent labeling, could be used to analyze the genetic dynamics of an outbreak of resistant bacteria in a neonatal intensive care unit at a Swedish hospital. Plasmids are a central reason for the rapid global spread of bacterial resistance to antibiotics. In a single experimental procedure, this method replaces many traditional plasmid analysis techniques that together provide limited details and are slow to perform. The method is much faster than long-read whole-genome sequencing and offers direct genetic comparison of patient samples. We could conclude that no transfer of resistance plasmids had occurred between different bacteria during the outbreak and that secondary cases of ESBL-producing Enterobacteriaceae carriage were instead likely due to influx of new strains. We believe that the method offers potential in improving surveillance and infection control of resistant bacteria in hospitals.

show abstract

“…Finally, setting up a screening program for MDRGN that would have a chance of having some infection prevention effect is complicated by the fact that MDRGN resistance is mostly plasmid mediated and several different species are involved. This means that resistance traits can be transferred from individual bacteria to other individual bacteria, and in rare cases even between species (Bosch et al 2017;Lindblom et al 2019). Consequently, to the extent that individuals develop symptoms by resistant bacteria due to an MDRGN colonisation, these may not be the bacteria targeted by screening, but rather from other bacteria in their gut adopting the same plasmid (Hagel et al 2019).…”

Section: Epidemiological Comparison Mrsa Vs Mdrgnmentioning

confidence: 99%

Screening for multi-drug-resistant Gram-negative bacteria: what is effective and justifiable?

Nijsingh

Munthe

Lindblom

et al. 2020

Monash Bioeth. Rev.

Self Cite

View full text Add to dashboard Cite

Effectiveness is a key criterion in assessing the justification of antibiotic resistance interventions. Depending on an intervention's effectiveness, burdens and costs will be more or less justified, which is especially important for large scale populationlevel interventions with high running costs and pronounced risks to individuals in terms of wellbeing, integrity and autonomy. In this paper, we assess the case of routine hospital screening for multi-drug-resistant Gram-negative bacteria (MDRGN) from this perspective. Utilizing a comparison to screening programs for Methicillin-Resistant Staphylococcus aureus (MRSA) we argue that current screening programmes for MDRGN in low endemic settings should be reconsidered, as its effectiveness is in doubt, while general downsides to screening programs remain. To accomplish justifiable antibiotic stewardship, MDRGN screening should not be viewed as a separate measure, but rather as part of a comprehensive approach. The program should be redesigned to focus on those at risk of developing symptomatic infections with MDRGN rather than merely detecting those colonised.

show abstract

Interspecies plasmid transfer appears rare in sequential infections with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae

Cited by 19 publications

References 35 publications

Identity of blaCTX-M Carrying Plasmids in Sequential ESBL-E. coli Isolates from Patients with Recurrent Urinary Tract Infections

Identity of blaCTX-M Carrying Plasmids in Sequential ESBL-E. coli Isolates from Patients with Recurrent Urinary Tract Infections

Optical DNA Mapping Combined with Cas9-Targeted Resistance Gene Identification for Rapid Tracking of Resistance Plasmids in a Neonatal Intensive Care Unit Outbreak

Screening for multi-drug-resistant Gram-negative bacteria: what is effective and justifiable?

Contact Info

Product

Resources

About