Low antimicrobial resistance in general practice patients in Rotterdam, the city with the largest proportion of immigrants in the Netherlands

Honsbeek, Maaike; Tjon-A-Tsien, Aimée; Stobberingh, Ellen E.; Steenwinkel, Jurriaan de; Melles∗, Damian C.; Lous, Jan J.; Richardus, Jan Hendrik; Voeten, Hélène

doi:10.1007/s10096-019-03804-8

Cited by 5 publications

(3 citation statements)

References 19 publications

(27 reference statements)

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“…The global tendency sustained by different studies in Europe and other continents showed increasing uropathogen AMR [19,[24][25][26]. In contrast, there are some countries such as the Netherlands that always reported low resistance rates based mostly on rational antibiotic consumption [27].…”

Section: The Importance Of Presenting Population Specific Amr Reportsmentioning

confidence: 99%

Spectrum and Antibiotic Resistance of Uropathogens in Romanian Females

et al. 2020

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Urinary tract infections (UTIs) in women represent a common bacteriological finding, with negligible recent and consistent research on antimicrobial resistance (AMR) in the female population. We designed a retrospective study to observe the incidence of frequent uropathogens and their resistance rates to common antibiotics. We elaborated multicenter research in three different teaching hospitals in Romania, analyzing 13,081 urine samples, of which 1588 met the criteria of inclusion. Escherichia coli (58.37%) was the most frequent Gram-negative uropathogen, presenting high resistance rates to levofloxacin (R = 29.66%), amoxicillin–clavulanic ac. (R = 14.13%), and ceftazidime (R = 6.68%). We found good sensitivity to imipenem and meropenem (both 98.16%), amikacin (S = 96.0%), and fosfomycin (S = 90.39%). The second most prevalent uropathogen was Klebsiella (16.93%), with the highest resistance quota to amoxicillin–clavulanic ac. (R = 28.62%), levofloxacin and nitrofurantoin (both R = 15.61%), and ceftazidime (R = 15.24%), and good sensitivity to imipenem (S = 93.93%), meropenem (S = 91.91%), and amikacin (S = 88.47%). Enterococcus (13.35%) was the most encountered Gram-positive pathogen. It proved the highest resistance to levofloxacin (R = 32.07%), penicillin (R = 32.07%), and ampicillin (R = 14.62%) and good sensitivity to vancomycin (S = 91.98%), fosfomycin (S = 94.4%), and nitrofurantoin (S = 89.15%). Considering the lack of recent and consistent data on this topic, we find our survey a valuable starting research study in this area with high significance for an accurate clinical approach.

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Section: The Importance Of Presenting Population Specific Amr Reportsmentioning

confidence: 99%

Spectrum and Antibiotic Resistance of Uropathogens in Romanian Females

et al. 2020

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“…Up to 2016, fewer than 6% of E. coli isolates collected from urine specimens in Western, Northern, and Southern European countries were resistant to nitrofurantoin [10–14]. Separate UK-based studies showed that nitrofurantoin-resistant E.…”

Section: Introductionmentioning

confidence: 99%

Alterations in chromosomal genes nfsA, nfsB, and ribE are associated with nitrofurantoin resistance in Escherichia coli from the United Kingdom

et al. 2021

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Antimicrobial resistance in enteric or urinary Escherichia coli is a risk factor for invasive E. coli infections. Due to widespread trimethoprim resistance amongst urinary E. coli and increased bacteraemia incidence, a national recommendation to prescribe nitrofurantoin for uncomplicated urinary tract infection was made in 2014. Nitrofurantoin resistance is reported in <6% urinary E. coli isolates in the UK, however, mechanisms underpinning nitrofurantoin resistance in these isolates remain unknown. This study aimed to identify the genetic basis of nitrofurantoin resistance in urinary E. coli isolates collected from north west London and then elucidate resistance-associated genetic alterations in available UK E. coli genomes. As a result, an algorithm was developed to predict nitrofurantoin susceptibility. Deleterious mutations and gene-inactivating insertion sequences in chromosomal nitroreductase genes nfsA and/or nfsB were identified in genomes of nine confirmed nitrofurantoin-resistant urinary E. coli isolates and additional 11 E. coli isolates that were highlighted by the prediction algorithm and subsequently validated to be nitrofurantoin-resistant. Eight categories of allelic changes in nfsA, nfsB, and the associated gene ribE were detected in 12412 E. coli genomes from the UK. Evolutionary analysis of these three genes revealed homoplasic mutations and explained the previously reported order of stepwise mutations. The mobile gene complex oqxAB, which is associated with reduced nitrofurantoin susceptibility, was identified in only one of the 12412 genomes. In conclusion, mutations and insertion sequences in nfsA and nfsB were leading causes of nitrofurantoin resistance in UK E. coli . As nitrofurantoin exposure increases in human populations, the prevalence of nitrofurantoin resistance in carriage E. coli isolates and those from urinary and bloodstream infections should be monitored.

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“…Despite clinical use of nitrofurantoin for nearly 70 years, the prevalence of nitrofurantoin resistance in E. coli remains relatively low in Europe. Up to 2016, fewer than 6% of E. coli isolates collected from urine specimens in Western, Northern, and Southern European countries were resistant to nitrofurantoin (11)(12)(13)(14)(15). Separate UK-based studies showed that nitrofurantoin-resistant E. coli accounted for 5% of urinary and bloodstream E. coli isolates collected in London, during 2005-2006 and 2011-2015, despite higher prevalence of resistance (>20%) to other commonly prescribed oral antimicrobials in the same isolates (16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Diverse Genetic Determinants of Nitrofurantoin Resistance in UK Escherichia coli

Wan

Mills

et al. 2021

Preprint

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Antimicrobial resistance in enteric or urinary Escherichia coli is a risk factor for invasive E. coli infections. Due to widespread trimethoprim resistance amongst urinary <E. coli and increased bacteraemia incidence, a national recommendation to prescribe nitrofurantoin for uncomplicated urinary tract infection was made in 2018. Nitrofurantoin resistance is reported in < 6% urinary E. coli isolates in the UK. However, mechanisms underpinning nitrofurantoin resistance in these isolates remain unknown. This study aimed to identify genetic determinants of nitrofurantoin resistance in a local E. coli collection and assess their prevalence in a larger dataset of E. coli genomes. Deleterious point mutations and gene-inactivating insertion sequences in both chromosomal nitroreductase genes nfsA and nfsB were identified in genomes of nine nitrofurantoin-resistant urinary E. coli isolates collected from north west London. Eight types of genetic alterations were identified when comparing sequences of nfsA, nfsB, and the associated gene ribE in 12,412 E. coli genomes collected from across the UK. Evolutionary analysis revealed homoplasic mutations and explained the order of stepwise mutations. An algorithm was developed to predict nitrofurantoin susceptibility and predictions for 20 accessible isolates were experimentally validated. Only one genome carrying oqxAB, a mobile gene complex associated with reduced nitrofurantoin susceptibility, was identified. In conclusion, mutations and insertion sequences in nfsA and nfsB are leading causes of nitrofurantoin resistance in UK E. coli. As nitrofurantoin exposure increases in human populations, the prevalence of nitrofurantoin resistance in carriage E. coli isolates and those from urinary and bloodstream infections should be monitored.

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Low antimicrobial resistance in general practice patients in Rotterdam, the city with the largest proportion of immigrants in the Netherlands

Cited by 5 publications

References 19 publications

Spectrum and Antibiotic Resistance of Uropathogens in Romanian Females

Spectrum and Antibiotic Resistance of Uropathogens in Romanian Females

Alterations in chromosomal genes nfsA, nfsB, and ribE are associated with nitrofurantoin resistance in Escherichia coli from the United Kingdom

Diverse Genetic Determinants of Nitrofurantoin Resistance in UK Escherichia coli

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