Molecular Detection of New SHV β-lactamase Variants in Clinical Escherichia coli and Klebsiella pneumoniae Isolates from Egypt

Elmowalid, Gamal A.; Ahmad, Adel Attia M.; Hassan, Muhammad Nadeem; El-Aziz, Norhan K. Abd; Abdelwahab, Ashraf M.; Elwan, Shymaa I.

doi:10.1016/j.cimid.2018.09.013

Cited by 11 publications

(11 citation statements)

References 19 publications

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“…The excess of Klebsiella associated mortality is similar to previous studies showing mortality rates up to 38.5% in other countries [44,45], including in the neighboring country, South Africa (26-35%) [46]. As previously reported in this community and elsewhere [10,17,22,47,48], an important public health concern is related to the emergence and widespread dissemination of ESBL-producing Klebsiella spp., challenging the appropriate management of MDR Klebsiella infections, that were mostly treated with ceftriaxone. The major dilemma is related to the finding of strains with reduced susceptibility to carbapenems (meropenem and ertapenem), often used as a second-line treatment options, as per international guidelines, but not foreseen in our setting [49].…”

Section: Discussionsupporting

confidence: 89%

“…Data on the molecular epidemiology and characterization of Klebsiella spp. are scarce in Africa including Mozambique [ 17 – 19 ]. However, data from an urban hospital in the city of Beira, central Mozambique showed high frequency (100% of isolates) of ESBL-producing K. pneumoniae among hospitalized children with urinary tract infections [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Klebsiella spp. cause severe and fatal disease in Mozambican children: antimicrobial resistance profile and molecular characterization

et al. 2021

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Background Klebsiella spp. are important pathogens associated with bacteremia among admitted children and is among the leading cause of death in children < 5 years in postmortem studies, supporting a larger role than previously considered in childhood mortality. Herein, we compared the antimicrobial susceptibility, mechanisms of resistance, and the virulence profile of Klebsiella spp. from admitted and postmortem children. Methods Antimicrobial susceptibility and virulence factors of Klebsiella spp. recovered from blood samples collected upon admission to the hospital (n = 88) and postmortem blood (n = 23) from children < 5 years were assessed by disk diffusion and multiplex PCR. Results Klebsiella isolates from postmortem blood were likely to be ceftriaxone resistant (69.6%, 16/23 vs. 48.9%, 43/88, p = 0.045) or extended-spectrum β-lactamase (ESBL) producers (60.9%, 14/23 vs. 25%, 22/88, p = 0.001) compared to those from admitted children. blaCTX-M-15 was the most frequent ESBL gene: 65.3%, 9/14 in postmortem isolates and 22.7% (5/22) from admitted children. We found higher frequency of genes associated with hypermucoviscosity phenotype and invasin in postmortem isolates than those from admitted children: rmpA (30.4%; 7/23 vs. 9.1%, 8/88, p = 0.011), wzi-K1 (34.7%; 8/23 vs. 8%; 7/88, p = 0.002) and traT (60.8%; 14/23 vs. 10.2%; 9/88, p < 0.0001), respectively. Additionally, serine protease auto-transporters of Enterobacteriaceae were detected from 1.8% (pic) to 12.6% (pet) among all isolates. Klebsiella case fatality rate was 30.7% (23/75). Conclusion Multidrug resistant Klebsiella spp. harboring genes associated with hypermucoviscosity phenotype has emerged in Mozambique causing invasive fatal disease in children; highlighting the urgent need for prompt diagnosis, appropriate treatment and effective preventive measures for infection control.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Klebsiella spp. cause severe and fatal disease in Mozambican children: antimicrobial resistance profile and molecular characterization

et al. 2021

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“…In this study, K. pneumoniae was isolated from 9% of diseased chickens and 16.7% of environment samples, which is inconsistent with the findings reported in a previous study in Egypt, where K. pneumoniae was recovered from 35% of broiler chickens and 25% of water samples [ 42 ]. However, the prevalence of K. pneumoniae among contact poultry workers (22.7%) and hospitalized patients (14.4%) in the same region was lower than lately published reports in Egypt [ 7 , 42 , 43 ] or abroad, both in China [ 44 ] and Taiwan [ 45 ]. Hence, the direct transmission may be facilitated via close contact between chickens and humans as evidenced previously by Davis et al [ 46 ].…”

Section: Discussionmentioning

confidence: 59%

“…The emergence of extended-spectrum β-lactamase-producing K. pneumoniae (ESBLK) in Egypt is of serious concern. Previous studies suggested that food-producing animals, particularly chickens, have been considered a possible source for transmission of ESBLK to humans [ 6 , 7 ]. However, integrated studies on chickens and their environment, contact workers and hospitalized patients in the same area are still missing.…”

Section: Introductionmentioning

confidence: 99%

Emergence of Colistin and Carbapenem Resistance in Extended-Spectrum β-Lactamase Producing Klebsiella pneumoniae Isolated from Chickens and Humans in Egypt

Elmonir

El-Aziz

Tartor

et al. 2021

Biology

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This study investigated the frequency of carbapenem and colistin resistance in ESBL-producing K. pneumoniae (ESBLK) isolates recovered from chickens and their environment, contact farm workers and hospitalized patients in Egypt. Further, the phenotypic and genotypic relationships between the community and hospital-acquired K. pneumoniae isolates in the same geographical area were investigated. From 272 total samples, 37 (13.6%) K. pneumoniae isolates were identified, of which 20 (54.1%) were hypervirulent. All isolates (100%) were multidrug-resistant (MDR) with multiple antibiotic resistance (MAR) indices ranging from 0.19 to 0.94. Colistin-resistant isolates (18.9%) displayed colistin MIC values >2 μg/mL, all harbored the mcr-1 gene. All isolates from patients (13/90, 14.4%), workers (5/22, 22.7%), chickens (9/100, 9%) and the environment (10/60, 16.7%) harbored a single or multiple β-lactamase genes, blaSHV, blaTEM, blaCTX-M1 and blaOXA-1, often in combination with carbapenemase genes (blaVIM, blaNDM-1 or blaIMP; 45.9%), the mcr-1 gene (18.9%) or both (13.5%). Enterobacterial repetitive intergenic consensus (ERIC)–PCR genotyping revealed 24 distinct ERIC types (ETs) with a discrimination index of 0.961. Six ETs showed clusters of identical isolates from chicken and human sources. The increased frequency and genetic relatedness of ESBLK and carbapenemase-producing K. pneumoniae (CPK) from chickens and humans pose a public health threat that urge more prudent use of antimicrobials in chicken farms to avoid the propagation and expansion of both ESBLK and CPK from the chicken sources to humans.

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“…The recent global dissemination of MDR and XDR Gram-negative bacteria has raised the alarm of antimicrobial resistance as a serious and an urgent threat to public health. Consequently, studies have been conducted to explore the distribution of several resistance genes in different reservoirs ( Tartor and El-Naenaeey, 2016 ; Elmowalid et al, 2018 ; Abd El-Aziz et al, 2021c ).…”

Section: Discussionmentioning

confidence: 99%

Whole-Genome Sequencing of Gram-Negative Bacteria Isolated From Bovine Mastitis and Raw Milk: The First Emergence of Colistin mcr-10 and Fosfomycin fosA5 Resistance Genes in Klebsiella pneumoniae in Middle East

et al. 2021

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Antimicrobial resistance is a major concern in the dairy industry. This study investigated the prevalence, antimicrobial resistance phenotypes, and genome sequencing of Gram-negative bacteria isolated from clinical (n = 350) and subclinical (n = 95) bovine mastitis, and raw unpasteurized milk (n = 125). Klebsiella pneumoniae, Aeromonas hydrophila, Enterobacter cloacae (100% each), Escherichia coli (87.78%), and Proteus mirabilis (69.7%) were the most prevalent multidrug-resistant (MDR) species. Extensive drug-resistance (XDR) phenotype was found in P. mirabilis (30.30%) and E. coli (3.33%) isolates. Ten isolates (four E. coli, three Klebsiella species and three P. mirabilis) that displayed the highest multiple antibiotic resistance (MAR) indices (0.54–0.83), were exposed to whole-genome sequencing (WGS). Two multilocus sequence types (MLST): ST2165 and ST7624 were identified among the sequenced E. coli isolates. Three E. coli isolates (two from clinical mastitis and one from raw milk) belonging to ST2165 showed similar profile of plasmid replicon types: IncFIA, IncFIB, IncFII, and IncQ1 with an exception to an isolate that contained IncR, whereas E. coli ST7624 showed a different plasmid profile including IncHI2, IncHI2A, IncI1α, and IncFII replicon types. ResFinder findings revealed the presence of plasmid-mediated colistin mcr-10 and fosfomycin fosA5 resistance genes in a K. pneumoniae (K1) isolate from bovine milk. Sequence analysis of the reconstructed mcr-10 plasmid from WGS of K1 isolate, showed that mcr-10 gene was bracketed by xerC and insertion sequence IS26 on an IncFIB plasmid. Phylogenetic analysis revealed that K1 isolate existed in a clade including mcr-10-harboring isolates from human and environment with different STs and countries [United Kingdom (ST788), Australia (ST323), Malawi (ST2144), Myanmar (ST705), and Laos (ST2355)]. This study reports the first emergence of K. pneumoniae co-harboring mcr-10 and fosA5 genes from bovine milk in the Middle East, which constitutes a public health threat and heralds the penetration of the last-resort antibiotics. Hence, prudent use of antibiotics in both humans and animals and antimicrobial surveillance plans are urgently required.

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Molecular Detection of New SHV β-lactamase Variants in Clinical Escherichia coli and Klebsiella pneumoniae Isolates from Egypt

Cited by 11 publications

References 19 publications

Klebsiella spp. cause severe and fatal disease in Mozambican children: antimicrobial resistance profile and molecular characterization

Klebsiella spp. cause severe and fatal disease in Mozambican children: antimicrobial resistance profile and molecular characterization

Emergence of Colistin and Carbapenem Resistance in Extended-Spectrum β-Lactamase Producing Klebsiella pneumoniae Isolated from Chickens and Humans in Egypt

Whole-Genome Sequencing of Gram-Negative Bacteria Isolated From Bovine Mastitis and Raw Milk: The First Emergence of Colistin mcr-10 and Fosfomycin fosA5 Resistance Genes in Klebsiella pneumoniae in Middle East

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