Prevalence and molecular epidemiology of carbapenem-resistant Gram-negative bacilli and their resistance determinants in the Eastern Mediterranean Region over the last decade

Sleiman, Ahmad; Fayad, Antoine Abou; Banna, H S; Matar, Ghassan M.

doi:10.1016/j.jgar.2021.02.033

Cited by 25 publications

(31 citation statements)

References 163 publications

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“…Therefore, the World Health Organization (WHO) has classified A. baumannii among the most dangerous MDR pathogens worldwide. It is considered one of the critical pathogens that need developing new antibiotics [3,4]. In Germany, A. baumannii is a ubiquitous pathogen, and several communities and hospital-based outbreaks were reported in 13 out of 16 federal states [5].…”

Section: Introductionmentioning

confidence: 99%

WGS based analysis of acquired antimicrobial resistance in human and non-human Acinetobacter baumannii isolates from a German perspective

et al. 2021

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Background Acinetobacter baumannii ability to develop and acquire resistance makes it one of the most critical nosocomial pathogens globally. Whole-genome sequencing (WGS) was applied to identify the acquired or mutational variants of antimicrobial resistance (AMR) genes in 85 German A. baumannii strains utilizing Illumina technology. Additionally, the whole genome of 104 German isolates deposited in the NCBI database was investigated. Results In-silico analysis of WGS data revealed wide varieties of acquired AMR genes mediating resistance mostly to aminoglycosides, cephalosporins, carbapenems, sulfonamides, tetracyclines and macrolides. In the 189 analyzed genomes, the ant (3″)-IIa conferring resistance to aminoglycosides was the most frequent (55%), followed by blaADC.25 (38.6%) conferring resistance to cephalosporin, blaOXA-23 (29%) and the blaOXA-66 variant of the intrinsic blaOXA-51-likes (26.5%) conferring resistance to carbapenems, the sul2 (26%) conferring resistance to sulfonamides, the tet. B (19.5%) conferring resistance to tetracycline, and mph. E and msr. E (19%) conferring resistance to macrolides. blaTEM variants conferring resistance to cephalosporins were found in 12% of genomes. Thirteen variants of the intrinsic blaOXA-51 carbapenemase gene, blaOXA-510 and blaADC-25 genes were found in isolates obtained from dried milk samples. Conclusion The presence of strains harboring acquired AMR genes in dried milk raises safety concerns and highlights the need for changes in producing dried milk. Acquired resistance genes and chromosomal gene mutation are successful routes for disseminating AMR determinants among A. baumannii. Identification of chromosomal and plasmid-encoded AMR in the genome of A. baumannii may help understand the mechanism behind the genetic mobilization and spread of AMR genes.

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Section: Introductionmentioning

confidence: 99%

WGS based analysis of acquired antimicrobial resistance in human and non-human Acinetobacter baumannii isolates from a German perspective

et al. 2021

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“…or non-European (e.g., USA, Brazil, etc.) countries [ 1 , 10 , 11 ] However, other carbapenemase (e.g., NDM) or β-lactamase (e.g., AmpC) encoding genes are increasingly recognized as determinants capable of rendering Gram-negative organisms resistant to multiple antimicrobial drugs [ 12 ]. Especially with multidrug-resistant Gram-negative BSIs [ 13 ], the molecular assays’ turnaround time—if compared to the phenotypic or genotypic antimicrobial resistance detection methods performed on the bacterial isolates grown from BCs [ 14 ]—would allow guiding the therapeutic decisions some days before culture-based antimicrobial susceptibility testing (AST) results are available [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Direct Testing for KPC-Mediated Carbapenem Resistance from Blood Samples Using a T2 Magnetic Resonance Based Assay

Angelis

Paggi

Lowery³

et al. 2021

Antibiotics

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Molecular-based carbapenem resistance testing in Gram-negative bacterial bloodstream infections (BSIs) is currently limited because of the reliance on positive blood culture (BC) samples. The T2Resistance™ panel may now allow the detection of carbapenemase- and other β-lactamase encoding genes directly from blood samples. We detected carbapenem resistance genes in 11 (84.6%) of 13 samples from patients with BC-documented BSIs (10 caused by KPC-producing Klebsiellapneumoniae and 1 caused by VIM/CMY-producing Citrobacter freundii). Two samples that tested negative for carbapenem resistance genes were from patients with BC-documented BSIs caused by KPC-producing K. pneumoniae who were receiving effective antibiotic therapy. In conclusion, our findings suggest that the T2Resistance™ panel can be a reliable tool for diagnosing carbapenem-resistant Gram-negative bacterial BSIs.

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“…There has been an alarming rise in bacterial resistance to antibiotics over the past two decades, representing a “silent pandemic” that appears unstoppable. This resistance has become especially frequent in healthcare-related infections (HCRIs) worldwide [ 1 , 2 , 3 ]. However, there has also been an increase in the emergence and transmission of multidrug-resistant bacteria in the community setting over the past few years, including residential facilities and care homes.…”

Section: Introductionmentioning

confidence: 99%

“…The more frequent hospitalization of these residents has favored exchanges between hospital and community, increasing the capacity to spread resistant bacteria in each setting [ 3 ]. The World Health Organization (WHO) has declared infection by these microorganisms as an emerging disease that poses a major public health threat worldwide [ 1 , 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…The large group of carbapenem-resistant bacteria includes carbapenemase-producing bacteria (CPB), for which there are limited therapeutic options, and infection control measures have proven ineffective to prevent the dissemination of these bacteria to date [ 4 ]. The WHO list of global priority pathogens includes carbapenem-resistant Acinetobacter baumannii (CRAb) and Pseudomonas aeruginosa (CRPa) and carbapenem-producing Enterobacteriaceae (CPE) [ 2 ]. The most frequently observed carbapenem-resistance mechanism is the production of carbapenemases [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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A Study in a Regional Hospital of a Mid-Sized Spanish City Indicates a Major Increase in Infection/Colonization by Carbapenem-Resistant Bacteria, Coinciding with the COVID-19 Pandemic

et al. 2021

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Bacterial resistance to antibiotics has proven difficult to control over the past few decades. The large group of multidrug-resistant bacteria includes carbapenemase-producing bacteria (CPB), for which limited therapeutic options and infection control measures are available. Furthermore, carbapenemases associate with high-risk clones that are defined by the sequence type (ST) to which each bacterium belongs. The objectives of this cross-sectional and retrospective study were to describe the CPB population isolated in a third-level hospital in Southern Spain between 2015 and 2020 and to establish the relationship between the ST and the epidemiological situation defined by the hospital. CPB were microbiologically studied in all rectal and pharyngeal swabs and clinical samples received between January 2015 and December 2020, characterizing isolates using MicroScan and mass spectrometry. Carbapenemases were detected by PCR and Sanger sequencing, and STs were assigned by multilocus sequence typing (MLST). Isolates were genetically related by pulsed-field gel electrophoresis using Xbal, Spel, or Apal enzymes. The episodes in which each CPB was isolated were recorded and classified as involved or non-involved in an outbreak. There were 320 episodes with CPB during the study period: 18 with K. pneumoniae, 14 with Klebisella oxytoca, 9 with Citrobacter freundii, 11 with Escherichia coli, 46 with Enterobacter cloacae, 70 with Acinetobacter baumannii, and 52 with Pseudomonas aeruginosa. The carbapenemase groups detected were OXA, VIM, KPC, and NDM with various subgroups. Synchronous relationships were notified between episodes of K. pneumoniae and outbreaks for ST15, ST258, ST307, and ST45, but not for the other CPB. There was a major increase in infections with CPB over the years, most notably during 2020, coinciding with the COVID-19 pandemic. This study highlights the usefulness of gene sequencing techniques to control the spread of these microorganisms, especially in healthcare centers. These techniques offer faster results, and a reduction in their cost may make their real-time application more feasible. The combination of epidemiological data with real-time molecular sequencing techniques can provide a major advance in the transmission control of these CPB and in the management of infected patients. Real-time sequencing is essential to increase precision and thereby control outbreaks and target infection prevention measures in a more effective manner.

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Prevalence and molecular epidemiology of carbapenem-resistant Gram-negative bacilli and their resistance determinants in the Eastern Mediterranean Region over the last decade

Cited by 25 publications

References 163 publications

WGS based analysis of acquired antimicrobial resistance in human and non-human Acinetobacter baumannii isolates from a German perspective

WGS based analysis of acquired antimicrobial resistance in human and non-human Acinetobacter baumannii isolates from a German perspective

Direct Testing for KPC-Mediated Carbapenem Resistance from Blood Samples Using a T2 Magnetic Resonance Based Assay

A Study in a Regional Hospital of a Mid-Sized Spanish City Indicates a Major Increase in Infection/Colonization by Carbapenem-Resistant Bacteria, Coinciding with the COVID-19 Pandemic

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