Resistance to nitrofurantoin is an indicator of extensive drug-resistant (XDR) Enterobacteriaceae

Abstract

Introduction. Nitrofurantoin is one of the preferred antibiotics in the treatment of uropathogenic multidrug-resistant (MDR) infections. However, resistance to nitrofurantoin in extensively drug-resistant (XDR) bacteria has severely limited the treatment options. Gap statement. Information related to co-resistance or collateral sensitivity (CS) with reference to nitrofurantoin resistant bacteria is limited. Aim. To study the potential of nitrofurantoin resistance as an indicator of the XDR phenotype in Enterobacteriaceae . Methods. One hundred (45 nitrofurantoin-resistant, 21 intermediately resistant and 34 nitrofurantoin-susceptible) Enterobacteriaceae were analysed in this study. Antibiotic susceptibility testing (AST) against nitrofurantoin and 17 other antimicrobial agents across eight different classes was performed by using the Vitek 2.0 system. The isolates were screened for the prevalence of acquired antimicrobial resistance (AMR) and efflux pump genes by PCR. Results. In total, 51 % of nitrofurantoin-resistant and 28 % of intermediately nitrofurantoin resistant isolates exhibited XDR characteristics, while only 3 % of nitrofurantoin-sensitive isolates were XDR (P=0.0001). Significant co-resistance was observed between nitrofurantoin and other tested antibiotics (β-lactam, cephalosporin, carbapenem, aminoglycoside and tetracycline). Further, the prevalence of AMR and efflux pump genes was higher in the nitrofurantoin-resistant strains compared to the susceptible isolates. A strong association was observed between nitrofurantoin resistance and the presence of bla PER-1, bla NDM-1, bla OXA-48, ant(2) and oqxA-oqxB genes. Tigecycline (84 %) and colistin (95 %) were the only antibiotics to which the majority of the isolates were susceptible. Conclusion. Nitrofurantoin resistance could be an indicator of the XDR phenotype among Enterobacteriaceae , harbouring multiple AMR and efflux pump genes. Tigecycline and colistin are the only antibiotics that could be used in the treatment of such XDR infections. A deeper understanding of the co-resistance mechanisms in XDR pathogens and prescription of AST-based appropriate combination therapy may help mitigate this problem.

Biofilm Formation by Escherichia coli Isolated from Urinary Tract Infections from Aguascalientes, Mexico

“…Furthermore, 4.05% (3/74 isolates) of the strains were categorized as XDR isolates; remarkably, all the strains presented a nitrofurantoin-resistant pattern. This is consistent with Khamari et al (2021) [68], who reported that resistance to nitrofurantoin indicates the underlying extensively drug-resistant (XDR) phenotype in Enterobacteriaceae, which could complicate the treatment of UTIs.…”

“…This is in contrast to our study, where the F group was one of the most prevalent phylogroups (14.9%). These differences in the prevalence of the phylogenetic groups reported in different studies may be explained by differences in sampling location, health status, dietary and host genetic factors, and host social conditions [68,69].…”

Antibiotic Stewardship and Treatment of Uncomplicated Urinary Tract Infection (UTI) in Children and Adolescents in the Emergency Department of a Community Hospital

“…Nitrofurantoin was not widely used in the population under study (3.5%), but it showed the highest resistance across sexes and age groups. Nitrofurantoin resistance is a marker of extensive drug resistance in Enterobacteriaceae, a family challenging to treat 30 but not seen in our findings. Last, ceftriaxone was administered a fifth of the time in the ED, but two-thirds of the uropathogens showed resistance.…”

Characterization of plasmid-mediated quinolone resistance genes and extended-spectrum beta-lactamases in non-typhoidal Salmonella enterica isolated from broiler chickens

“…There are several genetic mechanisms that confer F resistance, including chromosomally mediated mutations in nfsA, nfsB, and ribE proteins, as well as plasmid-mediated multiple drug efflux pumps that encode by oqxAB genes [50]. Available at www.veterinaryworld.org/Vol.15/June-2022/14.pdf Therefore, F resistance may represent an indicator of extensive antibiotic resistance in enteric bacteria [51]. Despite the infrequent use of C in poultry farming in Iraq, about 60% of the present isolates showed resistance to this antibiotic.…”