Transmission ofmcr-1-Producing Multidrug-resistant Enterobacteriaceae in Public Transportation in Guangzhou, China

Cong, Shan; Feng, Siyuan; Chen, Hongtao; Dai, Min; Paterson, David L.; Zheng, Xiaobin; Wu, Xingui; Zhong, Lan-Lan; Liu, Yan; Xia, Yong; Ma, Rui; Huang, Xi; Tian, Guo‐Bao

doi:10.1093/cid/ciy661

Cited by 34 publications

(34 citation statements)

References 46 publications

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“…In the current study, the high genetic diversity among the mcr-1 -positive E. coli strains #1, #2, and #3, which belonged to STs ST457, ST101, and ST1413, respectively, indicates that the isolates were unrelated. E. coli ST101 is considered as having an environmental lineage (related to water, sewage, and poultry), while many clinical isolates in multiple countries are also classified as E. coli ST101 20–22. It is also regarded as a reservoir for antibiotic resistance genes.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiology and molecular characterization of mcr-1 in Escherichia coli recovered from patients with bloodstream infections in Changsha, central China

Zhong¹,

Liu²,

Zheng³

2019

IDR

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Objectives The main aim of this study was to investigate the prevalence and molecular characteristics of the mcr-1 gene in Escherichia coli isolates obtained from all patients with bloodstream infections over a year in a Chinese teaching hospital. We also assessed the susceptibility profiles of the mcr-1 -positive strains and prognostic impact of this gene on the patients. Methods A total of 144 consecutive, non-repetitive E. coli isolates causing bloodstream infections were collected at a teaching hospital in Changsha, China from January to December 2016. The presence of the mcr-1 gene was assessed by PCR. All mcr-1 -positive E coli isolates were characterized by antimicrobial susceptibility testing, multilocus sequence typing (MLST), a conjugation experiment, and plasmid replicon typing. Clinical data were obtained from medical records. Results The mcr-1 gene was detected in three (2.1%) of the 144 E. coli isolates. The three mcr-1 -positive E. coli isolates were resistant to colistin. All three isolates showed a lower resistance to other classes of antibacterials, with all three being susceptible to carbapenems. The MLST results indicated that the three E. coli isolates were assigned to three different sequence types: ST457, ST101, and ST1413, respectively. The conjugation experiment showed that the mcr-1 gene was successfully transferred to the recipient ( E. coli EC600) from two isolates, one of which possessed IncI1 replicons and the other of which carried IncHI2 and IncN replicons. The patients with bloodstream infections caused by mcr-1 -positive isolates had severe underlying diseases and were cured after antibacterial treatment. Conclusion The prevalence of the mcr-1 gene in patients with E. coli bloodstream infection was 2.1% in Changsha, China. The mcr-1 -positive E. coli isolates had varied susceptibility profiles, although all three were susceptible to carbapenems. This therapeutic window is crucial given the risk of rapid deterioration in high-incidence areas worldwide.

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Section: Discussionmentioning

confidence: 99%

“…It is also regarded as a reservoir for antibiotic resistance genes. The mcr-1 -positive E. coli ST101 strains have been detected in chickens, public transportation, and one hospital in China 20,22,23. Thus, more attention should be focused on E. coli ST101 as it might promote the spread of mcr-1 .…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and molecular characterization of mcr-1 in Escherichia coli recovered from patients with bloodstream infections in Changsha, central China

Zhong¹,

Liu²,

Zheng³

2019

IDR

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“…These genes are often associated with bla CMY-2 and florR genes, which are found in animal enterobacterial isolates, and also with an insertion sequence, IS Apl1 , known in Pasteurella multocida , an animal pathogen [ 172 ]. Nowadays, Enterobacteriaceae harboring mcr genes are recovered from patients and healthy subjects [ 173 ], hospital surfaces [ 174 ], raw meat [ 123 ], livestock [ 175 ], fresh vegetables [ 176 ], wild birds [ 177 ], and surface samples from public transportation [ 178 ], indicating community spread. Moreover, mcr genes are being detected in enterobacterial isolates with other resistance genes.…”

Section: Special Features and Spread Of Polymyxin Resistance Amongmentioning

confidence: 99%

Polymyxins and Bacterial Membranes: A Review of Antibacterial Activity and Mechanisms of Resistance

2020

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Following their initial discovery in the 1940s, polymyxin antibiotics fell into disfavor due to their potential clinical toxicity, especially nephrotoxicity. However, the dry antibiotic development pipeline, together with the rising global prevalence of infections caused by multidrug-resistant (MDR) Gram-negative bacteria have both rejuvenated clinical interest in these polypeptide antibiotics. Parallel to the revival of their use, investigations into the mechanisms of action and resistance to polymyxins have intensified. With an initial known effect on biological membranes, research has uncovered the detailed molecular and chemical interactions that polymyxins have with Gram-negative outer membranes and lipopolysaccharide structure. In addition, genetic and epidemiological studies have revealed the basis of resistance to these agents. Nowadays, resistance to polymyxins in MDR Gram-negative pathogens is well elucidated, with chromosomal as well as plasmid-encoded, transferrable pathways. The aims of the current review are to highlight the important chemical, microbiological, and pharmacological properties of polymyxins, to discuss their mechanistic effects on bacterial membranes, and to revise the current knowledge about Gram-negative acquired resistance to these agents. Finally, recent research, directed towards new perspectives for improving these old agents utilized in the 21st century, to combat drug-resistant pathogens, is summarized.

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“…5,6 Despite the potential of colistin as a high-efficient antimicrobial agent, its massive use in clinical therapeutics and as a feed additive has led to the development of colistin resistance in E. coli. 7,8 To date, the most common reported mechanisms for colistin resistance in E. coli have involved the plasmidborne mobile colistin resistance (mcr) gene, which was newly discovered in 2016 and denoted as mcr-1. 9 Subsequently, several amino acid variants have been described, such as mcr-2 and mcr-3.…”

Section: Introductionmentioning

confidence: 99%

Resistance and Heteroresistance to Colistin in Escherichia coli Isolates from Wenzhou, China

Liao¹,

Lin²,

Jia³

et al. 2020

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Background: Colistin is being administered as last-line therapy for patients that have failed to respond to other available antibiotics that are active against Escherichia coli. The underlying mechanisms of colistin resistance and heteroresistance remain largely uncharacterized. The present study investigated the mechanisms of resistance and heteroresistance to colistin in Escherichia coli isolates from Wenzhou, China. Materials and Methods: Colistin resistance was detected by the broth microdilution method (BMD). Colistin heteroresistance was determined by population analysis profiles (PAPs). The polymerase chain reaction (PCR) was conducted to detect mcr-1, mcr-2, mcr-3, pmrA, pmrB, phoP, phoQ and mgrB, and quantitative real-time PCR (qRT-PCR) was used to determine the expression levels of mcr-1, pmrC, pmrA and pmrB. Lipid A characterization was conducted by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS). Results: 0.69% (2/291) of Escherichia coli strains were resistant to colistin, whereas the heteroresistance rate reached 1.37% (4/291). mcr-1, the mobile colistin-resistance gene, was present in the two resistant isolates. The substitutions in PmrB were detected in the two heteroresistant isolates. The transcripts levels of the pmrCAB operon were upregulated in two of the heteroresistant isolates. carbonylcyanide m-chlorophenylhydrazone (CCCP) was able to reverse colistin resistance of all isolates tested and exhibited a significantly higher effect on colistin-heteroresistant isolates. MALDI-TOF MS indicated that the additional phosphoethanolamine (PEtn) moieties in lipid A profiles were present both in colistin-resistant and heteroresistant isolates. Conclusion: The present study was the first to investigate the differential mechanisms between colistin resistance and heteroresistance. The development of colistin heteroresistance should be addressed in future clinical surveillance.

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Transmission ofmcr-1-Producing Multidrug-resistant Enterobacteriaceae in Public Transportation in Guangzhou, China

Cited by 34 publications

References 46 publications

<p>Epidemiology and molecular characterization of <em>mcr-1</em> in <em>Escherichia coli</em> recovered from patients with bloodstream infections in Changsha, central China</p>

<p>Epidemiology and molecular characterization of <em>mcr-1</em> in <em>Escherichia coli</em> recovered from patients with bloodstream infections in Changsha, central China</p>

Polymyxins and Bacterial Membranes: A Review of Antibacterial Activity and Mechanisms of Resistance

<p>Resistance and Heteroresistance to Colistin in <em>Escherichia coli</em> Isolates from Wenzhou, China</p>

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