Achromobacter xylosoxidans : épidémiologie au centre de ressources et de compétences de la mucoviscidose de Dijon et réservoir environnemental

Achromobacter xylosoxidans is an aerobic nonfermentative Gram-Negative rod considered as an important emerging pathogen among cystic fibrosis (CF) patients worldwide. In Dijon (Burgundy), the prevalence of colonised patients is high among CF patients and increasing among non-CF hospitalised patients. The natural habitat of this organism as well as the possible sources of patient contamination remain unknown.The aims of this study were to report the first epidemiological data about A. xylosoxidans in a French CF centre and to identify potential reservoirs of this organism in Burgundy. In a retrospective study, all the isolates recovered from the patients affiliated with our centre in 2010 since their first visit were analysed. Out of 120 patients, 21 (17.5%) had at least one positive culture with A. xylosoxidans. Genotyping analysis by Pulsed Field Gel Electrophoresis revealed that cross-Contamination was very rare. Acquired resistance was frequent to ciprofloxacin (since primocolonisation), to ceftazidime and to carbapenems (in persistent colonisations). Thanks to our protocol designed to detect A. xylosoxidans in environment, a total of 50 strains were isolated in hospital (33 isolates), domestic (9 isolates) and outdoor (8 isolates) samples, mainly in handwashing sinks, showers, and water. These environmental isolates shared characteristics with clinical ones: 6 genotypes in common and a constant resistance to ciprofloxacin. These results reveal potential sources of contamination for the patients at home or in hospital. Further studies are needed to help understanding the emergence of this bacterium and the mechanisms involved in acquired antibiotic resistance.Achromobacter xylosoxidans est un bacille à Gram négatif non fermentaire émergent dans la mucoviscidose. A Dijon, la prévalence de patients colonisés est élevée au Centre de Ressources et de Compétences de la Mucoviscidose par rapport à la moyenne nationale, et augmente également chez des patients hospitalisés atteints d’autres pathologies. Les réservoirs et le mode de contamination des patients sont inconnus.Les objectifs de ce travail étaient de décrire la situation épidémiologique dans notre CRCM et de mettre en évidence d’éventuelles sources de contamination pour les malades en Bourgogne.Dans une première étude rétrospective, toutes les souches d’A. xylosoxidans isolées chez les patients du CRCM depuis le début de leur suivi jusqu’en 2010 ont été analysées. Sur 120 patients, 21 ont présenté au moins une culture positive. Le génotypage par électrophorèse en champ pulsé n’a montré que de rares cas de transmissions croisées. Les résistances acquises aux antibiotiques sont fréquentes : ciprofloxacine (dès primocolonisation), ceftazidime et carbapénèmes (colonisations chroniques). Notre protocole de détection d’A. xylosoxidans dans l’environnement a permis d’isoler 50 souches (lavabos, douches, rivières, lacs) : 33 à l’hôpital, 9 à domicile et 8 dans la nature. Ces isolats partagent des caractéristiques avec les souches cliniques : 6 génotypes communs et résistance constante à la ciprofloxacine. Le risque de contamination des patients à domicile ou à l’hôpital est donc réel.D’autres études sont en cours afin de mieux comprendre l’émergence de cette bactérie, ses mécanismes de résistance acquise aux antibiotiques et les facteurs favorisant sa sélection dans l’environnement

Occurrence of CTX-M Producing Escherichia coli in Soils, Cattle, and Farm Environment in France (Burgundy Region)

CTX-M [a major type of extended-spectrum beta-lactamase (ESBL)] producing Escherichia coli are increasingly involved in human infections worldwide. The aim of this study was to investigate potential reservoirs for such strains: soils, cattle, and farm environment. The prevalence of blaCTX-M genes was determined directly from soil DNA extracts obtained from 120 sites in Burgundy (France) using real-time PCR. blaCTX-M targets were found in 20% of the DNA extracts tested. Samples of cattle feces (n = 271) were collected from 182 farms in Burgundy. Thirteen ESBL-producing isolates were obtained from 12 farms and further characterized for the presence of bla genes. Of the 13 strains, five and eight strains carried blaTEM-71 genes and blaCTX-M-1 genes respectively. Ten strains of CTX-M-1 producing E. coli were isolated from cultivated and pasture soils as well as from composted manure within two of these farms. The genotypic analysis revealed that environmental and animal strains were clonally related. Our study confirms the occurrence of CTX-M producing E. coli in cattle and reports for the first time the occurrence of such strains in cultivated soils. The environmental competence of such strains has to be determined and might explain their long term survival since CTX-M isolates were recovered from a soil that was last amended with manure 1 year before sampling

Achromobacter xylosoxidans : epidemiology among cystic fibrosis patients in Dijon, Burgundy and environmental reservoir

Achromobacter xylosoxidans est un bacille à Gram négatif non fermentaire émergent dans la mucoviscidose. A Dijon, la prévalence de patients colonisés est élevée au Centre de Ressources et de Compétences de la Mucoviscidose par rapport à la moyenne nationale, et augmente également chez des patients hospitalisés atteints d’autres pathologies. Les réservoirs et le mode de contamination des patients sont inconnus.Les objectifs de ce travail étaient de décrire la situation épidémiologique dans notre CRCM et de mettre en évidence d’éventuelles sources de contamination pour les malades en Bourgogne.Dans une première étude rétrospective, toutes les souches d’A. xylosoxidans isolées chez les patients du CRCM depuis le début de leur suivi jusqu’en 2010 ont été analysées. Sur 120 patients, 21 ont présenté au moins une culture positive. Le génotypage par électrophorèse en champ pulsé n’a montré que de rares cas de transmissions croisées. Les résistances acquises aux antibiotiques sont fréquentes : ciprofloxacine (dès primocolonisation), ceftazidime et carbapénèmes (colonisations chroniques). Notre protocole de détection d’A. xylosoxidans dans l’environnement a permis d’isoler 50 souches (lavabos, douches, rivières, lacs) : 33 à l’hôpital, 9 à domicile et 8 dans la nature. Ces isolats partagent des caractéristiques avec les souches cliniques : 6 génotypes communs et résistance constante à la ciprofloxacine. Le risque de contamination des patients à domicile ou à l’hôpital est donc réel.D’autres études sont en cours afin de mieux comprendre l’émergence de cette bactérie, ses mécanismes de résistance acquise aux antibiotiques et les facteurs favorisant sa sélection dans l’environnement.Achromobacter xylosoxidans is an aerobic nonfermentative Gram-Negative rod considered as an important emerging pathogen among cystic fibrosis (CF) patients worldwide. In Dijon (Burgundy), the prevalence of colonised patients is high among CF patients and increasing among non-CF hospitalised patients. The natural habitat of this organism as well as the possible sources of patient contamination remain unknown.The aims of this study were to report the first epidemiological data about A. xylosoxidans in a French CF centre and to identify potential reservoirs of this organism in Burgundy. In a retrospective study, all the isolates recovered from the patients affiliated with our centre in 2010 since their first visit were analysed. Out of 120 patients, 21 (17.5%) had at least one positive culture with A. xylosoxidans. Genotyping analysis by Pulsed Field Gel Electrophoresis revealed that cross-Contamination was very rare. Acquired resistance was frequent to ciprofloxacin (since primocolonisation), to ceftazidime and to carbapenems (in persistent colonisations). Thanks to our protocol designed to detect A. xylosoxidans in environment, a total of 50 strains were isolated in hospital (33 isolates), domestic (9 isolates) and outdoor (8 isolates) samples, mainly in handwashing sinks, showers, and water. These environmental isolates shared characteristics with clinical ones: 6 genotypes in common and a constant resistance to ciprofloxacin. These results reveal potential sources of contamination for the patients at home or in hospital. Further studies are needed to help understanding the emergence of this bacterium and the mechanisms involved in acquired antibiotic resistance

Analyse de souches environnementales d Achromobacter xylosoxidans (identification, antibiotype, génotype, et comparaison avec des souches cliniques)

Achromobacter xylosoxidans est un bacille à Gram négatif aérobie strict non fermentant, considéré comme un pathogène émergent chez les patients atteints de mucoviscidose. De récents travaux portant sur des souches cliniques ont été effectués par différentes équipes : analyse de génotypes, profils de résistances aux antibiotiques, étude du gène blaOXA-114 (gène codant pour une oxacillinase constitutive de cette espèce). Néanmoins, tous ces précédents travaux n ont porté que sur des souches cliniques isolées chez des patients atteints de mucoviscidose. Dans ce travail, nous nous sommes intéressés à des souches isolées dans l environnement, que ce soit à l hôpital ou dans des lieux extérieurs au milieu hospitalier. Nous avons effectué, sur une collection de souches environnementales identifiées comme appartenant à l espèce Achromobacter xylosoxidans, des travaux de génotypage, de séquençage du gène blaOXA 114, de spectrométrie de masse par technologie MALDI-TOF ainsi que des antibiogrammes en milieu gélosé. Les résultats obtenus nous ont permis de caractériser les souches environnementales, ainsi que de les confronter avec ceux obtenus pour les souches cliniques de la collection du laboratoire de bactériologie du CHU de Dijon. Nous avons observé une grande diversité au sein des souches environnementales et la circulation de certaines d entre elles. Dans quelques cas, des souches environnementales sont retrouvées en pathologie humaine. Ainsi nous avons démontré qu il existait des liens entre des souches d origine diverse. Enfin nous pouvons proposer un protocole d identification fiable pour cette espèce.DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Résistance à la céftazidime chez Achromobacter xylosoxidans isolé chez des patients atteints de mucoviscidose

DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Nosocomial Infections with IMP-19−Producing Pseudomonas aeruginosa Linked to Contaminated Sinks, France

We isolated IMP-19–producing Pseudomonas aeruginosa from 7 patients with nosocomial infections linked to contaminated sinks in France. We showed that blaIMP-19 was located on various class 1 integrons among 8 species of gram-negative bacilli detected in sinks: P. aeruginosa, Achromobacter xylosoxidans, A. aegrifaciens, P. putida, Stenotrophomonas maltophilia, P. mendocina, Comamonas testosteroni, and Sphingomonas sp

“Does the Salmonella Genomic Island 1 (SGI1) confer invasiveness properties to human isolates?”

Abstract Background In the eighties, a multidrug resistant clone of Salmonella Typhimurium DT104 emerged in UK and disseminated worldwide. This clone harbored a Salmonella genomic island 1 (SGI1) that consists of a backbone and a multidrug resistant region encoding for penta-resistance (ampicillin, chloramphenicol/florfenicol, streptomycin/spectinomycin, sulphonamides and tetracycline (ACSSuT)). Several authors suggested that SGI1 might have a potential role in enhancement of virulence properties of Salmonella enterica. The aim of this study was to investigate whether nontyphoidal S. enterica isolates carrying SGI1 cause more severe illness than SGI1 free ones in humans. Methods From 2011 to 2016, all patients infected with nontyphoidal S. enterica in our hospital were retrospectively included. All nontyphoidal S. enterica isolates preserved in our University Hospital (Dijon, France) were screened for the presence of SGI1. Clinical and biological data of patients were retrospectively collected to evaluate illness severity. Statistical analysis of data was performed by Kruskal-Wallis test or Fisher’s exact test for univariate analysis, and by logistic regression for multivariate analysis. Results A total of 100 isolates of S. enterica (22 serovars) were collected. Twelve isolates (12%) belonging to 4 serovars harbored SGI1: S. Typhimurium, S. Infantis, S. Kentucky, S. St Paul. The severity of the disease was age-related (for invasive infection, sepsis and inflammatory response) and was associated with immunosuppression (for invasive infection, sepsis and bacteremia) but not with the presence of SGI1 or with antimicrobial resistance. Conclusion A rather high proportion (12%) of human clinical isolates belonging to various serovars (for the first time serovar St Paul) and harboring various antimicrobial resistance profile carried SGI1. Diseases due to SGI1-positive S. enterica or to antimicrobial resistant isolates were not more severe than the others. This first clinical observation should be confirmed by a multicenter and prospective study

Outbreak of extended-spectrum beta-lactamase producing Enterobacter cloacae with high MICs of quaternary ammonium compounds in a Hematology ward associated with contaminated sinks

ObjectiveTo investigate an outbreak of extended-spectrum beta-lactamase (ESBL) producing Enterobacter cloacae that occurred in the Hematology ward (24-bed unit) of the François Mitterrand University Hospital (Dijon, France) between January 2011 and December 2013. The outbreak involved 43 patients (10 infected and 33 colonized). DesignWe performed environmental analysis to detect multiresistant E. cloacae for comparison with clinical isolates (genotyping by pulsed-field gel electrophoresis and MLST as well as ESBL-typing) and determined the MICs of the quaternary ammonium compounds (QACs) alkyldimethylbenzylammonium chloride (ADBAC) and didecyldimethylammonium chloride (DDAC). A bleach-based cleaning-disinfection program was implemented in December 2012 after mechanical removal of the biofilm in all sinks. ResultsWe have detected 17 ESBL-producing E. cloacae in patients sink drains, shower drains and medical sink drains. Sequencing of the bla genes performed on 60 strains recovered from patients and environment (n=43 clinical and n=17 environmental) revealed that bla CTX-M15 was predominant (37 isolates) followed by bla CTX-M9 plus bla SHV-12 (20 isolates). We observed a great diversity among the isolates: 14 pulsotypes (11 STs) in clinical isolates and 9 pulsotypes (7 STs) in environmental isolates. Six pulsotypes were identical between clinical and environmental isolates. MICs of the quaternary ammonium compounds widely used for disinfection were very high in clinical and environmental isolates. Immediately after the implementation of the disinfection program we noticed a substantial fall in cases number. Our findings demonstrate the role of drains as important reservoir of ESBL-producing E. cloacae and highlight the necessity to settle drains accessible to achieve correct cleaning as well as to use disinfectant with proved activity against nosocomial pathogens

Role of AxyZ Transcriptional Regulator in Overproduction of AxyXY-OprZ Multidrug Efflux System in Achromobacter Species Mutants Selected by Tobramycin

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